Medical assistance in dying | Die with HIS dignity

Recently, the option of receiving medical assistance in dying at a funeral home – for a fee – has sparked a lot of misunderstandings.

Dr Georges L’Esperance

Provider of medical aid in dying, president of the Quebec Association for the Right to Die with Dignity (AQDMD)*

It’s normal, this subject is sensitive. No one wants medical assistance in dying to become a lucrative business rather than humane and compassionate care.

However, it is essential to moderate the positions taken and to dwell for a moment on the reality on the ground that we experience, our patients and us, doctors who provide medical assistance in dying. The medical practitioners of the AMM interviewed as part of this survey are in favor of this offer, and it is for a single and good reason: as expressed by Dr.^D Nguyen, from the Quebec Society of Palliative Care Physicians, “doctors will follow the wishes of patients”.

There you have it, everything is said: follow the wishes of the patients and particularly in the last hours of their life, respect their dignity and their personal values, without bringing judgment.

1. On the commodification of medical assistance in dying

The reproaches are aimed at the commodification of medical assistance in dying, since the offer consists of renting a space to the applicant and his relatives.

However, this whole debate forgets that costs are already incurred by the plaintiff in the case of medical assistance in dying.

Indeed, the procedure requires the patient to choose a funeral service company beforehand in order to come and collect his remains at the hospital or at home, which is obviously expensive and restrictive.

2. The necessary respect for wishes and the logistical organization

Renting a room actually opens up the options available to the patient:

– MA applicants who are already hospitalized can receive care on site, but some prefer to go out for their last hours or days, for various personal reasons: dignity, calm, serenity of the last moments, sharing a last meal with wine and even champagne (yes!). It is the celebration of life that is often emphasized in these moments, and we can understand that the hospital is not the place of choice for everyone. That these patients can choose the place of their death themselves, even if it is a funeral home, is only respecting their wishes.

– On the other hand, even if many MAID take place in the patient’s home, some people do not want to receive care at home to preserve the family environment, or simply because their home is too small to accommodate all the relatives whose presence is desired. Here again, it is a question of providing a place allowing them to respect their wishes.

– Of course, there are other solutions (dedicated room in the hospital, palliative care homes… when they accept MAID), but they are not necessarily sufficient. They are sometimes refused by patients, for example because they do not lend themselves to a celebration, or there are restrictions of all kinds, or they are not available… There are many logistical constraints. Opening access to funeral homes, located throughout the territory and often near the residence of the applicant, is only a way of adding an option, sometimes simpler for the patient (often fragile and with reduced mobility) and his surroundings.

3. This already exists elsewhere in Canada

This way of providing care in a place chosen by the patient is already done everywhere else in Canada. This is the case in British Columbia, for example, where claimants received treatment in a reception tent in Victoria Park. Many examples exist elsewhere in the country always respecting the wishes of the patient: funeral homes, patio on the roof of a hospital, hotel rooms, recreational vehicle, back garden of a house, beach, etc.

In the end, the number of people who could benefit from the accompaniment service in a funeral home is probably relatively small, but allows to have an additional option aiming at the same objectives: respect for the dignity of the applicants, respect for their values , facilitation of the organization of the last moments by professionals whose job it is.

*As well as the following members of the AMM-Québec Community of Practice: D^D Maryse Archambault, Quebec, D^r Francois Aubin, Quebec; ​D^r Philippe Aubin, Maria; ​D^D Julie Boulanger, Quebec; D^r Laurent Boisvert, Montérégie and Montreal; D^r Michel Breton, Laval; ​D^r Pierre Carrier, Quebec; ​D^D Carole Cyr, Quebec; ​D^D Gabriella Del Grande, Laval; D^r Stephen DiTommaso, Montreal; ​D^D Sabrina Dery, Mont-Laurier; D^D Chantal Descoteaux, Saguenay; ​D^D Viviane Hoduc, Riviere-du-Loup; D^D Natalie Le Sage, Quebec; ​D^D Daniele Michaud; D^r Guy Morrissette, Outaouais; ​D^D Genevieve Roberge, Quebec; ​D^r Antoine St-Germain, Longueuil; D^D Ariane St-Jean, Argenteuil; D^r Claude Trudel, Laval; D^r Pierre Viens, Portneuf; Dr. Audrey Lafortune, Lanaudière; Dr. Benjamin Schiff Montreal