Redefining the Practice of Medicine
Euthanasia in Quebec
An Act Respecting End-of-Life Care (June, 2014)
Sean Murphy*
Part 4: The
Problem of Killing
The original text of Bill 52 did not define "medical aid dying"
(MAD), but it was understood that, whatever the law actually said, it was meant to authorize physicians to kill patients
who met MAD guidelines. The Minister of Health admitted
that it qualified as homicide, while others acknowledged that MAD meant
intentionally causing the death of a person, and that its purpose was
death. Various witnesses in favour of the bill referred explicitly
to lethal injection and the speed of the expected death of a patient.
Given the moral or ethical gravity involved in killing, it is not
surprising to find serious disagreement about MAD among health care
workers. Conflicting claims made about the extent of opposition to or
support for euthanasia within health care professions are
difficult to evaluate, but a review of the transcripts of the
legislative committee hearings into Bill 52 is instructive.
One physician member of the committee was shocked by the assertion
that there is no moral, ethical, or legal difference between
withdrawing life support and lethally injecting a patient.
Hospices and palliative care physicians rejected participation in
euthanasia. Sharp differences of opinion among other health care
workers were reported. Support for killing patients by lethal
injection was likened to support for the death penalty; that is, many more agreed
with the act in principle than were willing to do the actual killing.
So marked was the evidence of opposition to euthanasia
that doubts were raised about the possibility of implementing the
law.
Since the law was passed as a result of assurances from the Quebec
medical establishment that it could be implemented, a committee member
who is now a minister of the Quebec government warned that they would be
called to account if it is found that few physicians are willing to
participate. This political pressure is likely to provide an
additional incentive for the medical establishment to secure the compliance
of Quebec physicians.
The introduction of euthanasia into Quebec's health care system
is to be accomplished using the structures and powers established by
other Quebec statutes that govern the delivery of health care in the
province, which have established a multi-layered and overlapping
bureaucracy of committees, councils, commissions, boards, directors,
examiners, coordinators, syndics and commissioners. Physicians and other health care providers who
object to
euthanasia will find their working environments increasingly controlled by a
MAD matrix functioning within this system, a prominent feature of which is
an emphasis on patient rights.
Everyone authorized to enact or supervise adherence to policies or
standards can become a MAD functionary, using codes of ethics,
protocols, guidelines, directives, etc. to normalize euthanasia.
Similarly, every disciplinary and complaints procedure can be used to
force participation in MAD services. Those who openly advocate
refusal to provide or facilitate euthanasia can be fined from $1,500.00
to $40,000.00 per day under Quebec's Professional Code if
they are deemed to have helped, encouraged, advised or consented to a
member of a profession violating the profession's code of ethics.
The original text of Bill 52 did not define "medical aid dying"
(MAD). Nothing in the original Act Respecting
End-of-Life Care specified that MAD included killing a patient. Thus, on the
face of it, there was no conflict with Canadian criminal law and no basis for a
constitutional challenge by the federal government. Despite this,
everyone knew that, whatever the law actually said, it meant
euthanasia; it was meant to authorize physicians to kill patients
who met MAD guidelines.
This was obvious from the names of some of the organizations opposed to
Bill 52 (Quebec Rally Against Euthanasia; Physicians Alliance for Total
Refusal of Euthanasia) and from submissions to the
legislative committee in the fall of 2013. Living with Dignity cited
the Report of the Select Committee on Dying with Dignity1 to
demonstrate that "medical aid in dying" is equivalent to euthanasia.2 Dr. Catherine Ferrier, a palliative care physician, told
the legislators that "almost all my patients meet on the criteria to be
eligible to be killed by this bill."3 Professor Margaret Somerville warned against the corruption of medical
practice by "this awful killing aspect."4
Now, since these points were made by groups or individuals opposed to the
bill, it might be thought that their terminology was deliberately tendentious.
