Thank you very much for the question, which is indeed important.
Opponents of medical assistance in dying have long tried to portray medical assistance in dying and palliative care as mutually exclusive. That is the tactic that says you are with someone or against them. In fact, they are not in conflict. As I said, they are complementary and interrelated forms of care.
In Quebec, when the Act respecting end of life care was enacted and medical assistance in dying began to be offered, all public health institutions in Quebec had an obligation to offer this end of life care to all Quebeckers and to make it available.
The idea is not to impose medical assistance in dying, but to make it available. The only exception was for hospices, which are autonomous institutions managed by their own boards of administration. Originally, in December 2015, all these institutions had said they would never offer medical assistance in dying, because it was contrary to palliative care.
Determining for a patient what is the best way to die, for them, smacks of a medical paternalism that has no place in 2022. As caregivers, as physicians, our role is to inform the patient of the options available to them, make sure they clearly understand, and respect their choice, regardless of our own choice, our own values and our own convictions.
In end of life situations, there aren't 50 options, there are four: palliative care, medical assistance in dying, palliative sedation, and refusing or stopping treatment.
I'll come back to the 34 hospices—there are now many more than that in Quebec—that refused to offer medical assistance in dying. Today, more than half of them also offer medical assistance in dying in the care they provide.
We are focused on what the public requests and the interests of patients. One fact has always been true: among the patients who entered hospices, many requested medical assistance in dying along the way, because they could not suffer any longer. All that they could be offered was to put them to sleep until they died. That is not what people wanted.