The increase in the number of deaths resulting from medical assistance in dying (MAID) continues in Quebec, but the criteria are still being met.

The annual report of the Commission on End-of-Life Care reports 5,211 deaths as a result of MAID between April 1, 2022 and March 31, 2023. This number represents 6.8% of deaths registered in Quebec during this period, an increase of almost two percentage points compared to the 5.1% share of deaths attributed to MAID the previous year.

No explanation for Quebec

Since Quebec’s end-of-life law was passed in June 2014, the practice has seen an increase in cases every year. The guidelines allowing MAID continue to be well followed, and the report reports a compliance rate with the law of 99.5%.

The report finds that the proportion of deaths caused by MAID in Quebec, 593 per million, exceeds that of Ontario, Canada and Belgium.

“It is important that Quebec society, its elected representatives, professional associations, health and social service network managers and caregivers question the reasons underlying this trend. “The Commission cannot make a final statement,” we write in the document.

In Quebec, the minister responsible for seniors and health delegate, Sonia Bélanger, made it clear that it is not the Commission but teams of experts that should be looking for answers. “I hope that the experts will shed some light on the phenomenon in Quebec. Why do we see such openness to demand in Quebec? she said.

Minor non-compliance

The half percentage point of non-compliance was predominantly due to non-compliance with one of the main eligibility criteria for MAID, namely that the person has a serious and incurable illness.

“Our analysis shows that current guidelines on the MAID regime in Quebec are working well,” said Commission President Doctor Michel Bureau in a press release.

A constant profile

Although their numbers are increasing, the profile of people who have received MAID remains essentially the same from year to year. Almost three quarters of them (72%) were over 70 years old and nine out of ten people had either cancer (63%), neurodegenerative or neurological diseases, or even heart or respiratory diseases.

The vast majority had a survival prognosis of one year or less and as many as 97% of them suffered from intolerable and incurable physical and psychological ailments.

The majority (55%) of MAID care was provided in a hospital center, but almost a third of people (30%) received it at home, with the final group, 8%, receiving it in CHSLD. On average, MAID was administered 32 days after the signed request.

Around a third of the applications were not pursued further. The main reasons for this were that the person died before the completion of the assessment or before the administration of MAID, that they did not or no longer met the eligibility requirements provided for in the law, or that they withdrew their application.

Other participating doctors

Although the reluctance of the medical profession to participate in the AMM has been reported, on the contrary, the report indicates that 1,633 doctors participated in the AMM, an increase of 15% compared to 2021-2022. “We now surround our medical teams much better with protocols, with interdisciplinary teams, and that is important,” argued Minister Bélanger. I think doctors feel more supported. I am very pleased to see that a community of practice is still being created, that is important.”

At the same time, she recalled that with the revision of the law in June, specialized nurses will also be able to practice MAID and improve the services already in place.

The Commission on End-of-Life Care is mandated to examine all issues related to end-of-life care in Quebec and to monitor the application of specific requirements related to medical assistance in dying. It consists of health and social care professionals – doctors, nurses, pharmacists, social workers – lawyers, an ethicist and user representatives.