as to amend the law

Posted on October 14, 2019 at 5:00 am

Ariane Krol
The Press

The Legault government, which has agreed to withdraw the end-of-life criterion from the Quebec law on medical assistance in dying (MA), should take advantage of this to resolve two other problems. First ensure that requests from patients who have not received the MA will be analyzed to identify and correct situations where patients are harmed. Then, require all hospice homes to allow their patients to receive this care on site instead of forcing them to request a transfer elsewhere.

We thank Quebec for having heard reason. By not appealing the judgment of the Superior Court and agreeing to correct its Act respecting end-of-life care, it will restore access to the AMM for patients who were unfairly deprived of it.

Unfortunately, other obstacles still prevent Quebecers eligible for medical assistance in dying from using it.

Which, and how to fix it? Horror stories, reported in the media or by doctors, give us a glimpse of them, but to fully understand the problems, one would have to search for refused or unenforced applications.

There is plenty to do: one-third (34%) of written requests did not lead to the WMA, the Commission reported on end-of-life care in the spring.

The Commission looked at the explanations provided, but did not check whether the refusals were all justified or whether patients had been the victims of wrongdoing (pressure to withdraw their application, inaccurate information, deficient follow-up, etc.). And that's not counting all the requests made verbally, but for which no form was completed – how many potentially eligible patients were dissuaded from making a written request?

The Commission recommended that institutions analyze their procedures and apply the necessary corrective measures. But relying on those who are both judge and party is not the most effective way of ensuring that all Quebeckers have the access they are entitled to.

It would be preferable for the Commission to carry out an independent review of refusals and other non-follow-up requests, as it already does for cases where the MA has been administered. Yes, that would add to his task. But as we saw in his last two reports, the slippages dreaded by some have not occurred. Nor have they been demonstrated in countries with longer experience of the AMM, such as Belgium and the Netherlands, said Superior Court Judge Christine Baudouin in the Gladu-Truchon case.

It is therefore necessary to question the mandate of the Commission.

Instead of looking at every case where medical aid in dying was provided, would it not be more urgent to look into this 34% of the requests that were not followed up? vulnerable patients seem to be harmed?

The situation is improving for palliative care homes, which are now more likely to accept that their patients receive MDA at home – which is probably why the proportion of cases administered in these homes has increased slightly. But many still refuse, forcing applicants to go to die elsewhere … or to give up the AMM.

These houses may be community organizations, and receive only 45 to 50% of their funding from the Ministry of Health, they still receive $ 75,000 per bed. It is not normal that the extremely diminished patients that they host are placed in front of such a heartbreaking choice.

Fortunately, Quebec seems to take the situation very seriously. The Ministry has asked these centers to reconsider their refusal and to communicate the official position of their board of directors by the end of March. This will be followed, because the houses that refuse the AMM in their walls pose an excessive obstacle to access.

The federal government will also have to amend its law to eliminate its equally unfair criterion of a "reasonably foreseeable natural death". Quebec will have no choice but to exchange with Ottawa when adjusting its own law. But to tackle the resistance to access that patients and their loved ones complain about, there is no need to wait after anyone. The Legault government should take care of it without delay.