Health Minister Véronique Hivon seemed annoyed that people continued to
say that "medical aid in dying" meant euthanasia, which, she said, is "a very
loaded word,"
. . .because we're talking about euthanasia of
animals, because we're talking about euthanasia in the Nazi regime. So, yes,
it is a word very, very loaded.5
However, even though she insisted that "medical aid in dying" should not be
considered euthanasia,6 she admitted that it qualified as homicide.7
Further, even groups and individuals supporting the bill implicitly or
explicitly acknowledged that they understood "medical aid in dying" to mean physicians killing
patients. The Collège des médecins du Québec, for example, agreed that "medical
aid in dying" involved "an act of
intentionally causing
the death of a person."8 Professor Jocelyn Downie, who applauded the bill, noted that it
clearly included "the provision of a lethal injection."9 She recommended
that patients be given a choice between assisted suicide by a
self-ingested toxic drug and death by lethal injection,10 and suggested that
the bill could include euthanasia by starvation and dehydration in addition to
"the lethal injection category,"11 thus providing patients with another
lethal "option."12
Lawyer Stéphanie Vallée, now Quebec Minister of
Justice but then a Liberal member of the
committee, noted that "in the
context of medically
assisted dying . . . the
purpose is death," adding that "there is
a distinction
between a treatment
for alleviate
suffering, which
is not intended to
. . . administer
a lethal dose,
and medical
assistance to die . . .which is
really aimed at the
death."13
Gloria Jeliu, representing the Observatory for Aging and Society,
which did not take a position for or against euthanasia, cautioned that
those who want "medical help to die" must understand "it is a lethal
injection and is extremely
fast. . ."
But I guess most people, I suspect, know with
certainty that the medical assistance to die is the sting, the final sting,
the sting ... Doctor, give me the shot. I do not want to live. That is the
definition of physician-assisted dying. It is a lethal injection of
barbiturate and curare, if I remember correctly, and it causes death within
minutes.14
Indeed, the repeated reference to killing disturbed Liberal committee
member Yves Bolduc, a physician and former Quebec Minister of Health.
"[M]ost people," he said, "always talk to us about killing," adding, "Athough I
do not agree.
We are not in
medicine to kill."15
However, Bolduc himself, reflecting on the results of surveys purporting to
indicate physician support for euthanasia, also understood that Bill 52 was
intended to authorize physicians to kill their patients:
I think that what people said they wanted to do at the end of life,
they were ready to give morphine to relieve the people, but I'm
not sure they are willing to
a give big dose of
morphine or
barbiturate,
or curare
to kill the person
in the space of five
minutes.16
Despite the absence of a formal definition of "medical aid in
dying," these admissions and assertions show that
the Minister of Health, legislators and those making submissions
to the committee all understood MAD to mean that physicians
should kill patients under the conditions specified in Bill 52. ARELC's
definition of MAD simply
confirms the obvious, even though it tries to conceal the
obvious by using "hastening death" as a rhetorical
figleaf.17
It is generally agreed that killing someone is a matter of
considerable moral or ethical gravity, even when it is agreed
that the killing is justified. But justifications offered for
euthanasia are sharply disputed, so it is not surprising to find
serious disagreement about MAD among health care workers.
As committee member Stephanie Vallee observed, "the polarization in
the debate is
really about the
issue of physician-assisted
dying, because it
resonates with all of
us in our most fundamental
values."18
Conflicting claims are made about the extent of opposition to or
support for euthanasia within health care professions.
These are
difficult to evaluate because of the variables affecting
responses to surveys or polls, as well as the natural inclination of
partisan groups to emphasize or interpret results in ways
favourable to their causes. In addition, health care workers
seem more inclined to contact groups that share their concerns
rather than groups opposed to them. For example, Living
with Dignity reported contacts from people opposed to euthanasia
in general and family medicine,19
while the Quebec Association for the Right to Die with Dignity
claimed that "many caregivers" in the palliative care community
support euthanasia,20 but
are unable to express their views.21
A review of the transcripts of the legislative committee
hearings into Bill 52 might be criticized as merely anecdotal,
but it is instructive nonetheless.
Quebec's Interprofessional Health Federation told legislators that
conscientious objection to euthanasia was not an issue raised among
their members.22 On the other
hand, the Order of Nurses said that it did not consider MAD to be
a form of "care," but "a procedure that terminates life,"23
while the Association of Health Facilities and Social Services
anticipated that physicians, at least at the outset, would be reluctant to
be the first to start the practice.24
Liberal committee member Dr. Yves Bolduc supported euthanasia, but was
sensitive to the moral significance of killing a patient by lethal
injection. Thus, he was shocked by the claim by the province's human rights
commissioner that there is "no significant moral, ethical, or legal
difference between unplugging a person or the fact of accelerating [death]
to allow him to relieve his suffering."25
Dr. Bolduc (Jean-Talon):
. . . I am a
doctor and I'm not a
lawyer, but I must admit
I was a little
confused by what you
are telling me. There is a big
difference between injecting someone and letting him die. . .
