Webcast archive: Québec’s College of Physicians guide to euthanasia

This week, we discuss the new guide for physicians performing “MAID” released by the Quebec College of Physicians.

In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:

  • Québec’s College of Physicians’ guide to medical aid in dying
  • A note on the federal election

Please note that this text is only a script and that our webcast contains additional commentary.


  • Québec’s law allowing euthanasia will come into effect in less than two months.
  • Up to now, we’ve only found one set of regulations published in the Official Gazette of Québec which relates to “medical aid in dying.” This regulation describes only a part of the changes that will be necessary to implement a “carefully regulated” euthanasia program
  • On our webcast of September 11, we mentioned the Québec College of Physicians’ Guide. We’ve finally got hold of a copy, and would like to let you know about a few important items we found in it.
  • First, some general observations.
    • There is a strong bias toward assisted death. In the document, euthanasia is described as a way to relieve pain.
    • There is nothing (apart from ethical behaviour) to prevent a doctor from falsifying the request form of someone with a communication disability, obtaining a rubber-stamp approval from a second doctor, obtaining the lethal dosage from a pharmacist, performing the euthanasia and producing a report of an apparently legitimate process.
    • There is no provision for the forms or the process to be accessible to people with sensory or communication disabilities, such as access to neutral scribes and interpreters, documents in accessible formats, etc.
    • There is no provision to prevent a third person who fills out a form on someone’s behalf) from being a member of the family or exerting undue influence, or having an interest in the property of the person making the “request”.
    • Will all physicians be allowed to perform euthanasia, (including podiatrists, dermatologists, plastic surgeons) or just general practitioners?
    • The guide states that on average, a doctor would perform euthanasia less than once per year. With 22,500 doctors in Québec, do they expect maybe 22,000 deaths?
  • The guide indicates that the doctor who makes the decision about the euthanasia request will be the “treating physician.” But who will decide for the 25% of Québécois who don’t have a family doctor?
  • Several of the kinds of “suffering” named could apply to people in abusive relationships, or who are depressed. For example, “total dependence” and “the feeling of desperation in the face of a hopeless situation” both characterize battered women’s syndrome.  As well, chemical imbalance of depression can create the false impression that there is no escape from one’s problems.  Are we going to kill people because they have a chemical imbalance in their brains?  Will social interventions be sufficient?
  • The guide states that the person “is the best judge of her/his tolerance of suffering and of the means to relieve that suffering.” But what should be done when ignorance, a lack of resources, and prejudices interfere with that judgment.  What will she do if the doctor has only offered medical, and not social alternatives?  What will she do if appropriate palliative care is not available in her area, or a therapist has shown prejudice toward her as a person who is ill or disabled?  Is she really in the best position to evaluate her options under the circumstances?
  • The guide often makes references to “an interdisciplinary team who assists the patient.” Is this realistic when 25% of Québécois don’t even have a family doctor?  Are these teams destined to become Death Doctors?
  • The same principle applies to the vision for mental and spiritual health care at the end of life. The guide says that the person should receive “a specific, multidimensional therapeutic approach (listening, spiritual and religious support, psychotherapy, pharmacology, social intervention, etc.).”  Is this likely to happen when palliative care Is only available to 16-30% of the population?
  • The guide continues in the tradition of not defining “end of life.” It describes the signs for three “phases” of end of life:
    • The terminal diagnosis stage can extend from a week to eight years.
      • People with cancer – a few months
      • People with pulmonary or circulatory diseases, from 2 to 5 years
      • Elderly people and those with fragile health, from 6 to 8 years.
    • The signs of a very advanced and progressive illness, advancing rapidly toward death – less than four days
    • The signs of imminent death, alteration of vital signs – less than 24 hours.
    • One of the signs given for a terminal prognosis is delirium, which should automatically disqualify a person for euthanasia.
  • We’ll resume our discussion of the physicians’ guide next week


Around 15 percent of the population of Canada, 5 million people, have a physical or mental condition that substantially limits major life activities due in large part to barriers in the environment.  The number of people who are directly affected by disability – family, friends and service providers – is much larger.

One hundred percent of those who ask for and receive assisted suicide have a disability, whether or not they also have a terminal or degenerative illness.

On the other hand, less than 1,000 Muslims in Canada wear the niqab or burqa.

So why has the hijab become an election issue, while none of the political parties has taken a clear position on the issues of palliative care, in-home services or assisted suicide?

Disability is the only minority group that any person can join at any time.  Disabled people face high rates of unemployment, institutionalization and violence, because of discriminatory social policies and prejudice.

The most common reasons people ask for assisted suicide – loss of autonomy, inability to do activities they enjoyed, perceived loss of dignity, feeling like a burden – relate not to dying, but to how people with disabilities are treated in our society.

According to the Canadian Hospice and Palliative Care Association, only 16-30% of Canadians have access to hospice and palliative care.  The solution chosen by the government – assisted suicide – is to kill people because society won’t provide the services necessary so people can live well and in comfort until they die at home.

Maybe we should re-examine our priorities during this electoral campaign.

(Don’t forget to vote!)