Basically, Quebec's journey was the following. The act regarding physician-assisted dying is the Act Respecting End-of-Life Care. It contains a general framework for all end-of-life care, including palliative care, continuous palliative sedation and physician-assisted dying. It provides a framework for organizing the whole process of providing end-of-life care and the monitoring of that.
In that context we did not choose to go with what is designated by the term “euthanasia” because it is pejorative and implies that this could possibly happen without consent. That is not at all what we are dealing with. And so we came back to the concept of physician-assisted dying, provided by a physician.
In Quebec, the debate was launched in the main by the College of Physicians. It wondered whether it was possible in certain exceptional circumstances for a physician to legitimately offer to help his patient to die if he has nothing left to offer to keep him alive. We chose to have the physician administer the medication himself rather than giving it to the patient, giving him a means to commit suicide. In that case, the patient could do this without medical supervision, at home, in his or her basement, or at some other time, when his condition might have changed. We felt it was important that this be associated with a health care process.
When the law was discussed and passed the Carter ruling had not come down yet. So we were working in the context of the Canadian criminal law before that ruling.
We also thought that “assistance to suicide” could have changed the true nature of the law, what we refer to in English as the pith and substance of that law which was in our opinion a health-related law. Assistance to commit suicide seemed to us to be outside of medical processes. The College of Physicians did not subscribe to that approach either. In Quebec there was no real call for opening the door to have physicians assist suicide. That was a choice that is related to the rest of the act, a health-related act, an end-of-care act. Assisting suicide was not perceived as being part of the end-of-life care continuum.