Tuesday, October 1, 2013

Vivre dans la Dignité (Living with Dignity): from their submission to the Quebec Committee on Health and Social Services- September 25, 2013 concerning euthanasia Bill 52

On September 25, 2013 Vivre dans la Dignité (Living with Dignity) presented before the Quebec Committee on Health and Social Services concerning Bill 52 "An Act Respecting End-of-Life Care"

The following is a slightly edited version of the September 25, Living with Dignity submission.

Who is Living with Dignity: 

Our group is a non-profit citizen movement, non-religious and non-partisan, which was formed in 2010. Its mission is to defend the inherent and inalienable value that is the dignity of every individual. It includes people from all sectors of society, many of whom work in health care (physicians, nurses, pharmacists, etc.). Several thousand members and sympathisers support it.

Why Living with Dignity opposes Bill 52: 

Let there be no doubt: what Bill 52 is proposing is to cross a red line. A big red line. The one that has been drawn from the beginning of our country and that is universally accepted around the world: a citizen cannot cause death another citizen, for any reason except in cases of self-defence. Historically the only exception to this prohibition, which has always made consensus, was the death penalty, which is now banned in our country, in spite should we remember, that many polls have consistently demonstrated a desire of the majority of the population to legalize it (about 60-70% approval). ... No. Without going into the details of the legal arguments in support of this decision, we can say that the legal foundation on which our society rests, is based on affirmations of certain basic rights. ...This is the red line that the Government of Quebec with Bill 52 wants to blow, to strike and to be replaced by something else that is not quite clear, a shapeless and subjective thing that is evoked by words such as "medical aid in dying" and "terminal palliative sedation."

A matter of Life and Death:

To illustrate more clearly, let us say that if a decision of the National Assembly entailed the adoption and coming into force of Bill 52, this would be likely to bring about the premature death of hundreds and possibly thousands of individuals each year (we will demonstrate below how we arrive at this estimate). ...For this reason, it is important that each member has the maximum amount of information and freedom to exercise his or her vote in an informed way and not be content with those platitudes or clichés that are currently conveyed on this issue.

Living with Dignity believes it would be inconceivable from an ethics point of view that the vote in the National Assembly be expressed otherwise than by a free vote, and for all parties, whether in power or in opposition.

The distribution of legislative powers: health and criminal law

Under the Constitution Act of 1867, criminal law is under exclusive federal jurisdiction (Article 91, 27). 

On the other hand, health is primarily a matter under provincial jurisdiction.

In the exercise of its jurisdiction on criminal law, the Federal Parliament adopted various measures in the Criminal Code (R.S.C., 1985, c. C-46), including those relating to consent to death (s. 14), the duty of persons to provide necessaries of life (s. 215), the duty of persons undertaking acts dangerous to life(s. 216), the duty of persons undertaking acts (s. 217), criminal negligence (s. 219) and, more importantly for our purposes, the prohibitions of homicide (s. 222), murder (s. 229), counselling or aiding suicide (s. 241) (note, in passing, that suicide and attempted suicide are not prohibited since the offense of attempted suicide was abolished in 1972. However, counselling or aiding suicide remains an indictable offense) and, finally, the administering of noxious substances (s. 245). 

Civil law: the inviolability and integrity of the person 

In the exercise of its jurisdiction over property and civil rights, Quebec adopted various provisions in the Civil Code of Quebec [CCQ] to consecrate the principles of inviolability and integrity of the person. 
"Every person is inviolable and is entitled to the integrity of his person. Except in cases provided by law, no one may interfere with his person without his free and enlightened consent. "(Art. 10)  
"No person may be made to undergo care of any nature, whether for examination, specimen taking, removal of tissue, treatment or any other act, except with his consent. If the person concerned is incapable of giving his consent to care, a person authorized by law or by mandate given in anticipation of his incapacity may do so in his place. "(Art. 11) 
According to the Minister of Justice, the "care" referred to in Article 11 are: 
"All kinds of tests, samples, treatment or intervention, medical, psychological or
social, or not required by the state of health, physical or mental." (Ministère de
la Justice, “Commentaires du ministre de la Justice. Le Code civil du Québec,
tome 1, Québec, Les Publications du Québec, 1993, art. 11 CCQ, at p. 12)
("Comments of the Minister") (unofficial translation).
The Canadian and Quebec charters

