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Doctors Mount Opposition As Quebec Prepares For New Assisted Death Law

The tug-of-war has left medical professionals wondering where hospitals will house the new service, and how individual doctors’ rejection of the practice will be handled.
Graham Hughes/The Canadian Press

As Quebec gears up to become the first Canadian province to legalize physician-assisted death, vocal opposition from medical practitioners — and a government that's threatening them with sanctions — suggests the roll-out could be complicated.

This week, Quebec's palliative care homes declared they would not be offering the service within their walls, a stance echoed by the palliative care unit at the Montreal University Health Centre (known as its French acronym, the CHUM), one of the province's largest hospitals.

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While the independent centers' position is unsurprising — they had successfully lobbied to be exempted from the new law — the CHUM's rejection proves more problematic. When the legislation comes into effect on Dec. 10, hospitals will be legally obligated to provide the treatment.

The provincial health minister came out against CHUM's palliative unit's statement, calling it "totally ridiculous."

"If they go ahead with this, they could face sanctions," Gaetan Barrette told La Presse. He also told reporters he wished palliative care homes would rethink their position.

But the tug-of-war leaves medical professionals wondering where hospitals will house the new service, and how individual doctors' rejection of the practice will be handled.

Palliative care physician Claude Baillargeon, who works at CHUM, told VICE News that while he is not against the option of medically assisted death, he doesn't think his department is the right host for the procedure.

"People in palliative care don't ask us to die, they're usually very happy to live those final moments surrounded by their loved ones, free of physical suffering," says Baillargeon. He explains that for palliative care professionals, the goal is to provide a peaceful environment for the patients and their families, and that adding medically-assisted death to the ward would change the atmosphere. "We find it unacceptable that this would be done in a bed within this care unit, it's such a contradictory message."

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He says it's important for the government —and for the public— to make the distinction between palliative care and medically-assisted death. "It's as if we would ask neonatal units to offer abortions," he says. "It's just not compatible."

Baillargeon says the service will likely be a difficult adjustment for practitioners working in any unit. "It's hard to ask a nurse who is, for instance, on a floor devoted to surgery and to healing patients, to then switch gears and provide this type of treatment," he says.

Collège des médecins spokesperson Dr. Yves Robert told VICE News individual medical practitioners will have the right to refuse to administer the treatment.

"It's in the code of ethics, they have the right to conscientious objection," he says, adding that in these cases, it's up to the institutions — never the patients — to find another willing physician. In cases where entire wards reject the procedure, the hospital is required to ensure medically assisted death is offered somewhere else in the establishment.

Enforcing this, Robert says, is the minister's responsibility. "Our work is to ensure that doctors who do offer this service are well trained and act professionally."

It's a process the Canadian health care community is watching closely. A Supreme Court of Canada ruling overturned the ban on doctor assisted suicide earlier this year, and by February 2016 doctors across Canada will be able to help terminally ill patients die. And while the development of the new federal legislation has been put on hold during the election period, medical practitioners are hoping Quebec's experience will provide a model to follow.

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Robert says the roll-out will have its "adaptation period," but points out this is the case with any new medical service. "It's just another new medical activity, but it's an important activity because it's so emotionally involving and reminds us of our own mortality."

He says the Collège des médecins has been preparing a training program for doctors who will be providing the service, developing a 70-page manual — to be released next week — and offering a series of conferences. "We've also asked the Ministry of Health and Social Services to create interdisciplinary support groups to support doctors and teams in each region," he adds.

According to Robert, the next step should be a public education campaign, to cut through some of the misinformation.

Contrary to recent media reports, Robert specifies there will be no such thing as 'standardized' euthanasia kits. He says each patient's case will be unique, and it's up to a team to decide which combination of medication is most suitable. "It's a kind of kit, but its contents are determined following very technical reasoning," he says.

"People often have this false perception that this is euthanasia on demand," he says. "But that's not it at all." He explains that the law is incredibly strict and requires the patient to be over 18, capable of giving consent, and terminally ill. The patient also has to prove they are in unmanageable, unbearable pain, "and then you also need a second opinion from another doctor."

Follow Brigitte Noel on Twitter:  @Brige_Noel