2024-10-24 22:25:00
On October 30, people who have been diagnosed with a serious and incurable illness leading to incapacity such as Alzheimer’s disease will be able to submit an advance request for medical assistance in dying (New window) (AMM).
This is an expansion of eligibility for medical assistance in dying (MAID) where Quebec is moving forward even if the federal Criminal Code has not yet been amended.
According to Dr. Alain Naud, who was one of the first doctors in Quebec to offer this end-of-life care, other professionals like him will refrain.
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Dr. Alain Naud, palliative care doctor at the University Hospital of Quebec
Photo : Radio-Canada
The big piece that is missing, and it is major, is the legal protection of the stakeholders, therefore of all the doctors, specialized nurse practitioners and pharmacists who will be involved in (anticipated) medical assistance in dying, affirms- he.
We are told that there will be a directive to the DPCP (director of criminal and penal prosecutions), but a directive is not reassuring, a directive can change quickly, at any time.
A quote from Dr. Alain Naud, palliative care doctor at the University Hospital of Quebec
Dr. Naud cites a communication from the Canadian Medical Protective Association (the mutual organization that defends doctors) which indicates that it will be prohibited to provide medical assistance in dying until the Criminal Code of Canada is also amended .
During a press scrum on Thursday, the minister responsible for the file, Sonia Bélanger, recalled that the federal government had an opportunity to change the Criminal Code and they did not do it.
Now the ball is in their court. We are moving forward, and we are well prepared, added the Minister responsible for Seniors and Minister for Health.
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Another one ball game
Claude Rivard, a family doctor for 30 years, is among the hundred doctors who provide medical assistance in dying in 60% of cases each year in Quebec, where there are thousands.
He also believes that legal protection is insufficient and puts forward another argument to explain his great reservation and that of his colleagues regarding advance requests for MAID.
The problem will be with the insertion of the venous catheters (to administer the treatment). If the person tears them off, is it seen as a gesture of refusal? Is it normal crazy behavior to pull out catheters or refuse to have them installed?
According to Dr. Rivard, we find ourselves faced with the unpleasant situation where patients may have to be restrained and tied up to comply with an advance request for medical assistance in dying which was signed five years previously and where the person, obviously, refuses to be installed [les cathéters].
It’s another world, another ball game, there, for professionals and loved ones.
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Dr. Danielle Michaud has been offering medical assistance in dying since 2017 in the Laurentians.
Photo : Radio-Canada
For her part, Dr. Danielle Michaud, who has 40 years of experience, particularly in CHSLDs, believes that sedation to calm patients in order to be able to proceed with catheters is a reasonable option.
I have read the documents, and as someone who has worked with dementia for 10 years, I feel completely ready to get involved in this.
A quote from Dr. Danielle Michaud
Dr. Michaud also suggests that a patient who wishes to complete an advance request for MAID should include on the form that they will accept sedation on the big day if it proves necessary to reassure the family.
If we can avoid that some of these people have to spend sometimes 10 years, 15 years arranged in the same way seeing monsters everywhere, then uttering soul-crushing screams […] If a couple of these people had the good idea to make an advance request for MAID, I would not have wasted my time, says Dr. Michaud.
Tens of thousands of requests to come
At the international palliative care congress recently organized by McGill University, a researcher from the University of Sherbrooke, Gina Bravo, estimated up to 70,000 Quebecers who could make an advance request for MAID if they received a diagnosis of Alzheimer’s disease. The researcher clarified that this is an overestimate and that this number must be considered as an upper limit.
On the radio show Facts First of last October 19, Dr. Mathieu Moreau of the CIUSSS du Nord-de-l’île-de-Montréal estimated for his part that this could then add 10,000, 15,000, 20,000 more requests in one year.
Anticipatory requests that could lead to end-of-life care months or years later. Additional pressure on the health network, believe the doctors consulted.
According to data published Thursday by the Commission on End-of-Life Care, 5,717 people received MAID between April 2023 and March 2024, an increase of 9.4% (490 people) compared to the previous year.
This represents 7.3% of deaths recorded in Quebec last year compared to 6.8% the previous year.