Did you have doctors who advised you, in your opinion?26
When assured that the commission included a physician, he mused
that the opinion probably included "a value judgment."27
In fact, the opinion included much more than that, but, for
present purposes, it is enough to recognize in this exchange the
existence of serious disagreement among physicians about Quebec's euthanasia project.
Hospices, though not required to allow physicians to kill their
patients, spoke strongly against euthanasia and expressed fears
that legalizing the procedure would ultimately compromise their
operations.28
Most palliative care physicians - up to 90% - are adamantly
opposed to the MAD provisions in ARELC.29
Some have stated that they will resign if euthanasia is
introduced into their units.30
Speaking for the Quebec Palliative Care Network, Dr. Christiane
Martel emphasized how legalizing euthanasia would cause profound
conflicts for palliative care physicians:
And
I was at a conference
a few weeks ago, 140 or 150
stakeholders in palliation
asked the question: What
will I do with the
request for medically
assisted dying?
And there I saw
more doctors cry
than I've ever seen
in my 18 years in
medicine because it
concerns us deeply. It
is we who are there at
the end of life, it is
we who receive these
requests , and it
is a conflict with our
values.31
The anti-euthanasia organization Living with Dignity told
legislators that health care workers in general and family
medicine had contacted them, and plan to agitate for exemption
from legal requirements to participate in euthanasia.
"There are many who are preparing to do this, warned Marc
Beauchamp. "If you pass this law," he said, "you will being
firing a slingshot into the medical system such as you cannot
even imagine."32
Dr. Claude Morin, who might be taken as representative of those
most strongly opposed to euthanasia, was
adamant that he would not provide it, help anyone else
to do it, or even offer suggestions about how the service might
be provided.33
The
testimony of others appearing before the committee also suggested that
health care workers and others were often profoundly disturbed by the
idea of killing a patient.
One of the more striking examples was an experience related by
Marie-Claude Mainville of NOVA Montreal, who told the committee
about a woman who asked her to lethally inject her dying mother.
Mainville gave the woman a morphine syringe (actually a
palliative rather than lethal dose) and said, "You do the
injection."
"And she was just outraged," Mainville said, "saying: But you're
not actually going to ask me to kill my mother? You are paid for
it, you!"34
So there is
a difference between
wanting it "generally"
and doing it. It's like
the death penalty, there
are people who may be
in favour, but
that would certainly
not be the executioner
who would do the lethal
injection. So we,
that is our position
also ... We agree with the idea
not to
prolong the suffering, the idea of
pushing the syringe
that causes death,
that is another debate.35
Mainville, canvassing NOVA nurses, found some nurses
willing to provide lethal injections and other who said they
would never do so.36
Linda Vaillant, speaking for the
Pharmacists
Association of Health Facilities of Quebec, told the committee that Bill 52
caused discomfort for many members of the association because "[p]eople have really
made it clear they do not want them to be seen as people who
help others to die."37
Similarly, Dr. Bolduc warned his committee colleagues not to
assume that physicians who express support for euthanasia
will also be willing to kill a patient.
The real question, it will be: Yes, you agree to the
medical assistance to die, if you agree that if that, are you
ready to do it? It's going to be the challenge. Because there
are many people who all agree that someone else should, but how
many are willing to do it [themselves]?38
So marked was the evidence of opposition to euthanasia
that Dr. Bolduc - almost alone among his committee
colleagues - repeatedly raised the question of how access to
euthanasia could be provided if physicians were unwilling to
provide it for reasons of conscience.39
"If people agree to respect the conscientious objection,"
he observed, "it is possible that there will be nobody who is
willing to do it,"40 at
least in some locations.41
. . . I'm not sure that there are many physicians in
Quebec who will want to do this. And when you're
in a region as large
as Montreal,
the Laurentians where there are
hundreds of thousands
of people, in practice, you can
always eventually find
someone who will
agree to do it . . . But when you are in Sainte-Anne-des-Monts,
you know, a population of 12,000 or 13,000 people,
Îles-de-la-Madeleine, about 12,000 people, also the area of
Bonaventure thirty thousand people, I'm not sure we'll be able
to find a professional who will do it. . . .But when the time
comes for the injection, it cannot be done remotely and a nurse
can't be asked to do it. . . the doctor will have to do it
himself.42
At various points, Dr. Bolduc expressed grave doubts about
whether or not the law could be successfully implemented.
