Later this week, Quebec will likely adopt Bill 11, which has amendments to its right-to-die legislation allowing people with degenerative illnesses like Alzheimer’s disease to make advance requests for medical assistance in dying.
This is a change MAID advocates have been demanding for years, but public debate has been largely overshadowed by a more trivial issue: Where can people get MAID?
The latest furor began when La Presse published an article last month about a funeral home in Saint-Jean-sur-Richelieu, Que., that offers a “turnkey” service that includes MAID, embalming/cremation, funeral services and burial. The article included a photo of the funeral director moving a comfy recliner where a client had sat while having MAID administered 15 minutes earlier.
Is getting an assisted death in a funeral home undignified? Is it a disturbing commercialization of death? The polemic raged on for weeks.
Currently, Quebec law requires that MAID be administered “in a facility maintained by an institution” (in other words, a health care facility like a hospital, hospice, or long-term care home) or a private home.
In the end, though, legislators sensibly decided that what ultimately matters is respecting people’s wishes and that they die where they see fit.
A funeral home is a solemn, serene place. Hospitals rarely are. And not everyone wants to die at home in the bed that their surviving spouse will use after their demise.
Across the country, MAID has been administered in all kinds of places outside of hospitals and homes: on the beach, in hotels, in recreational vehicles, in tents, on an outdoor patio of a hospital, and more.
But of the 10,064 MAID deaths in 2021, just over one per cent took place outside of private homes (44 per cent), hospitals (28 per cent), hospices (20 per cent) and long-term care homes (6 per cent).
Medical assistance in dying is a medical procedure, but it is also a ritual. People want their family and friends around, and there is often champagne flowing and a lot of laughing and reminiscing – much like a funeral, wake or celebration of life.
The funeral home in question charged $700 for the room rental – just as it would for a viewing. Does that represent the commercialization of death? Not any more than renting a hotel room or paying rent for a room in long-term care. And even when someone dies in a hospital, the funeral home charges a pretty penny to pick up the body.
The assisted death itself, done by a doctor, is “free” – covered by medicare.
One of the most welcome amendments to Quebec’s assisted dying legislation is that it makes it mandatory for all health facilities to grant a patient’s request for assisted death.
Far too often across Canada, patients who request MAID are shoved out the door of faith-based hospitals, care homes and hospices at end-of-life because these institutions have a religious objection to assisted death.
This is completely unacceptable. Institutions that receive public funding to deliver care must do so without prejudice and, if they don’t agree, they should not get public funding.
Yet, in Canada, we have an unholy incursion of the church into the state of health care, with faith-based providers refusing not only MAID, but abortion, tubal ligation and more.
Medical assistance in dying was first legalized in Quebec in 2015, then a year later in the rest of Canada. It was reserved for those whose condition was “grievous and irremediable” and whose death was “reasonably foreseeable.”
Since then, there has been a steady liberalization of the law, largely spurred by court cases filed by patients frustrated by the arbitrary limits set on dying with dignity.
The “reasonably foreseeable” rule was, predictably, struck down. And Canadians (and Quebeckers) no longer have to be on the verge of death to be eligible for assisted death.
Quebec is pushing the boundaries again by allowing advance requests for MAID, and the legislation it has crafted is cautious and thoughtful.
Quebec, however, continues to refuse MAID for people with intractable mental illness and to mature minors, something federal legislation will eventually allow.
In fact, federal law was supposed to change in March, but that has been delayed for a year. Similarly, Quebec’s rules on advance requests for MAID will take two years to be implemented.
The public, for the most part, wants the dithering to stop, and for their wishes to be respected – not only on the location of their deaths, but on their ability to access MAID when they see fit.
What is truly undignified is making people suffer unduly when they are ready to die.
André Picard