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Reaction to the tabling of Bill 11 and Federal AMAD Committee Report

The Mirage of Advance Requests

What kind of society administers death to those who have lost their 
decision-making capacity? 

A look at the many ethical and moral pitfalls of expanding access to MAiD in:
- Quebec: Decision-making incapacity, disability and the obligation of hospices to offer MAiD 
- Ottawa: Decision-making incapacity, mature minors and mental disorders

Montreal, February 18, 2023 - After the successive tabling of the report of the Special Joint Committee on Medical Assistance in Dying (AMAD) in Ottawa (on February 15th, 2023) and Bill 11 in Quebec City (the following day), the citizen network Living with Dignity and the Physicians' Alliance against Euthanasia would like to shed light on the many problems inherent in the proposals to expand access to medical assistance in dying that are now on the table in Canada. Both organizations will certainly be making submissions to the specific consultations on Bill 11 and wish to testify on that occasion.

The common denominator: the mirage of advance requests

Both Quebec and Ottawa are proposing to offer MAiD through advance requests to persons who are at risk of losing their decision-making capacity (to consent to MAID).

Quebec (Bill 11):

The Bill allows people with a serious and incurable illness that could make them incapable of consenting to medical care to make an advance request for medical assistance in dying so that they can have MAiD administered, should such a loss of capacity occur.

Ottawa (AMAD recommendation 21):

That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable health problem, disease or disorder leading to loss of decision-making capacity.

Only one other country in the world gives death to individuals who have lost their capacity to consent, but who are still conscious, the Netherlands. We endorse the words of Dr. Trudo Lemmens, Professor of Law and Scholl Chair in Health Law and Policy at the University of Toronto, in his submission to the AMAD Committee, which illustrates the mirage of advance requests (essential reading):

Advanced requests for MAID further raise insurmountable ethical and human rights concerns. This is reflected in this: Belgium only allows MAID based on advanced requests when persons are permanently unconscious, to avoid euthanizing people who still enjoy life and may resist. The Netherlands originally had difficulty with MAID based on advanced requests, since it was considered impossible to defend this practice on the basis that persons ‘suffer unbearably’, when they were no longer able to confirm this. It now has permitted it for persons even when they appear to resist.

Health care for major neurocognitive disorders and geriatric heath care is making great strides every year. We should be investing more substantially in supporting individuals in the aforementioned groups and reassuring the public that a dignified life in the advanced stages of Alzheimer's and other dementias is possible! More difficult stories of personal experiences exist, but they are not the norm. They are even rarer with adequate care and support.

Quebec: Bill 11

The confirmation that access to MAiD for mental disorders is still not envisaged in this legislative project is excellent news. We hope that this choice can inspire the rest of Canada.

However, there are two other proposed expansions of access to MAiD that are highly problematic:


Without being explicitly stated in the text of the bill (where only a reference to the removal of the end-of-life criterion is mentioned),severe neuromotor disability would be an acceptable criterion for access to MAiD. Members of Parliament sitting on the Parliamentary Committee that will study the Bill should expect a strong reaction from groups representing individuals with disabilities. Already, the Regroupement des activistes pour l'inclusion au Québec (RAPLIQ) has called this expansion "very dangerous".

The obligation for hospices to offer medical assistance in dying

According to the Alliance des maisons de soins palliatifs du Québec25 of the 35 hospices offer medical aid in dying  (four hospices are in the process of doing so, and for another it is in consideration). In this context, forcing palliative care facilities to offer MAiD by means of mandatory legislation seems completely disproportionate. It should be remembered that at the outset, facilities dedicated to the culture of palliative care will never be primary destinations for obtaining MAiD, even though the majority of hospices now offer it when a patient changes his or her mind. The rigidity of the Bill (lack of exceptions, unlike the previous version) is incomprehensible and Quebec should respect the fact that a small group of hospices prefer to offer only palliative care, which is at the heart of their mission. As an example, the brief presented by Maison Victor-Gadbois for study of the previous law clearly present the challenges of a palliative care home.

We remember that access to MAiD is not a problem in Quebec. However, access to quality palliative care in the living environment of the patient's choice deserves a great deal of improvement: the need is critical.

