Last year, approximately 7% of deaths recorded in Quebec occurred following a request for medical assistance in dying, a percentage that places us first in this regard in the world. How can we explain our fervor towards medical assistance in dying? Because it ticks several boxes on the list of elements that constitute what is now considered a good death in Quebec, suggests a study which has just been published in the journal Mortality.
The Laval University research team that carried out this study conducted interviews with 16 people – people hospitalized in geriatrics and their loved ones, geriatricians and other members of the healthcare staff – in order to identify the elements that we must come together to have a “beautiful death”.
“Today, most people die in hospital after having exhausted all medical remedies that can prolong life,” underlines the head of the study, Félix Pageau, geriatrician, ethics researcher and professor at the Faculty of Medicine. medicine from Laval University. This is very different from what existed just a century ago. By necessity, what is considered a “beautiful death” has evolved a lot over time. The adoption of the law which legalized medical assistance in dying, in 2015, also changed expectations regarding the end of life.
The responses of the people who participated in the study made it possible to identify a few elements on which there is consensus. People want a death free from physical and psychological suffering, free from pain or discomfort, and free from physical or psychological distress. “These elements overlap, but there is a gradation in their intensity,” specifies Professor Pageau, who himself carried out the interviews as part of a master’s degree in philosophy.
Furthermore, the people who took part in the study believe that it is essential to be able to count on the support of the healthcare team, family and loved ones. “They don’t want to die alone. They realize that what really matters at the end of a life is not the accumulated wealth, but the relationships they have established with other people,” emphasizes Félix Pageau.
Finally, the other element that there is consensus is the desire to end one’s days in a soothing physical environment. Tellingly, some healthcare workers pointed out that their workplace was a horrible place to die. “The acute care units were designed to ensure the efficiency of the work of the healthcare teams,” recalls Professor Pageau. Little attention was paid to aesthetics and design. Here again, at the end of life, people go back to basics and they want to be surrounded by beauty.”
-Two other items were frequently mentioned by those who took part in the study, but the preferences expressed went in opposite directions. Some people want to remain conscious until the end so they can communicate with their loved ones, while others would prefer to die in their sleep or without being aware of it. Same divergence of views regarding the speed of death. Some people want a death that comes abruptly, while others prefer to have time to prepare and say goodbye to their loved ones.
— Félix Pageau, on the importance given to being surrounded by loved ones at the end of life
“Medical assistance in dying brings together several of the elements that make for a “beautiful death,” notes Professor Pageau. This is undoubtedly what explains the strong popular support for its legalization. Culturally, the Quebec population was there.”
There are other ways to help more people have a “beautiful death,” he continues. “If our health system could allocate more resources to palliative care and home care, we would get closer to the end-of-life ideal for a large part of the population.”
In addition to Professor Pageau, the signatories of the study published in Mortality are Ariane Plaisance, who was a doctoral student in community health at Laval University at the time of the study, and Vincent Marchildon, who was a resident in internal medicine at Laval University at the time of the study.
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