Quebec defies federal government to consider allowing assisted dying in certain circumstances

BMJ 2013; 346 doi: (Published 21 January 2013) Cite this as: BMJ 2013;346:f427
  1. Charlotte Santry
  1. 1Toronto

Lawyers have cleared the way for the province of Quebec to allow doctors to help patients with incurable conditions to die.

Quebec has the constitutional power to prevent such doctors from being prosecuted, a 450 page report by three legal experts concluded.

Assisted dying is banned under Canada’s Criminal Code and opposed by the federal government.

But in light of the report, published in French on Tuesday 15 January,1 Quebec politicians are planning to produce draft legislation by June 2013 that would permit assisted dying in specific cases.

The report recommended that assisted dying should happen only in cases where a patient has an “incurable disease and is near the end of their life,” said one of the coauthors, Michelle Giroux, of Ottawa University’s law faculty.

She said that it was aimed at patients facing “unbearable suffering, either physical or psychological, which cannot be helped by science.” The patient would need to be “capable of making rational choices,” and two doctors’ signatures would be required.

Doctors who did not approve could refer the patient to a colleague.

Gaétan Barrette, president of the Fédération des Médecins Spécialistes du Québec, said that the “extensive” report provided sufficient safeguards to prevent doctors or relatives abusing their powers.

“The report is extremely clear in saying that if there’s any appearance of external influence, it [assisted dying] is not allowed,” he said.

However, it would not help people who believed that their condition was unbearable and wanted to die but who did not have a terminal disease, he said, citing the example of a man who had all his limbs amputated after a severe infection.

The anaesthetist Marcel Boulanger, vice president of the right to die advocacy group the Association Québécoise pour le Droit de Mourir dans la Dignité, said that the report would clarify doctors’ roles and provided greater transparency.

“There are a whole lot of end of life decisions that take place that are foggy, and some clandestine decisions are made,” he said.

He added, “This report stands up for our social conscience. It’s not natural in a developed society for old people to die on a stretcher in the emergency department.”

But opinions on the report are mixed in Quebec and across Canada. Although the Quebec College of Physicians has spoken in favour of euthanasia in “exceptional” situations, a Quebec based group called the Physician’s Alliance for Total Refusal of Euthanasia is lobbying against it.

The Canadian Medical Association is also against euthanasia and assisted suicide. President Anna Reid said that “an important societal debate is occurring, and Canada’s doctors will continue to monitor the evolution of this discussion.”

Quebec would be the first Canadian province to permit doctor assisted suicide. The British Columbia Supreme Court ruled last year that the ban should be partly struck down; this is being appealed by the federal government.2


Cite this as: BMJ 2013;346:f427


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