Doctors in Canada’s Quebec province will be able to administer a lethal drug to terminally-ill patients and others suffering “constant and unbearable physical or psychological pain” by the end of next year.

A law which significantly affirms “the right of everyone to end-of-life care that is appropriate to their needs” was passed in the provincial National Assembly by 94 votes to 22 in a free vote on June 5. Quebec Health Minister Gaétan Barrette said the law would come into force within 18 months, as soon as a commission on end-of-life-care was established.

Quebec joins Oregon, Vermont and Washington as North American jurisdictions allowing medical aid in dying. The law, which draws heavily on Belgian and Dutch models, is designed “to ensure that end-of-life patients are provided care that is respectful of their dignity and their autonomy and to recognize the primacy of wishes expressed freely and clearly with respect to end-of-life care”.

Basic requirements are that the patient:

• be at least 18, capable of giving consent and possess a province health card as a resident of Quebec.
  
• is suffering an incurable serious illness,
  
• is in an advanced state of irreversible decline in capability, and
  
• suffers constant and unbearable physical or psychological pain which cannot be relieved in a manner the patient deems tolerable.
  

The bill does not use the term euthanasia. Defining the act of hastening death as a medical service, and therefore a matter of provincial competence, the Quebec government seeks to avoid Canadian federal criminal law which defines all assistance in dying as culpable homicide.

The Canadian House of Commons overwhelmingly rejected a bill legalizing physician-assisted dying in 2010. A private member’s bill on similar lines has since been introduced in the federal parliament, but reports indicated it is unlikely to be debated in the near future.

The bill says institutions, palliative care hospices and private health facilities must offer end-of-life care and “ensure that it is provided to the persons requiring it in continuity and complementarity with any other care that is or has been provided to them”. Doctors and private health nurses may provide it at the patient’s home.
Every palliative care hospice must inform persons of the end-of-life care it offers before admitting them.

The Quebec bill says the provision of end-of-life care is to be guided by the following principles:

• respect for end-of-life patients and recognition of their rights and freedoms must inspire every act performed in their regard,
  
• end-of-life patients must be treated at all times with understanding, compassion, courtesy and fairness, and with respect for their dignity, autonomy, needs and safety, and
  
• the healthcare team providing care to end-of-life patients must establish and maintain open and transparent communication with them.
  

It establishes a regime for advance medical directives and specifies that they will be binding.

Two doctors, including an independent one who is not treating the patient, must verify the request. A doctor unwilling to act must notify the responsible authority so that another physician can be called in to administer the fatal dose. (Ends)