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Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations
  1. Lori Seller1,2,
  2. Marie-Ève Bouthillier3,
  3. Veronique Fraser1
  1. 1 Centre for Applied Ethics, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2 Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
  3. 3 Centre d’éthique, Direction qualité, évaluation, performance et éthique, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Quebec, Canada
  1. Correspondence to Lori Seller, McGill University Health Center, Montreal, QC H4A 3J1, Canada; Lori.seller{at}


Background Medical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.

Methods A retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.

Results Of 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.

Interpretation We highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

  • euthanasia
  • palliative care
  • end of life care
  • regulation

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  • Contributors LS conceived of the project and developed the research protocol with input from VF and M-EB. LS and VF did the data collection. LS, VF and M-EB summarised the data into tables which LS used to calculate descriptive statistics. LS and VF co-wrote the manuscript. M-EB assisted with data analysis and interpretation. All authors provided critical feedback and approved the finalised draft for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This research study was reviewed and approved by the Research Ethics Board of the McGill University Health Centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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