On June 5, the province of Quebec, Canada, passed an end-of-life care bill that gives terminally ill patients the legal option to choose to end their life. It is the first successful attempt so far to pass an assisted suicide bill in Canada.

Although assisted suicide remains illegal in the rest of Canada, as in most other countries, the change in Quebec represents just the most recent installment in a long-running and far-reaching debate about the right to die with medical aid.

Regulating and respecting ‘dying with dignity’

Quebec’s new law, known as Bill 52, sets out specific rules for medical care providers in handling a patient’s choice to die, the health criteria that must be met for a person to obtain medical aid in dying, and the requirements that must be met when a request for end-of-life care is made.

A patient requesting medical aid in dying must be an insured citizen of Quebec, suffer from a serious and incurable illness, be in an advanced state of irreversible decline, and experience constant and unbearable physical or psychological suffering.

The request for end-of-life care must be made in writing via a specific form provided by the Minister of Health and Social Services and co-signed by a medical care or social services provider.

Before administering medical aid in dying, the responsible physician is required to ensure that the patient’s request is being made freely without any external pressure and to verify that the patient’s suffering and desire for end-of-life care remains unchanged over a reasonable amount of time.

“Sometimes when you are suffering in pain, one hour can feel like one week….The protection of the vulnerable is reflected in every aspect of this bill,” said Parti Québécois member of the National Assembly Véronique Hivon, who first drafted the bill.

Hivon added: “For me, dying with dignity means dying with the least amount of suffering…and respecting who that person always was during his or her whole life.”

Assisted suicide opponents vow to take action

While supporters of assisted suicide argue that individuals should be able to decide the time and conditions of their own death, opponents have raised the concern that legalization will put vulnerable patients at risk of being coerced into assisted suicide in order to ease the financial burden of caring for them.

Opponents also fear that assisted suicide could become the norm, instead of the continued push to provide better palliative care and find new cures and therapies. A number of organizations, such as the Physicians’ Alliance Against Euthanasia, Living with Dignity, and the Euthanasia Prevention Coalition, intend to launch legal action against the new law on constitutional grounds.

A statement by the Physicians Alliance Against Euthanasia, which comprises more than 600 Quebec doctors, said: “This [bill] constitutes a serious betrayal of the sick and the dying, as the act of killing a terminally ill patient is not treatment, but homicide.”

Living with Dignity released a similar statement denouncing Bill 52: “With some exceptions, our elected officials have also chosen to ignore that Quebec does not have jurisdiction to decriminalize euthanasia. Killing a patient, even at his or her request, is not a medical treatment; it is a homicide and, as such, prohibited by the Criminal Code.”

The legal fights are far from over

This is not the first time in Canada a decision supporting assisted suicide has been challenged in court. In 2012, a Justice of the Supreme Court of British Columbia ruled in favour of allowing Gloria Taylor, a woman who suffered from Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s disease, to choose an assisted suicide when she saw fit.

Justice Lynn Smith ruled that denying a patient the choice for their end-of-life care constituted a breach of their right to equality, which is set out in the Canadian Charter of Rights and Freedoms. The decision effectively ruled that the pertinent section of the Criminal Code was invalid.

However, the Justice’s ruling was appealed by the federal government and in October 2013 the British Columbia Court of Appeal overturned the lower court’s decision. The British Columbia Civil Liberties Association (BCCLA), which had aided Gloria Taylor in her legal battle, then took its own appeal of the overruling to the Supreme Court of Canada (the country’s top court). In January the Supreme Court said it would hear this latest appeal, which is set to take place in the fall of this year.

As such, it is clear that there may be a long road ahead for both supporters and opponents of Quebec’s assisted suicide bill, as the legal challenges may be far from over. Indeed, in light of the long, ongoing struggles in British Columbia, the words of the Physicians’ Alliance Against Euthanasia seem both apt and daunting: “The battle has just begun.”