A solid social consensus has made Quebec a champion ofmedical help in dying (AMM) last year. With numbers that are enough for now 5.1% of deathswe are ahead of the Netherlands (4.8%) and Belgium (2.3%), where this practice has been established for some time. Paradoxically, this progress occurs while its expansion in Ottawa, as in Quebec, is stalling. These delays, while not indicative of precipitation, still warrant careful review in 2024.

Just before the Christmas holidays, the Trudeau government announced its decision to negotiate this Deferring eligibility for MAID for people with mental illness divides the medical community. While some have grown apprehensive about the arrival of the March 17, 2023 date, many have complained of over-caution. It is true that the gains are largely made on the front lines of organizational mechanics.

However, as we know, the healthcare web is so dysfunctional that it only spills from coast to coast through crises. This grace period therefore runs the risk of devolving over time into sterile haggling, with no gain or even denial of heartbreaking care for the suffering patients who could have benefited from this anticipated expedient.

It is recalled that the Expert Group on MAID and Mental Illness expertly marked the floor. We know what to do and we know how to do it. In Quebec, we also benefit from an additional advantage: MAID is offered from the perspective of a continuum of care and additionally benefits from the enlightened oversight of the Commission on End-of-Life Care. It therefore comes with an implicit commitment: the quality and universality of palliative care must be flawless in order to guarantee the exceptional status of euthanasia at all times and under all circumstances.

So must it be with mental health care, the poor relatives of a failing public system. MAID should never be a substitute for necessary care that the state would not otherwise provide. The challenge here is even more colossal: Canada’s spending in this area is up to half as much as in several OECD countries.

Furthermore, the panel of experts warned us, in the mental health field it is not always enough to provide the best care. There is a spiral of vulnerability to consider: poverty and housing at the top. We must address it if we do not want this system to suffer from a similar problem to the one that is ravaging our public services so much, which is being torn between multiple gears.

Right now, all of Canada is holding its breath because this critical situation has been added. But MAID should not be offered to some and not offered to others as we have not been able to secure all issues of incurability, irreversibility, capacity, suicidal risk and the impact of structural vulnerabilities as mandated by the expert panel.

To this end, we await with great impatience the keys that should give us the final report of the Special Joint Committee on MAID, expected by February 17th. Nevertheless, the question of disabilities that lead to unbearable physical and mental suffering will remain. Outside of Quebec, this state of health is sufficient for free access to MAID. Again, you must be suffering from a serious and incurable disease. An asymmetry that the College of Physicians of Quebec rightly denounces.

In Quebec City, Bill 38 intended to add severe and terminal neuromotor disabilities to the list of eligible diseases, a last-minute amendment that undermined the work of the Health and Human Services Commission. It also opened the door to drive decisions and disability, extending its benefits to specialty nurses. His death on the soap opera last June was greeted as a bitter failure by all the players involved, even the most reluctant.

Rich in a fortnight of hearings, but above all in the words of a hundred experts and interest groups, around 80 briefs and 3,000 opinions from the public, the examination of PL 38 had enabled a remarkable cross-party consensus. It is to be hoped that this good agreement will not crumble too much when Health and Senior Citizens Minister Sonia Bélanger submits a new version.

Above all, it is to be hoped that the CAQ government will tackle this as soon as parliamentary work resumes. The unification of MAID laws in Quebec and Canada is essential. A multi-stage diet is unworthy of all approaches to a dignified death. We have so far demonstrated exemplary humanity, ethics and scientific and medical integrity. It is important to continue this momentum consistently, whereby care must be taken not to confuse caution and hesitation in the turn.

To see in the video