Quebec tables bill to include advanced consent in assisted dying

Quebec lawmakers have presented legislation that, if passed, will expand medical assistance in dying (MAID) and allow people to ask for it before they are incapacitated by an incurable disease.

Bill 11, which was tabled on Thursday by Sonia Bélanger, the minister responsible for seniors, modifies the act respecting end-of-life care to allow people to make an advanced request for MAID.

If passed, it will allow those suffering from degenerative diseases, like Alzheimer's, to apply for MAID and give advanced consent.

In the spring of 2022, lawmakers had proposed changes to Quebec's MAID framework to allow for advanced consent, but they decided at the time to postpone changes to law, citing the need for further discussion.

In its current form, Bill 11 would establish a set of guidelines by which a person can provide an advance request for MAID. They must have a serious and incurable illness or a "serious and incurable neuromotor disability."

They must then make a free and informed request — that is notarized or made in the presence of witnesses — describing the extent of the suffering they no longer wish to tolerate.

Once the patient is incapacitated by their illness, two professionals would have to agree that the patient is experiencing the level of suffering they described in their request before MAID can be administered.

Under the bill, a patient who is capable of giving consent to care may, at any time, withdraw their advance request.

Bill 11 also would require palliative care hospices to offer MAID and would allow specialized nurse practitioners to administer "continuous palliative sedation and medical aid in dying."

The Quebec bill does not expand MAID to those with mental disorders like depression, stating that "a mental disorder is not considered to be an illness."

A consultation process will take place before the bill can be adopted.

Marc Tanguay, the interim leader of the Quebec Liberal Party, said his party would permit its MNAs to vote freely on the bill according to their conscience, and he was anticipating an important, non-partisan discussion in advance of a vote.

"We need to do diligent work but serious work so that the law is clear and is applied uniformly everywhere in Quebec," he said.

The federal government legalized MAID in June 2016 but, at first, only those whose deaths were "reasonably foreseeable" qualified. This essentially limited MAID to those with terminal illnesses who were nearing the end of their lives.

In October 2020, the federal government expanded the law and did away with the requirement that the death be reasonably foreseeable. The change allowed people with "serious and incurable illness, disease or disability [excluding mental illness, for now]" to qualify for MAID.

Patients must also be in an "advanced state of irreversible decline in capability" and be enduring intolerable suffering "that cannot be alleviated under conditions the person considers acceptable."

Provinces and territories have their own regulations and policies for implementing MAID.

Currently, Quebec law requires a person to be able to provide informed consent at the time of receiving MAID, which excludes people with degenerative illnesses, including Alzheimer's disease.

In December 2021, a non-partisan committee recommended that adults in Quebec diagnosed with incurable and incapacitating diseases be able to make an advanced request for MAID prior to them becoming incapacitated by their illness.

Canadians whose only ailment is a mental illness like depression or a personality disorder are scheduled to be eligible for MAID under the federal regulations in March 2024. Such requests were initially slated to be legalized this year, but Justice Minister David Lametti said a delay was necessary to allow the medical community to prepare for the complexities of those cases.