Quebec- The Only Province in Canada Where Assisted Suicide Is A Right

Montreal, Quebec city skyline.
Montreal, Quebec city skyline.

For several decades at least, the issue of assisted suicide and euthanasia has been debated passionately by Canadian politicians, activists and even ordinary citizens. It is now once again in the spotlight, after Quebec’s Court of Appeal recently ruled in favor of maintaining the rights of terminally ill Quebecers to receive assistance when choosing to commit suicide.

Eighteen months ago, when Bill 52 came into law, Quebec achieved the dubious honor of becoming the first province in Canada where a terminally ill patient has the right to request “medical aid in dying.” On December 22, a three-judge Court of Appeal panel in Quebec overturned a judgment by Justice Michel Pinsonnault who, on December 1, 2015, ruled that Bill 52 contradicts provisions in the Criminal Code of Canada on euthanasia.

Basically, Justice Pinsonnault’s position was that Canadian law should take precedence over Quebec law. But the Quebec Court of Appeal ruled that since end-of-life care is an extension of “healthcare,” it is a provincial issue, not a federal one.

Dr. Paul Saba, along with his patient Lisa D’Amico, a woman who is living with life-threatening disabilities, were the ones who sought the injunction to contest Bill 52, but unfortunately they were unsuccessful. Dr. Saba is the head of the Quebec Coalition of Physicians for Social Justice, a physicians’ grassroots organization that has as its mandate to advocate for health issues that affect the poor, the elderly and those suffering from mental illness. Dr. Saba, a Jewish family physician, is a leader among doctors opposed to Bill 52.

“The solution to this is not euthanasia,” says Dr. Saba. “Doctors are not G-d. We don’t know when people are going to die.”

Dr. Saba relates a story that happened to one of his own patients. “She was actually my patient and [her husband was told] that there was going to be no quality of life and she was going to end up being in a vegetative state. She had severe pneumonia and, in fact, we were able to arrange a transfer to a specialized center and she got the care she needed. She’s now alive,” said Saba. “The husband said ‘I would be without my wife today if I had listened to the doctors.’

“Doctors cannot always know the outcomes,” says Dr. Saba. “We cannot always be correct in our prognosticating. If euthanasia comes into effect, there will be more stories like this.”

The fact is that Bill 52 is a slippery slope that could result in the deaths of many elderly and infirm in Quebec. Disabled patients could be coerced into “choosing” to end their lives by relatives motivated by greed or by an unwillingness to care for them. When a person is under tremendous financial or psychological distress, is he really making a free choice? As a society, we do whatever we can to stop healthy individuals from committing suicide. The same should be done for the disabled.

The Av Beis Din of Montreal, Rav Yonasan Binyamin Weiss, shlita, is a well-known halachic authority on medical issues. He has lectured widely on the topic of assisted suicide and euthanasia and, recently, gave a powerful shiur on the topic at Agudath Israel.

I spoke to Rav Weiss about the issue and he told me that the public debate has focused largely on the so-called slippery slope and the dangers to vulnerable members of society. “What is largely ignored is the issue of violation of one of the most basic tenets of morality, and of the eternal values embodied in the Torah, and in Judeo-Christian belief,” Rav Weiss explained.

Rav Weiss quoted various halachic sources that say that according to halachah, one is prohibited from hastening the death of another human being, and thus euthanasia — whether direct or indirect — and assisting suicide are against the Torah. This is true even where there is an explicit request from the patient or his family.

Dr. Saba says Quebec should provide good palliative care, rather than opt for lethal injections. He says 70 percent of Quebecers do not have access to adequate palliative care.

Practically speaking, what does Bill 52 mean for chareidi doctors who practice medicine in Quebec?

Dr. Eli Segal is an ER physician at the Jewish General Hospital (JGH). In June 2015 he spoke at a medical ethics symposium on end-of-life care convened by Rabbi Raphael Afilalo, director of pastoral services at the JGH.

Dr. Segal prefers to use the term “euthanasia,” as opposed to “medical aid in dying.” (Euthanasia is when a person intentionally causes the death of another, in order to protect him/her from further suffering; assisted suicide is when a person helps another person kill him or herself.) Dr. Segal says he doesn’t support euthanasia on moral and religious grounds.

“I find [the law] a bit frightening as a physician. As a health practitioner, [I believe] it goes against our primary instinct to heal. To kill is very scary,” he said. Dr. Segal, like Dr. Saba, believes that better use of pain control and psychiatric support, and especially more accessible palliative care in Quebec, are better recourses.

Dr. Saba says the new law forces him as a physician to either perform euthanasia or refer patients. “I will neither perform the act nor refer, so my ability to practice medicine is prejudiced,” he said.

He could be “severely sanctioned” by the College of Physicians for refusing to be involved in an act “that goes against the practice of medicine.”

“Euthanasia is not a medical act,” Saba said, noting that even in jurisdictions like Holland and Belgium where it is legal, it is not classified as health care the way Quebec is trying do to. He says the safeguards the Quebec government has promised to put in place are “smoke and mirrors.”

Rav Weiss says the good news is that the law, both the one in Quebec and the one that is expected to be passed in Canada, does not mandate that all Quebec physicians must participate in assisted suicide or euthanasia, only that facilities such as hospitals must offer the service of medical aid in dying to individuals. The law recognizes an individual doctor’s right not to offer the service, on moral or religious grounds. Should an Orthodox Jewish doctor find himself pressured to participate, he should consult with a halachic advisor.

Quebec’s health minister, Gaetan Barret, maintains that the law is one that Quebecers have been awaiting a long time. “People in this province have had the debate,” he said. “People are waiting for that law. I don’t think there are people waiting to have access to medical aid in dying, but the principle of having the choice is something people want to have.” But according to a recent poll, at least two-thirds of Quebec doctors have indicated they want no part of euthanasia.

Meanwhile, Justin Trudeau, the new prime minister of Canada, appears to be in no hurry to deal with the explosive issue of doctor-assisted dying. On Dec. 3, the federal government asked the Supreme Court of Canada (SCC) for a six-month extension on the Carter decision that had struck down sections of the Criminal Code against assisted suicide. The Carter decision comes into effect Feb. 6, 2016, but the extension, if granted, would extend the suspension until August 6, 2016. That would leave the present prohibitions against assisted suicide and euthanasia in place until then.

The federal government is expected to urge the SCC to give it six more months to craft a new law on the matter.