Unlike other Canadian provinces, Quebec codes of ethics for health care professionals are enacted by provincial statute. Quebec is also unique in having a provincial euthanasia law, which includes a protection of conscience provision for health care professionals specific to that service.
Freedom of conscience for services other than euthanasia
Physicians
The Code of Ethics for Physicians1 and the gloss on the Code by ALDO Quebec,2 an authoritative document, require objecting physicians to advise patients of the consequences of not receiving the contested service, and “offer to help the patient find another physician.” They are not obliged to help the patient find someone willing to provide the contested service. Objecting physicians are normally quite willing to explain how patients can find other physicians or health care professionals. . . [Full text]
Quebec’s euthanasia law, the Act Regarding End of Life Care (ARELC), permits two kinds of euthanasia, distinguished here as reportable and non-reportable euthanasia.
Reportable euthanasia is identified as “medical aid in dying” in ARELC.1 Only physicians may administer a lethal substance, and only to a legally competent person who is at least 18 years old, meets other criteria and personally gives informed consent. Physicians must conform to procedural guidelines and reporting requirements. Most people probably believe that this is the only type of euthanasia authorized by the law.
Non-reportable euthanasia is not explicitly identified in the law, but is permitted for legally incompetent patients (including those under 14 years old) who are not dying. Substitute decision makers acting under the authority of Quebec’s Civil Code2 can order them to be starved and dehydrated to death. There are no procedural guidelines, no reporting requirements, and it appears that the order can be carried out by anyone responsible for patient care.3 All of this was incorporated into ARELC by a revision of the original text.
Note that section 50, the protection of conscience provision in ARELC for health care professionals, pertains ONLY to reportable euthanasia. The Act does not recognize the possibility of conscientious objection by health care professionals unwilling to participate in euthanasia by starvation and dehydration. . . [Full text]
A Quebec Superior Court judge has invalidated sections of both the federal and Quebec laws on medically assisted dying, ruling Wednesday they were too restrictive and therefore unconstitutional.
Justice Christine Baudouin found in favour of two Quebecers struck by incurable degenerative diseases who’d argued they were denied a medically assisted death under laws that are discriminatory. . . [Full text]
One out of two doctors who have turned down requests for medical assistance in dying by terminally-ill patients have probably done so without justification under the Quebec law, says the head of the province’s commission on end-of-life care.
“It’s 50-50,” Dr. Michel Bureau told the Montreal Gazette in an interview. “Are there some doctors who are too strict in the application of the criteria? We have observed this (attitude) in several cases.”
Despite the progress made in implementing the so-called dying with dignity law, some physicians continue to resist carrying out assisted dying, although in fewer numbers than when the legislation came into effect on Dec. 10, 2015, Bureau added. . . . [Full text]
Since 10 December, 2015, euthanasia has been provided by physicians in Quebec under the terms of An Act Respecting End of Life Care (ARELC). Health and social services agencies established by the government throughout the province are state agencies responsible for the delivery and coordination of health care in the province administrative regions. These are called Centres intégrés de santé et de services sociaux (CISSS) and Centres intégrés universitaires de santé et de services sociaux [CIUSSS). Some administrative regions (like Montreal and the Quebec City region) have more than one CISSS or CIUSSS.
These agencies are responsible for the delivery of euthanasia. For two years beginning 10 December, 2015, they were required to make reports twice yearly to a commission established by the law to monitor the administration of euthanasia (the Commission sur les soins de fin de vie) and publish them on their websites. These twice-yearly reports will apparently cease to be published after that time. The Commission draws from these and other reports to make its required summary of activity to the legislature (National Assembly).
The Project has compiled the statistics provided in these reports from10 December, 2015 to 10 December, 2017. The compilation includes tables and charts, some of which are reproduced below.
Euthanasia Requests in Quebec, 2016-2017
Note that, in some cases, the number of patients lethally infused is higher than the number of requests because euthanasia was provided in response to a request made in the previous reporting period. In addition, not all euthanasia deaths are captured in these reports, as some regions with low populations do not publish reports, and euthanasia may be provided by private entities that are not subject to the statutory twice-yearly reporting requirement.
The number of euthanasia requests made weekly in the province increased from about 14 in 2016 to about 23 in 2017. In Montérégie the number of requests weekly doubled; they more than tripled in Bas-Saint-Laurent.
Euthanasia was provided about 9 times weekly in the province during 2016 and 14 times weekly in 2017.
The number of euthanasia deaths increased by about 67% from 454 in 2016 to 757 in 2017. This is about 1.1% of deaths from all causes, a rate not reached by Belgium for 9 years after legalization.
In Outaouais the number of euthanasia deaths almost doubled (11 to 21)
In Chaudière-Appalaches the number more than doubled (18 to 40)
The number of euthanaia deaths more than tripled in Saguenay-Lac-Staint-Jean (6 to 19)
The number of euthanasia deaths quadrupled in Côte-Nord (2 to 8), and more than quadrupled in Abitibi-Témiscamingue (4 to 18).
434 requests for euthanasia were not acted upon in 2017, up from 263 in 2016. However, the percentage of all requests not acted upon remained constant at 37%.
In 11% of the cases the patient died of natural causes before euthanasia was provided, up from 9% in 2016.
About 8% of the patients did not qualify for the procedure, down from 11% in 2016.
Marked increases in rates of continuous palliative sedation occurred in a couple of regions, notably Laurentides (a 2017 reate almost six times that of 2016)
