Quebec says it’s ready to start accepting advanced MAID requests as of Oct. 30

On Oct. 30 Quebec will become the first province to allow a person with a serious and incurable illness to request a medically assisted death months or even years before their condition leaves them unable to consent to the procedure.

Quebec’s Health Department says it will be ready to meet the expected demand for advanced applications for medical assistance in dying when it begins accepting those requests next week.

Dr. Stéphane Bergeron, an associate deputy minister in the department, told reporters in a briefing on Thursday that it will take time for the first requests to be approved, which will give the health system further room to prepare.

“It’s not something we do in a few minutes during one consultation or appointment,” he said. “It’s something we have to take our time with, that will certainly require several meetings between the (health professionals) and the patient.”

Quebec chose to expand its MAID program to help people with illnesses such as Alzheimer’s without waiting for Ottawa to update the Criminal Code so health workers aren’t committing a crime if they end the life of someone who can’t consent.

“It is certainly not an ideal situation because the criminal code says something and the provincial government says something else,” said medical law attorney Patrick Martin-Ménard.

The Criminal Code says a health-care worker who administers a medically-assisted death must ensure that the person gives “express consent” immediately before they receive MAID. They must also offer an opportunity to withdraw the request. There are exceptions, but for the consent requirement to be waived under Canadian law, a person seeking MAID must fulfil several criteria, including that they entered an arrangement specifying the day on which they wanted to die.

To Quebec’s displeasure, the federal government has so far refused to amend the Criminal Code to protect doctors from possible prosecution, but Quebec has decided to protect them through a directive to prosecutors, coming into effect on Oct. 30. 

In a statement to CityNews, the office of federal health minister Mark Holland said that “Medical assistance in dying (MAID) is a complex and deeply personal issue. Given this complexity, the Government of Canada is taking the necessary time to examine the details of what the Government of Quebec has announced. We are committed to working with Quebec – and all provinces and territories – to carefully consider next steps.”

The province says it has ordered the Crown prosecutor’s office not to charge doctors who choose to participate in the advanced MAID program as long they comply with the provincial act.

#WATCH: Quebec’s Health Department says it will be ready to meet the expected demand for advanced applications for medical assistance in dying when it begins accepting those requests next week.

READ: https://t.co/3usgjTnkuy pic.twitter.com/rnYFiQSOPB

— CityNews Montreal (@CityNewsMTL) October 24, 2024

“There was quite a significant period of time in which even though abortion was still a crime under the criminal code, it had been decriminalized in order to make it possible for doctors to give abortions without fear of prosecutions,” said Martin-Ménard.

Bergeron says that people who seek approval for advanced MAID applications must fulfil several obligations, including that they describe in detail the symptoms that health-care workers will need to witness before administering the procedure. They must also have a serious and incurable condition that causes them “constant and unbearable physical or psychological suffering.” 

Bergeron said the province didn’t have an estimate of how many requests the health network might receive in response to the expansion, for which he said there is a “strong consensus” in Quebec. Earlier this year, six professional orders, including those representing Quebec’s doctors and nurses, put out a statement urging the federal government to amend the Criminal Code to allow for advanced requests. 

On Thursday, Bergeron and two other doctors present at the briefing said Quebec’s experience in delivering MAID would help them navigate the challenges presented by the new rules.

Health professionals, they said, would have to determine whether a patient who is agitated or uncooperative at the moment of assisted death was resisting because it’s a common symptom of a neurocognitive illness or because they were refusing the MAID treatment.

Dr. Catherine Ferrier, a doctor in the division of geriatrics at the McGill University Health Centre who objects to MAID, said she sees a number of “ethical and practical problems” with advance requests in particular.

“I would not help a patient to fill out an advanced request for MAID in the area of neurocognitive disorders because of all of the problems that I see with this process,” Ferrier said.

“When they have advanced dementia and they’re at home or an interesting home, somebody’s going to come along and they won’t remember having made the request,” she added.

The Criminal Code says a health-care worker who administers a medically-assisted death must ensure that the person gives “express consent” immediately before they receive MAID.

“Some people are trying to get more information about when this will be possible,” said Martin-Ménard. “I certainly think there is a very strong need for that right now and I think for for the patients who are considering this, there is a significant need for clarity as well.”

Provincial data indicate that requests for MAID have grown every year since the law went into effect in December 2015. A recent report says that 5,717 people received MAID between April 1, 2023, and March 31 of this year, accounting for 7.3 per cent of the province’s deaths during that period.

The number of doctors involved in administering MAID also rose 10 per cent in the same period, to 1,804, an increase the Quebec college of physicians described as “good news” given the demand. A spokesperson said in an email that the order expects the demand for MAID to continue to grow in response to the program’s expansion.

-With files from The Canadian Press