"I'm not sure we'll be able to give effect to the law," he said,
adding that he hoped "that there are professionals who will have
enough conviction to say, "I'll be ready to help people in
situations that require it."43
He also expressed some annoyance at five professional organizations - the
Collège des médecins, the Quebec Federation of General Practitioners, the
Quebec Federation of Medical Specialists, the Quebec Association of Boards
of Physicians, Dentists and Pharmacists and the Quebec Medical Association -
which told the committee that "the vast majority of their members were in
agreement," an assertion that he had come to question.44
If, after passing the law, it were found that few physicians are
willing to provide the service, he warned, "then we will have to
have those groups come and explain how it is that they
unanimously agreed with the commission that accessibility would
not be a problem," since the law was based on that assurance.45
. . .this is not just a government responsibility, then,
there are groups who came here and told us that it would work,
then they will have responsibility . . . we will remind people:
the application of the law
will not just be the
responsibility of the government,
it will be the responsibility
of all the major ... groups who came here
and told us
that it was a
good thing to do,
and who were willing
to cooperate.46
Dr. Bolduc, now a minister in Quebec's Liberal government, is in a
position to call Quebec's medical establishment to account should his
predictions about the implementation of ALERC prove accurate. The
prospect of being called to account is likely to provide an additional
incentive for the five organizations to secure the compliance of Quebec
physicians.
The implementation of An Act
respecting end-of-life care (ARELC) and introduction of euthanasia into
Quebec's health care system is to be accomplished
using the structures and powers established by other Quebec statutes that
govern the delivery of health care in the province, notably the Act
Respecting Health Services and Social Services. This is the law that
provides the administrative framework for the delivery of health care and
the enforcement of health care policy. Other relevant statutes include the
Professional Code and the laws specific to each of the health care
professions. These laws have established a multi-layered and overlapping
bureaucracy of committees, councils, commissions, boards, directors,
examiners, coordinators, syndics and commissioners.
Appendix "A" identifies the key statutes and the health care structures
established by them relevant to the purposes of ARELC.
Appendix "B"
describes statutory complaint and disciplinary procedures that could be turned against health care workers who decline to
provide or facilitate euthanasia.
Physicians and other health care providers who want no part of
euthanasia will find their working environments increasingly controlled by a
MAD matrix functioning within this system, a prominent feature of which is
an emphasis on rights47 and the vindication of "user rights,"48 including a
purported "right" to "medical aid in dying" promised by ARELC.49
The Minister for Social Services and Youth Protection is empowered to
issue "policy directions" that are to guide health and social service
agencies and institutions in providing end-of-life care, including
euthanasia.50 As noted in Part 1, the
official representatives of major professional organizations have made clear
their support for euthanasia. For example, the
Collège des médecins du Québec, the regulator of
medical practice, believes that euthanasia can be an acceptable
"medical act," consistent with a Code of Ethics requirement (i.e.,
that physicians ensure that "death occurs with dignity" and that
"appropriate support and relief" is provided to the patient).51
Health care in every region in Quebec is delivered under the direction of
a regional health and social service agency (Appendix
A2).
ARELC requires
every agency to establish general rules concerning access to end-of-life
care, including euthanasia, for all institutions and palliative care
hospices in its jurisdiction.52 The agencies must inform people living in
their regions of how to access end-of-life services, including euthanasia,
and provide information about "the rights and options of end-of-life
patients."53 In addition to regional health and social service agencies,
"local health and social services networks" have been established (Appendix
A5). These are intended to focus particularly on access to services, which,
in this case, means euthanasia.
