Quebec is one of the places in the world where medical aid in dying (MAID) is used the most. How to explain it? The Commission on End-of-Life Care, which has just tabled its annual report, would like us to look into the question.
With the aging of the population and the possible broadening of eligibility criteria, the number of cases is expected to increase. If we want to avoid possible slippages, we must fully understand the phenomenon, redouble our efforts in the training of medical personnel and keep the Quebec population well informed.
During the last 12 months ending in March, 3,663 Quebecers received MAID, an increase of 51% compared to the previous year, we learn from reading the report. Good news: in more than 99% of cases, the MA complied with the requirements, notes the Commission, which ensures compliance with the Act. These data are reassuring.
To continue on this path and avoid any drift, resources must be added. Because MA requests are going to increase. In seven years, 10,786 people received it. That’s more cases per million people than Ontario, Canada and Belgium. The social acceptability of MAID seems high in Quebec.
But the files are more and more complex, we note. “The serious and incurable illnesses at the origin of a request for MAID are more and more varied and raise more questions concerning admissibility”, it is underlined.
The Commission therefore recommends, with good reason, that the Government of Quebec set up an advisory service which could be addressed, in real time, by personnel involved in complex cases of MA applications.
This recommendation is all the more relevant as the eligibility criteria will expand over the years. Bill 38 tabled last spring already provided for the admission of advance requests by people suffering from a serious and incurable disease leading to incapacity, a file courageously defended by Sandra Demontigny, suffering from early Alzheimer’s. Next step: mental health disorders (Ottawa has just asked for a delay to review its law), severe disabilities, and ultimately, pediatric cases. Emotional discussions are to be expected, and physicians (and nurse practitioners who may soon be authorized to administer MAID) are increasingly at risk of swimming in troubled waters. Not only will they need clear criteria on which there is consensus in Quebec society, but they will also need to be trained and supported in their practice, starting at university.
The population would also benefit from being better informed. There is still a great misunderstanding, partly fueled by the portrayal of MAID in popular culture. An example: recent episodes of STAT, the daily newspaper of ICI TÉLÉ, in which an oncologist receives the request for marketing authorization from a long-term patient suffering from terminal cancer. The doctor asks a young colleague for a second opinion in an almost improvised way, standing in his office, between two appointments. Later, when he meets him in a hallway, he says to him: “I hope you won’t object! We understand that this is a fiction and not a documentary, but these exchanges give the impression that the requests for MA are poorly framed. In fact, there is a whole mechanism in place: mandatory opinion of a second doctor, multidisciplinary assessment committee, etc.
Hence the relevance of another recommendation from the Commission on end-of-life care: that Quebec carry out an information and awareness campaign aimed at the population. And that it set up a support service to answer the questions of the suffering people and their loved ones.
However, the Commission is reassuring: according to the doctors’ clinical summaries, MA is not a “default” choice. People who request it have received palliative care or have refused it.
On the other hand, nothing is known about the quality of this care or the time at which it was offered, two questions that should be clarified.
If Quebec is one of the places in the world where MA is practiced the most, we must be exemplary at all levels.