Quebecers no longer seeing doctor-assisted deaths as last resort: oversight body

'Medical aid in dying is not there to replace natural death,' said the head of the independent body that monitors the practice of doctor-assisted deaths in the province.

As the frequency of medical aid in dying continues to rise in Quebec, the head of the independent body that monitors the practice in the province says he worries doctor-assisted deaths are no longer being seen as a last resort.

Quebecers have stopped appreciating MAID as an exceptional procedure for people with incurable illnesses whose suffering is unbearable, Dr. Michel Bureau said in a recent interview.

“We’re now no longer dealing with an exceptional treatment, but a treatment that is very frequent,” said Bureau, head of Commission sur les soins de fin de vie, which reports to the legislature.

Quebec is on track to finish the year with seven per cent of all deaths recorded as doctor-assisted, Bureau said. “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.”

Earlier this month, Bureau’s commission sent a memo to doctors reminding them that only patients who have a serious and incurable disease, who are suffering and who have experienced irreversible decline in their condition can receive MAID. The memo reminded doctors that the procedure must be independently approved by two physicians, and that doctors shouldn’t “shop” for a favourable second opinion.

“We see, more and more, that the cases receiving medical aid in dying are approaching the limits of the law,” Bureau said. “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.”

Bureau said he’s witnessed a slight increase in the number of cases that violate Quebec’s end-of-life legislation.

In the commission’s last annual report, which covered a period between spring 2021 and spring 2022, it said 15 out of 3,663 doctor-assisted deaths in Quebec didn’t respect the law. The problematic cases involved one instance in which MAID was administered to someone who had an expired provincial health insurance card. In six cases, patients were not admissible for the procedure; in three other cases, patients were unable to consent.