Quebec’s health ministry says it will be ready to meet the anticipated demand for advanced requests for medical assistance in dying when it begins accepting those requests next week.

Dr. Stéphane Bergeron, associate deputy minister at the ministry, told reporters at a press briefing Thursday that it will take time for the first applications to be approved, giving the health system additional margin to prepare.

“This is not something we do in a few minutes during a consultation or appointment,” he said. “It’s something you have to take your time with, which will certainly require several meetings between (healthcare professionals) and the patient.”

On October 30, Quebec will become the first province to allow a person suffering from a serious and incurable illness to request that medical assistance in dying be administered to them months or even years later, when their condition prevents it. to consent to the intervention.

Quebec has chosen to expand its medical assistance in dying program to help people suffering from illnesses such as Alzheimer’s disease, without waiting for Ottawa to update the Criminal Code. Instead, the province has asked the Crown attorney’s office not to lay charges against doctors who choose to participate in the advanced MAID program as long as they follow provincial law.

The Criminal Code states that a health care worker who administers medical assistance in dying must ensure that the person gives “express consent” immediately before receiving MAID. They must also offer the possibility of withdrawing the request. There are exceptions, but for the consent requirement to be waived under Canadian law, a person requesting medical assistance in dying must meet several criteria, including having made an arrangement specifying the day they wished to die.

Bergeron says people seeking approval for an advanced MAID application must fulfill several obligations, including describing in detail the symptoms that health care workers will need to witness before administering the procedure. They must also suffer from a serious and incurable illness which causes them “constant and unbearable physical or psychological suffering”.

To the great dismay of Quebec, Ottawa has shown itself reluctant to quickly update the Criminal Code to allow advanced requests for MAID. Matthew Kronberg, a spokesperson for federal Health Minister Mark Holland, said in a statement Thursday that MAID is a “complex and deeply personal issue.” Faced with this complexity, the Government of Canada is taking the necessary time to examine the details of what the Government of Quebec has done. announced. We are committed to working with Quebec – and all provinces and territories – to carefully consider next steps.

Bergeron said the province does not have an estimate of the number of requests the health network could receive in response to the expansion, for which he said there is a “strong consensus” in Quebec. Earlier this year, six professional orders, including those representing Quebec doctors and nurses, issued a statement urging the federal government to amend the Criminal Code to allow advance requests.

On Thursday, Bergeron and two other doctors at the briefing said Quebec’s experience with medical assistance in dying would help them meet the challenges presented by the new rules.

Health care professionals, they say, should determine whether an agitated or uncooperative patient at the time of assisted dying was resisting because it is a common symptom of a neurocognitive illness or because he refused treatment by MAID.

Dr. David Lussier, director of a geriatric pain clinic at the McGill University Health Center, said at the news conference that doctors who work with people with dementia and Alzheimer’s have techniques that help them calm patients who become agitated and resist treatment, including light sedation. . Another doctor, Guy Morissette, said doctors would not use “very restrictive” techniques such as physical restraints, and might instead decide to postpone the procedure while the patient is further evaluated.

However, Dr. Catherine Ferrier, a physician in the division of geriatrics at the McGill University Health Center who opposes MAID, says she sees a number of “ethical and practical problems” with advance requests in particular.

People’s wishes change as they move through a chronic illness, she said, making it nearly impossible to obtain proper consent. The push for advanced requests is based in part on “stigma” and the assumption that people with neurocognitive disorders suffer and have no quality of life, she added, which is not not necessarily the case.

“You don’t know what your experience will be,” she said.

Provincial data indicates that requests for medical assistance in dying have increased every year since the law came into effect in December 2015. A recent report indicates that 5,717 people received medical assistance in dying between April 1 2023 and March 31 of this year, which represents 7.3 percent of requests for medical assistance in dying. deaths in the province during this period.

The number of doctors involved in administering MAID also increased by 10 percent during the same period, to 1,804, an increase that the Collège des médecins du Québec called “good news” given of demand. A spokesperson said in an email that the order expects demand for MAID to continue to grow in response to the program’s expansion.

This report by The Canadian Press was first published October 24, 2024.