Quebec doctors are caught in an impossible pinch between a new provincial law authorizing euthanasia that came into force this week and delays to changes the federal government must make to the criminal code to allow assisted dying.
In principle, terminally ill patients in Quebec who meet a series of conditions have been able to ask their doctors to inject them with life-ending drugs since Wednesday, when the province became the first jurisdiction in Canada to permit euthanasia.
But in practice, they are frozen by the legal uncertainty. The federal government is requesting an extension to a Supreme Court ruling that it change the criminal code by Feb. 6, 2016, during which time the criminal code must in theory by applied in a uniform fashion across the country. There is a court challenge seeking to uphold the criminal code requirements in Quebec right up until the end which is being appealed by the provincial government.
On Friday, Prime Minister Justin Trudeau acknowledged the difficulties of being “in a situation where the law is in the process of changing.” But he said Ottawa won’t fight Quebec’s request from the top court for permission to proceed ahead of the other provinces.
Still, the risk of criminal charges, a lawsuit or moving too fast on such a delicate matter means that no doctor, however willing, is likely to go ahead with the procedure for now, says Dr. Georges L’Espérance, a Montreal neurosurgeon who is president of Quebec’s Dying with Dignity Association.
The province’s assisted-dying law has come into force, but there is still a lot of legal uncertainty. How are doctors likely to conduct themselves in the current climate?
I think that for the moment doctors won’t be doing much because there is the possibility, however small, that someone could sue them . . . Jurists and lawyers are telling us that even a private complaint could be blocked by Quebec’s attorney general, or at least that’s what is most likely to happen. In any event, there’s no real rush. There’s no one today asking for medical aid in dying who will receive it the next morning.
Requesting to end one’s life is a lengthy process.
If there are one or two patients in the province that have been waiting for this to put an end to their life, it could be a disappointment. But we also have to be reasonable. It’s been thousands of years that medical aid in dying has not existed. It has come about because of the advancement of medical technologies in the last 50 years. We have recognized that, but it’s not three or four months that is going to make the difference.
The most important thing is that the law has been accepted and passed. Now if there has to be a delay of a few months to go to the Supreme Court, then we’ll have to wait a few months. In the meantime there are methods to relieve those patients who are incapacitated. It’s really just a legal problem and a political fight between the province and the federal government.
So you don’t expect any doctors to play the hero in the next week or so in order to make a point or a precedent?
No, and it’s not something you can just decide one day. There’s a process to go through and even the doctors who are the most open to doing it, such as myself, would not do it for the moment. It’s not like abortion. When that was an issue 40 years ago, if you were to have waited three months longer, it would be too late. That’s not the case here, and what’s more, we have ways of relieving peoples’ suffering.
Do you know of patients who are living a sort of roller-coaster ride, who were waiting for Dec. 10, then were disappointed by the court ruling and now have hope again?
Not personally. There probably are a few, though not many. . . There was someone who wrote to me to tell me about their father who is in distress. I lived through a similar situation just a month ago with my own mother.
But the new rules for palliative sedation (guidelines for relieving a patients’ suffering by rendering them unconscious until death occurs) have come into force without being contested, right?
They always existed as part of the normal tools for providing end-of-life care. I think it’s hypocritical personally, because sedating someone so that they are still alive but unconscious for eight days, 10 days, 15 days.
Because it is entering into the realm of a philosophical argument?
It’s paternalistic because the difference is a matter of semantics and a sophism. They say that with terminal palliative sedation, the goal is to relieve suffering and, unfortunately, death follows. That semantic difference means absolutely nothing for a patient who is at the end of their life and suffering.
This conversation has been edited for length.