A Brief History of the Rapid Expansion of Access to Medical Assistance in Dying in Quebec, Canada

Ten years after the legalization of physician-assisted dying in Canada, experts around the world are pointing to Canada as a counterexample. The British Columbia civil liberties group that spearheaded the decriminalization of physician-assisted death in 2015 now warns that it has become too easy to obtain Medical Asssistance in Dying (MAiD) in Canada and calls on the government to put safeguards in place. What about Quebec, which now leads the world in terms of deaths by MAiD (7.3%), surpassing countries where the practice has been legal for decades, such as the Netherlands and Belgium?

Use of a Euphemism to Increase Social Acceptability

The adoption of an euphemism to name what is called euthanasia in Europe was motivated by the fact that, under the federal Canadian criminal law at the time, ending another person’s life was illegal. By defining the practice of euthanasia as a medical act, Quebec was able to ensure that it fell under provincial jurisdiction, since healthcare is a provincial responsibility. Moreover, there was a greater chance that the public would accept a practice called “medical assistance” rather than “euthanasia,” especially given that the population already seems confused about the various end-of-life practices. Ten years later, it must be acknowledged that the public is indeed confused. Indeed, quantitative and qualitative studies have since shown that the Quebec population mixes up different end-of-life practices such as refusal or cessation of treatment, palliative care, and continuous palliative sedation with medical assistance in dying. It raises the question of whether Quebecers are broadly in favour of euthanasia or of any form of medical aid that can alleviate end-of-life suffering. It is unfortunate to note that France appears to be following Quebec in the use of this euphemism rather than other European countries.

A Rapid Expansion in the Name of the Canadian Charter of Rights and Freedoms

A few months after the adoption of the Quebec law, the rest of Canada authorized MAID (including assisted suicide). This legalization followed the historic Carter decision, in which the Supreme Court of Canada ruled that the law prohibiting medically assisted death violated section 7 of the Canadian Charter of Rights and Freedoms by limiting the right to life, liberty, and security of the person.

Shortly thereafter, legal actions were initiated by two disabled individuals who were not facing an imminent or reasonably foreseeable death against the Attorney General of Canada and that of Quebec, on the grounds that the eligibility criteria for MAID were unconstitutional and contrary to the Canadian Charter of Rights and Freedoms. The Beaudouin judgment rendered in their favour led to the removal of the requirement for a foreseeable death in 2020 , opening the door to future expansions of the eligibility criteria for MAID in Canada.

Removal of the Final Consent Requirement: Opening the Door to euthanasia of incapable persons

Adopted in March 2021, Bill C-7 allows individuals eligible for MAID who risk losing their capacity to consent to waive the requirement for final consent at the time of MAID through a written agreement with their healthcare professional. This law has made it possible to provide MAiD based on advance consent, unlike the previous requirement of contemporaneous consent.

Finally, on October 30, 2024, advance requests for medical assistance in dying were legalized in Quebec, despite federal legislation that prohibits them. Quebec proposed to bypass this provision by asking the director of the provincial Criminal and Penal Prosecutions Office not to punish healthcare professionals who practice MAID in accordance with provincial law. To submit an advance request for medical assistance in dying (AR-MAID), the individual must be suffering from a serious and incurable illness leading to incapacity and be capable of consenting to care at the time of the request. Discussions with healthcare professionals already suggest that the requirement for the illness to lead to incapacity will be debated. Indeed, can a first stroke justify an AR-MAID? Can schizophrenia, which may lead to incapacity, justify an AR-MAID, and ultimately, isn’t life itself a mortal disease that can lead to incapacity?

No limits are strong enough to stop Canada, especially Quebec, from continuously expanding the boundaries of euthanasia. Given that Canadian court judgments can be interpreted as recognizing MAiD as a right and that it is now permitted to end the life of an incapacitated person, how far will this social experiment, to which we have not freely and fully consented, ultimately lead us?