Legalization of euthanasia in Quebec, Canada as “medical aid in dying”: A case study in social marketing, changing mores and legal maneuvering

Résumé

We discuss the logic and implications behind the choice, in the 2014, Quebec province law, Bill 52, which legalized euthanasia, of calling it “medical aid in dying”. The adoption of this euphemism to define the practice of euthanasia as a medical act was so that it would arguably be considered part of health care, which is under provincial jurisdiction, rather covered by the federal criminal code. Also, the general public was more likely to accept a practice labelled “medical aid” than “euthanasia”. Polls indicate that many Quebecers and health care professionals are confused about what is legal and illegal. We suggest that there is an ethical imperative for lawmakers to clearly inform the public about the explicit nature of what is being legalized. After passage of Bill 52, the Supreme Court of Canada, in 2015, decreed in Carter v. Canada, to legalize the practice of assisted suicide and/or euthanasia throughout Canada, and gave the Federal Government one year to establish guidelines. The Supreme differentiated between when there is no health care issue, and when a person is suffering from a “grievous and irremediable medical condition”. The objection raised by two senatorial reports, that we should not offer death as an option to abridge suffering when adequate palliative care is not universally available, has not been directly confronted. Despite concerns about the costs of palliative care, research found that in the United States, each dollar spent on palliative care saves over $1.30 in medical expenses. We contend that with assisted suicide, patients have greater freedom to change their minds free of social pressure and not complete their assisted suicide. In fact, between 1998 and 2012, 36% of people in Oregon who received lethal medications for assisted suicide did not take the medications. The ending of life is one of the most challenging issues before legislators. It is paramount that they should search for a convincing consensus among the public based upon a clear understanding of options and exercise prudence before overly determining outcomes. QUÉBEC CANADA EUTHANASIE SUICIDE-ASSISTÉ LÉGALISATION JURIDIQUE ÉTHIQUE SOIN-PALLIATIF FIN-DE-VIE ATTITUDE