2023-08-16 19:58:44
While the frequency of medical assistance in dying continues to increase in Quebec, this practice seems to be considered less and less as a last resort.
Quebecers have stopped seeing physician-assisted dying as an exceptional procedure for people with incurable diseases whose suffering is unbearable, according to what Dr.r Michel Bureau, who leads the National Assembly’s Commission on End-of-Life Care. “We are no longer dealing with exceptional treatment, but with very frequent treatment. »
Quebec is on track to end the year with 7% of all deaths recorded as physician-assisted, according to the Dr Bureau, which specifies: “it is more than anywhere else in the world: 4.5 times more than Switzerland, three times more than Belgium, more than the Netherlands and twice more than Ontario”.
Earlier this month, the commission sent a note to doctors reminding them that only patients with a serious and incurable disease, who are suffering and who have experienced an irreversible decline in their condition, can receive medical assistance in dying. . The memo reminded them that the procedure had to be independently approved by two doctors and that doctors should not “shop around” for a second favorable opinion.
“We are seeing, increasingly, that cases receiving medical assistance in dying are approaching the limits of the law. It’s not just terminal cancer anymore, there are all kinds of diseases, and that’s great, but it takes a lot of rigor on the part of doctors to make sure they stay within the bounds of the law. . »
Michel Bureau says he has observed a slight increase in the number of cases that violate Quebec end-of-life legislation.
problematic cases
In the commission’s latest annual report, which covered a period between spring 2021 and spring 2022, we can read that 15 of the 3,663 physician-assisted deaths in Quebec did not comply with the law. The problematic cases involved a case where medical assistance in dying was administered to a person whose health insurance card had expired. In six cases, the patients were not eligible for the procedure and in three others, the patients might not give their consent.
These 15 cases were reported to the College of Physicians of Quebec. In an email, the college said none of the cases had been referred to its internal disciplinary tribunal. Spokesperson Leslie Labranche said the self-regulatory body did not have data indicating whether further disciplinary action might have been taken once morest doctors who allegedly violated the rules on medical assistance in dying.
On the other hand, the college refused to comment on the memo sent by the commission.
Michel Bureau fears that doctors will be put in difficult situations by elderly patients who are ready to die, but whose health problems are not serious enough to qualify them for medical assistance in dying which, specifies he, “is not there to replace natural death”.
He assures that he has not heard of a single case in Quebec for which medical assistance in dying had been recommended by a doctor rather than by a patient.
Stricter rules in Quebec
According to Health Canada’s most recent annual report on medical assistance in dying, released in July 2022, physician-assisted deaths accounted for 3.3% of deaths in Canada in 2021. In Quebec, which had the highest number of assisted deaths nationwide, the number was 4.7% of deaths that year, second only to British Columbia at 4.8%.
These numbers have continued to rise. In 2022, medical assistance in dying accounted for 6.1% of deaths in Quebec, according to the Quebec Statistical Institute. And in British Columbia, it accounted for 5.5% of deaths in 2022, according to the province’s health ministry; as of June 30, this proportion reached 6.2. %.
Michel Bureau does not know why Quebec has a higher rate of medical assistance in dying than other regions of Canada, even if, in his opinion, the framework for such recourse in Quebec is stricter than elsewhere in Canada and better monitored.
But even if strict rules surround the procedure, medical assistance in dying is deeply integrated into the Quebec health system. “It’s very easy to go from palliative care to physician-assisted dying,” says Dr.r Bureau.
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