Quebec, Assisted Suicide Capital of the World

"We're now no longer dealing with an exceptional treatment, but a treatment that is very frequent." "[Quebec is on track to complete the year with 7% of all deaths recorded as doctor-assisted] That's more than anywhere else in the world: 4.5 times more than Switzerland, three times more than Belgium, more than the Netherlands. It's two times more than Ontario."

"We see, more and more, that the cases receiving medical aid in dying are approaching the limits of the law. It's no longer just terminal cancer, there are all kinds of illnesses -- and that's very good, but it requires a lot of rigour from doctors to ensure they stay within the limits of the law."

"Medical aid in dying is not there to replace natural death."

"It's very easy to go from palliative care to medical aid in dying."

Dr. Michael Bureau, head, Commission sur les soins de fin de vie

Quebec is at the global forefront of medical aid in dying, with a higher proportion of people choosing the procedure in the province than anywhere else on earth. (Radio-Canada)

The enactment of a federal law permitting end-of-life medical assistance in committing suicide was an issue receiving mixed results in Canada. Some felt it was timely and needed, that when people deeply felt it was time for them to leave life due to extenuating medical conditions causing unendurable pain the humane thing for any caring society to do was to help these souls expedite themselves to freedom from pain, at their choice. 

 

Others raised concerns that once this setting aside of the prohibition against assisted suicide became law, there would be an inevitable loosening of guidelines, opening this new social service to an even greater number of people not facing end-of-life issues. Indeed, there have been 'updates' to the original legislation, loosening some of the strictures against assisted suicide being used indiscriminately by the medical profession and society in general.

 

Medical Assistance in Dying (MAID) as it is practised in Canada now, has resulted in Canada overtaking all other developed countries that permit assistance in accomplishing suicide, surpassing them in numbers and in the looseness of those whose medical conditions and even social status fails the original categories of permissible suicide assistance. Scheduled for the future is the acceptance of requests from people suffering mental illness. And later still, adolescents considered mature enough to make that decision for themselves.

Now, the head of the independent body monitoring assisted suicide in Quebec has publicly stated his concerns that doctor-assisted deaths -- that the original legislation made clear were to be viewed as a last resort -- when all else fails, has fallen by the wayside. MAID, it appears, is no longer viewed as an exceptional procedure to be undertaken on behalf of people suffering unbearably, and approaching the end of their lives.

 

A patient looks out a window at the palliative care unit at St Mary's Hospital Centre in Montreal   Photo by Phil Carpenter /Montreal Gazette

 

The commission that Dr. Bureau heads, earlier in the month forwarded a reminder memorandum to the province's medical practitioners, that it is only those patients with a serious, incurable disease, suffering and who have experienced an irreversible decline in their condition, who are deemed to be eligible to receive MAID. The procedure must be approved independently by two doctors; there should be no 'shopping' for a favourable second opinion.

He has noted, he stated, an increase in the occurrence of cases violating Quebec's end-of-life legislation. In the previous annual report, covering a period between spring of 2021 and spring 2022, 15 of 3,663 doctor-assisted deaths in Quebec failed to respect the letter of the law. Problematic cases included the administering of MAID to an individual with an expired provincial health insurance card; rather than continue to rely on provincial health coverage that had expired, the patient chose death.

Patients in another six cases were found not admissible for the procedure, while in another three cases, patients were in a condition of health that led to their inability to give consent. These are cases reported to the provincial college of physicians, College des medecins du Quebec. An emailed response had the college confirming that none of the 15 cases were referred to its internal disciplinary tribunal; additional negligence. Not was data available whether disciplinary measures may have been taken toward doctors violating MAID rules.

A concern was expressed by Dr. Bureau that doctors find themselves in awkward situations with elderly patients, ready to die, but whose health problems are not sufficiently serious to qualify them for MAID. Doctor-assisted deaths, according to Health Canada's most recent annual report on the subject, accounted for 3.3 percent in 2021 of deaths in Canada. Quebec had the highest rate of MAID deaths country-wide, their number was 4.7 percent that year, and numbers have steadily continued to rise.

Concerns about over-using MAID in Quebec