Québec - 1331 reported euthanasia deaths (April 1, 2018 - March 31, 2019) At least 13 deaths did not comply with the law.

Fourth report from Québec's Commission on end-of-life care

By Amy Hasbrouck and Taylor Hyatt 

Toujours Vivant - Not Dead Yet.

On October 2, Québec’s Commission on end-of-life care released its fourth report for the period April 1, 2018 to March 31, 2019. The Commission reported a substantial increase in the number of euthanasia over the previous years. They reported:

Link to the analysis by Amy Hasbrouck and Taylor Hyatt on the previous Third Québec report (Link).

• There were 1,331 euthanasia were reportedly performed this year April 1, 2018 - March 31, 2019). Added to the 1,630* for the 28 months from December 10, 2015 to March 31, 2018, bringing the total to 2,909 euthanasia in Québec since the program began. We’ll talk in a few minutes about why those numbers don’t add up.
• Continuous palliative sedation (CPS) was performed on 1,243 people during the reporting period. Added to the 1,704 CPS performed during the 28 months from December 10, 2015 to March 31, 2018, this brings the total to 2,947. 
• Euthanasia and CPS each accounted for 1.9% of deaths in Québec during the reporting period, for a total of nearly 4% of all deaths in the province. 
• *As explained in footnote 19 on page 27, 1,630 euthanasia deaths is a corrected total from the Commission’s summary report issued last spring. Apparently “two MAiD reported by an institution as having been administered were not administered.” 

The exact number of euthanasia deaths is hard to pin down from the report.

• On pages iii, 12, 27 (footnote 19), 37 and 38, the report says “1,279 people received MAiD between April 1, 2018 and March 31, 2019.” This figure, when added to the 1,630 from previous years, gives the reported total of 2,909.
• But on page 23, the report says “according to reports from institutions, 1,937 requests for MAiD were made between April 1, 2018 and March 31, 2019; of these, 1,271 were administered and 672 were not administered.” 
• The 1,271 figure, added to the 60 euthanasia performed by doctors outside of institutional settings and reported by the Collège des médecins du Québec (CMQ), gives a total of 1,331 euthanasia. 
• Maybe you’ve noticed that 1,937 minus 672 does not equal 1,271, but rather 1,265. The six missing people are accounted for in a note in figure 3.17 which does not show the outcome of the six euthanasia requests in region 10. The Commission explains: 
• “In order to respect the rules of confidentiality, and because of the risk of identification related to the disclosure of a small number of individuals, the exact distribution of the euthanasia administered and not administered could not be provided.” 
• As for the 1,279 figure used elsewhere in the report, we don’t know where it comes from, or if it includes the 60 euthanasia reported by the CMQ. And if you think we’re being nit-picky, just remember that euthanasia laws are supposed to impose “stringent limits” that are “scrupulously monitored and enforced.” 

This year, the Commission received 1,400 euthanasia reports, some of which document euthanasia performed before the reporting period. 

“The Commission notes that 86 forms were received more than six months after the administration of MAiD and some of them more than one year later.” 

A few things to note about the Commission’s process:

• The Commission can only evaluate compliance with the law; it has no influence over other aspects of the medical practice, even if they could affect euthanasia. So, for example, if the doctor makes a mistake in diagnosis or the cause of a decline in capacity, that would probably fall outside the Commission’s area of responsibility.
• Two-thirds of the commissioners must agree that a violation has occurred for a finding of non-compliance to be made. Such cases are referred to the institution’s Council of Physicians, Dentists and Pharmacists (CPDP) and the Collège des médecins du Québec. There is no remedy for the loved ones of ineligible people who are euthanized, or where safeguards are ignored. 
• This year the Commission introduced a new procedure for evaluating reports, in response to the growing number of euthanasia. Declarations are examined by a sub-group including at least three commissioners; if all group members agree that the eligibility criteria were met and the safeguards complied with, the case is recommended for approval by the whole commission. If there is disagreement in the small group, the case is referred to the full commission for further discussion. 

The commission took a first look at 1,384 reports, and needed more information or had questions on 31%, or 430 of them. The Commission found that 96% of the 1,354 cases it ruled on complied with the law, but it could not reach a decision in 41 cases (3%) because they didn’t get the information they requested from the doctor. The commission found that 13 euthanasia (1%) did not comply with the law.

• Four people were not eligible: 
• Three people did not have a serious and incurable illness (they all had broken hips); 
• One person’s medical insurance card had expired. 

• In nine cases, safeguards were violated. 
• The second doctor examined the person before the euthanasia request was signed in five cases. 
• The doctor did not conduct the interviews to ensure that the request was informed, that the person’s suffering persisted and they still wanted euthanasia. “In two cases, the physician who administered the MAiD met the person only on the day of the [euthanasia].” 
• One request form was witnessed by a non-qualified person. 
• “In one case, the second doctor consulted had a family connection with the doctor who asked for the opinion.” 

Of those who asked for MAiD, 65% received it.
The three most common reasons euthanasia was not administered were:

• The person was not eligible (246 people, or 37%)
• The person died before the evaluation process was completed or before MAiD could be administered (224 people, or 33%) 
• The person withdrew their request (127 people, or 19%). 

Forty percent of those approved were euthanized within ten days of making the request.

The Régie d’assurance maladie du Québec (RAMQ) reports that 682 doctors billed for services related to MAiD. According to the CMQ, of 23,478 doctors registered, 480 say they performed euthanasia in 2018.

If there’s a take-away message from this report, it would probably be that the number of euthanasia deaths is increasing rapidly, and procedures are still handled in a slip-shod manner. We still wouldn’t get on an airplane with a 1% chance of crashing, and a 3% uncertainty factor.