Almost all institutions that operate local community service centres,
hospital centres or residential and long-term care centres54 are required to
offer end-of-life care (which includes euthanasia),55 to establish clinical
programmes56 and policies concerning it,57 and to include reference to it in
their codes of ethics.58 This includes rehabilitation centres, described in
the Act Respecting Health and Social Services, which serve
developmentally disabled patients.59
It was noted above that almost all institutions will be required to offer
end-of-life care that includes euthanasia. One exception to the
general rule is palliative care hospices, which may offer euthanasia, but are not required to do
so. Before admitting patients, they must explain what kind of end-of-life
care they offer.60 (Part
8)
Section 72 of the Act concerns any institution operating a
"general and specialized hospital centre" that offers only palliative care.
Such institutions "may continue to offer that care exclusively" (i.e., need
not provide euthanasia), as long as they notify patients of this before
admitting them.61 According to the
government, this section is intended to apply only La Maison Michel
Sarrazin.62 (Part
8)
Obviously, every individual or group that is authorized to enact or
supervise adherence to policies or standards can become a MAD functionary,
using codes of ethics, protocols, guidelines, directives, etc. to normalize
euthanasia. Similarly, every disciplinary or complaints procedure can be used to force participation in MAD services. However,
two elements of the MAD matrix warrant special notice.
First, regional and local complaints commissioners and the Health and
Social Services Ombudsman are all empowered to take action on their own
initiative to enforce "the rights of a user or group of users" (Appendices
B3.3,
B9.2),
while syndics (investigators) for professional orders may lodge complaints
of professional misconduct without waiting for a complaint (Appendix
B10.2). Any or
all of these individuals who are MAD advocates could create considerable
difficulty for physicians who are unwilling to participate in or facilitate euthanasia.
Second, the Professional Code provides that anyone who
"knowingly helps or, by encouragement, advice or consent" leads a member to
violate the order's code of ethics can be fined not less than $1,500.00 and
not more than $20,000.00 for each day the violation continues. In the case
of an incorporated entity, the minimum and maximum fines are $3,000.00 to
$40,000.00 per day. (Appendix B10.3)
The Collège des médecins
du Québec believes that its Code of Ethics supports
euthanasia, and will likely become an
active MAD advocate. Thus, the Physicians' Alliance for
Total Refusal of Euthanasia, the Euthanasia Prevention Coalition and other
groups that oppose euthanasia might face prosecution and substantial fines
if they continue to help, encourage or advise physicians not to participate in
the procedure.
Notes
1. "Euthanasia: An act that involves deliberately
causing the death of another person to put an end to that person’s
suffering."
Report of the Select Committee on Dying with Dignity,
(March, 2012), p. 18
2.
Consultations & hearings on Quebec Bill 52 (Hereinafter
"Consultations), Wednesday, 25 September 2013 - Vol. 43 no. 38:
Living
with Dignity (Nicolas Steenhout, Dr. Marc Beauchamp, Michel Racicot), T#023
3.
Consultations,Tuesday 24 September
2013 - Vol. 43 no. 37:
Physicians' Alliance for Total Refusal of Euthanasia
(Dr. Catherine Ferrier, Dr Serge Daneault, Dr François Primeau), T# 040
4.
Consultations, Wednesday, 9 October 2013 - Vol. 43 N° 45:
Professor Margaret
Somerville, T#092
5. Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Living
with Dignity (Nicolas Steenhout, Dr. Marc Beauchamp, Michel Racicot), T#039
6. Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Living
with Dignity (Nicolas Steenhout, Dr. Marc Beauchamp, Michel Racicot), T#040
7.
Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Living
with Dignity (Nicolas Steenhout, Dr. Marc Beauchamp, Michel Racicot), T#039
8.
Consultations,
Tuesday, 17 September 2013 - Vol. 43 no. 34: Collège des médecins
(Dr. Charles Bernard, Dr. Yves Robert, Dr. Michelle Marchand), T#013
9.
Consultations, Wednesday, 9 October 2013 - Vol. 43 N° 45:
Professor Joceyln Downie, T#019
10.
Consultations, Wednesday, 9 October 2013 - Vol. 43 N° 45:
Professor Joceyln Downie, T#020
11.
Consultations, Wednesday, 9 October 2013 - Vol. 43 N° 45:
Professor Joceyln Downie, T#072
12.
Consultations, Wednesday, 9 October 2013 - Vol. 43 N° 45:
Professor Joceyln Downie, T#085
13.
