Quebec to allow early MAID requests, bypassing federal law changes

Quebec Moves to Allow Early MAID Requests, Bypassing Federal Law Changes

In a significant legislative development, Quebec has introduced a bill that would allow individuals to request medical assistance in dying (MAID) before they become incapacitated by an incurable illness. 

This move comes as part of Bill 11, which was tabled by Sonia Bélanger, the Minister responsible for Seniors, and aims to expand the existing framework for MAID in the province. 

The bill seeks to provide individuals suffering from degenerative diseases, such as Alzheimer’s, the ability to make advance requests for assisted dying, a provision not currently available under federal law.

Key Provisions of Bill 11

The proposed legislation outlines several critical changes to the current MAID framework in Quebec:

1. Advance Requests: The bill permits individuals with serious and incurable illnesses to submit a notarized request for MAID while they are still capable of making informed decisions. This advance request would remain valid even if the individual loses the capacity to consent due to their illness.

2. Eligibility Criteria: To qualify for MAID under the new provisions, individuals must:

• Have a serious and incurable illness.
• Provide a free and informed request, which must be notarized or made in the presence of witnesses.
• Describe the extent of suffering they wish to alleviate.

3. Assessment Before Administration: Once a patient becomes incapacitated, two healthcare professionals must confirm that the patient is experiencing the level of suffering described in their initial request before MAID can be administered.

4. Withdrawal of Consent: Patients retain the right to withdraw their advance request at any time while they are capable of giving consent.

5. Palliative Care Requirements: The bill mandates that all palliative care hospices must offer MAID services, addressing a current gap where not all facilities provide this option.

6. Expanded Roles for Nurse Practitioners: The legislation will also expand the scope of practice for specialized nurse practitioners, allowing them to administer “continuous palliative sedation” during the end-of-life process.

Context and Rationale

The introduction of Bill 11 follows a recommendation from a non-partisan committee in December 2021, which suggested that adults diagnosed with incurable and incapacitating diseases should be allowed to make advance requests for MAID. 

This recommendation was rooted in the recognition of the challenges faced by individuals with degenerative diseases who may lose their decision-making capacity before they can express their wishes regarding assisted dying.

Currently, Quebec law requires individuals to provide informed consent at the time of receiving MAID, which excludes those with conditions like Alzheimer’s disease. The new bill aims to address this gap, allowing individuals to plan their end-of-life care in advance.

Federal Law and Mental Health Exclusions

While Quebec moves forward with its legislation, the federal government is still working on changes to its MAID framework. As of now, individuals whose only medical condition is a mental illness, such as depression, are scheduled to become eligible for MAID in March 2024. 

However, the Quebec bill does not extend MAID eligibility to those with mental disorders, stating that “a mental disorder is not considered to be an illness” under the current framework.

Public Reaction and Implications

The response to the proposed changes has been mixed. Advocates for end-of-life rights have welcomed the bill as a progressive step towards ensuring individuals have control over their own deaths. 

However, concerns remain about the ethical implications of allowing advance requests, particularly regarding the potential for coercion or the influence of external pressures on vulnerable individuals.

As Quebec continues to navigate the complexities of MAID legislation, the province is positioning itself as a leader in end-of-life care, with a framework that reflects the needs and wishes of its citizens. 

If passed, Bill 11 would not only expand access to MAID but also set a precedent for other provinces and territories in Canada, potentially influencing future federal regulations.

In conclusion, Quebec’s initiative to allow early MAID requests represents a significant shift in the approach to assisted dying, reflecting the province’s commitment to providing compassionate care for those facing terminal illnesses. 

As the legislative process unfolds, the implications of this bill will be closely monitored, both for its impact on individuals seeking end-of-life options and for its potential influence on broader discussions about MAID across Canada. 

The ongoing dialogue around these issues underscores the importance of balancing individual rights with ethical considerations in the realm of healthcare and end-of-life decisions.