The Quebec government has adopted Bill 11 - “An Act to Amend the Act Respecting End-of-Life Care and Other Legislative Provisions” - after local funeral director Mathieu Baker brought the subject of medical assistance in dying (MAID) back to the attention of provincial legislators. 

Baker is the owner Complexe Funéraire Brome-Missisquoi and Complexe Funéraire Haut Richelieu and he has been offering a space for individuals seeking assisted death services outside of the typical hospital or long-term care facility setting. 

After becoming aware of the situation, it sparked discussions around MAID at the provincial level and it led the government to review what was previously known as Bill 38. According to a written statement to CIDI from the communications team for the Ministry of Health and Social Services, the goal with Bill 11 is to ensure that “the principles of dignity and autonomy in decision-making” are at the heart of MAID through the expansion of the service - including where MAID can be provided and who is eligible to receive it - and it described the amendments as being “eagerly awaited” by Quebecers. 

Baker emphasized in an interview with CIDI that he was originally not on board with providing MAID in his facilities, but that he eventually came around after speaking with individuals that work in the health field and that have thorough knowledge on MAID in Quebec. After receiving a number of requests from families to receive MAID at his funeral homes, it was only natural for Baker to meet the needs of those who turned to him for help. While Bill 11 now allows him to offer MAID in his funeral homes, Baker said there are still some questions surrounding the amendments that he and other Quebecers hope to get answers to.  

“There was a high demand. People don’t necessarily want to die at their house and they certainly don’t want to go back to the hospital. If they aren’t in the system, even palliative care homes don’t necessarily like to deal with all that comes around medical aide in dying,” explained Baker. “Medical aide in dying has changed things dramatically. The funeral industry has changed, the people, it’s changed the medical view - it’s changed a lot. (…) It’s normal to have a lot of different opinions, but the reason why I started the service was simple: I was listening to my clients needs.”

Baker said the decision to provide the service took a lot of people by surprise, but that it’s not something he and his team took “lightly.”

“We were associated with a lot of doctors, especially in the Haut Richelieu region. (…) There’s a bunch of factors of why we start to offer it. Quite honestly, I was very hesitant. There were two doctors who persuaded me to offer the service so that’s where I am right now, but I am super happy that I made it happen,” he mentioned. 

Baker noted that demand for MAID through his funeral homes is not something that he dealt with a few years ago, but that he and his team have the skills to help facilitate the process for the families and the medical staff providing MAID.

“The person obviously receiving MAID has reflected on the issue and has decided to go with it. That person may have four or five children that may not necessarily be on the same page. There’s a lot of tension and stuff to deal with when it comes to for the actual event to take place. We are used of dealing with grief and we are used of dealing with these families, we are already in contact with these families. It’s certainly, to me, a totally natural procedure,” he explained. 

Under Bill 11, it is possible for someone to receive MAID in a place other than a hospital or a  palliative care home, including a funeral home. However, it specifies that "no person may promote or advertise a good or service provided as part of a commercial activity by associating it directly or indirectly with medical aid in dying, or demand any sum related directly or indirectly to obtaining such aid,” according to the Ministry of Health and Social Services. While Baker considers Bill 11 as a step in the right direction for MAID, he emphasized that he lacks some clarity on what this specific amendment means in terms of what he can or cannot do in terms of making people aware of MAID and what he offers. He mentioned to CIDI in a recent phone call that he has reached out to the provincial government for answers, but it suggested to reach out to his lawyers to help him better interpret the law. 

“I’ve been calling them repeatedly asking them to explain certain issues. We’ve been having phone calls after phone calls from families that want clarifications, it's not just us but them as well. I find it irresponsible for them not to answer my demands or at least for the families who are going through this difficult time,” he said. “(…) Not that I don’t want to, but I can’t spend an hour or two hours on the phone explaining to people that have all these questions about MAID. Some families want to tag us, they want to put it on Facebook. All of these things are unclear to me. I’d like to basically put a section on my website about MAID and the service that I offer and I don’t want to promote it or put it in the paper. I just want people to refer to it if they call me and I don’t have time to spend two hours explaining the different options.”

