A Quebec report on end-of-life care reveals that the province is in a class of its own when it comes to euthanasia, though the rest of Canada is not far behind.

The work of the provincial Commission on End-of-Life Care, the 130-page report presented Feb. 18 to the Quebec National Assembly compiles five years of data (2018-2023) and contrasts the practice of assisted suicide and euthanasia in nine jurisdictions, including several U.S. states, Canada, Quebec, the Netherlands and Belgium.

The authors of the report say the differences between jurisdictions is “astonishing” and speak of “explosive growth in Quebec and Canada.”

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A graph that displays the number of euthanasia deaths per million of the population in the Netherlands, Belgium, Quebec and Canada from 2003 to 2023 provides a stark picture of those differences. Though euthanasia deaths have increased in all jurisdictions, particularly since 2020, “annual growth is much higher in Quebec and Canada (30 per cent to 50 per cent) than in Belgium and the Netherlands (10 per cent to 20 per cent).

“In Belgium and the Netherlands, too, growth was not as strong as in Quebec and Canada in the first few years after legalization.”

Euthanasia deaths in 2023 accounted for 7.3 per cent of all deaths in Quebec (in 2020, it was 3.1 per cent), contrasted with 5.4 per cent in the Netherlands, 4.1 per cent in Canada, and 3.1 per cent in Belgium.

Though saying that the “differences are not explained,” the commission points broadly to the jurisdictional variations in the “social and health microcosm surrounding a person at the end of life, the community, its culture, the culture of the family and loved ones, the civil infrastructures of solidarity and the network of care and services.”

In addition to the sheer number of Quebecers opting for medical assistance in dying (MAiD), the nature of the suffering recorded in MAiD applications is another cause for concern among some commentators.

Close to half of Quebecers said they felt themselves being a burden on family, friends or health-care workers, 35 per cent report emotional distress, anxiety, fear or existential suffering and 22.8 per cent mentioned isolation or loneliness as a cause of their suffering.

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These numbers are consistent with those published in Health Canada’s 2023 report on MAiD. While 21.1 per cent of terminally ill applicants (Track 1) reported “isolation or loneliness” as a cause of their suffering, 47.1 per cent of non-terminally ill (Track 2) Canadians who applied for MAiD cited isolation as contributing to their decision.

Canadian Yuan Yi Zhu, assistant professor of International Law at Leiden University, has written extensively on MAiD in Canada. In an email exchange, Zhu told The Catholic Register that “these are shocking numbers.”

“Like almost every Western society, Quebec is unable to offer appropriate social and health care to its increasingly aging population, so MAiD effectively becomes a way for society to deal with those it cannot care for, all in the name of autonomy and dignity.”

The subject of social isolation, particularly among immigrants and seniors, has been the focus of academic study, policy initiatives and federal funding for many years. A 2010 study, Social Relationships and Mortality Risk: A Meta-analytic Review, compared the increased chance of early death due to a lack of social connections to the mortality risk in smoking 15 cigarettes a day.

Dr. Kristine Theurer, researcher and president of Java Group Programs, an organization that provides standardized peer support programming for senior living, told the Register that loneliness has been “an issue for such a long time, way before COVID. COVID just brought it into the limelight.”

“People are dying, literally dying, for real meaningful connection with other people. When I say dying, the research shows that people are more likely to fall, to get heart disease, to get cancer, when they do not have those connections in their life.”

Zhu said the most worrying aspect of the euthanasia statistics is that “Quebec and Canadian society remain broadly supportive of MAiD.”

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“The reality is that, once legalized, assisted suicide and euthanasia coarsen a society's sense of morality. Quebec just happens to be a very stark example of this phenomenon.”

In her introduction to the report, commission president designate Lucie Poitras writes, “the progress made in end-of-life care in Quebec over the past 10 years is phenomenal and deeply rooted in social consensus. However, much remains to be done.”