You are entirely correct. We must certainly not see it as a failure, but as an element in a continuum of care, quite simply.
Again, medical assistance in dying is a legitimate and legal type of care; it is not a shameful type of care. I have been involved in palliative care for 37 years and in medical assistance in dying since the beginning, and I have never promoted medical assistance in dying. In my opinion, that care is no more or less honourable than palliative care, sedation or refusing treatment. What is important is to offer the patient the options that are available, explain them clearly, and make sure the patient is making the decision based on their own values, beliefs and convictions.
In the field of palliative care, some of the opponents of medical assistance in dying oppose it based on religions conviction, which is often carefully concealed, and some out of ideological conviction. We could so a whole psychoanalytic examination of this. We know how important palliative care is and how significant a role it has played in the last 30 years. It was essential to be able to offer it to all Quebeckers. So I think that some physicians see medical assistance in dying as an admission of failure. They may unconsciously feel that they have failed when they find themselves in a situation where they have promised to support a patient until their death and they have to tell the patient that they can no longer support them at their end of life because the patient has made a choice they oppose.
Personally, as a palliative care physician, when I get a request from a patient who tells me that the oncologist says there is nothing left to be done, I tell them that there is everything left to be done, that we will do it together and I will hold their hand to the end, regardless of what end of life choice they make. I tell them I will be with them and I will respect their choice.