Last week the government of Quebec announced plans to recognize aid in dying as a legal and protected medical practice in the province. They promise a new law by this summer.

A tremendously exciting announcement, it reveals a seismic shift in the thinking of both medical and political leaders. I cannot overstate the magnitude and power of this shift, and fervently hope America’s medical associations and politicians soon follow suit.

Specifically, the government of Quebec intends to regulate aid in dying in spite of the federal crime of assisting a suicide. As in the U.S., federal laws generally supersede provincial ones, and most people assume laws against assisting a suicide prevent doctors from providing life-ending medication to qualified patients who ask.

Canada’s national spokespeople are irate because they, too, hold this assumption. They respond that Quebec cannot change Canada’s criminal code. Even now federal lawyers are defending the assisted-suicide law against a British Columbia judge’s ruling that it’s unconstitutional as applied to aid in dying. They say federal law defines the crime broadly and they must defend it because parliament has repeatedly rejected reform.

But Quebec disagrees, says it intends to proceed and will stand on firm legal ground when it does. The Quebec government is confident it has the authority to adopt law and policy to meet its citizens’ deep desire for more choices at the end of life. How is this possible?

It is possible because aid in dying is different from assisting suicide. It is as different as a surgery is from a stabbing. One is a crime and the other a careful medical practice. Governments outlaw stabbings, but that doesn’t prevent them from regulating surgeries.

Apparently in Canada’s separation of powers, the federal government defines and prosecutes crime, and the provinces oversee healthcare. Quebec health officials have simply adopted the common-sense view that easing the suffering of a dying patient and ensuring a peaceful and pain-free death is a medical matter, not a criminal one. And as such, it falls under the jurisdiction of the province to regulate the practice of medicine.

For well over a decade Compassion & Choices has argued vigorously for a change from the language of “suicide.” We urge that “Language Matters,” as we call on academics, public officials, journalists and headline writers to employ neutral, accurate words to refer to assisted death. Oregon’s experience informs much of the national dialogue, yet commentators notoriously deploy inflammatory suicide language in what should be neutral public forums. Assisting a suicide is a felony in Oregon; to call medical procedures under Oregon’s Death with Dignity Act “assisted suicide” falsely labels them a crime.

Assisting a suicide – to maliciously goad a mentally ill person to act on his self-destructive impulses – should be understood as a crime. Aid in dying – to mercifully respond to a rational dying person’s request to abbreviate his suffering –should be understood as medical practice. Repeatedly, anti-choice forces have won political contests by blurring this stark and monumental distinction. That tactic just lost its mojo in Quebec.

Here, finally, officials are no longer blind to the distinction between assisted suicide and aid in dying, and they embrace its concrete legal consequences. Here at last comes validation that we have not been merely picking at semantics. Different words evoke different circumstances and different conduct.

Don’t think the blinders fell suddenly. Exhaustive study and deliberation by prominent entities gradually, carefully, broadened the perspectives and changed the formal position of government.

Doctors took the first step. In 2006 the provincial medical association, the Collège des Médecins du Québec, embarked on three years of study in which it examined modern medicine and society, polled its members, and reflected on the results. The Collège’s refreshing and authoritative discussion paper, Physicians, Appropriate Care and the Debate on Euthanasia – A Reflection, came out in October 2009 and launched the serious dialogue now bearing fruit.

Quebec’s National Assembly responded by appointing an all-party select committee that held hearings and deliberated for two years. Last March it published a beautiful report of findings and recommendations. Its 178 pages are available in English and well worth the read.

Finally, the government appointed three expert lawyers to a judicial panel to make policy recommendations and propose steps to implementation. It is this report that lays out the legal rationale and explains how the Assembly and the Ministry of Health are to proceed. For French readers, the 400-page document is available here.

The lesson here is that lawyers and politicians go where doctors lead them. They want doctors to decide what constitutes ethical practice for the 21^st century. Tradition-bound medical societies of the United States (notably the AMA) guard their historic dominance in the doctor/patient relationship and refuse to acknowledge changing public expectations. They resist measures that entrust to patients crucial decisions about their own lives and deaths. They have used and continue to use their enormous political power and vast treasure to obstruct sane policy on aid in dying.

Other, more progressive medical societies (notably the American Medical Women’s Association and the American Public Health Association) have embraced change and support both the use of accurate language and the option of aid in dying.

With this enlightened example to our north, perhaps American medicine cannot continue its obstructionism much longer.

The Quebec government says it will proceed with so-called “dying with dignity” legislation aimed at allowing doctors to help some terminally ill patients end their lives.

A provincial panel of legal experts studying medically assisted end-of-life procedures released its recommendations Tuesday, suggesting Quebec could bypass the Canadian Criminal Code — which prohibits assisted suicide — and allow doctors to help some people who wish to die at a time of their own choosing.

The panel concludes that when a terminally ill patient is receiving palliative treatment and can demonstrate with lucidity the desire to end his or her life, helping that patient carry out that wish should be considered part of the continuum of care.

“Every person should be able to make their own choice according to their values and according to their experience, their life, at the end of their life,” said Jean-Paul Ménard, who led the legal panel.

Ménard said the decision on whether to comply with a patient’s request would be left to doctors to judge, on a case by case basis.

“The doctor will always be free … in this kind of process,” he said, adding that if a physician refused to help a terminally ill patient die, that patient would be free to seek help from another doctor.

Federal government backs status quo

The federal government has made it clear it is unwilling to change the law, announcing last summer that it would appeal a June ruling by British Columbia’s Supreme Court, which partially struck down the ban on assisted suicide.

Judge Lynn Smith’s ruling said the Criminal Code section that targets anyone who “aids or abets a person to commit suicide” should not apply to doctors honouring the wish of a terminally ill patient.

Gloria Taylor, the B.C. woman who brought the suit before the court, died in October, but the B.C. Civil Liberties Association is carrying on her legal fight.

Quebec will proceed on its own, minister says

Véronique Hivon, Quebec’s social services minister, said the 400-page report by the Ménard committee concludes the province is on solid legal ground in proceeding with its legislation and does not need Ottawa’s co-operation to move forward.

“The constitutional basis is clear,” said Hivon. “We are really in a field of regulating end-of-life care — and adding the possibility for somebody to have access to medical aid in dying.”

While still in opposition, Hivon served on a multi-party task force comprised of nine MNAs, who spent two years travelling around the province holding public hearings and studying end-of-life issues.

The task force’s landmark Quebec report in 2012 recommended that doctors be allowed to help terminally ill patients die, in exceptional circumstances, if that is their wish.

‘Scary precedent,’ opponent says

Opponents fear changing the law could be the start of a slippery slope that would see some people killed without their explicit consent or people suffering from depression or other psychological pain helped to die, even though they are not terminally ill.

“There are scary precedents,” said Georges Buscemi, the president of the Quebec Life Coalition, referring to the recent case of 45-year-old deaf twins in Belgium who chose to die by lethal injection on Dec. 14, after learning they were going blind.

“Give it a few years, and you’ll have cases like these twins,” said Buscemi. “The floodgates open.”