An unprecedented study published in the British Journal of Medical Ethics, denounces the misuse and easy access to what is euphemistically called “Medical Aid in Dying” (MAiD), which in reality implies resorting to euthanasia and assisted suicide in Quebec. The authors claim that this is sometimes applied abruptly with little or no effort to mitigate or relieve the patient’s suffering through non-lethal medical means. Thus, some patients requested MAiD without being informed about palliative care options for end-of-life care.

Between December 2015 and June 2017, researchers Lori Seller and Véronique Fraser from the McGill University Health Center, and Marie-Eve Bouthillier, from Laval, evaluated 80 cases of patients requesting MAiD in two Quebec hospitals and one long-term care center. The authors of this research study explain that “When MAiD was legalized in Quebec three years ago, the clinical guidelines recommended that MAiD be approached as a last resort when other care options are insufficient.”

The researchers revealed several paradoxical situations. One in five patients had not signed any advance directives, that is for instance do-not-resuscitate orders for their end-of-life conditions. The bioethicist, Lori Seller, believes that “If palliative care was initiated sooner, patients may benefit from it, but the issue remains as to whether there would be less recourse to MAiD. We raise the question without having an answer for now. It would require further research.

These findings have appeared at a time when the number of euthanasia cases has soared. According to a report recently submitted to the Canadian National Assembly by the Commission for the End-of-Life, there were 845 cases between 2017 and 2018 compared to 638 cases the previous year. The report revealed that in the past 3 years, the legal requirements were not respected in 5% of the cases, and several cases were also cited where MAiD requests were filed even before proposing palliative care.

Physicians appear to be responsible since, in 29 cases, the physician is not impartial in his explanations to the patient about the criteria for requesting MAiD. In 9 other cases, the physician who did not practice MAiD was not sufficiently careful in verifying the patient’s health status, pain level, and adequately informed consent. Five patients were not suffering from an incurable disease, in two other patients were not at the end-of-life. For 17 other cases, the stipulated guidelines for access to MAiD were not followed. The commission thus questions the lack of clear communication regarding end-of-life care.

Last May, the College of Physicians warned that patients would turn to euthanasia due to inadequate palliative care services. Palliative care physicians have renewed their urgent appeal to upgrade palliative care which is under developed in Québec.

Alliance VITA has repeatedly emphasized the inherent dilemma of claiming to develop palliative care, while simultaneously legalizing euthanasia and terminal sedation. This inevitably leads to conflicts since these two approaches are contradictory. Palliative care is incompatible with euthanasia. The warning signs observed in Quebec demonstrate that these procedures lead to a dead end.