10 years after the adoption of the law opening the door to medical aid in dying (MAiD), more and more Quebecers are turning to this option to end their lives, whether or not their natural death is foreseeable.
Let’s remind our family and friends that they will never,
ever be a burden to us.
Let them see in concrete terms how we will support them.
Let’s encourage an open dialogue on these end-of-life challenges,
with a focus on aid in living.
Context of this campaign
In Quebec, health care workers, spiritual care providers and volunteers accompanying patients who are considering requesting medical assistance in dying have a duty of neutrality and cannot express their point of view on the subject. Health professionals sometimes express their opinions on their patients’ health-care choices, but the issue becomes particularly delicate when it comes to MAiD.
Family and friends of people considering MAiD are always free to speak out. More often than not, people who disagree with a loved one’s choice to request medical aid in dying are silent or reluctant to broach the subject directly. This silence is often due to a fear of damaging the existing relationship, or of restricting the loved one’s freedom in such a personal matter. The Living with Dignity citizen network is convinced that speaking out freely and respectfully can, on the contrary, have a positive impact on the relationship, on the patient’s eventual end of life and on the grief experienced by the family member or friend who chooses to speak out. This implies that the family member or friend will have already verified with the health-care providers the availability of quality palliative care for the person concerned.
This page is constantly evolving. We will improve it with your comments.
Get informed, dialogue and accompany
Get informed
Before engaging in an exchange with a loved one considering MAiD, it is important to be familiar with the Act Respecting End-of-Life Care, adopted on June 5, 2014.
To better understand it, it is worth while to read the following page prepared by the Government of Quebec.
If you find that the terms “end-of-life care” and “medical aid in dying” seem incompatible, you are not alone. The Living with Dignity citizen network, like many palliative care organizations around the world, has been opposed to this terminology since it was founded in 2010. Even today, despite the law being in effect, it is inconceivable to us to associate the notion of care with that of providing death.
Quebec is still the only place on the planet that presents what elsewhere is called “euthanasia” as a form of care.
On a global scale, this idea is still frowned upon. One example among many: the ethical reflection (February 16, 2023) signed by 13 organizations representing 800,000 French health professionals.
Can giving death be considered as care?
Interprofessional ethical reflections
Download the English version.
Screenshot of an extract from the cover of the Ethics notice.
To find out more :
Canada’s medical assistance in dying (MAID) law
Adopted on June 17, 2016, it has since coexisted with the Quebec law.
The briefs presented by the Living with Dignity citizen network
Since 2010, LWD has taken a critical look at the various expansions of access to MAiD.
Dialogue
Has your friend or family member confided in you that he or she is considering medical aid in dying?
Thank him for the trust that he shows by sharing this very personal reflection with you.
This is the time to listen empathetically, without judgment, to the reasons that guide his reflection.
While respecting his privacy, try to understand what is motivating him to consider MAiD:
- His state of health (progress, new diagnosis, relationship with his health care team, pain management or the lack of it, other concerns*, etc.);
*Help him to express what is bothering him; even seemingly small issues may have a significant impact for a person whose daily life is marked by illness: room temperature, the personality of a member of the health care team, meals he doesn’t like, inability to leave his room, and so on. - His feelings (regarding loss of autonomy, freedom of choice, desire to control the timing and context of his death, fatigue, etc.);
- His fears (about access to appropriate care, physical and psychological suffering, loss of autonomy, choice of living environment, potential burden on loved ones, etc.);
- The lack of an effective palliative care team to manage his condition.
Make sure he knows what other options he can consider:
- If your loved one is at the end of life (all palliative options, advance medical directives, withdrawal of treatment;
- If your loved one is not at the end of life (support, advice or accompaniment services, specific medical care or social services to address the sources of suffering, home care, early palliative care, etc.).
Your loved one needs to know about the possible alternatives that will guarantee his comfort without having to resort to MAiD.
After which, there are two scenarios open to you:
- You can immediately inform him of your reservations about the proposed choice of MAiD.
- Or you can confide in him that you want to take time to consider this news before discussing it with him, while expressing or not your discomfort with his potential choice of medical aid in dying.
Here’s a series of tips to help you explain your objection with love and respect…
These suggestions may or may not be appropriate for the conversation you wish to have with your loved one. We are convinced that you are the best person to choose the words and ideas that will start a constructive dialogue. Trust yourself!
Your personal instinctive reaction
Beyond all the theory about medical aid in dying, it is your own personal reaction that is most important.
If your loved one’s choice troubles you, make sure you are calm before expressing your misgivings to him.
Make sure he understands that it’s not out of a selfish fear of losing him that you are expressing your objection, then you can share:
your uneasiness at the prospect of death caused by a series of lethal injections;
your deep conviction that there are other options far preferable to induced death;
your certainty that the time remaining can be very precious for him and his loved ones.
The treasure of palliative care
How can we define palliative care in a few words? We like the definition proposed by the Canadian Hospice Palliative Care Association :
« …Palliative care is a specialized form of healthcare for individuals and families who are living with a life-limiting illness that is usually at an advanced stage. The goal of palliative care is to provide comfort and dignity for the person living with the illness, as well as the best quality of life for both this person and their family.»
