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Quebec's end-of-life bill opens door to Ontario discussion

Toronto health lawyer Elyse Sunshine says Quebec's new end-of-life-care bill will likely open the door to more discussion about assisted suicide in Ontario and may result in physicians in this province having to face these types of questions more often from patients.


As a result, she says Ontario health-care providers must ensure they understand their legal obligations under this province's existing laws to operate within the confines of the regulatory framework.


"I think it definitely opens the dialogue," the lawyer says in an interview with AdvocateDaily.com.


Sunshine, partner with Rosen Sunshine LLP, tells the online legal news service that people will be watching closely to see how the new legislation works in Quebec.


"There's a lot of support for this type of thing in the rest of the country anyway and I would not be shocked if eventually we had similar legislation in Ontario," she says.


Bill 52, sometimes referred to as an act respecting end-of-life care, passed in the National Assembly in Quebec City, reports CBC News. The legislation allows a doctor who has been given the consent of the patient to administer medication to cause death, the public broadcaster says.


CBC also says the bill lays out a number of qualifications for end-of-life-care, including the provision that the person must "be an insured person within the meaning of the Health Insurance Act," which refers to how they would have to possess a Quebec health card. One must be a resident or temporary resident of Quebec in order to receive a health card in the province, says CBC.


Sunshine tells AdvocateDaily.com that some patients may ask their Ontario health provider about the bill and mistakenly assume that they could just go to Quebec before they die to access the provisions of the new law. She says it's important for health-care providers in Ontario to understand that the legislation only applies to Quebec residents.


The lawyer doesn't anticipate the bill will result in a large number of Canadians moving out of their home provinces to go to Quebec at the end of their lives.


"It's only available to residents of Quebec and in order to be  resident of Quebec you have to be living there for a certain period of time so it's not as if you could go there for the last two weeks of your life to die, to be assisted (in dying)," she says.


Sunshine also notes that most individuals who are dying want to be surrounded by the people they care about so for someone to pick up and move to Quebec near the end of their life – away from this support – likely won't be a choice for many.


She says there's already pressure on health-care providers in Ontario to facilitate death for people and she expects the Quebec law will only add to that.


"The Quebec law doesn't change anything in Ontario, where health professionals have to continue operating within the confines of this province's laws and the policies that have been enacted by the College of Physicians and Surgeons," she says. "It may put some pressure on our health professionals, who are obviously trying to do their best for patients who are in a difficult situation."


She points to the College of Physicians and Surgeons of Ontario's policy on decision-making for the end of life.


Sunshine says the Quebec law may most intensely affect those physicians who don't specialize in end-of-life decision making.


"Knowing that just a province away, there's this ability to control the manner of one's own death, I can see it increasing this type of discussion that can occur between a doctor and a patient on the issue," she says. "I think health professionals really need to be up to speed on what their obligations are in making these decisions."


Sunshine notes that the Criminal Code of Canada still makes it an offence for a physician to aid in the death of a patient. That law was challenged in the Rodriguez case in 1992, but was upheld. More recently, the law was challenged by a woman who had ALS and claimed that the law violated her right to equal treatment under the law. The British Columbia Supreme Court found that law to be unconstitutional, but the Court of Appeal for British Columbia found that the Rodriguez case already confirmed that the law was constitutional. The Supreme Court of Canada will hear that appeal later this year. Unless and until the Supreme Court reverses the BCCA's ruling, it remains a criminal offence for a physician to assist in the death of a patient, she explains.


This puts the new Quebec law at odds with the Code, says Sunshine, and there have been rumblings that the federal government may launch a court challenge of that province's end-of-life-care bill.


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