The steady increase in requests for medical assistance in dying (MAID) has made Quebec the world leader in this practice, which accounted for 7.9 per cent of deaths in the province in 2024—2025. However, a longtime palliative care doctor says the province falls short when it comes to the ability to die with dignity at home from old age. The proportion of natural deaths at home in Quebec — which hovers around 10 per cent to 11 per cent — is dismal by comparison, said Geneviève Dechêne, a family doctor for 45 years who has worked exclusively in home-based palliative care for the past two decades. She said the proportion of natural deaths at home is higher in the rest of Canada. “The lowest rate in the West is in Quebec. People come here to see what not to do,” said Dechêne. Despite the potential of at-home palliative care to reduce costs and relieve the pressure on emergency rooms, the provincial government is making little progress in expanding it, she says. Dechêne is the founder of a home intensive care team at a hospital in the Verdun borough of Montreal. In her opinion, there is no doubt that the lack of adequate palliative care contributes to the rise in MAID, even though Quebec’s commission on end-of-life care refuses to make this connection. It isn’t easy to access palliative care outside of hospitals or long-term care facilities in Quebec. In its 2022 Directory, the Canadian Hospice Palliative Care Association listed only 35 palliative care residences in Quebec, totalling 335 beds — compared to an aging population of just over nine million people, a quarter of whom will be over 65 by 2030. The province also has six palliative care day centres and 25 home intensive care teams. “At this rate, we’ll probably be in good shape by 2055, but by then, all the baby boomers will be dead,” she said. “But the crisis in hospital care — overwhelmed by people who don’t want to be there and don’t need to be there — is happening right now.” Saying that these dying patients don’t need to be in the hospital isn’t just a figure of speech, said Dechêne. That’s where a home intensive care team, on call 24/7, comes in. “When we’re called to the deathbed of a man we’ve known for a year, we’re already prepared. It’s the same nurse and the same doctor who will go to the ER to see him. The family is prepared … that’s the ideal scenario, as opposed to suffering terribly for 12 months with repeated trips to the ER,” she said. The organization Aux trois sentiers is a pilot project that also provides end-of-life care at home, but only during the final moments of life, explained its founder and president, Caroline Ouellet, an anesthesiologist and intensivist. “What sets us apart is really that we offer an alternative to hospitalization. We all share the same goal: to keep our patients out of the emergency room. We’ll get you out of that four-bed room in a dilapidated hospital and bring you back to the comfort of your own home,” she said In its January 2024 pre-budget brief, FADOQ, a network representing seniors in Quebec, cited studies showing that home-based palliative care programs lead to 65 per cent fewer hospitalizations and to a 50 per cent reduction of costs during the final year of life. Despite these savings, the government is slow to invest in this area, said Dechêne. She doesn’t mince words when it comes to denouncing the hospital-centric nature of the Quebec health care system. The provincial government encourages family doctors to work in hospitals to curb deficits in certain hospitals, she said. She says that family doctors like this model. It pays them well, is highly valued and gives them privileged access to specialists, unlike their colleagues in private practice, but it doubles government expenses, she says. “We pay the family doctor, and we pay for the specialist’s consultation. That’s not very cost-effective,” said Dechêne. In an email, Santé Québec, a government-owned health corporation, said intensive home care services were “fully in line with government guidelines on home support (and) recognized as an essential component for providing more intensive acute (short-term) care at home.” However, when pressed further about plans to develop these services, it said there are no separate policies for intensive home care, as it is seen as part of overall home support services. When asked about the possibility of adding intensive home care teams during a May 8 announcement of an investment in home support services, Quebec Health Minister Sonia Bélanger first praised Dechêne’s team. “People want to spend their final days in their own living environment. So, to achieve that, we need to expand home support services. We are fully committed to that,” she said. Ouellet believes that to develop home-based palliative care, the government will have to spend before they can save. “If we keep sending our dying patients to the hospital, sooner or later we won’t be able to perform surgeries, we won’t be able to administer chemotherapy, and we won’t be able to treat pneumonia. The math just doesn’t add up,” she said. Older Quebecers, she said, have experienced the deaths of their parents and do not want to die the same way. “I don’t want to be a burden, I don’t want to lose my mental faculties, I don’t want someone changing my diapers. I don’t want to put my children through that,” she added. This, she believes, is one reason for the popularity of MAID. “We’ve placed a great, great deal of emphasis on the link between dignity and MAID as the only way to die with dignity, when that’s simply not true. You can very well die with dignity when you have access to good end-of-life care.” “If we no longer champion assisted dying, it will mean that we’ve sufficiently developed and funded robust palliative care as an alternative to hospitalization — which, yes, will cost money, but will save the health care system, citizens, and society much more in the long run. Then we’ll be able to say we’ve won our battle.” This report by The Canadian Press was first published Aug. 4, 2026. Pierre Saint-Arnaud, The Canadian Press
