Number of assisted deaths up by 282% in Quebec

Commission’s report questions whether regulations are being followed properly

The number of cases of assisted dying in Quebec jumped by 282 per cent in 2016-2017 compared with the previous year, highlighting the growing popularity of the province’s so-called dying with dignity law but also raising questions about whether the rules are being followed properly.

In total, 638 terminally ill Quebecers died following the intervention of a doctor, up from 167 in 2015-2016.

The greatest demand for assisted dying occurred in the Montérégie area, followed by Montreal and Quebec City, according to the report by the Commission sur les soins fin de vie.

The report, tabled Thursday in the National Assembly, found that in 31 cases, Quebec’s assisted-dying law was flouted, most often because the doctor who was consulted was not independent of the patient, as the law requires. In 2015-2016, the commission noted that in a dozen cases the law was not respected.

“The report by the end-of-life commission shows that in the great majority of cases, medical aid in dying was administered in conformity with the law,” Health Minister Gaétan Barrette said in a statement. “These results demonstrate the continuous efforts that have been made since the law came into effect (on Dec. 10, 2015) to make sure that all involved understand well the requirements (for assisted dying).”

But a patient-rights advocate expressed concern that the dramatic increase in the number of cases partly reflects the reality that palliative care is lacking in some parts of Quebec and the living conditions in long-term care centres are far from ideal.

Paul G. Brunet, executive director of the Conseil pour la protection des malades, said he’s not against the assisted-dying law, but he criticized the “horrible” conditions of many public long-term care centres.

“Personally, I would rather die faster than continue living in a diaper, not getting adequate hygiene, not eating well and slowly dying from humiliation and frustration,” Brunet said of the conditions in some CHSLDs, as long-term care centres are known in French.

On June 5, 2014, Quebec became the first province in Canada to permit physician-assisted dying when it adopted Bill 52 in a free vote in the National Assembly. Two years later, on June 17, 2016, Ottawa passed its own law.

Under the Quebec legislation, an adult patient who makes a request for assisted dying must not only be at “the end of life” but must suffer from a “serious, incurable illness.” The individual must also “experience constant and unbearable physical or psychological suffering.”

Bill 52 stipulates that before granting a request for assisted dying, the doctor must verify “the persistence of suffering and that the repeatedly expressed wish to obtain medical aid in dying remains unchanged, by talking with the patient at different times.” The report found that doctors did not follow this requirement in seven cases.

In 20 cases, doctors who were consulted on whether all conditions were met for assisted dying were not truly independent of the patients. In one case, a doctor assisted a patient in death (delivering fatal injections) even though the individual did not suffer from a “serious, incurable illness.”

The report also noted Quebec doctors rejected a total of 377 requests.

The report’s findings come amid a growing desire by some members of the public to expand the scope of assisted dying. On Thursday, a survey by the Canadian Pediatric Surveillance Program observed that 118 pediatricians confirmed they had exploratory conversations with children, teenagers and parents about assisted dying for minors.

In a separate study last month, an overwhelming majority of Quebec caregivers said they favour extending medical aid in dying to those afflicted with Alzheimer’s disease or dementia. At present, a patient who makes the request must do so “in a free and informed manner,” thereby excluding those with dementia.