2024-10-19 04:00:00
Quebecers who have been diagnosed with Alzheimer’s disease will be able to make an advance request for medical assistance in dying as of October 30. Like a will, they will be able to fill out a form in anticipation of the moment when they can no longer consent to care. Requested for a long time, this expansion is welcomed with relief by patients, even if doctors have reservations about its implementation.
As of October 30, Quebec will become one of the rare states to allow requests for early medical assistance in dying, in the event of incapacity. But this expansion, demanded for a long time by patients, could remain marginal, according to various experts.
Nearly 10 years after the arrival of medical assistance in dying (MAID) in Quebec, it will now be possible to record one’s last wishes in advance, in the case of an illness leading to incapacity.
“The population has wanted this for a long time, I hear about it in my office every week,” says Quebec doctor Alain Naud.
With the aging of the population, the number of people suffering from a major neurocognitive disorder, such as Alzheimer’s disease, has tripled in 20 years in Quebec. Starting in 2040, the Alzheimer Society predicts more than 20,000 new cases per month in the country.
“Everyone knows someone [avec un diagnostic] and saw a parent or spouse die, then said to himself: “It’s not true that I’m going to make it to the end.” It’s a pretty cruel disease,” continues Dr. Naud.
PHOTO D’ARCHIVES/JEAN-FRANCOIS DESGAGNES
Easier said than done
Nevertheless, the doctor, who was a pioneer of AMM, maintains a reserve of caution. Because a few days before its entry into force, the terms of this expansion remain unclear, as does the form to complete, which has still not been sent to doctors. The form will not be accessible to the public, but only to health professionals, via the RAMQ website.
For doctors, the new law is easier to apply on paper than in CHSLDs.
“There still remains a lot of uncertainty about how the law will translate into practice,” explains family doctor Mathieu Moreau.
Will the symptoms described in the form to be filled out be ambiguous or easy to observe, for example? Or how will patients, who are often aggressive or do not like to be touched, accept the installation of a catheter to obtain medication?
Example from the Netherlands
According to Dr Moreau, the example of the Netherlands could suggest that there will be little demand.
It is the only country with a law similar to that of Quebec allowing early medical assistance in dying. In 2023, only eight patients received it.
However, requests for MAID for people suffering from dementia but who are still capable of consenting are increasing. In Quebec, a person with such a diagnosis can also request MAID and obtain it, if they suffer from it.
Criminal act?
Ottawa’s refusal to follow Quebec and amend the Criminal Code remains an obstacle to advance requests.
“Doctors will remain cautious,” believes the president of the Quebec Association for the Right to Die with Dignity (AQDMD), Georges L’Espérance. This could complicate the task of patients wishing to obtain it.
The professional orders concerned, however, said they were reassured that the Director of Criminal and Penal Prosecutions of Quebec would come out against any criminal or private prosecution.
Lawyer Hélène Guay, in Montreal, specializes in health, human and elder rights. Photo Hugo Duchaine
For lawyer Hélène Guay, it appears “inevitable” that relatives will oppose anticipated MAID, whether in relation to the moment of proceeding or to the trusted third person chosen by the patient, for example.
“Is Quebec ready? she asks. In any case, he is innovative.”
How will early medical assistance in dying work?
The person must be accompanied by a doctor or specialized nurse practitioner to help them complete the form provided. Designate one or two “trusted third parties”, whose role will be to ensure that wishes are respected. Describe in detail the symptoms of the disease, which will constitute consent to receive MAID. Sign the form in the presence of the healthcare professional, two witnesses (or a notary) and the trusted third party(ies).
To be valid, the advance request must be filed in the register provided for by law.
A person who is capable of consenting to care may withdraw or modify their request at any time.
The person will be able to receive MAID if:
She is suffering from an incurable illness; She is incapable of consenting to care; She presents an irreversible decline in her abilities; She experiences unbearable physical or psychological suffering. A second healthcare professional must confirm compliance with these conditions.
Source: Government of Quebec
You can consult the guide from the Ministry of Health and Social Services ici.
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