Quebec injunction delays introduction of physician-assisted suicide law

The Canadian Medical Association is worried that too much attention is being focused these days on doctor-assisted death, at the expense of other end-of-life issues
The Canadian Medical Association is worried that too much attention is being focused these days on doctor-assisted death, at the expense of other end-of-life issues

A court injunction has delayed the upcoming introduction of Quebec’s right-to-die legislation, as the federal government decides how to address the upcoming decriminalization of physician-assisted death.

Quebec’s Dying with Dignity law was adopted in June 2014 and was set to come into effect on Dec. 10, ahead of the February 2016 deadline set by the Supreme Court of Canada last winter.

The provincial legislation, a first in Canada, outlines the conditions in which the terminally ill can request physician assistance in dying.

But an injunction filed by the Coalition of Physicians for Social Justice successfully pushed that back to at least February. Quebec’s Superior Court heard arguments last week from the group and a disabled woman who opposes the legislation, and decided Tuesday to issue the injunction. Quebec has indicated it will appeal the decision.

“If there is a stay, either federally or in Quebec, what we're going to see is prolonged suffering for individuals who are right now suffering horribly and waiting for access to physician-assisted dying,” Wanda Morris, CEO of Dying With Dignity, tells Yahoo Canada News.

“Quebec is ready to roll this out. They really have a textbook example of democracy at work,” Morris says.

In the meantime, the federal government also has to decide how to move ahead on physician-assisted death. A Supreme Court ruling from last February set Feb. 6, 2016, as the deadline for a federal law on physician-assisted suicide. The court’s ruling applies to competent adults who have a grievous and irremediable medical condition and clearly consent to the termination of life.

If the federal government doesn’t have new legislation governing the practice in place by then, it will simply be decriminalized and other relevant sections of the Canada Health Act — for example, rules around patient consent — will be applied as necessary.

It’s been reported that the federal government will ask the top court for an extension to that deadline in order to craft legislation dealing directly with physician-assisted suicide.

Quebec’s impending legislation

Quebec’s health minister has said that he will have to respect any court ruling that prevents the right-to-die legislation from coming into effect.

“It really shows the ideology behind some doctors in this province,” Gaétan Barrette told the MontrealGazette last week. “You have a group that has absolutely no relation whatsoever with that issue that is going to court to ask for an injunction. That is quite surprising.”

The federal government has asked Quebec to wait until it has decided how to deal with the upcoming Supreme Court deadline to put a provincial law into place, the Gazette reported.

In the meantime, a provincial panel of representatives from nine provinces and territories — B.C. is observing and Quebec isn’t involved— is looking at how federal legislation for physician-assisted suicide can help patients while also protecting the vulnerable, Morris says. The panel will advise the government on what the system should look like and how informed consent can be ensured.

The panel is co-chaired by University of Toronto bioethicist Jennifer Gibson and physician assistant Maureen Taylor. Its final report is expected by the end of the year.

“This is essentially putting the provincial governments on track to be able to have consistent nationwide legislation and to have it in place by Feb. 6,” Morris says.

Canada has other jurisdictions to look to in this process. Several American states, including Oregon, Washington and Vermont, as well as countries, such as Belgium, Luxembourg and the Netherlands have legislation in place to allow physician-assisted death.

The availability of the procedure in other jurisdictions means that the courts had the comfort of a wealth of knowledge to look at in deciding to allow physician-assisted suicide in Canada while protecting vulnerable people, Morris says — something that was lacking in 1993 when the court ruled against Sue Rodriguez, a Victoria woman with ALS (amyotrophic lateral sclerosis) who fought for the legal right to assisted suicide.

“When Sue Rodriguez came to trial there was a binder of evidence,” Morris says. “When the case with Gloria Taylor came, there was a bookcase full of binders.”

Taylor was a B.C. woman who was the lead plaintiff in a B.C. lawsuit requesting the right to physician-assisted suicide. She died in 2012 of an infection related to a colon perforation.

Alternative federal paths

The federal government’s own three-member panel includes University of Manitoba psychiatry professor Harvey Max Chochinov, University of Ottawa law professor Benoît Pelletier, and Catherine Frazee, the former co-director of Ryerson University’s institute for disability research and education.

That panel must operate within the framework of the Supreme Court’s ruling in order to provide the federal government with a report on moving forward on assisted-death legislation. Critics said when the panel was announced that it could not be impartial, given that two of its members were federal witnesses opposed to the issue when the case was before the Supreme Court.

The panel was given a deadline of after Oct. 19 to report its findings to the federal government. In the meantime, it appears the government is looking for more time to bring forward legislation that deals clearly with physician-assisted death.

But while nobody wants to see legislation rushed out without due consideration, pushing back the expiration date set by the Supreme Court isn’t the only option the government has, Morris says.

“It's critical that there not be a delay,” she says of the availability of physician-assisted death. “Ultimately it's ideal if there's legislation in place that will clarify [the practice]. But it's not necessary that that legislation be in place for Feb. 6.”

In order to prevent a delay in access to physician-assisted death, the federal government could allow the February deadline set by the Supreme Court to pass while continuing to work on its own legislation, Morris says. This will provide some access for terminally-ill patients who desire it while comprehensive legislation is finalized.

Fewer doctors would be willing to perform physician-assisted death without that legislation in place, Morris says, but some have indicated they are prepared to move forward, which means the option would exist in the short term for some patients.

“Ultimately, I think everyone is going to be served by clear, comprehensive legislation,” Morris says. “But the question is, should you make the people that are suffering right now wait for that, or can you allow these people to still have access?”

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