Does palliative care really allow for a dignified end-of-life? You can affirm it with confidence. And in very exceptional cases of intractable pain or discomfort at the end of life, palliative sedation is an option worth considering.
The availability of palliative care at the time and in the setting chosen by the sick person (home, residence, hospice or institution) sometimes depends on his or her postal code. We should not be afraid to insist on receiving services that we have a right to: The right to quality palliative care is an integral part of Quebec’s End-of-Life Care Act.
To help explain the importance of palliative care, we have produced a video series entitled The Treasure of Palliative Care, which you can watch on your own or with your loved one.
The Quebec Coalition for Access to Palliative Care and the Association québécoise de soins palliatifs have also produced these excellent audiovisual tools for National Hospice Palliative Care Week (with English subtitles).
The dignity of a human being is never lost
This is the core of the debate surrounding medical aid in dying: can a person’s illness, disability or loss of autonomy undermine his or her dignity? We are convinced that they cannot. Nothing can take away a person’s dignity. It is a good idea to remind your loved one that, in your eyes, his or her dignity will never be called into question, because it does not depend on the presumed quality of his or her life, but on the simple fact that he or she is part of the great human family, called to solidarity.
We discussed this issue in depth with Louis-André Richard, professor of philosophy and author of numerous books on the subject, in a series of videos (in French) including Mourir et vivre dans la dignité (Dying and living with dignity) and Mort paisible et mort en paix (a Peaceful death and dying in peace) .
We also share with you an illustrated fact sheet (in French) prepared by Dr. Félix Pageau and VITAM – Sustainable Health Research Centre, that addresses the following issues: dignity, dementia, autonomy, vulnerability and frailty in the care of the elderly.
Don’t be afraid of natural death
It is only natural to fear certain aspects of death and the unknowns surrounding it. Our fears are sometimes fuelled by preconceived ideas about the last moments of life, or by the traumatic experience of the death of a loved one whose pain was not properly managed. For the vast majority of us, however, death occurs naturally and peacefully. Dr. Kathryn Mannix’s work is exemplary in this respect, and we highly recommend it. Here is the introduction to her TedX lecture “What happens when you die?” (15 min).
The Société française de soins palliatifs (French Palliative Care Society) has another video with Dr. Mannix entitled “Dying for Beginners Apprendre à mourir” (4 min), with magnificent animations.
Ensure the support of the network of family and friends
Explore in concrete terms everything your loved one’s network can do to demonstrate your willingness to accompany him with dignity until his natural death (prioritizing what “I” can do).
Fear of becoming a burden was cited by 46% of MAiD recipients in Quebec in 2022-2023. And 76% felt that they had lost their dignity. On the other hand, tables extracted from page 55 of the most recent report by the Quebec Commission on End-of-Life Care (in French) show that only 4 of the 5037 people who received MAiD cited physical suffering alone. Since mental suffering is a determining factor, family and friends have a crucial role to play in responding effectively, to the best of their ability.
You can offer to help your loved one explore ways of reducing or eliminating the sources of psychological suffering that affect him, or that he his afraid of.
Perhaps you can work as a team with extended family and friends to organize regular visits. Create a network of family and friends who are happy to put aside certain commitments, projects or hobbies to spend time with, help and support your loved one. Your loved one will be relieved to know that you will never be so busy that you forget him. You will prove in this way that it is not at all a burden to prioritize time spent with him, but a real privilege (“I’m happy to free up some time for you”).
The creation of an informal calendar could be envisioned, with each person committing to come and share a few hours with the sick person. And why not bring snacks, meals, photos, music, souvenirs, games, etc.?
Yes, there may be tears, but there will also be many smiles and new memories. Your loved one has a lot to share; perhaps he needs a little encouragement to share his wisdom and the richness of his experiences. All with patience, gentleness and comfort.
Remember that a host of resources exist, that are well catalogued by L’Appui for caregivers:
https://repertoire.lappui.org/en
If your loved one’s network is limited, don’t hesitate to turn to external resources to help combat isolation or loneliness, such as Little brothers or the volunteers of the Albatros Movement (in French).
In cases where death is not immediately foreseeable (illness or disability/physical impairment)
Once all possible treatments have been considered, it is important to ensure that your loved one has access to all the care and services to which he is entitled to, in the living environment of his choice.
The text of the law governing the extension of MAiD to people with severe physical disabilities is clear: the patient must have “assessed the possibility of obtaining support, advice or accompaniment services, in particular from the Office des personnes handicapées du Québec, a community organization or a peer helper, such as assistance in initiating a service plan”.
Such care and services are sometimes difficult to obtain, and we must not hesitate to refer a loved one to community organizations that work to enhance the value of aid in living, such as:
With website in English
Moelle épinière et motricité Québec (MEMO-QC) and the Regroupement des activistes pour l’inclusion au Québec (RAPLIQ).
With websites in French
Confédération des organismes de personnes handicapées du Québec (COPHAN), the Comité d’action des personnes vivant des situations de handicap (CAPVISH) and Coop ASSIST.
Other suggestions
Don't waste time
If your loved one mentions that they are considering medical aid in dying, it’s best not to wait too long before expressing your reservations.
