Québec euthanasia regulations are clear as mud

By Amy Hasbrouck

When Québec passed its euthanasia law in 2014, we pointed out many problems, hoping that these would be remedied before the law came into effect.

Eighteen months later we are on the verge of entering the euthanasia era in Québec, with many issues still unsettled. Thus far, Québec has:

  • Issued a set of regulations governing a narrow slice of the euthanasia process;
  • Offered a “five year plan” for palliative care which proposes “equitable” but not “universal” access to palliative care;
  • Through the college of physicians, issued guides to performing euthanasia and continuous palliative sedation, and offering care “at the end of life.”

The government of Québec has also threatened hospices which refuse to perform euthanasia with loss of funding, in direct violation of § 72 of the law. The government is also requiring doctors who refuse to kill their patients to provide a referral for euthanasia.

Despite these actions, many standards and procedures remain unclear:

  • The application process still lacks any provision for accessibility to people who have communication disabilities. Nor are there guarantees that people with mobility impairments will receive medical care in a timely manner on equipment which is accessible to them.
  • There are still no protections against family members with financial interests who witness or fill out the forms on the person’s behalf.
  • There are no procedural barriers to serial applications in case of refusal, or “doctor shopping.”
  • Neither a psycho-social evaluation, nor a home visit is required to verify capacity to make decisions, that the decision is free and informed, or to ensure the person is not being abused or coerced.
  • The competency determination does not appear to involve the judicial process already used for determining capacity in Québec.
  • There is no requirement that the person receive palliative care or other support services to enable him or her to live well until natural death occurs. The “choice” to die remains an illusion where the person does not have a choice in where or how to live.
  • The definition of “end of life” is entirely subjective, and can range from two months to eight years.

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