Consultations,
Thursday, 19 September 2013 - Vol. 43 no. 36:
Quebec Bar
(Johanne Brodeur, Marc Sauvé, Michel Doyon), T#060
14.
Consultations, Tuesday, 1 October 2013 - Vol. 43 no. 40:
Observatory for Aging and Society (André Ledoux, Gloria Jeliu, Denise Destrempes,
Claude Tessier), T#117
15.
Consultations, Wednesday, 9 October 2013 - Vol. 43 N° 45:
Professor Margaret
Somerville, T#059
16.
Consultations,
Tuesday, 8 October 2013 - Vol. 43 No. 44: Institute for Care Planning (Danielle Chalifoux, Denise Boulet, Louise Boyd), T#113
17.
ARELC, Section 3(6).
18. Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Quebec Association for the Right to Die with Dignity
(Hélène Bolduc, Dr. Marcel Boisvert, Dr. Georges L'Espérance), T#059
19.
Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Living
with Dignity (Nicolas Steenhout, Dr. Marc Beauchamp, Michel Racicot), T#103
20.
Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Quebec Association for the Right to Die with Dignity
(Hélène Bolduc, Dr. Marcel Boisvert, Dr. Georges L'Espérance), T#018
21.
Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Quebec Association for the Right to Die with Dignity
(Hélène Bolduc, Dr. Marcel Boisvert, Dr. Georges L'Espérance), T#037
22.
Consultations, Thursday, 26 September 2013 -
Vol. 43 no. 39:
Interprofessional Health Federation
of Quebec (Régine Laurent, Julie Martin, Michàle
Boisclair, Brigitte Doyon), T#110,
T#112
23.
Consultations,
Tuesday, 8 October 2013 - Vol. 43 no. 44: Quebec Order of Nurses
(Lucie Tremblay, Claudia Gallant, Suzanne Durand, Sylvie Truchon), T#099
24.
Consultations, Wednesday 18 September 2013 - Vol. 43 no. 35:
Quebec Association of Health Facilities and Social Services
(Michel
Gervais, Diane Lavallée), T#109
25. Consultations,
Friday, 4 October 2013 - Vol. 43 no. 43:
Commission
on Human Rights and Youth Rights (Jacques Fremont, Renée Dupuis, Daniel
Carpentier, Marie Carpentier), T#096
26. Consultations,
Friday, 4 October 2013 - Vol. 43 no. 43:
Commission on
Human Rights and Youth Rights (Jacques Fremont, Renée Dupuis, Daniel
Carpentier, Marie Carpentier), T#098
27.
Consultations,
Friday, 4 October 2013 - Vol. 43 no. 43:
Commission on
Human Rights and Youth Rights (Jacques Fremont, Renée Dupuis, Daniel
Carpentier, Marie Carpentier), T#102
28. Consultations, Tuesday, 1 October 2013 - Vol. 43 no. 40:
Alliance of
Quebec Hospices (Lucie Wiseman, Suzanne Fitzback, Pierre Hébert), T#014;
Consultations, 1 October 2013 -
Vol. 43 no. 40:
Michel
Sarrazin Home (Dr. Michel L'Heureux, Dr. M. Louis-André Richard), T#014,
T#059
29.
Consultations, Wednesday, 2
October 2013 - Vol. 43 no. 41:
Quebec Society of
Palliative Care Physicians
(Dr. Patrick Vinay, Dr. Michelle Dallaire), T#043
30. Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Living
with Dignity (Nicolas Steenhout, Dr. Marc Beauchamp, Michel Racicot), T#102
31. Consultations, Tuesday, 1 October
2013 - Vol. 43 no. 40:
Quebec Palliative Care Network
(Alberte Déry, Dr.Christiane Martel, Danielle Blondeau, Pierre Deschamps,
Jessy Savaria, Yvan Lessard), T#064
32.
Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Living with Dignity
(Nicolas Steenhout,
Dr. Marc Beauchamp, Michel
Racicot), T#103,
T#104
33.
Consultations,
Tuesday 24 September 2013 - Vol. 43 no. 37:
Quebec Rally Against Euthanasia
(Dr. Claude Morin, Dr. Marc Bergeron, Daniel Arsenault, Clément
Vermette), T#101
34.
Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4:
NOVA Montreal (Dr. Michael Laplante, Marie-Claude Mainville), T#121
35.
Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4:
NOVA Montreal (Dr. Michael Laplante, Marie-Claude Mainville), T#122
36.
Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4:
NOVA Montreal
(Dr. Michael Laplante, Marie-Claude Mainville), T#038, T#106
37. Consultations,
Tuesday, 17 September 2013 - Vol. 43 no. 34:
Pharmacists Association of Health Facilities of Quebec (François
Paradis, Linda Vaillant), T#031
38.
Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4:
NOVA Montreal (Dr. Michael Laplante, Marie-Claude Mainville), T#117
39. Consultations, Wednesday 18 September 2013 - Vol. 43 no. 35: Quebec Association of Health Facilities and Social Services
(Michel
Gervais, Diane Lavallée), T#101;
Consultations,
Tuesday 24 September 2013 - Vol. 43 no. 37:
Quebec Rally Against Euthanasia
(Dr. Claude Morin, Dr. Marc Bergeron, Daniel Arsenault, Clément
Vermette), T#099;
Consultations, Thursday, 26 September 2013 -
Vol. 43 no. 39:
Interprofessional Health Federation
of Quebec (Régine Laurent, Julie Martin, Michàle
Boisclair, Brigitte Doyon), T#054,
T#055,
T#057;
Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4:
NOVA Montreal (Dr. Michael Laplante, Marie-Claude Mainville), T#110,
T#116; Consultations, Thursday, 3 October 2013 - Vol. 43 no. 42:
Quebec Association of Gerontology (Catherine Geoffroy, Nathalie
Adams), T#049
40.
Consultations, Tuesday, 17 September 2013 - Vol. 43 no. 34: Federation of General Practitioners of Quebec
(Dr. Louis Godin, Dr. Marc-André Asselin),T#103
41.
Consultations, Wednesday 18 September 2013 - Vol. 43 no. 35: Quebec Association of Health Facilities and Social Services
(Michel
Gervais, Diane Lavallée), T#095
42. Consultations, Thursday, 3 October 2013 - Vol. 43 no. 42:
Quebec Association of Gerontology (Catherine Geoffroy, Nathalie
Adams), T#054
43.
Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4:
NOVA Montreal (Dr. Michael Laplante, Marie-Claude Mainville), T#119
44. Consultations,
Tuesday, 8 October 2013 - Vol. 43 No. 44: Institute for Care Planning (Danielle Chalifoux, Denise Boulet, Louise Boyd), T#110
45. Consultations,
Tuesday, 8 October 2013 - Vol. 43 No. 44: Institute for Care Planning (Danielle Chalifoux, Denise Boulet, Louise Boyd), T#115
46. Consultations,
Tuesday, 8 October 2013 - Vol. 43 No. 44: Institute for Care Planning (Danielle Chalifoux, Denise Boulet, Louise Boyd), T#116
47.
An Act Respecting Health Services and Social Services (R.S.Q. Chapter S-4.2)
(Hereinafter "ARHS&SS") Sections 2(8), 3(2), 4-28.
(Accessed 2014-07-26)
48.
ARHS&SS, Sections 33, 40,49, 52, 64(4), 66, 72, 74, 76.7, 76.10,
76.11(4), etc. (Accessed 2014-07-26)
49.
ARELC, Section
4.
50.
ARELC,
Section 19.
51. Collège des médecins du Québec,
Physicians, Appropriate Care and the Debate on Euthanasia: A Reflection.
(16 October, 2009) p. 2. For the Collège's view on the
acceptability of euthanasia, see p. 3 to 7. (Accessed
2014-07-26)
52.
ARELC, Section 17.
53.
ARELC, Section 18.
54.
ARELC, Section 3(1).
55.
ARELC, Section
7.
56.
ARELC, Section 9.
57.
ARELC, Section
8.
58.
ARELC, Section 10.
59.
ARHS&SS, Sections 86-87.
(Accessed 2014-07-26)
60.
ARELC, Section 13
61.
ARELC, Section
72
62. Note: in Bill 52, the original
section number was 65. Consultations & hearings on Quebec Bill
52, Wednesday, 25 September 2013 - Vol. 43 no. 38:
Quebec Association for the Right to Die with Dignity
(Hélène Bolduc, Dr. Marcel Boisvert, Dr. Georges L'Espérance),
T#030, T#032