In the case of a reasonably foreseeable death, the process of two assessments, authorization and administration of medical aid in dying can be very rapid. As of 2021, the initial 10-day period no longer exists. If the patient meets the criteria of the law, the administration of a MAiD can take place as early as the day after a positive assessment (90 days if natural death is not reasonably foreseeable, according to Canadian law).
You can express your views in person and/or by handwritten letter
Whenever possible, face-to-face meetings are preferable. The use of e-mail or telephone should be avoided in such circumstances. If you are geographically distant, videoconferencing may be an option.
If you choose to speak in person, it is best to do so informally during an exchange in which you are discussing other topics. It is up to you to raise the issue at the right moment, as the conversation progresses, after you have actively listened to the reasons why your loved one is resorting to MAiD. If you choose to do this in person, we strongly suggest that you also write a handwritten letter that you can offer your loved one at the end of the conversation. This will give your loved one a chance to read your letter and calmly reflect on your invitation not to request medical assistance in dying.
We invite you to write this handwritten letter in your own words.
To help you design it, here is a sample letter with a few suggestions.
Additional details
- Be careful before using more loaded terms such as “euthanasia”, “assisted suicide”, etc.
At this stage, it is best not to use words that could block the dialogue.
- Dare to express your spiritual or humanist convictions
Whatever your convictions, it is good to express them freely to your loved one. It is important that he hears all the sources that lead to you having this this heart-to-heart dialogue with him.
- Write or record his life story and thoughts with him
Have him deliver the pearls of his existence, reflecting on the meaning he gives to his life and the challenges he is currently facing. Passing on this gift to loved ones will open up new avenues of communication.
- Organize a celebration of his life
When the end draws near, why not invite family and close friends to a celebration of life? It could be at home, in a hospital room or elsewhere. The person you are caring for may want to help plan the gathering, but it’s up to you and those closest to him to think of the best ways to remember the good moments in his life. It is also an opportunity for all of you to express your gratitude and love.
Accompanying your loved one
What will the listening and dialoguing stages achieve?
You are probably hoping they will lead your loved one down paths other than medical aid in dying.
If this is the case, you should be aware that such a decision can change, and that it will be up to you to keep the lines of communication open so that you can talk again, if need be.
During your dialogue, you may have committed to specific actions. It is important that your loved one realizes that you keep your promises and will carry out these actions.
It will also be important to remind family and friends of words and gestures that will warm your loved one’s heart, so that he feels well supported throughout all the stages leading up to his or her natural death.
If your relative or friend nevertheless chooses to go ahead with MAiD, you will be called upon to continue your support, respecting both his choice and your limits (to be communicated to his entourage).
Your loved one needs to understand that he is free to make his own end-of-life choice, but that you will not be able to support the decision if he opts for MAiD. He must understand that this choice will in no way diminish the love or friendship you feel for him. It is precisely because of this precious bond that you can remain true to your convictions without damaging the quality of your relationship.
You should set the limits you want. If you do not wish to be present the day MAiD is administered, or if you prefer to withdraw at the time of the lethal injections, it is possible to express this, with love and respect.
“The riches of palliative care, from its origins to the present day, will have revealed the surprising power of life operating against our attempts to control everything. What does this mean? Experience has shown that, beyond denial, revolt or resignation, paying attention to the last moments of an existence that is ending, without causing a voluntary departure, opens up surprising perspectives. Surprisingly and paradoxically, it seems to help us tame our fear of the spectre of death, while helping to pacify those around us. Surrendering to benevolent hands until the natural end of the journey generates an experience of proven humanity, that of shared vulnerability.” (translation)
Louis-André Richard, philosophy professor and author quoted above.
Important remarks
Do you know someone whose request for medical assistance in dying was accepted and who now knows the date of his or her induced death?
Dialogue is always possible, but it becomes increasingly complex as the day for the administration of MAiD approaches.
Together with family, friends, medical staff and, if appropriate, spiritual advisors, it is important to assess the consequences for the patient and loved ones of questioning the planned action. This will help mitigate the effects, since conflicts of opinion are common in families, and are often noticed by the patient.
In certain circumstances, a brief mention of one’s personal convictions explaining the choice not to be present during the administration of medical aid in dying could be sufficient.
Is your situation particularly complex? Please do not hesitate to contact our team by e-mail.
Are you interested by the content of this page?
Feel free to share aidinliving.org directly with your own network.
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Thank you for signing our Manifesto for a dignified and natural end-of-life and for the promotion of quality healthcare in Quebec. You can also take advantage of this opportunity to receive newsletters from our citizens’ network to help you keep up to date with end-of-life issues in Quebec.
If you would like to help publicize our radio campaign in your area, contact our team by e-mail or make a financial contribution to our citizen network.
Call for testimonials and comments
Your personal story of accompanying a loved one could be of great assistance to someone in a situation similar to yours.
You can contact our team by e-mail. We will make an appointment with you to collect your testimonial in the format of your choice, anonymously or not.
We also welcome your constructive feedback to help us improve this tool.
The use of masculine gender is generic and is intended only to keep the text simple.
