Saturday, March 25, 2023

Medical assistance in dying: the advance application process should be clarified

As part of the expansion of medical aid in dying protocol, caregivers are put in control when patients who are incapacitated change their minds after a preliminary inquiry.

If the patient refuses to receive medical aid in dying at the last minute, but is not considered competent to make an informed decision, his wishes must be expressed at the time of obtaining the request.

“If the person is not lucid, it is not a refusal, it is a resistance”, decided the president of the group of experts in the question of incapacity and medical assistance in dying, Jocelyn Maclure, on the first day of the consultation. on the proposal to the chapter on medical assistance in dying.

Listen to an interview with Dr. Alain Naud, family physician and palliative care physician at the CHU de Québec-Université Laval on the Sophie Durocher radio show broadcast live every day at 2:35 am via QUB radio:

This piece of legislation aims to make eligible for this end-of-life care people who suffer from a serious and incurable disease, as well as people with a neuromotor disorder, such as Alzheimer’s or dementia.

Opinion in the same direction, Dr. George l’Espérance, of the Quebec Association for the right to die with dignity, confirmed that it is “absolutely normal” that patients resist treatment, and that it is common to establish a hospital.

“If you want to send a catheter to someone who is a little agitated, you will have resistance,” he said, adding that this resistance can be reduced by using certain drugs.

“We must not worry about this resistance, and continue with the process of medical assistance in dying,” stated in the same direction the director of research of the Federation of the Alzheimer Society of Quebec, Nouha Ben Gaied., however, highlighting this concern. it should be a “last resort” and only be considered in “conditions of advanced and irreversible decline”.

Minister Bélanger proposes to extend medical assistance to people suffering from serious and incurable diseases, as well as to people with neuromotor disorders.

According to that, it is too much, according to the opinion of the doctors, who see it as too restrictive a rule and which creates a risk “to the detriment of people”.

“If we decide to set very restrictive rules, we will deprive a large part of the population. Wanting to distinguish between physical disability and neuromotor disability, we will necessarily restrict access to medical assistance in dying, while our goal is to expand it to all,” said Dr. Alain Nault of the College of Medicine.

The criteria for “serious and incurable disease” are quite accurate in the eyes of doctors, who argue that “each case is unique” and should be determined in discussions between doctors and patients. The Quebec Association for the Right to Die with Dignity shares the same opinion.

The College of Physicians also recommends accelerating the reflection on the extension of medical assistance to die for people with mental disorders before April 2024, to maintain a good connection between provincial and federal laws.

Recently, Quebec has gone from “a progressive society in North America (…) to an unfairly restrictive area to access medical assistance in dying”, if we believe Dr. Alain Nault.

“We cite as an example,” replied Minister Bélanger, praising the “very professional and interdisciplinary performance” that Quebec has developed.

“Disability is a very broad concept.” […]. I think it is important that we can make nuances and note, as a precautionary principle, and therefore we bring the concept of “neuromotor” disability, which was deprecated.

She received the support of senior MP Véronique Hivon, who argued that “it cannot be done on the ground”, she said this afternoon.

Ms Hivon asked parliamentarians to take the necessary time to implement a rigorous consultation process on expanded medical aid in dying. “Anyone who wants to be heard must be heard,” he said.

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