Quebec considers broadening access to doctor-assisted death

Quebec will consider broadening its criteria for doctor-assisted death, including the possibility of allowing patients with dementia to provide advance consent to end their lives, Health Minister Gaétan Barrette says.

Province to ask court to clarify definition of 'foreseeable death,' consult experts on advance consent

Quebec Health Minister Gaétan Barrette said the provincial government is open to reviewing all aspects of its assisted-dying rules, but won't make changes before next year, if at all. (Jacques Boissinot/Canadian Press)

Quebec will consider broadening its criteria for doctor-assisted death, including the possibility of allowing patients with dementia to provide advance consent to end their lives, Health Minister Gaétan Barrette says.

Barrette's announcement Friday comes a month after a Montreal man, Michel Cadotte, was charged with second-degree murder in connection with the death of his wife, Jocelyne Lizotte, who had Alzheimer's disease. 

Cadotte, whose wife's request for doctor-assisted death had been denied, took to his Facebook page before he was arrested to say he "gave in to her demand for help in dying."

"It was a very sad situation," Barrette said.

However, he said, determining at what stage someone is still cognitively competent to give advance consent for a progressive disease such as Alzheimer's presents a legislative and medical challenge.

"There are people who are a little bit incompetent, momentarily incompetent; they become incompetent once again, and then progress towards profound incompetence," he said.

"Where do you draw the line, exactly?"

That is one of several questions Barrette will ask experts to consider over the next year or so, he said, while stressing that the situations lawmakers are confronting are extremely complex and that great prudence is required.

Quebec wants courts to clarify terms

Quebec will turn to the courts to clarify the concept of a "reasonably foreseeable death," the definition used in C–14, the federal assisted-death legislation, but not in the provincial law.

"I can reasonably predict that you are all going to die," Barrette told reporters, illustrating the problem. "What does a 'reasonably foreseeable death' mean in the context of medically assisted death?"

As it stands, Quebec's assisted-dying law requires that applicants for medical assistance in dying must be near the end of their natural lives, in an advanced state of "irreversible decline." 

Jean Brault died on April 7, 2016, after starving himself to qualify for a medically assisted death. (Radio-Canada)

That's led to cases such as that of Jean Brault, a Quebec man with a debilitating handicap who resorted to a 53-day hunger strike to qualify for doctor-assisted death. Brault would not have had to starve himself under the federal legislation.

Professional orders representing Quebec doctors, nurses, social workers and pharmacists have all unanimously called on Quebec to adopt the federal government's criteria.

Who's being turned down, and why?

In all, 461 Quebecers received medical aid in dying in the first year of Quebec's legislation. However, there's a wide range in the rate of acceptance of applications for help in dying, with fewer than a third of cases being approved in some regions.

Barrette has asked Quebec's end-of-life commission to review every case in which a request for medically assisted death was denied.

"We see more and more situations where people, patients would have liked to have access to medical aid in dying," Barrette said, while stressing that the review was not intended to scrutinize doctors' judgment calls.

Barrette said the government is open to a review of all aspects of its assisted-dying rules, but that no concrete changes would be made before next year, if at all.

"We don't have the data, [nor] the collective knowledge today to make a decision, so caution is of the order."