The wood-paneled wall, surrounded by surfaces in muted white and blue, gave the room the feel of a boutique hotel. A lone bird flew near an iceberg in a framed photograph above a coffee maker, a stereo system and a landline.<\/p>\n
But the sofas and armchairs were oriented not toward the wall-mounted TV but toward the medical bed at the center of the room. A large plastic container for used syringes hinted further at the place\u2019s purpose: a facility for medically assisted dying.<\/p>\n
The room was inside a new palliative care center in Lanaudi\u00e8re, a region of Quebec where 13 out of 100 people die through assisted death. That is the highest rate in the province, itself the world leader in assisted deaths, according to Canadian and Quebec government reports. Built with money from private donors and run by the provincial government, the center reflected two elements that have propelled Quebec to the top: assisted death\u2019s integration into the public health care system, and its broad public support.<\/p>\n
Since Quebec pioneered assisted dying in Canada in 2015, it has fueled a profound social transformation in the French-speaking province. Choosing to die, on one\u2019s own terms and without suffering, is now seen as an individual right in a society that has rejected the Roman Catholic Church\u2019s teaching that euthanasia is a grave sin.<\/p>\n
\u201cThis is a social phenomenon that has grown exponentially,\u201d said Dr. Louis Daigle, an emergency physician in Lanaudi\u00e8re who has administered 662 medically assisted deaths since 2017. \u201cA lot of people now idealize this way of dying, with dignity, so much so that I think there is a belief that there are now two good ways to die: either suddenly or with medically assisted dying.\u201d<\/p>\n
The rapid increase \u2014 8 percent of all deaths in Quebec are now from assisted dying, compared with 5 percent in Canada overall \u2014 has raised questions in and outside of the province. Opponents in France, which is now debating assisted death, have pointed to Quebec as a cautionary tale: a society that embarked on a slippery slope toward the expansion and normalization of assisted dying.<\/p>\n
Quebec\u2019s Commission on End-of-Life Care, which oversees assisted dying in the province, reviews each case after death to ensure it adhered to the law, said its president, Dr. Lucie Poitras.<\/p>\n
Unlike in the rest of Canada, Quebec society \u2014 lawmakers, health officials, ethicists, and patients and religious groups \u2014 held an official public debate lasting several years before legalizing assisted dying in 2014, Dr. Poitras said. That built a societal consensus around \u201cthe importance of autonomy or control over one\u2019s death, which is very strong here,\u201d she said.<\/p>\n
\u201cQuebec\u2019s rate is higher than anywhere else in the world,\u201d Dr. Poitras said. \u201cDoes an optimal rate exist? I don\u2019t think so.\u201d<\/p>\n
But even some supporters say that the province needs to take a hard look at what has made it the global leader after only one decade, leapfrogging countries with long-established assisted dying laws like the Netherlands.<\/p>\n
Manuelle L\u00e9gar\u00e9, a well-known television producer, recently created a play<\/a>, \u201cClub Sandwich Mayonnaise,\u201d about the assisted death of her father, the comedian Pierre L\u00e9gar\u00e9. The play hit a chord by asking sensitive questions: Was assisted dying still a last resort? Did lack of adequate health care push people toward it? Did Quebec widen access too quickly \u2014 at the start, for those with a terminal illness, extending in recent years to people with chronic illnesses or dementia<\/a>?<\/p>\n \u201cI wanted to call a timeout,\u201d Ms. L\u00e9gar\u00e9, who otherwise supports assisted dying, said in an interview. \u201cYes, we had a big debate before we legalized it, but it\u2019s evolved without asking too many questions.\u201d<\/p>\n Researchers point to a host of reasons. In the province, it has been framed from the start as a way to die in dignity, avoiding terms like \u201ceuthanasia\u201d or \u201cassisted suicide\u201d used in some European countries. In Quebec, only doctors or nurse practitioners can administer an assisted death, while elsewhere only the patient is allowed to perform the final act.<\/p>\n \u201cIn jurisdictions where doctors write a prescription but patients have to take it themselves, the rates are much lower,\u201d said Isabelle Marcoux, a University of Ottawa professor and a leader of a network researching assisted dying in Quebec.<\/p>\n Assisted dying is covered fully by Quebec\u2019s public health insurance. Doctors are allowed to initiate conversations with patients about assisted dying as an end-of-life option, whereas patients must bring it up first in places like Australia and some American states, said Marie-\u00c8ve Bouthillier, a bioethicist at the University of Montreal who is also a leader in the research network.<\/p>\n But experts say that the rapid increase cannot be separated from the history of modern Quebec. In a social transformation known as the Quiet Revolution, the province\u2019s historical French majority began moving away in the 1960s from the Catholic Church, which had exercised a grip on most aspects of their lives. Within a generation, a once deeply conservative and religious society defined itself through its social progressivism.<\/p>\n The Catholic Church has been the biggest opponent of assisted dying in Quebec, arguing that it is morally wrong to end life even to relieve suffering and that such acts cannot be considered care.<\/p>\n In what many experts regard as a continuing rejection of church teachings, assisted dying is highest in regions with heavy concentrations of French Qu\u00e9b\u00e9cois, like Lanaudi\u00e8re, which stretches 150 miles northeast from the suburbs of Montreal into the forests of central Quebec. Lanaudi\u00e8re\u2019s death rate from assisted dying, at 13.4 percent<\/a>, is much higher than the provincial average of 7.9 percent.<\/p>\n In Lanaudi\u00e8re, assisted deaths are concentrated in the region\u2019s northern half, where a quarter<\/a> of the predominantly French Qu\u00e9b\u00e9cois population is 65 or older, compared with 21.7<\/a> percent for the province at large.<\/p>\n Dr. Daigle, who has carried out 662 assisted deaths, said he often hears references to religion among his patients, most of whom are over 80 and have late-stage cancer.<\/p>\n \u201cThey say that when they were growing up, they were told that they had to suffer to go to heaven, but now they say that makes no sense at all,\u201d Dr. Daigle said. \u201cThey came to realize at some point that the old values made no sense, that there was no point in suffering like that.\u201d<\/p>\n