4.1 The Canadian Charter of Rights and Freedoms 

The Canadian Charter of Rights and Freedoms, constitutes Part I of the Constitution Act, 1982, which itself constitutes Schedule B of the 1982 Act on Canada, 1982, c. 11(UK) (the "Canadian Charter") The fundamental principle of the Canadian Charter is to guarantee certain rights and freedoms: 
“1. The Canadian Charter of Rights and Freedoms guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society. " 
including, in particular, certain legal rights: 
"7. Everyone has the right to life, liberty and security of person and the right not to be deprived thereof except in accordance with the principles of fundamental justice." (Emphasis added). 
4.2 The (Quebec) Charter of Human Rights and Freedoms

Quebec has also adopted in 1975 a Charter of Rights and Freedoms (LQ chapter C-12) (the "Quebec Charter") which provides, among other rights and principles, the following: 
"WHEREAS every human being possesses intrinsic rights and freedoms designed to ensure his protection and development; 
Whereas all human beings are equal in worth and dignity, and are entitled to equal protection of the law; 
Whereas respect for the dignity of human beings, equality of women and men, and recognition of their rights and freedoms constitute the foundation of justice, liberty and peace; 
Whereas the rights and freedoms of the human person are inseparable from the rights and freedoms of others and from the common well-being; 
Whereas it is expedient to solemnly declare the fundamental human rights and freedoms in a Charter, so that they may be guaranteed by the collective will and better protected against any violation;…  
1. Every human being has a right to life, and to personal security, inviolability and freedom. "
Medical practice and the current state of the law - refusal and cessation of treatment

The courts recognize that the refusal and withdrawal of treatment and or power by the patient (or their legal representative) are allowed and do not constitute illegal acts, so that the nursing staff should be comply.

The right to refuse a treatment and the right to interrupt a treatment apply in respect of artificial or extraordinary care (e.g. respirator) as well as in respect of ordinary care or life support (e.g. feeding, hydration, ventilation). It is a right to "let die", not a right "to be killed."

Medical practice and the current state of the law – therapeutic obstinacy 

The Select Committee has clearly defined therapeutic obstinacy: 
"Use of aggressive treatment to prolong the life of a patient in the state of an illness, with no real hope of improving his condition." (RSCDWD, p.18) 
We are strongly opposed to therapeutic obstinacy, which is in fact also recognized by the courts and the legislation already in place, whether this therapeutic obstinacy is caused by the physician or, which is what happens more often, in response to requests from the patient or his family.

By the refusal of therapeutic obstinacy, either by the physician, the patient or his family, you do not want to cause death, you accept that you cannot prevent it. Consequently, there is no illegal act as long as the patient's consent is free and informed.

Medical practice and the current state of the law - palliative sedation 

There is a huge confusion about palliative sedation, and prudence leads us to make important distinctions.

Sedation without intent to cause death 

Sedation, even with the cessation of artificial hydration and nutrition, carried out with the free and informed consent of the patient or his legal representative, does not constitute a homicide under the Criminal Code, as long as the intention is not to cause death but to relieve the patient even if death ensues, because death is not a desired effect. (Louis-André Richard and Michel L’Heureux in "Plaidoyer pour une mort digne," PUL at pp. 36 to 59) (unofficial translation).

Sedation with intent to cause death 

"In this case, the purpose of terminal sedation, beyond the verbally expressed intent, is to cause the patient's death within a short time, either by the natural progression of his illness or by dehydration. In this scenario, the physician leaves the territory of palliative care to enter squarely into that of euthanasia or medical aid in dying. Terminal sedation in such conditions constitutes assisted suicide or a sort of euthanasia. "(Ménard Report, p. 251 referring to the Report of the Expert Panel of the Royal Society of Canada, End-of-life Decision Making, Ottawa, November 2011, at p. 40.) (emphasis added)

Bill 52 - Redefining the practice of medicine 

The Bill, by its section 63, is redefining the practice of medicine in a fundamental way by amending s.31 of the Medical Act (RSQ, c. M-9) (MA) (new additions are in italics) 
"The practice of medicine consists in assessing and diagnosing any health deficiency ... and treating illness to maintain or restore health or to provide appropriate symptom relief. " (MA s. 31, 1) 
One might think that this addition is only intended to clarify the scope of the care that aim only to relieve symptoms including palliative care as it is known today...

But the same section 63 adds a 12th activity to those reserved to physicians under section 31 of the Medical Act! 
"The following activities in the practice of medicine are reserved to physicians: 12 ° administering the drug or substance allowing an end-of-life patient to obtain medical aid in dying under the Act respecting end-of-life care (insert the year and chapter number of this Act)."
This is an enormous medical change.