Despite the lack of clarity around marketing MAID, Baker emphasized that it is the most “dignified and personalized service” that he has ever offered and that people should have options when it comes to making decisions about their health. 

“It gives us a certain liberty. I was interviewed by France 2 - a big television [channel] in France- because in France, MAID is almost non-existent. People are going to Belgium to get MAID so you need the means, you need the time. That’s a lot of energy to go to a different country just to receive that,” he highlighted. “Here in Quebec, that is totally impossible because the first criteria of MAID is that you need the medical card of Quebec (which covers costs for MAID). A lot of people are looking at Quebec and Quebec is doing a lot of great things right now, but I think they need to do a lot due diligence and make things clear.”

One of the individuals that helped encourage Baker to offer MAID through his funeral homes is Josée Poisson. Poisson worked in the health field and returned to university to do a Masters in Applied Ethics focusing on MAID after realizing how some health professionals were uncomfortable with providing the service as result of not being thoroughly informed. She personally experienced MAID with her father when he grew ill and the family went through a number of options before they found themselves at the hospital. 

“Just before the pandemic, my father started having health problems and that’s why we spoke a lot about MAID while I was doing any Master degree. When my father realized that his condition was declining and that there was no way that his situation would improve,  he opted to ask for medical assistance in dying,” explained Poisson. “He didn’t want to die at home. He was living in a long-term care facility with my mother and he didn’t want my mother to be reminded of him dying in the apartment. Then I thought that we could do it at my home, but my children came home and even as adults they did not want to see their grandfather die in the living-room of the house. So we found ourselves going to the hospital.”

While the hospital staff provided her father with great care, Poisson describes hospitals as not being the “best place to have a calm and serene death.” It was when she went to the Complexe Funéraire du Haut Richelieu to establish the funeral services the family needed that she recognized the benefits of their approach and the location for MAID. She told CIDI that it was when the pandemic subsided that she contacted Baker to suggest that he open up his rooms to provide MAID when they’re not in use. 

“If we look at the statistics, there is already 1% of people that did not do MAID at the hospital or at a residence. There were already people receiving MAID in other locations. If I look at the experience of some doctors, sometimes it can be in hotel rooms and there are some people that have asked for it at the edge of the water in a place where they grew up,” she noted. “This was already happening.”

Recognizing a lack of awareness surround MAID, Poisson will be providing conferences in the fall at Complexe Funéraire Brome-Missisquoi that will be open to the general public. She emphasized that the end of life is still a significant moment and that people should have the right to choose  - and have options - as they enter their final days. 

“As of now, the majority of hospitals don’t have a reserved space for MAID, a separate room that’s bigger and adapted. If we found ourselves in a standard hospital room with all of the noise around us, the doctors talking, the nurses talking, it’s not a serene place,” she said. “(…) Those people that are against it taking place elsewhere can still choose choose the hospital or their residence, they aren’t constrained to choose a place they don’t want. I just want there to be a possibility of options for people, in their final days, so they can choose the place they want.”

Dale Weil, vice-president of l’Alliance des maisons de soins palliatifs du Québec, expanded further on Bill 11 by explaining that palliative care homes in the province have “never been against MAID and they have always respected the wishes of their patients.” However, there is one clause in Bill 11 that has presented a cause for concern for Quebec’s palliative care homes. Under the new law, palliative care homes must provide MAID on-site and they cannot refuse to provide the service to an individual that seeks their help for the sole purpose of receiving MAID.

More information on the amendments in Bill 11 can be found by visiting Quebec's National Assembly's website.

To hear more from Baker, Poisson and Weil on Bill 11 listen to the full program below: (note -- Poisson speaks in French)