Doctors say Quebec paved the way for medical assistance in dying in Canada and influenced federal MAID legislation, passed by the House of Commons 10 years ago to allow eligible adults to request the process.
The province now has the highest MAID rate in the world. Medically assisted deaths made up a record 7.9 per cent of all deaths in Quebec, or 6,268 cases, in 2024-2025. Across Canada, the rate was 5.1 per cent, or 16,499 medically assisted deaths.
Less clear is whether the growing number of Quebecers who resort to MAID reflects a broad consensus in the province, or if it’s a symptom of poor access to care that forces patients to turn to that option.
In 2009, a legislative commission conducted extensive consultations on end-of-life care. Following a report in 2012, Quebec passed the Act Respecting End-of-Life Care, which came into force in 2015.
That same year, in the case of Carter v. Canada, the Supreme Court of Canada struck down certain sections of the Criminal Code and recognized the right to medical assistance in dying under specific conditions. Legislation known as Bill C-14 amended the Criminal Code and received royal assent in 2016, making Canada one of the few countries to authorize medical assistance in dying.
“It’s clear that Quebec has truly been the pioneer, the leader overall, in end-of-life care. We mustn’t forget that, because the law in Quebec is broader than just the issue of medical assistance in dying,” said Véronique Hivon, who championed the MAID file as a then-member of Quebec’s national assembly.
“There were several regulatory elements suggested in the Supreme Court’s Carter decision that seemed to me to be directly inspired by Quebec legislation.”
The province approached the issue with a “social dialogue” that spanned more than half a decade, helping to demystify and normalize the idea, she said.
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“It’s a completely different approach from the federal government, because the federal government was forced into it by a court decision,” said Hivon, who now teaches in the political science department at the Université de Montréal.
Dr. Laurent Boisvert, spokesman for the Quebec Association for the Right to Die with Dignity, also sees Quebec as a trailblazer.
“This explains why medical assistance in dying in Quebec is supported by 90 per cent of the population,” he said.
Hivon believes Quebec’s success comes down to the fact that legislators took their time and gathered lots of public input. The special commission travelled to eight regions to hear from experts, but also from “citizens who had had all sorts of experiences with loved ones or themselves,” she noted.
“In politics, often we want to move so fast, we want to produce results so quickly, that sometimes we gloss over things. And when the reforms are finally implemented, they aren’t always fully developed.”
Genesis in Quebec
Dr. Michèle Marchand, a physician and ethicist who retired a decade ago, looked back to explain the origins of the debate around MAID in Quebec.
In the early 2000s, several high-profile cases were brought to the attention of the Quebec College of Physicians. Marchand cited the case of a mother who helped her son, who was in his 30s and had multiple sclerosis, commit suicide, as well as a man who helped his quadriplegic uncle take his own life.
The college’s board of directors concluded it was inappropriate for individuals to assist loved ones in ending their lives, and that if anyone were to, they should be physicians, said Marchand.
A report served up by the college several years later helped push Hivon to propose the creation of a special commission — “because they said that in certain circumstances, doctors found themselves facing therapeutic dead ends with people who were suffering immensely at the end of their lives,” she recalled.
According to Marchand, some doctors chose to relieve the suffering of terminally ill patients before the law came into effect, practising a sort of informal medical assistance in dying.
“The debate on euthanasia has always been very polarized. There are those for and against, and no one in between. We said to ourselves, ‘We don’t want to open up euthanasia to everyone, but it’s already happening.’ We might as well have a proper framework,” she said.
A continuum of care
Quebec has established a commission on end-of-life care, which reviews all requests for MAID and produces a detailed annual report. The majority of patients who resort to MAID have received palliative care, statistics show. That fact leads Hivon to conclude that residents do not turn to the process due to a lack of access to care.
“It’s not out of desperation, but obviously we need to be sure. We must always remain very vigilant about this, and I think the study will be very enlightening in this regard,” she said, referring to a survey by an interdisciplinary consortium examining the popularity of MAID in the province.
Boisvert believes that even if access to palliative care was improved, there wouldn’t necessarily be fewer medically assisted deaths.
“These aren’t two opposing types of care; they’re on a continuum,” he said.
“I provide medical assistance in dying to many patients who receive high-quality palliative care both at home and in institutions. But these people reach a point where what they are experiencing, and what they are expected to experience, no longer corresponds to what they consider a dignified life.”
It’s up to each individual to define what a dignified life is for them, he added.
“There are people who, at a certain point, despite the best palliative care, come to say: ‘No, I’m not going to continue living like this.’ And we have the immense privilege in Canada and in Quebec of having the right to say enough is enough.”
