Quebec Bill Would Expand Assisted Dying to Include Advanced Consent

Quebec Minister for Health and for Seniors Sonia Belanger tables a legislation on end of life care and assisted death, at the legislature in Quebec City on Feb. 16, 2023. (Jacques Boissinot/The Canadian Press)

Sonia Bélanger, the Quebec minister responsible for health and seniors, tabled Bill 11 on Thursday, which would allow people diagnosed with serious illness—such as Alzheimers—to give advanced consent to medical assistance in dying (MAID) before they are incapacitated.

Quebec currently has the highest number of MAID deaths per capita of any place in the world, Michel Bureau, president of the province’s Commission on End of Life Care, said at a press conference last year. Just over 5 percent of all deaths in the province are due to MAID.

Use of MAID has risen sharply since Quebec passed its own legislation (separate from federal legislation passed around the same time) in 2016. According to the most recent Health Canada data, for 2021, Quebec’s use of MAID increased 44 percent year over year, compared to about 32 percent nationally.

A total of 9,741 Quebecers have died by MAID since 2016. In 2016, there were 494 MAID deaths in the province. In 2021, there were 3,281.

Currently, Quebec law requires informed consent for MAID, which is not possible in the advanced stages of degenerative disease.

Bélanger told reporters on Thursday, “I am a nurse by profession and I have always been guided by the desire to offer the best care, with a lot of empathy and respect. Medical assistance in dying is exactly that: empathy and respect.”

She said the proposed legislation is based on expert opinions and citizen input, but the province will now have the “opportunity to continue our reflection accompanied by different groups who will come to present their positions.”

Quebec and Canada are both considering to what extent they will expand MAID in the coming months and years.

Nationally, MAID is available for mentally competent adults with serious physical illness undergoing “unbearable physical or mental suffering” that is in “an advanced state of decline that cannot be reversed.” Eligibility is set to expand in March to patients suffering from mental illness, who don’t necessarily have any other conditions.

Quebec College of Physicians on MAID for Minors

Dr. Louis Roy of the Quebec College of Physicians told the parliamentary joint committee on MAID in October that MAID should be considered for babies born with “severe deformities and very serious syndromes for which the chances of survival are virtually nil.”

“[The deformities] will cause so much pain that a decision must be made to not allow the child to suffer,” he said. He said MAID is offered under such conditions in the Netherlands.

MP Garnett Genuis responded in a video posted on YouTube, “Killing a child is always wrong, no matter the circumstances.”

“Disability is no justification for killing children. There is never a justification for killing children,” Genuis said.

Opponents of MAID expressed similar views this week in response to a report tabled Feb. 15 by the parliamentary committee on MAID. The report said the government should establish a requirement that the parents or guardians of a mature minor should be “consulted” on MAID “but that the will of a minor who is found to have the requisite decision-making capacity ultimately ... [take] priority.”

It also suggested the government research experiences of minors with respect to MAID, including “minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors.”

Inclusion Canada, an organization that advocates for the disabled, called it a “discriminatory disaster.”

MP Michael Cooper, who presented the Conservative Party’s dissenting report, called the committee’s recommendations “reckless.”

Peter Wilson and Marnie Cathcart contributed to this report.