«Bill 52 An Act respecting end-of-life care Introduction Introduced by Madam Véronique Hivon Minister for Social Services and Youth Protection ...»
FIRST SESSION FORTIETH LEGISLATURE
An Act respecting end-of-life care
Madam Véronique Hivon
Minister for Social Services and Youth Protection
Québec Official Publisher
The purpose of this bill is to ensure that end-of-life patients are
provided care that is respectful of their dignity and their autonomy
and to recognize the primacy of wishes expressed freely and clearly with respect to end-of-life care.
The bill specifies rights with respect to end-of-life care, in particular by affirming the right of everyone to end-of-life care that is appropriate to their needs.
The bill sets out special rules applicable to the providers of endof-life care, that is, institutions, palliative care hospices and private health facilities, in order to provide a framework for the organization and regulation of end-of-life care. In this respect, it specifies the special functions and powers of health and social services agencies and of the Minister of Health and Social Services.
The bill also establishes specific requirements for certain types of end-of-life care, namely terminal palliative sedation and medical aid in dying. It prescribes the criteria that must be met for a person to obtain medical aid in dying and the requirements to be complied with before a physician may administer it. It also prescribes the special functions of the council of physicians, dentists and pharmacists of the institutions with respect to end-of-life care.
A commission on end-of-life care is established under the name “Commission sur les soins de fin de vie”, as well as rules with respect to its composition and operations. The mandate of the Commission is to examine all matters relating to end-of-life care and to oversee the application of specific requirements relating to medical aid in dying.
The bill establishes an advance medical directives regime and specifies the conditions that must be met in order for such directives to have binding force.
Lastly, the bill contains the amending, transitional and final provisions necessary for the carrying out of this Act.
LEGISLATION AMENDED BY THIS BILL:– Civil Code of Québec;
– Code of Civil Procedure (chapter C-25);
– Medical Act (chapter M-9);
– Act respecting health services and social services (chapter S-4.2).
AN ACT RESPECTING END-OF-LIFE CARE
THE PARLIAMENT OF QUÉBEC ENACTS AS FOLLOWS:
PURPOSE OF ACT
1. The purpose of this Act is to ensure that end-of-life patients are provided care that is respectful of their dignity and their autonomy. The Act establishes the rights of such patients as well as the organization of and a framework for end-of-life care so that everyone may have access, throughout the continuum of care, to quality care that is appropriate to their needs, including prevention and relief of suffering.
In addition, the Act recognizes the primacy of freely and clearly expressed wishes with respect to care, in particular by establishing an advance medical directives regime.
TITLE IIEND-OF-LIFE CARE
2. The provision of end-of-life care is to be guided by the following
(1) respect for end-of-life patients and recognition of their rights and freedoms must inspire every act performed in their regard;
(2) end-of-life patients must be treated, at all times, with understanding, compassion, courtesy and fairness, and with respect for their dignity, autonomy, needs and safety; and (3) the healthcare team providing care to end-of-life patients must establish and maintain open and transparent communication with them.
3. For the purposes of this Act, (1) “institution” means any institution governed by the Act respecting health services and social services (chapter S-4.2) that operates a local community service centre, a hospital centre or a residential and long-term care centre, as well as the Cree Board of Health and Social Services of James Bay established under the Act respecting health services and social services for Cree Native persons (chapter S-5);
(2) “palliative care hospice” means a community organization that holds an accreditation granted by the Minister under the second paragraph of section 457 of the Act respecting health services and social services and has entered into an agreement with an institution under section 108.3 of that Act in order to secure all or some of the care required by its end-of-life patients;
(3) “end-of-life care” means palliative care provided to persons at the end of their lives, including terminal palliative sedation, and medical aid in dying.
RIGHTS WITH RESPECT TO END-OF-LIFE CARE
4. This chapter complements the provisions of the Civil Code with respect to care and the provisions of the Act respecting health services and social services and of the Act respecting health services and social services for Cree Native persons with respect to the rights of users and beneficiaries.
5. Every person whose condition requires it has the right to receive end-oflife care, subject to the specific requirements established by this Act.
Such care may be provided to the person in a facility maintained by an institution, in a palliative care hospice or at home.
This section applies within the framework of the legislative and regulatory provisions relating to the organizational and operational structure of institutions and the policy directions, policies and approaches of palliative care hospices and within the limits of the human, material and financial resources at their disposal.
6. Except as otherwise provided by law, a person of full age who is capable of consenting to care may, at any time, refuse to receive, or withdraw consent to, a life-sustaining treatment or procedure; the refusal or withdrawal may be expressed by any means.
The physician must ensure that such a decision is made freely and provide the person with all information needed to make an informed decision, in particular information about other therapeutic possibilities, including palliative care.
7. A person may not be denied end-of-life care for previously having refused to receive a treatment or procedure or having withdrawn consent to a treatment or procedure.
