Quebec’s ombudsperson—le protecteur du citoyen—offered her support to Bill 52, An Act respecting end-of-life care, in a brief presented to the national assembly’s committee on health and social services. (We discussed Bill 52 on Slaw previously here.) The ombudsperson’s submission to the assembly is important because as its French name indicates, the protecteur du citoyen’s mandate is to protect the rights of citizens or groups of citizens, which includes proposing amendments to existing or draft acts, regulations, directives, and administrative policies in order to improve them for the public good.
In the brief, ombudsperson Raymonde Saint-Germain acknowledges the sensitive nature of the debate surrounding end-of-life care, and the rational, emotional and moral arguments—particularly with respect to “palliative terminal sedation” and assisted suicide. She finds that the right to life, respect for individual rights, respect for a person’s autonomy and the protection of vulnerable people are reflected in all the provisions of Bill 52. She also notes that the Bill respects the rights and freedoms of doctors by not requiring them to participate in a medical procedure that would violate their values and what their conscience tells them to do.
Saint-Germain is of the opinion that the legal and medical controls present in Bill 52 (e.g., a person who has not made a written countersigned request for terminal palliative sedation or medical aid in dying could not receive such medical services) do not devalue the right to life, a fundamental right guaranteed by the Canadian and Quebec charters of human rights and freedoms. These controls a priori and a posteriori are present at all levels of the process to ensure compliance with the legislation on medical assistance to die.
Saint-Germain also believes that the development of quality palliative care services is intrinsically linked to medical aid in dying for individuals faced with exceptional suffering and whose death is imminent. Without offering quality palliative care, a hospital or other health care institution cannot meaningfully offer assistance with dying:
“This factor is of crucial importance. Every person must be able to benefit from quality care and a stable environment where respect for their privacy is assured when they reach this terminal stage of their lives.”
For instance, Saint-Germain recommends that the government amend the Bill to ensure that an individual (i.e., private) end-of-life room is offered free of charge to every user whose death is imminent.
The problem is, not every region or institution in Quebec offers end-of-life palliative care services. Based on a 2004 study , 2010 statistics (fifty percent of palliative-care beds are located in hospital settings, source: Direction de la lutte contre le cancer, 2010-2011 activity report), and 2012 statistics (there were 685 palliative-care beds in Quebec – that is 110 beds short of the minimum required by the government’s ratio of 1 bed per 10,000 people, source: access to information requests, AQRP, 2012), most existing services are clearly deficient. For Bill 52 to meets its goal, Saint-Germain recommends that the province update its end-of-life palliative care policy and quickly develop a ministerial action plan with the aim of improving the services offered in every region that requires it.
Nonetheless, the ombudsperson’s support for medical aid in dying is contingent on outright access to quality end-of-life palliative care. Indeed, this is as it should be. It is clear that health care workers cannot offer quality, respectful, assistance with dying if their institutions lack appropriate palliative care facilities and resources. Quality palliative care may not include assisted suicide, but respectful assisted suicide may not exist without quality care.
The other recommendations of the ombudsman’s brief concern accountability by institutions and the Commission sur les soins de fin de vie, as well as clarification of the application of the complaint examination procedure.
Several other interested stakeholders have submitted their own briefs against or in support of the Bill for end-of-life care. These briefs can be viewed here. The committee will continue accepting submissions from interested stakeholders until October 10, 2013.