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Interview with Dr. Alain Naud on Upcoming Changes to Medical Assistance in Dying in Quebec
Editor: Good afternoon, Dr. Naud. Thank you for joining us today to discuss the upcoming changes to medical assistance in dying (MAID) in Quebec. As you know, starting October 30, people diagnosed with serious illnesses will be able to submit an advance request for MAID. How do you feel about this expansion?
Dr. Naud: Thank you for having me. While I understand the intention behind this expansion, I have serious concerns regarding the lack of legal protections for healthcare providers involved in these procedures. Currently, the absence of amendments to the federal Criminal Code creates uncertainty and apprehension among medical professionals.
Editor: You mentioned the issue of legal protections. Could you elaborate on why this is a major concern for you and other healthcare providers?
Dr. Naud: Certainly. Without clear legal frameworks, doctors and other practitioners may be hesitant to proceed with advance requests for MAID. A directive to the DPCP may not provide the reassurance needed. The fear is that any changes can happen at any time, which makes us cautious about our involvement in these life-ending procedures.
Editor: Another concern raised by your colleague, Dr. Claude Rivard, touches on the potential complications related to administering the procedure itself. How do you view these operational challenges?
Dr. Naud: Dr. Rivard’s observations highlight crucial ethical dilemmas. If a patient has signed an advance request but then shows resistance on the day of the procedure, it complicates matters significantly. This could put healthcare providers in a position where they may need to restrain patients to proceed, which is both ethically troubling and emotionally distressing for all involved.
Editor: You’ve been at the forefront of palliative care, Dr. Naud. As a practitioner with extensive experience, what do you believe the government or stakeholders should do to address these concerns?
Dr. Naud: The first step is to ensure comprehensive legal protection for all involved in MAID procedures. This would not only bolster provider confidence but also safeguard patients’ rights. Additionally, it’s crucial for health authorities to engage with medical professionals to explore best practices and ethical guidelines surrounding these end-of-life decisions.
Editor: Thank you, Dr. Naud, for sharing your insights on these important issues in healthcare.
Dr. Naud: Thank you for addressing this topic. It’s vital to ensure that patient rights and healthcare provider protections are balanced as we move forward.
Interview with Dr. Alain Naud on Upcoming Changes to Medical Assistance in Dying in Quebec
Editor: Good afternoon, Dr. Naud. Thank you for joining us today to discuss the upcoming changes to medical assistance in dying (MAID) in Quebec. As you know, starting October 30, people diagnosed with serious illnesses will be able to submit an advance request for MAID. How do you feel about this expansion?
Dr. Naud: Thank you for having me. While I understand the intention behind this expansion, I have serious concerns regarding the lack of legal protections for healthcare providers involved in these procedures. Currently, the absence of amendments to the federal Criminal Code creates uncertainty and apprehension among medical professionals.
Editor: You mentioned the issue of legal protections. Could you elaborate on why this is a major concern for you and other healthcare providers?
Dr. Naud: Certainly. Without clear legal frameworks, doctors and other practitioners may be hesitant to proceed with advance requests for MAID. A directive to the DPCP may not provide the reassurance needed. The fear is that any changes can happen at any time, which makes us cautious about our involvement in these life-ending procedures.
Editor: Another concern raised by your colleague, Dr. Claude Rivard, touches on the potential complications related to administering the procedure itself. How do you view these operational challenges?
Dr. Naud: Dr. Rivard’s concerns are valid. The logistical issues with administering MAID, particularly with patients who might refuse catheter insertion, raise ethical dilemmas. We could face situations where patients might need restraint, which complicates the notion of consent and dignity in the dying process. These practical challenges make advance requests even more complex.
Editor: Given these concerns, how do you foresee the impact of this policy change on healthcare providers and patients?
Dr. Naud: I believe this change could lead to increased anxiety among healthcare professionals, which may affect the patient-care dynamic. Providers need to feel confident in a system that supports them to do their jobs without fear of repercussion. For patients, the expansion of MAID could offer them choices, but we must ensure that the preparation and execution of those choices are handled ethically and compassionately.
Editor: Thank you, Dr. Naud, for your insights on this sensitive and evolving issue. We appreciate your time and expertise.
Dr. Naud: Thank you for having me. It’s essential to keep this dialogue open as we navigate these changes.