Bill 52 - "End-of-life care"

Section 3(3) of Bill 52 defines "end-of-life care" as "palliative care provided to persons at the end of their lives, including terminal palliative sedation, as well as medical aid in dying."

Including terminal palliative sedation and medical aid in dying under palliative care is an aberration! Palliative care aims at softening the end of life but not to cause death. 

As emphasized, and rightly so, by the Collège des médecins in its submission of September 17, 2013 to this Commission (SCM): 
"Despite the extreme importance that palliative care has taken in this difficult period that is the end of life, it is not clear to us that we should associate too closely "end-of-life care" and "palliative care". Palliative care is not confined to the end of life, any more than the end-of-life care is not limited to palliative care. The thing is even less clear if we think including in this category of care a new option such as medical aid in dying. Palliative care has developed in a context where any action to actively and voluntarily shorten life was forbidden. To the point that what is privileged is accompaniment and other means that have been explored to relieve symptoms, such as palliative sedation for refractory symptoms. It is understandable that, for many, medical aid in dying is contrary to the very spirit of palliative care."(SCM, p. 4) (emphasis added)
"Medical aid in dying" - Definition 

Despite being such an important medical act, Bill 52 does not provide any definition of medical aid in dying, if not only through the amendment to the activities reserved to physicians by section 63 of the Bill. The legislator has an obligation, at least of a moral nature, to define what it is talking about, especially when what is at issue is to cause the death of a human being. What is meant by this undefined term?

And let us recall that section 63 of Bill 52 reserves to physicians the administering of the drug or substance to a person to obtain medical help in dying. This is an act of deliberately causing death, an act of euthanasia!

This corresponds to the definition of "homicide" in the Criminal Code: 
"A person commits homicide when, directly or indirectly, by any means, he causes the death of a human being."(s. 222(1))
And a culpable homicide is murder under section 229 of the Criminal Code.

Even the Collège des médecins admits also the need to define medical aid in dying and recognizes that this act consists in intentionally causing the death of a person:
"It also seems useful to better clarify in this section or elsewhere in the Bill, what is meant by "medical aid in dying." As we have already stated elsewhere, this term suits us as long as the act is performed by a physician in a care setting, which excludes physician-assisted suicide. The fact remains that it is an act of intentionally causing the death of a person but in the context of end of life care, in exceptional circumstances and under the conditions established by law. "(SCM, p .5) (emphasis added)
Therefore, if medical aid in dying is euthanasia and euthanasia is a crime, how can anyone seriously claim that Quebec has jurisdiction because it is a matter of criminal law within the exclusive jurisdiction of the National Assembly? 

"Medical aid in dying" - Eligibility 

The eligibility criteria for medical aid in dying have sometimes been qualified as serious, restrictive and the argument has even been made that medical aid in dying would apply only in extreme cases to end-of-life persons or those that are terminally ill and that could not see their pain relieved. In the name of science and truth we must examine those criteria to realize that the message conveyed by many in the public and in the 
media message is far to correspond to what is really written in sections 26 and 28 of Bill 52. 

A person "suffering from an incurable serious illness" (s. 26(2)) 

This illness can be physical or psychological, and the patient does not necessarily have to be terminally ill or at an end-of-life stage. This disease can include, of course, amyotrophic lateral sclerosis (ALS), Parkinson’s, cancer, Alzheimer's, multiple sclerosis, etc., but also depression, anorexia, arthritis, blindness, difficulty hearing or vision as the Belgian experience teaches us (Dossier of the European Institute of Bioethics, April 
2012, EUTHANASIA IN BELGIUM: 10 years on, at pages 5 and 6, a copy of such Dossier) (Report on Belgium) 

With "an advanced state of irreversible decline in capability" (s. 26(3))

The decline in question here can cover both physical and psychological, and many geriatricians and psychiatrists confirm that many patients could satisfy this criterion, and here again, the patient does not necessarily have to be terminally ill or at an end-of-life stage. 

