Doctors, hospices struggle with Quebec’s new law forcing palliative care to offer MAiD

Quebec physician Bruno Gagnon feels squeezed out of his decades-long palliative care career because of his moral objection to medical assisted dying (MAiD).

With years of experience and a faith-based passion for bringing comfort to those living their final days, Dr. Gagnon says he still has a lot to offer in the field, but feels hampered by current circumstances.

on June 7 Account 11 went into effect to expand MAiD in the province, including requiring all palliative care facilities to offer the procedure. Now, as Dr. Gagnon to The Epoch Times, it appears his choices are to either retire or open a private practice, neither of which is ideal.

He had felt marginalized in the profession for several years because of his views on MAiD, he said, and now it’s official.

Dr. Gagnon recently applied for work at a farm, only to be told that he lost the job due to his objection to MAiD. While the facility is required to offer the procedure, it would not be able to do so on days when he was the only doctor on duty if hired, he said. That would cause logistical problems.

“It’s not palliative care anymore,” Dr. Gagnon said. “I do not know what it is.”

He gave examples of patients who were offered MAiD by his colleagues instead of a treatment that could have alleviated their suffering, which he believes palliative care should be about.

Due to patient confidentiality, he could not speak about the details of those cases. He did say that some patients had chronic pain, delirium and heart disease. Those conditions could have been treated before the decision to go ahead with MAiD, he said.

In one case, Dr. Gagnon returned from vacation to find that a colleague had arranged MAiD for one of his team’s patients. He spoke with the patient and her caregiver and helped resolve some interpersonal issues between them. He also treated some of the patient’s ailments. The patient then chose not to continue with MAiD.

The worst experience of his career – and it’s a difficult career, he said, working with people at the end of their lives – was seeing the fear one of his team’s patients felt as she prepared for a MAiD.

“We have what I call a euthanasia mentality. She’s old, she’s sick, she has multiple illnesses, she’s better off dead,” Dr Gagnon said.

‘Room for doctors who object to MAiD’

Georges L’Esperance, a neurosurgeon and president of the Quebec Association for the Right to Die in Dignity, supports the new law. He says that palliative care workers who object to MAiD can still work in Quebec facilities, and that it is only the institution itself that should offer MAiD.

“It’s natural to have room for doctors or nurses to object to MAiD, but they don’t have to limit the rights of other citizens,” he told The Epoch Times.

When told of Dr. Gagnon said he was limited in his job opportunities because he didn’t want to offer MAiD, said Dr. L’Esperance that he could not comment. “It would be important to have all the facts,” he said.

As for dr. Gagnon’s stories of patients being offered MAiD instead of treatments for the ailments they suffered from, Dr. L’Esperance not that they represent a general experience in Quebec.

“This is one of the arguments. We always hear that, and it’s not true,” he said.

He quoted national data from 2021 showing that more than 80 percent of people receiving MAiD had prior palliative care.

“The other thing is that there are less than 10 percent of people in Quebec [who die] who have MAiD, so it means everyone else has palliative care.”

Dr. Gagnon says these statistics don’t take into account the quality of palliative care and show that the remaining 20 percent have never received palliative care, which is a problem. “The vast majority of patients die without access to proper palliative care,” he said.

Dr. L’Esperance called Quebec facilities that have opposed MAiD “hypocritical” for providing palliative sedation, which he says is a slow version of MAiD. A patient is sometimes sedated to avoid suffering in his or her final days or hours.

Dr. However, Gagnon says this characterization of palliative sedation is unfair.

“Palliative sedation is an extreme treatment for symptom control that respects the normal dying process. The goal is not to kill, but to enlighten,” he said.

He said he’s seen healthcare workers who once supported MAiD change their perspective after seeing the number of patients getting the procedure, up to about 10 a day at a facility where he worked.

Although dr. Gagnon and Dr. L’Esperance have opposing views on MAiD, they both said that one’s spiritual faith can greatly influence palliative care approaches and one’s understanding of MAiD. Dr. However, Gagnon said his opposition to MAiD is not primarily based on faith. He just doesn’t see it as part of palliative care and says he would feel the same way if he weren’t a religious man.

To trust

Dr. L’Esperance said many reasons for choosing to die can be considered valid — including not wanting to be a burden on one’s family — “unless you think life is something sacred above all else.”

He said MAiD has become especially popular in Quebec, in part because the province has become less religious than many other places. CBC reports that according to Dr. Michel Bureau, president of the Quebec commission on end-of-life care, between April 2021 and March 2022, Quebec had more maid deaths per capita than anywhere else in the world.

So says the World Health Organization spiritual dimension is an essential part of palliative care, along with the medical, psychological and social dimensions.

Dr. Gagnon said he believes palliative care providers should have Christian values. The best doctors and nurses he’s seen in his career are those who are motivated by their faith, he said, noting that they serve patients with passion and offer them spiritual hope as they move into the afterlife.

“Palliative care is about being with a patient and family in respectful acceptance of the mystery of the dying process. MAiD ultimately rejects a part of our humanity,” he said.

St. Raphael’s is a Catholic palliative care facility in Montreal that is, to date, one of the few in Quebec that does not offer MAiD.

Executive director Olivia Leveque told The Epoch Times she’s not sure how St. Raphael’s will handle the new law.

“We have to follow the law,” she said. “We are currently analyzing the situation to its fullest extent.”

St. Raphael’s has formed a committee to review how the hospice will implement the demands. Ms Leveque said the timeline for implementation is not yet clear. She thinks they will have a few more months.

“Our main focus has always been palliative care, and always will be to provide excellent palliative care and compassionate services.”