Quebec began accepting advanced requests for assisted suicide on Oct. 30, and the federal government has pledged not to stand in the Francophone province’s way. 

Bill 11, which was approved by the National Assembly of Quebec back in June 2023, will allow people with grievous and irremediable conditions, Alzheimer’s disease in particular, to request a medical-killing procedure before their condition deteriorates to a point where they can no longer grant personal consent. 

Canada’s Minister of Health Mark Holland declared again during an Oct. 28 press conference that Quebec activating this law represents a violation of the Criminal Code. 

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“The Criminal Code has not changed,” said Holland. “It is still illegal in this country under the Criminal Code to enact advance requests.” Later during the media availability, Holland said he “cannot direct a province how it’s going to administer its judicial system.” 

Prosecutors in Quebec have reportedly been instructed not to pursue cases related to clinicians who process these advanced requests.

Justice Minister Simon Jolin-Barrette recently declared in a press release that “the issue of advance requests for medical assistance in dying is widely agreed upon in Quebec.” And Sonia Belanger, the Quebec Minister for Seniors, told media outlets that the province is moving ahead after conducting a “rigorous assessment.”

Jasmin Lemieux-Lefebvre, the coordinator of Vivre dans la Dignité (Living with Dignity), a Quebec-based citizen’s network standing up for the value of life,  said that closer observation reveals that advanced requests are not overwhelmingly popular with health practitioners, and there are concerns about effectively instituting this new mandate. 

“When you dig a little bit and you talk with people on the first line who are dealing with people with Alzheimer’s and other neurocognitive disorders, you can see that the support for such an expansion of MAiD is much lower,” said Lemieux-Lefebvre. “They see how difficult it will be to apply. 

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“The form was available one week before Oct. 30,” continued Lemieux-Lefebvre. “The (Quebec College of Physicians) is giving information to all the clinicians about how to welcome these requests on the eve of the expansion. This is very last minute and it is completely arbitrary to choose Oct. 30 to open the way to this expansion. We hear from so many MAiD providers who are very uncomfortable with the speed with how this was pushed and introduced.”

Within the week of medical professionals scrutinizing the form, Vivre dans la Dignité has already received reports of confusion about how to fill out the document, which could create confusion for nurses or other practitioners reading these forms months or years down the line.   How to objectively record clinical manifestations (signs and symptoms) is an emerging key concern as it appears the process creates a substantial avenue for subjective leeway. 

“What kind of clinical manifestation should start the evaluation process to receive MAiD,” asked Lemieux-Lefebvre. “There are no guidelines about what should not be there. There is a lot of trust in the clinician’s judgment. Of course, when you look at the document (Quebec College of Physicians) it should be directly linked to the disorder. It should be things that are objective to find.” Lemieux-Lefebvre also pondered how this new system would account for people with “happy dementia.” Those these individuals are experiencing an advanced neuro-cognitive disorder and are dependent, they nevertheless exude joy in their life 

Cathy Barrick, the CEO of the Alzheimer’s Society of Ontario, also weighed in advance requests.

Barrick told media outlets that “people with a diagnosis of dementia deserve the same rights as everyone else. So, if MAID is a legal end-of-life option for people, then we believe that it should be accessible to people with dementia.

However, Barrick also endorsed more robust alternative palliative care options. 

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The federal government is launching a national consultation regarding MAiD advanced requests later this month. Conversations will be staged with patients, provincial and territorial governments, providers, the public, Indigenous Peoples and other stakeholders.

The consultation’s feedback period is expected to conclude by late January 2025.