Even the Collège des médecins, although most favorable to the Bill, recognizes these difficulties: 
"As well, we believe that the requirement that death is inevitable and imminent should be made more explicit, using the concept of "terminal phase". The easiest way would probably require that the person be in terminal phase... This requirement would replace the requirement that the medical condition of the person is characterized by an advanced state of irreversible decline in capability. Psychiatrists have advised us that many of their patients could apply and meet the eligibility criteria as currently formulated. The same applies to patients with a degenerative disease still at an early stage. It is easy to understand the reluctance of physicians to satisfy such requests. "(SCM, p.8) 
“Suffering from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable" (s. 26(4))

This is a (very) subjective evaluation by the patient himself and which depends on his personality, his ideas, his values and his tolerance to pain (see Report on Belgium, p.6.). Let us recall as well that the patient may refuse to receive palliative care which would relieve his pain and that the physician cannot refuse medical aid in dying because he refused palliative care (Bill 52, s. 7)

And all this, without necessarily having consulted anyone nor notified his relatives who may learn of the death by the media as s. 28 (1) (e) provides that the physician who performs medical aid in dying can only discuss the patient’s request with the patient’s close relations if the patient so wishes.

"Terminal palliative sedation" - Definition 

As for medical aid in dying, Bill 52 does not propose any definition of terminal palliative sedation, if not only through the amendment to the activities reserved to physicians by section 63 of the Bill.

What is the source of the term "terminal palliative sedation"?

The Ménard Report tells us that the term "continuous palliative sedation" as defined in the RSCDWD is also called "terminal sedation" (at pp.10 and 248) 

But even the Ménard Report specifies that two situations must be distinguished:
"The first involves the use of this practice in a patient whose disease is in terminal phase but is so advanced to the point where the patient can no longer swallow nor be hydrated. The use of terminal sedation with withdrawal of hydration and nutrition may, at this time, be acceptable in the context of palliative care to limit the patient's suffering. This practice of terminal sedation is accepted by the medical profession in patients whose end of life is imminent in terms of hours or days, or a week at most. In such a situation, terminal sedation does not shorten the patient's life." (Pp.250-251) (emphasis added) (unofficial translation) 
"The second situation involves the application of terminal sedation with nutrition and hydration withdrawn in a patient who could still be hydrated and fed or whose death is not as imminent as described above .... In this case, the purpose of terminal sedation, despite the verbally expressed intention, is to cause the patient's death within a short time, either by the natural progression of the patient’s illness or by dehydration. In this scenario, the physician leaves the territory of palliative care to enter squarely into that of euthanasia or physician assisted dying. Terminal sedation in such conditions constitutes an aid to suicide or a sort of euthanasia." (p. 251) (emphasis added) (unofficial translation)
Therefore, it is not clear whether, in Bill 52, the term ”terminal palliative sedation” means "some sort of euthanasia" or not ... Is it a "continuous palliative sedation" (in order to relieve pain) or another disguised form of euthanasia (continuous palliative sedation in order to cause death)? This is a blatant lack of transparency by the legislator

"Terminal palliative sedation" – Absence of any control

The rules applicable to terminal palliative sedation are quite different from those applicable to medical aid in dying. The only before-the-fact control under Bill 52 for terminal palliative sedation is to get a written free and informed consent by the, patient or (which does not exist for medical aid in dying) by "the individual authorized to consent to care on behalf of the patient" (s .25).

The only obligation that remains is for the physician who provides (but not one that prescribes it) terminal palliative sedation to notify the council of physicians, dentists and pharmacists (CPDP) (ss. 33, 34) but terminal palliative sedation may be administered by someone other than a physician, then in such a case the person who will administer the terminal palliative sedation (a nurse?) shall have no obligation to notify the CPDP.

As terminal palliative sedation escapes any control, would it not be tempting to pretend that we have given a terminal palliative sedation rather than to say that, in fact, we have administered medical aid in dying?

Conscientious objection - Myth or Reality? 

The physician who refuses a request for medical aid in dying for reasons of conscience must notify his director of professional services (DPS) and the DPS must then take the necessary steps to find another physician willing to deal with the request (s. 30). But despite this, Bill 52 states that "This Act does not limit the right of health professionals to refuse, in accordance with their code of ethics, to provide or take part in providing end-of-life care for reasons of conscience." (s.44). But the Code of Ethics of Physicians provides that: "A physician must, where his personal convictions prevent him from prescribing or providing professional services that may be appropriate, acquaint his patient with such convictions; he must also advise him of the possible consequences of not receiving such professional services. The physician must then offer to help the patient find another physician."(R.R.Q., c. M-9, r.17, s. 24). This obligation conflicts with the obligation to rather notify his DSP under section 30 of the Bill.

