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Voluntary euthanasia deaths in Quebec outstrip predictions by three to one

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6331 (Published 23 November 2016) Cite this as: BMJ 2016;355:i6331
  1. Owen Dyer
  1. Montreal

The number of assisted deaths in Quebec since medical assistance in dying was legalised was three times higher than expected, according to the province’s health minister.

“I mentioned many times that I was expecting about 100,” Gaétan Barrette told a news conference. “It’s almost three times that. Actually, in a one year period it will be over 300.”

Georges L’Espérance, president of the Quebec Association for the Right to Die with Dignity, said in January that he would be “very surprised if we have more than 50 or 60 cases in the first year.” 1

Assisted dying has been available in Quebec under provincial legislation since December 2015.2 It has been legal in the rest of Canada since July 2016 following the passage of federal legislation.

Quebec, alone among North American jurisdictions, requires the lethal dose to be injected and personally administered by a willing doctor.

Barrette, a former radiologist, said that there was regional variation in uptake, with Quebec City seeing more requests than Montreal. He attributed this to the secularism of the nominally Catholic francophone Quebecois, who largely threw off church influence in the “Quiet Revolution” of the 1960s.

Annual reports on the policy were mandated by Quebec’s legislation, and Barrette’s comments updated figures from the first report, which documented the first six months of legal euthanasia.3 It showed that 161 patients received euthanasia, while 87 had requests denied or withdrawn.

Upon review, 21 of the 161 completed assisted deaths had not met the legally required criteria. Three patients were deemed insufficiently ill, while in 18 cases the physician giving a mandatory second opinion on the patient’s eligibility lacked the required degree of independence from either the patient or first doctor.

Barrette said that finding a truly unconnected second physician was difficult in rural areas, adding that the law might require tinkering to ease this requirement.

Despite the higher than expected uptake, he said, “I think that the public can continue to have confidence in the process.”

Figures recently released showed that doctors in Ontario assisted 109 patients to die since the federal ban was lifted in July. This would put Canada’s largest province roughly on course to match Quebec’s annual per capita rate. A comprehensive national reporting system is expected in 2018.

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