We learned last week that more people die while resorting to medical assistance in dying (MAID) in Quebec than in other territories where this medical intervention is permitted. While respectively 2.3% and 4.8% of deaths in Belgium and the Netherlands in 2021 resulted from requests for euthanasia, the current trend indicates that 7% of deaths in Quebec in 2022-2023 could result from euthanasia. medical assistance in dying.
Moreover, several individuals and groups have called for a review of the eligibility criteria for medical assistance in dying in order to make it accessible. Recall that the decision of the Superior Court of Quebec in the Truchon-Gladu case in 2019 invalidated the “reasonably foreseeable” death criterion in the assessment of the admissibility of MAID requests. Clearly, a cognitively capable person living with a serious and incurable disease that has led to an advanced and irreversible decline in his abilities and suffering that cannot be alleviated in a way that he deems acceptable no longer has to wait to be engaged in an end-of-life trajectory before requesting MA.
Sensitive to this social demand, the Government of Quebec recently tabled a bill aimed at modifying the Act respecting end-of-life care. If passed, this bill:
– will add severe and incurable neuromotor disability to the medical conditions that can give access to MAID;
– allow advance requests for MA for people who have been diagnosed with a neurocognitive disease that will lead to incapacity;
– authorize specialist nurses to administer MAID;
– will force palliative care homes and units that were not already doing so to offer MAID.
A worrying trend?
It is healthy to ask whether this popularity of MAID reveals a particular social evil or a murky relationship to death. It is true that the chronically insufficient supply of quality home care, long-term care and palliative care can encourage many citizens to seriously consider the option of MAID in order to avoid ending their lives in which they will find unsatisfactory, if not unacceptable.
Although this social phenomenon should be followed closely, we do not believe that it testifies to a denial of death or a non-recognition that human life most often includes an ultimate stage marked by the irreversible decline of abilities and dependency.
MAID requests are part of a desire to live out one’s end of life as much as possible according to one’s values, and to remain an agent capable of exercising one’s autonomy until the end.
The decision to request MAID is generally preceded by a sometimes painful discussion with relatives. It also requires the person concerned to discuss their desired death with at least two doctors.
The use of MAID implies a recognition of the salience of the process of dying in human life. For the many contemporaries who, adhering to a secular vision of the world, do not believe in the existence of an afterlife, the possibility of living the home stretch in a way that conforms to their values contributes to the feeling of having lived a good life, a meaningful life.
Planning for death facilitates, among other things, goodbyes and the presence of loved ones in the last moments. As the philosopher Samuel Scheffler argued, the human person generally has posthumous interests. Many of us want, among other things, that our loved ones keep a certain image to remember us.
If the demand to exercise greater control over the end of life testifies to the desire of the Moderns to extend their mastery over nature and their destiny, it should not be confused with the posthumanist fantasy of “conquering death”. The possibility of exercising one’s autonomy can contribute to the acceptance of the death to come. As reported in a study to be published, several caregivers note that the person they have accompanied has become more serene once their request for MAID has been accepted. “That he could choose how he was going to leave”, said one of the participants, “appeased him”1.
Our position is not that all MAID expansion requests should be granted or that MAID is necessary for a good death. Rather, it is that a conception of the good life normally includes a conception of the good death, and that conceptions of the good life are plural in liberal democracies. The state must, while protecting the vulnerable, allow people as much as possible to remain moral agents until the end.
1. “Exploratory study on the experience of families whose member has died in the context of medical assistance in dying in Quebec”, Isabelle Dumont, Interventionnotoh 156, spring 2023