Access to medical aid in dying unequal across Quebec, report finds

Despite how quickly the number of people to receive medical assistance in dyinghasgrown in Quebec, access to aid in dying is unequal across the province.

Thatis the key finding ofthefirst report examining the impact of Quebec's end-of-life care law since it was enacted in 2015, which was tabled inthe National Assembly Wednesday.

"The introduction of [medical assistance in death] as end-of-life care in Quebec has been variable; fast in many institutions, but much slower in others," reads the report fromQuebec's Commission on end-of-life care.

The mandate of the commission chaired by Dr. Michel Bureau isto examine all matters relating to end-of-life care and to oversee the application of the law's requirements.

73 per cent increase from 2016 to 2017

The law's "application is going well, despite intense debates in the media about end-of-life matters, the care that accompanies it and access to care," said Bureau in a preamble to the report.

So far, 1,632 people have received a medically assisted death in Quebec. From 2016 to 2017, the number of people who received medical aid to dieincreased by 73 per cent, according to the report.

That increase "illustrated its social acceptability as a form of end-of-life care," the document said.

But the proportion of deaths that were assisted by a physician differs significantly by region, indicating disparities in the level of access, the report found.

The proportion is highest in the Quebec City area (1.97 per cent of deaths in the region were by medical aid in dying), and the lowest is in the Gaspregion (0.34 per cent). In Montreal, the percentageat 0.80is also relatively low.

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"The commission is aware that there is an unequal access to [medical aid in dying] in Quebec, that each institution must conduct its own critical analysis and, if necessary, make appropriate corrections," the report concluded.

It also said there need to be fewerbarriers to receiving end-of-lifecare at home, and verbal requests should be heeded sooner.

In general, though, the report says, requests are treated properly.

People with cancer form majority

It found that the majority 78 per cent of people who have received aid in dyingsince 2015 had cancer.On average, they were 72 years old.

Ten per cent suffered from degenerative diseases.

Quebec's Act respecting end-of-life care allows for people to choose help to die when they are at "end of life," which two Montrealerswith degenerative diseases are challenging.

They argue that, although they may not be considered at the end of their lives, they should qualify for assisted death because of their persistent and intolerable suffering.

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The report did not take a positionon that controversial issuebut said some distinctions between Quebec's lawand Canada's, which says a natural death must be "reasonably foresseable,"have led to confusion and anxiety in patients.

Quebec Health Minister Danielle McCann said Wednesday a group of experts islooking into that issue and the possibility of widening the criteria for accessing end-of-life care.