Currently, as the bill is worded, no I wouldn’t, Dr. Claude Rivard. The experienced family doctor in palliative care shows the new context that is looming on the horizon.
There we want to give that care to people who are no longer able or conscious to the end, who have dementia and who can no longer say, “Yes, I want it” after things they decided years ago. Really, it’s something else entirely, explains Dr. Rivard.
dr Claude Rivard, general practitioner, has been providing medical euthanasia since 2015.
Photo: Radio Canada
According to the draft law examined, a patient who is unlikely to be able to consent any longer should fill out a form in the presence of a competent specialist in order to describe in detail the physical or mental suffering to be considered for him one day, medical assistance in dying.
“Imagine someone who says in their application, ‘I want medical help dying if I can no longer recognize my children’, but only recognizes one in three. »
— A quote from Dr. Claude Rivard, general practitioner
dr Rivard has been providing medical euthanasia on a regular basis since 2015.
And what to do with a demented patient who refuses the procedure when he sees the injection? asks Dr. Rivard. Should this be interpreted as a denial of medical euthanasia?
happy madness
In Quebec, thousands of people are diagnosed with Alzheimer’s disease each year. Their numbers are increasing as the population ages.
Alzheimer’s is a deadly disease whose intensity, order of onset, and development of symptoms vary from person to person, as does the duration of each stage of the disease’s development.
For geriatrician David Lussier of the University Institute of Geriatrics in Montreal (IUGM), the main dilemma will be happy dementia.
like dr As Lussier explains, I can now say, “I want medical help in dying if I don’t recognize my family,” but it’s very possible that if I don’t recognize my family, I’ll be happy in the present moment that I do like to eat, take part in activities, dance, sing.
dr David Lussier, geriatrician at the University of Montreal Institute of Geriatrics (IUGM).
Photo: Radio Canada
“The doctors I know who practice euthanasia […] Difficulty imagining providing medical assistance to someone who is dying who, firstly, does not remember asking for it and, secondly, is happy in their daily life. »
— A quote from Dr. David Lussier, geriatrician at the University Institute of Geriatrics of Montreal
This concern is shared by the Quebec Federation of Alzheimer’s Societies.
It seems important to us to emphasize that people with happy dementia do not meet the law’s criteria, says Nouha Ben Gaied, director of research and development and quality of services at the Federation.
Nouha Ben Gaied, director of research and development and quality of service at the Quebec Federation of Alzheimer’s Societies.
Photo: Radio Canada
It seems important to us that medical euthanasia is seen as end-of-life care in the case of advanced deterioration […] advanced stage 6 or 7, adds Ms. Ben Gaied.
doctors under pressure
Since medical euthanasia began in Quebec in 2015, one of the challenges has been raising awareness and persuading physicians to offer this intervention to a growing number of patients who desire it.
Today there are more than 1,400 of Quebec’s 22,000 physicians.
according to dr Lussier, a few dozen doctors performed around 60% of the 3,600 procedures of this type in 2021-2022.
Population aging and social acceptability mean that Quebec is currently well ahead of the Netherlands and Belgium in terms of seeking medical assistance when dying.
As Radio-Canada revealed in February, medical euthanasia currently accounts for more than 7% of deaths. At this rate, more than 5,000 people will have used it this year, compared to 3,663 last year. Five years ago it was less than 1,000.
However, fears Dr. Lussier put increased pressure on the participating doctors.
I have a feeling we’re going to have quite a few people making pre-enquiries […] and that not all physicians want to make these preliminary inquiries, concludes the physician, who works at the University of Montreal’s Department of Geriatrics.