Downie urges Québec physicians to expand interpretation of euthanasia law.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article by Jocelyn Downie, Canada's leading pro-euthanasia academic, that was published by Policy Options on July 25 asks the question: Who is actually eligible for medical assistance in Dying in Quebec?

Many people are not aware that Canada has two euthanasia laws, the federal law and the Québec law.

There are several differences between the two laws, such as the Québec law does not permit euthanasia for mental illness alone.

Downie avoids the issue of euthanasia for mental illness alone and states:

The recent Quebec CSFV guidance on the meaning of “serious and incurable illness” under the Quebec law says that to be eligible, a person needs to be “on a death trajectory, predictable or not.” 

It says that the following do not meet the eligibility criterion of “serious and incurable illness”:

• “A symptom or set of symptoms”
• “Pathologies or conditions frequently associated with ageing, particularly in very old age, which can lead to an advanced and irreversible decline in capacity as well as significant suffering”
• “Imminent death, if no serious and incurable disease could be identified”
• “Disability unless it is caused by a serious and incurable disease (for example, the sequelae of a stroke caused by a cerebrovascular disease”

In other words, Québec has stricter euthanasia guidelines than the rest of Canada.

Downie's purpose for writing the article is to urge Québec euthanasia doctors to go ahead and follow the federal, not the provincial guidelines. Downie writes:

So what does this mean for eligibility in Quebec? What are clinicians and patients to do in the face of the inconsistency between the federal and Quebec laws (as recently interpreted by the CSFV)?

Well, thankfully, despite the recent statement from the CSFV, and despite the appearance of MAiD eligibility being narrower in Quebec than in the rest of Canada, the Collège May 2021 statement, makes it clear that clinicians are actually free to rely upon the federal criteria, and patients can ask for that. Patients in Quebec can receive MAiD if they have a serious illness, disease, or disability, and the CSFV’s list of excluded conditions need not restrict access to MAiD. Clinicians and patients need to know this so that patients are not wrongfully denied access to MAiD.

Downie side-steps the issue of euthanasia for mental illness alone, but in fact it is this issue that will provide the greatest difference between the Québec law and the federal law.

Québec's euthanasia reporting system is better. 

Québec's euthanasia report is compiled with data from multiple sources, thereby uncovering possible infractions of the law but also possible under-reporting. As stated by EPC's past President Amy Hasbrouck, the recent Québec euthanasia report contains a reporting discrepancy. Hasbrouck wrote:

Table 4.1 also shows the number of euthanasia reported by hospitals, nursing homes and other facilities (2,415) added to the number reported by the College of Physicians (273) for a total of 2,688, which is 262 more than the official figure of 2,426.

The most recent Québec euthanasia report also uncovers 7 violations of the law.

The federal euthanasia report only collects data from the reports submitted by the medical practitioner who carries out the death. Only collecting data from those who do the act does not enable the federal government to uncover possible abuses or under-reporting.

In conclusion, the Québec euthanasia law is somewhat tighter than the federal law. Downie, who strongly promotes euthanasia, is urging Québec euthanasia practitioners to follow the federal and not the Québec guidelines.

In March 2023, when the federal law will permit euthanasia for mental illness alone and the Québec law will continue to prohibit it, Downie will likely urge Québec euthanasia practitioners to follow the federal guidelines and ignore Québec's prohibition of killing people with mental illness.