In addition, section 44 applies only to health care professionals and not to other employees of the institution may be required to participate in medical aid in dying or terminal palliative sedation help and does not protect them from any resulting discrimination against conscientious objectors.

No guarantee of uniform standards 

The Bill provides for a series of standards: 
● The Minister determines policy directions (s. 20); 
● Each professional order adopts clinical protocols (s.32);
● Every health and social services agency determines the general rules of access to end-of-life care (ss. 18 -19); 
● Each CPDP adopts clinical protocols (s. 32); 
● Every institution adopts: a clinical program for end-of-life care (s. 9), a policy of end-of-life care (s. 10), and, in its code of ethics a section pertaining specifically to the rights of end-of-life patients (s. 11). 
And all this without any obligation or guarantee of uniformity across Quebec!

Ineffectiveness of control by the end-of-life Commission

The Bill provides for the establishment of a Commission named “Commission sur lessoins de fin de vie” ( CSFV ) to examine any matter relating to end-of-life care (ss. 35 to 42). 

As indicated in the Report on Belgium at its paragraph 5.1 on page 5: 
"From the time of its initial report and subsequent reports, the Commission for Control and Assessment acknowledged its inability to act, going on to say that it is not capable “of assessing the proportion of declared cases of euthanasia compared with the number of real cases which have actually taken place." Yet, in 2002 the stated objective of bringing euthanasia out of the shadows was a major argument made by those in favour of its legalization. From the time of the very first report for 2002 and 2003, the Commission acknowledged that "it was aware of the limits of control with which it had been entrusted regarding the implementation of the law of May 28 2002." It goes on to say "it is quite evident that the effectiveness of its mission resides, on the one hand, in the medical profession’s respect for the obligation to declare actual cases of euthanasia and on the other, in the manner in which the declarations are drafted." This is, in a nutshell, the problem of how to carry out control after the event (death of the patient), based on the medical practitioner's declaration. Is it not illusory to expect a medical practitioner to denounce him/herself when he/she has failed to comply with one or several basic rules and regulations? Can anyone seriously imagine that he/she will scrupulously comply with the rules in such instances when he/she is actually unaware of one or several rules and regulations? Is it not more likely that he/she will refrain from declaring euthanasia or that he/she will act in such a manner that he/she is not directly implicated? Nonetheless, nearly 10 years after the implementation of the law, the Commission continues to consider that the legal conditions have been met. It has never felt the need to refer a single medical file to the Crown Prosecution Service."
Why shouldn’t this admission of the ineffectiveness of controls by the Belgian Commission itself not apply to us in Quebec, with the result that the number of cases of medical aid in dying actually practiced will always be underestimated... besides the fact that, if the Bill remains as currently drafted, cases of terminal palliative sedation do not even have to be disclosed to our CSVF? 

Is the Quebec approach well founded? A"care"?

The position adopted by Quebec in both the RSCDWD and the Ménard Report, is that medical aid in dying is "care" and therefore falls under the provincial jurisdiction over health matters. Living with Dignity disputes this affirmation for the following reasons. 

In all the articles of the CCQ dealing with "care" for people, articles 10 to 18, 207, 258, 
259, 272, 281, 285, 291, 559, 561 and 2166, the term "care" is understood as an act of 
relief, of maintenance of life, of safeguard of life and not an act that consists of taking 

The same interpretation is found in several laws of Quebec.

Medical aid in dying and terminal palliative sedation (with intent to cause death) is not "care" and, therefore, Quebec has no jurisdiction to decriminalize these acts which fall under the Criminal Code and the exclusive jurisdiction of the Federal Parliament. 

Is the Quebec approach well founded? 
Impact of the ChartersBill 52, in attempting to decriminalize medical aid in dying and terminal palliative sedation (with intent to cause death), severely violates fundamental rights protected by the Canadian Charter of Rights and freedoms:
". 7 Everyone has the right to life, liberty and security of person and the right
not to be deprived thereof except in accordance with the principles of
fundamental justice. "
Bill 52 also violates fundamental rights protected by the Charter (Quebec) of human rights and freedoms: 
"Whereas all human beings are equal in worth and dignity, and are entitled to equal protection of the law; ...
1. Every human being has a right to life, and to personal security, inviolability and freedom. "
Consequences - THE QUESTION: how many cases of euthanasia? 