ORGANIZATION OF END-OF-LIFE CARE
SPECIAL RULES APPLICABLE TO PROVIDERS OF END-OF-LIFECARE §1. — Institutions
8. Every institution must offer end-of-life care and ensure that it is provided to the persons requiring it in continuity and complementarity with any other care that is or has been provided to them.
For this purpose, an institution must, among other things, establish measures to promote multidisciplinary cooperation among the different health or social services professionals practising within the institution.
9. Every institution must include a clinical program for end-of-life care in its organization plan. In the case of a local authority referred to in section 99.4 of the Act respecting health services and social services, the plan must also include in-home care for end-of-life patients.
10. Every institution must adopt a policy with respect to end-of-life care.
The policy must be consistent with ministerial policy directions and be made known to the personnel of the institution, to the health and social services professionals who practise in the institution, and to end-of-life patients and their close relations.
The executive director of the institution must report annually to the board of directors on the implementation of the policy. The report must state the number of end-of-life patients who received palliative care, the number of terminal palliative sedations administered, the number of requests for medical aid in dying, the number of times such aid was administered and the number of times such requests were refused, including the reasons for the refusals.
The report must also state, where applicable, the number of terminal palliative sedations administered and the number of times medical aid in dying was administered in the premises of a palliative care hospice under agreement with the institution as well as the number of times such aid was administered by a physician practising in a private health facility with which the institution is associated in accordance with section 17.
The institution must include a summary of the report in a separate section of its annual management report.
11. Every institution must include, in the code of ethics adopted under section 233 of the Act respecting health services and social services, a section pertaining specifically to the rights of end-of-life patients.
12. When an end-of-life patient requests in-home palliative care from an institution, but the person’s condition or environment is such that proper care could not be provided at home, the institution must offer to admit the person to its facilities or direct them to another institution or to a palliative care hospice that can meet their needs.
13. An institution must offer a private room to every patient who is receiving end-of-life care in its facilities and whose death is imminent.
§2. — Palliative care hospices
14. End-of-life care may be offered in the premises of a palliative care hospice.
Every palliative care hospice must inform persons of the end-of-life care it offers before admitting them.
15. A palliative care hospice and an institution must specify in their agreement under section 108.3 of the Act respecting health services and social services the nature of the services the institution is to provide in the premises of the hospice and the monitoring mechanisms that will allow the institution, or one of its boards, councils or committees determined in the agreement, to ensure that quality care is provided in the hospice.
On the request of the institution, the palliative care hospice must communicate any information required for the carrying out of the agreement. The manner in which such information is to be communicated is specified in the agreement.
16. Every palliative care hospice must adopt a code of ethics with respect to the rights of end-of-life patients and adopt a policy with respect to end-oflife care.
These documents must be made known to the personnel of the palliative care hospice, to the health and social services professionals who practise in the hospice, and to end-of-life patients and their close relations.
§3. — Private health facilities
17. End-of-life care may be provided at the patient’s home by physicians and, within the scope of their practice, nurses who practise in a private health facility within the meaning of section 95 of the Act respecting health services and social services.
However, such a physician may not provide terminal palliative sedation or medical aid in dying otherwise than in association with the local authority of the territory where the facility is situated.
The terms of the association must be set out in a written agreement. The agreement must include the monitoring mechanisms that will allow the local authority, or one of its boards, councils or committees determined in the agreement, to ensure that quality care is provided.
On the request of the local authority, the physician must communicate any information required for the carrying out of the agreement. The manner in which such information is to be communicated is specified in the agreement.
SPECIAL FUNCTIONS OF HEALTH AND SOCIAL SERVICES
18. Every health and social services agency must determine the general rules governing access to the end-of-life care provided by the institutions and palliative care hospices in its territory.
19. Every agency must inform the population living in its territory of the end-of-life care services available and the manner of accessing them, as well as the rights and options of end-of-life patients.
This information must be available on the websites of the agencies.
SPECIAL FUNCTIONS AND POWERS OF THE MINISTER
20. The Minister determines the policy directions that are to guide institutions and agencies when organizing end-of-life care, including those institutions must take into account when formulating their end-of-life care policy.
21. The Minister may require of institutions and agencies that they supply, in the manner and within the time specified, statements, statistical data, reports and other information required for the performance of the Minister’s functions, provided it is not possible to link that information to any specific patient having received end-of-life care.
22. In order to ascertain compliance with this Title, a person authorized in writing by the Minister to carry out an inspection may, at any reasonable time, enter any premises operated by an institution or a palliative care hospice.
The person may, during an inspection, (1) examine and make a copy of any document relating to the end-of-life care offered in those premises; and (2) demand any information relating to the carrying out of this Title as well as the production of any related document.
Any person having custody, possession or control of such documents must make them available on request to the person conducting the inspection.
A person conducting an inspection must, if so required, produce a certificate of capacity.