Paul Tuns:

Two Bloc MPs are sponsoring Bill C-390, which if passed, would expand Canada’s euthanasia law to permit so-called advanced directives.

Sylvie Bérubé (Abitibi—Baie-James—Nunavik—Eeyou) and Luc Thériault (Montcalm) held a press conference on May 22 to announce that they have introduced C-390, An Act to amend the Criminal Code (provincial medical assistance in dying framework), to permit provinces to allow advanced directives.

The press conference was held in collaboration of a coalition of euthanasia advocates, including the Quebec Association for the Right to Die with Dignity, the Quebec Bar (Barreau du Québec), the College of Physicians of Quebec, the Order of Nurses of Quebec, the Order of Pharmacists of Quebec, and the Order of Social Workers and Marriage and Family Therapists of Quebec, along with Dying with Dignity Canada.

During the press conference, Helen Long, CEO of Dying with Dignity, argued that without advanced requests for euthanasia, some patients might choose an earlier medicalized killing and thus they are “humane and compassionate.”

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said “euthanasia killing is bad enough, but killing by advanced request changes the nature of consent, meaning, someone can be killed without a clear and present consent.” He said that patients might change their mind but their new wishes could be ignored under the assumption they were no longer competent to make medical decisions. “When consent becomes secondary, it changes the question of who can be killed by lethal injection.”

Jasmin Lemieux-Lefebvre, coordinator of the Living with Dignity citizen network, said “the boundary of incapacity must not be crossed.” She said, “A thorough review is required before expanding access to medical assistance in dying by advance request,” because “Crossing the boundary of incapacity and contemporaneous consent to administer MAiD would have serious and unprecedented consequences.”

In a 2023 brief to the National Assembly of Quebec when legislators in that province were considering Bill 11, An Act to amend the Act respecting end-of-life care, Living with Dignity said that removing contemporaneous consent created “practical issues” of conflicts of interest and the administration of quality care.

In a statement, Living with Dignity noted that “Holland is the only country in the world that allows the death of a person by advanced request when they are incapable of decision-making and conscious” while “Belgium only allows it when a person is incapable and unconscious.”

In 2022, Montreal gerontologist Dr. Catherine Ferrier, argued against advanced directives for euthanasia. She said, “Advance directives were invented to allow advance refusal of high-technology medical interventions expected to be futile or excessively burdensome.” She explained how they become problematic when used to request euthanasia. “They are a request to be left alone, to not be touched. If one dies after treatment is refused or withdrawn, it is through the natural progression of the illness. An advance request for MAiD, on the other hand, is asking for an active intervention to end life. The important ethical distinction between these acts is often blurred in the current debate.”

Ferrier also said that advanced directives undermine the principle of informed consent, which “requires full knowledge of the condition for which an intervention is being considered, which is not possible in advance.” She said, “research shows that people change their mind as an illness progresses, and later choices are very different from those they would have made when they were well or in the early stages of the disease.”