The following link for the Quebec National Assembly website allows you to read the Bill and comment on it https://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-11-43-1.htmlThe citizen network Living with Dignity and the Physicians’ Alliance against euthanasia invite active participation of the population in this consultation.

Ottawa: The AMAD committee report

The reading of the 23 recommendations of the committee's report allows us to take a glimpse at the new expansions of MAiD at the Federal level.

The 16th is the most troubling:

Recommendation 16

That the Government of Canada amend the eligibility criteria for MAID set out in the Criminal Code to include minors deemed to have the requisite decision-making capacity upon assessment.

There is no age limit, only "decision-making capacity". While a young person would not be able to vote or buy a lottery ticket, he or she could access MAiD if natural death is reasonably foreseeable.

Access to MAiD in cases where mental disorder is the sole medical condition is unfortunately, still on the agenda. It will become a possibility on March 17, 2024 if the Federal Bill C-39 is passed.

Particular attention should be paid to recommendations 11 and 12 as Quebec elected officials prepare to debate the issue of MAiD and disability in the context of Bill 11:

Recommendation 11

That the Government of Canada, through the Department of Justice, and in consultation with organizations representing persons with disabilities, explore potential amendments to the Criminal Code that would avoid stigmatizing persons with disabilities without restricting their access to MAID. Options considered should include replacing references to “disability” in section 241.2(2) of the Criminal Code, with attention to the potential legal ramifications of such an amendment across Canada.

Recommendation 12

That the Government of Canada convene an expert panel to study and report on the needs of persons with disabilities as they relate to MAID, similar to the Expert Panel on MAID and Mental Illness.

There is a considerable amount of work foreseen on the horizon, as across the country, various groups representing people living with disabilities have been very unhappy with the impact of access to medical assistance in dying since Track 2 became available (for individuals whose natural death is not reasonably foreseeable) since Bill C-7 was passed in 2019. For Inclusion Canada, "The Committee's final report is a discriminatory disaster".  Their press release from the day before yesterday and their moving video show the obvious abuses of the system in place: https://www.youtube.com/watch?v=tDaUuXwAtIw.

These words are echoed in the dissenting report of the Special Committee.

Note: Living with Dignity has indexed on this page all the testimonies expressing reticence or opposition to the themes explored during the work of the AMAD committee. These testimonies demonstrate the great diversity and expertise of the groups and individuals questioning the merits of expanding access to MAiD.

Two concluding observations

Two days ago, Radio-Canada confirmed that more than 7% of deaths result from medical assistance in dying in Quebec: "Quebec is now well ahead of the Netherlands and Belgium in the use of medical assistance in dying. The article confirmed that the Commission des soins de fin de vie has launched a consultation to understand the phenomenon. However, it should not be limited to physicians who provide MAiD. A multidisciplinary approach needs to be put in place as soon as possible. Another question is whether we should wait for the results of this consultation prior to embarking on a new Bill to expand access to MAiD.

The views of other nations also invite us to reflect on the very rapid adoption of MAiD in Quebec. In the midst of the French debate on "active assistance in dying", 13 organizations representing 800,000 caregivers published an opinion yesterday on the potential legalization of euthanasia. They state that this practice "cannot in any way be considered as care and alert legislators to the risks for vulnerable people". A relevant reminder for Quebec and Canada.


Available in French only

Title translation: Can providing death be considered be considered as care?
Interprofessional ethical reflections on the prospects of legalizing assisted suicide and euthanasia and their possible impacts on the practice of health care.
16 February 2023

Living with Dignity is a Quebec non-profit citizen network with no religious or political affiliation. Its mission is to promote the protection of the life and inherent dignity of people made vulnerable by sickness, old age or disability, by ensuring an end to their lives that is natural and respectful of the person and their dignity, through compassionate accompaniment.

The Physicians’ Alliance against Euthanasia seeks to ensure quality medical care and respectful decision-making for vulnerable patients, especially those at risk of pressure to end their lives prematurely through euthanasia or assisted suicide, and to protect the professional integrity of all health care workers.

Media contacts :

Jasmin Lemieux-Lefebvre
Living with Dignity Citizen Network 

Charmine Francis
Physicians’ Alliance against Euthanasia