End-of-life patients have been pressured not to use medical assistance in dying when they visit Quebec palliative care homes, according to the Ministry of Health and Social Services. Concerned by this situation, on September 3, Quebec asked all general managers of palliative care homes who do not yet offer medical assistance in their institution to "reconsider" their position.
In a letter signed by the Assistant Deputy Minister, the Dre Lucie Opatrny, and obtained by The Pressit can be read that "the Ministry of Health and Social Services (MSSS) has been brought to the attention of patients where they have been actively and with pressure to reconsider their decision to choose the AMM ( medical assistance in dying) by the employees, which appears very worrying.
Victim of a power failure, the MSSS was not able yesterday to give more details on the pressures suffered by some patients.
The situation does not surprise the Dr Georges L'Esperance, president of the Quebec Association for the Right to Die with Dignity.
It is known that this kind of pressure sometimes occurs.
The Dr Georges L'Esperance
Director of the Palliative Care Home Michel Sarrazin and Vice-President of the Alliance of Palliative Care Homes of Quebec, the Dr Alain-Philippe Lemieux claims to have been "surprised" and "troubled" by the content of the deputy minister's letter. Speaking of the pressure that some patients may experience not to receive medical assistance in dying, he says that "no house has a policy of this kind". The Dr Lemieux declined to comment further because the Alliance requested a meeting with the Deputy Minister on this issue.
In his missive, the Dre Opatrny recalls that section 13 of the End-of-Life Care Act stipulates that "palliative care homes determine the end-of-life care they provide on their premises". The Deputy Minister noted that "palliative care homes have used this prerogative of the Act to allow them to offer or not the AMM within their walls in relation to institutions in the health and social services network. for whom it is an obligation ".
The Deputy Minister noted that several palliative care homes have revised their initial position and now offer the AMM, which allows "to avoid transfers to another institution during this sensitive and intense period for the patient and his family." But in 28 of the 35 palliative care homes in Quebec, the AMM is still not available, confirms the spokesperson of the Ministry, Marie-Claude Lacasse.
Call for change
The Dr Esperance severely criticizes palliative care homes that transfer patients seeking medical assistance in dying to other facilities, "sometimes in the middle of winter, at night." "It does not make sense," he says. He finds the situation all the more unacceptable as palliative care homes are partly financed by public funds. "We can not put the beliefs of physicians and stakeholders ahead of patients' desires," argues the Dr L'Esperance, who reminds that doctors can refuse to give medical assistance to die, but that they then have the obligation to address the patient to a colleague.
In her letter, Deputy Minister Lucie Opatrny writes that the Commission on End-of-Life Care recommended in January that palliative care homes "reconsider their position not to offer marketing authorization".
"On the basis of all these considerations, the MSSS invites you to reconsider with your care teams and formally, through your board of directors, the position of your hospice regarding the possibility of offering AMM in your premises and ensure a vigil against the reported situations ", can read.
– With the collaboration of Patrick Lagace, The Press