The decision to allow early requests for MAID has been praised by advocates, but raises concerns for others.
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As of Wednesday, Oct. 30, Quebec will become the first province in Canada to allow people to make advance requests for medical assistance in dying (MAID).
Long asked for, the change has been praised by advocates, but criticized by those who believe Quebec has moved too fast on the issue.
Meanwhile, the provincial government says it’s ready to meet the expected demand brought on by expanding the program.
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Here’s a brief overview of the issue.
What are advance requests for MAID?
Quebec adopted a law last year to allow people with a serious and incurable illness, such as Alzheimer’s disease, to make early requests for MAID.
The advance requests mean a person with an illness that will eventually leave them unable to grant consent can arrange to receive a medically assisted death when their condition worsens, be it months or years in the future.
Previously, people who received a doctor-assisted death had to be able to consent right up until the last moment.
People seeking to make the early requests still need to meet several criteria. Among them is that the person must have already received the diagnosis. They cannot make a request in case they one day suffer from a given disease.
At the time of the request, the person must also be able to describe in detail the symptoms they could experience in the future that would make them want to receive MAID, should they no longer be able to consent at that point.
If they change their mind while still capable of consenting to care, the person will be able to withdraw their request.
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What are advocates saying?
Dr. Georges L’Espérance, the head of the Association québécoise pour le droit de mourir dans la dignité, believes Wednesday marks a “great step forward” for patients in Quebec.
L’Espérance said there have been calls to implement advance requests ever since the laws surrounding MAID were first introduced.
In his view, the requests not only extend a patient’s autonomy but also provide peace of mind, allowing people to enjoy their post-diagnosis life to the fullest after deciding at which stage they no longer want to live.
“It allows a person to say, ‘I know this disease will take away my personality, or everything I’ve been my entire life, and I don’t want to reach that point. But for the moment, I still have joie de vivre,’” L’Espérance said.
“It gives them a sense of serenity and removes a huge weight from their shoulders,” he added. “They’ll be able to live … with the certainty that when the right time comes, they’ll be able to receive medical assistance in dying.”
What are critics saying?
Some health officials believe allowing advance requests is problematic because of the unpredictability of a patient’s condition and how their wishes may evolve over time.
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Dr. Catherine Ferrier, an assistant professor of family medicine at McGill University, fears such requests carry the risk of people dying who might have chosen otherwise if they were still able to make the decision.
“There are huge gaps in consent, and that’s a big concern to me,” said Ferrier, who is also a board member of Living With Dignity.
Ferrier noted that positive outcomes for dementia patients are often achieved, and expressed concern that early requests might be seen as a “quick fix” of sorts from people who fear what the disease will bring.
“As you come to terms with your disease, while you get used to the idea of not being able to do all the things you could do before, you’re still happy,” she said. “The whole idea of predicting what we might want a few years down the road is problematic.”
Are there legal issues surrounding the requests?
As it stands, Canada’s Criminal Code prohibits health professionals from administering MAID as part of an advance request.
Quebec and several of its professional orders have been pressuring the federal government to amend the Criminal Code since last year, but that has yet to happen.
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As recently as last week, the federal government was still asking Quebec to wait before allowing the requests. On Monday, the government announced it won’t challenge Quebec’s law, but continued to urge caution.
Quebec had already decided to move forward with the requests.
Since the Criminal Code hasn’t been amended, the provincial government has instead asked Quebec’s office of criminal prosecutions to not pursue charges against doctors if they comply with the provincial law.
In early September, the office’s director issued a directive to prosecutors stating that charging health professionals over the issue would “not be in the public interest.”
Will the change lead to more MAID requests?
The number of MAID requests in Quebec has increased each year since the law went into effect in late 2015.
Last week, representatives of the province’s Health Ministry said they don’t have an estimate of how many requests the expansion might lead to, but insisted the system is ready.
According to the committee that oversees MAID in Quebec, 5,717 people received the service between April 2023 and March of this year, representing 7.3 per cent of all deaths in the province. The number of requests climbed by nine per cent over the previous year.
The committee expects that increase to continue now that advance requests are permitted.
The Canadian Press contributed to this report.
jfeith@postmedia.com
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