Medically assisted dying: Quebec's extraordinary citizens' debate.

Author:Kelley, Geoffrey
Position::MEDICALLY ASSISTED DYING
 
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On December 4, 2009, the Quebec National Assembly unanimously adopted a motion creating a special parliamentary committee to examine the question of dying with dignity. The four political parties represented in the Assembly at that time (the Quebec Liberal Party, the Parti Quebecois, Action Democratique du Quebec and Quebec Solidaire) approved a motion that would lead to extensive public consultations on end-of-life issues, including palliative care, living wills and, most contentiously, the difficult issue of euthanasia. The result was a rewarding experience for all concerned--parliamentarians, the media and the general public, as citizens and representatives of civil society came forward to comment on one of life's most emotionally charged moments and to explore how death and dying are dealt with in our modern world.

From the outset, the goal was to reach out to the public. In the 20 years that preceded the committee's work, the debate over euthanasia in Canada had focused either on the courts (as in the Sue Rodriguez and Robert Latimer cases) or on votes in the House of Commons to amend the Criminal Code of Canada. This time, the goal was to generate and allow as many people as possible to express an opinion on the matter.

The process

The motion adopted in the Assembly was quite specific as to how the special committee was to proceed. The first step was to invite 32 experts drawn from medical, legal and ethical fields, along with various professional associations interested in the issue, to testify at the National Assembly in Quebec City. At this stage, the experts were asked for their advice on how to craft a consultation document, which questions needed to be answered, and how best to engage the population on these issues. The committee asked them to refrain from giving their personal opinion for the moment, as it was expected that they would return during the next stage of the committee's deliberations to add their voices to the general consultation. The committee members were probably engaging in wishful thinking, as many of the experts clearly took sides in the euthanasia debate right from the start.

Of particular interest was the testimony of the College des Medecins (Quebec's college of physicians), which had published a document on euthanasia in October 2009 and had concluded that several "grey zones" existed in end-of-life treatment and care. (1) The College asked legislators to clarify issues associated with palliative sedation, living wills and a new concept known as "medically assisted dying." The College's position was reinforced by the two medical federations (general practitioners and specialists), which claimed that their members supported the idea of permitting euthanasia. (2) Once the expert testimony had concluded, a 42-page consultation document was released in May 2010. It was hoped that the document would help define the various concepts in play (euthanasia versus assisted suicide, for example), provide specific case histories to illustrate the choices facing doctors, patients and society, and inspire citizens to participate in either public hearings or an online survey. (3)

The adventure was launched. Over the summer of 2010, the committee began to receive briefs from across the province. The initial motion had promised that the committee would travel across Quebec to hear witnesses. Eight cities were selected to host the hearings: Gatineau, Montreal, Quebec City, Saguenay, Sherbrooke, Saint-Jerome and Trois-Rivieres. Starting on September 7, 2010, in Montreal, (4) a parliamentary odyssey began that included 29 days of public hearings, 273 briefs received, the testimony of 239 individuals and associations and the participation of 114 individuals in "open mike" sessions at the conclusion of each hearing. In addition, 6,558 people completed the online survey - a record number for a National Assembly survey. Finally, the work of the special committee received a great deal of media attention both in Quebec and from across Canada. This attention paid to a "citizens' debate" helped stimulate interest in the issue at hand.

After the public hearings ended, several members of the committee travelled to France, Belgium and the Netherlands to meet with elected officials, doctors, lawyers and ethicists who had taken part in the debate on euthanasia in their respective countries. During the Quebec hearings, the positions of these countries had been depicted in contradictory ways, from a progressive paradise (Belgium, the Netherlands), where euthanasia is practised without restriction, to sinister lands where the vulnerable perish against their will.

The final chapter was the drafting of a final report, which was tabled on March 22, 2012, and contained 24...

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