Belgium has a population of about 11M people and eligibility criteria for euthanasia nearly identical to those found in Bill 52. There are approximately 105,000 deaths each year in Belgium. What are the results?
● 235 cases of reported euthanasia in 2003 (first full year of application of the new law)
● 1133 cases of reported euthanasia report in 2011 and 1432 in 2012
● a figure that almost doubles every 4 years and represents more than 1% of deaths! 
What does this hold for us in Quebec, with a population of about 8M people?
● in 2011, we had 59,300 number of deaths in Quebec which would correspond to 593 cases of euthanasia (1% of deaths) and more than the number of deaths on the roads (479 in 2011) ;
● in 2012, we had 60,800 number of deaths which would correspond to 608 cases of euthanasia (1% of deaths) again more than the number of deaths on the roads (436 in 2012)
But road accidents and deaths that result from them are a curse that the Quebec Government is trying to combat by huge advertising campaigns!

To use an image, this is the equivalent of almost emptying 3 times per year the 223 beds of the CHSLD Drapeau-Deschambault or the 226 beds of the Saint-Sacrement Hospital in Quebec City.


Medical aid to dying persons is urgent, but without medical aid in dying!

Medical aid in dying and terminal palliative sedation (with intent to cause death) is not a "care" and, therefore, Quebec has no jurisdiction to decriminalize these acts which fall under the Criminal Code and the exclusive jurisdiction of the Federal Parliament.

In addition, Bill 52 severely violates fundamental rights protected by the Canadian and the Quebec Charters, which confirm that the worth and dignity of a person does not decrease with age, status or capability.

Each person must be able die "at his or her hour ", not later (no therapeutic obstinacy) nor earlier (no euthanasia in whatever form).

"Euthanasia remains the saddest manifestation of despair which I invite all those who suffer not to yield." (Serge Daneault, p.147 in Boisvert, Marcel and NEAULT, Serge, être ou ne plus être, débat sur l’euthanasie, Voix parallèles, 2010,) (unofficial translation)

Euthanasia is also a manifestation of the failure of our health services to relieve pain, whether physical, psychological or moral, and the failure of our families to accompany well those who are dying. 

Consequently, the Quebec Government should prioritize respect for the dignity of every person by improving palliative care as defined by the World Health Organization (WHO) throughout the province of Quebec. The Quebec Government must above all invest financial and human resources in palliative care.

It is extremely sad and disappointing to realize that Bill 52, as drafted in the portion dealing with different forms of proxy death on demand, is actually an exercise in contortion and circumvention to accept by an abusive use of deception and ambiguity revolutionary an extremely daring and dangerous legislative initiative, contrary to the principle of security of persons as set out in our charters of rights and freedoms and protected by our Criminal Code.

To get there, Bill 52 has decided to use the Medical Act, which is here manipulated and exploited to perform a maneuver of legal circumvention of the Criminal Code of Canada. This exercise will affect all those who have embraced the medical profession based on what it has been until now, namely a caring relationship that excludes any form of participation in homicides. We cannot accept such an exercise even in the name of a 
vague concept of compassion for end-of-life persons. The consequences are just too many and too serious, both for sick people (especially those with one or another form of vulnerability), and for the caregivers.

Living with Dignity appeals to reason and genuine compassion. Our society has medical and social challenges to meet, including improving the quality and access to health care for the seriously ill or the dying persons. We have made great strides in recent years, thanks to the development of palliative care and the development of pain relief care. Much remains to be done, it is true, and Living with Dignity is convinced that as a society we must continue in the same direction. We must continue to face these challenges with wisdom, with determination and respect. The real solution is a policy of human support and access to care, that is, access to real medical care as recognized by the international community, and which are neither euthanasia (or its designation " medical aid in dying ") nor terminal sedation with intent to cause death. Therein lies the challenge for the future to continue the work of humanization that previous generations have initiated and have entrusted us with.

The Members of the National Assembly cannot in good conscience support this Bill, which, despite nice promises, does not in any way solve the problem of suffering, and which assuredly will affect the safety of the most vulnerable and the integrity of thousands of people working in health care, including physicians. The members of the National Assembly cannot give their support to a Bill that is unconstitutional and violates the rights and freedoms of the citizens of Quebec, rights affirmed and protected by Canadian and Quebec charters and by the Universal Declaration of Human Rights.

Living with Dignity, finally, repeats its call for a free vote for all members of the Quebec National Assembly, in accordance with respect for the freedom of conscience of each and every one of them. 

Submission from Living with Dignity
Bill 52, An Act Respecting End-of-Life-Care 

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