Requests for medical aid in dying doubled in Quebec since start of pandemic, commission says

More people, per capita, are dying with medical assistance (MAID) in Quebec than anywhere else in the world, according to Quebec's commission on end-of-life care.

Since the start of the pandemic, requests for the procedure have more than doubled — from 1,774 in 2019-2020 to 3,663 in 2021-22.

The increase means the percentage of people who chose MAID in Quebec is greater than in Belgium and the Netherlands, where it has been legal for decades. It has been legal in Quebec since 2015.

Between April 2021 and March 2022, 5.1 per cent of deaths in the province were medically assisted. In the Netherlands, 4.8 per cent of deaths were due to MAID and in Belgium, it was 2.3, according to Dr. Michel Bureau, the chair of Quebec's commission on end-of-life care.

Bureau said he was surprised by the rapid increase in the number of requests for MAID in Quebec. In his opinion, the increase could be explained by the fact that MAID is being presented to patients as care, not euthanasia.

"Quebecers who receive medical assistance in dying are at the end of life. They have suffering that cannot be alleviated and they meet all the criteria," Bureau said. "The commission on end-of-life care analyzes all requests for medical assistance in dying to ensure that they comply with the law."

More doctors are also administering MAID. RAMQ, which administers public health and drug insurance plans and pays health professionals, saw a 28 per cent jump in the number of physicians who billed for at least one procedure related to a MAID request in 2021-2022. Most of them administered MAID more than once during this period.

Georges L'Espérance, a neurosurgeon and president of the Quebec association for the right to die with dignity, said the increase in MAID doesn't surprise him.

The law was changed in March 2021 to allow terminal patients to use MAID earlier. Previously death had to be "reasonably foreseeable," meaning the patients had to be in their final days or months of life.

With the change, and greater awareness of MAID among doctors and patients, L'Espérance expected the number of people using the procedure to rise.

"It means also that patients are more aware of their dignity and their own autonomy and that's what they want, they want to have a kind of control up to the end," he said.

The proportion of deaths due to MAID varies greatly from one region to another in Quebec. In the Lanaudière and Lower St. Lawrence regions, nearly nine per cent of people who died in 2021-2022 received MAID. In Montreal, it was less than four per cent.

The acceptance rate for requests for medical assistance in dying also varies greatly from one region to another. For example, in the Chaudière-Appalaches region, 98 per cent of patients who applied for MAID were granted it. In Quebec City, the proportion dropped to 75 per cent and in Montreal, it was only 54 per cent.

This difference appears to have no connection to language because the trend holds true uniformly throughout Montreal.

"Does the fact that there are more specialists on the island of Montreal mean that people continue treatment for longer? I don't know," Bureau said.

Before the pandemic, Quebec's College of Physicians was concerned that the lack of palliative care would lead patients to choose medical assistance in dying.

But the commission on end-of-life care believes that this fear is unfounded. Bureau said the proportion of deaths resulting from medical assistance in dying will likely continue to increase.

"We have to be prepared for the growth of medical assistance in dying to continue," he said. "Because the year [2022-2023] is already very much underway, and the trend is continuing."