Quebec population highly supportive of extending Medical Aid in Dying to incapacitated persons and people suffering only from a mental illness: Content analysis of attitudes and representations

In 2015, the province of Quebec in Canada became one of the few jurisdictions to legalize medically assisted dying. Thereafter, a public commission was mandated to study the extension of Medical Aid in Dying (MAiD) to incapacitated persons and people suffering from only a mental illness. To better understand debates concerning different forms of assisted dying and their eligibility conditions, we assessed the attitudes of the Quebec general population toward extending Medical Aid in Dying to incapacitated persons and those suffering only from a mental illness and their representations of those practices. We conducted an interpretative content analysis of 31 semi-structured interviews conducted as part of a large-scale study aimed at documenting Knowledge, Attitudes, and Representations of Quebecers regarding MAiD, continuous palliative sedation, and palliative care (KAR Study). Our analysis was complexified since participants often mixed responses regarding different current and proposed end-of-life practices, and they frequently declared a lack of knowledge of practices. To illustrate this emerging aspect of our results, we quantitated the content of the interview transcripts to create a structured qualitative dataset. Of the 31 participants, 29 were in favour of MAiD. All those in favour considered that the practice should be accessible to incapacitated persons and 27 of them believed that access should be granted to those who suffer only from a mental illness. However, 20 of the 31 participants (64.5%) confused the term Medical Aid in Dying with other legal forms of end-of-life practices such as palliative care, withdrawing, and withholding of life-sustaining treatments, and advance directives about treatment. Sixteen (51.6%) said they lacked knowledge about one or several of the end-of-life practices discussed in the interview. Although the participants were very favorable toward MAiD, there was widespread confusion in participants’ understanding of what constitutes MAiD, thinking it includes other currently legal end-of-life practices. It is not possible to determine whether our participants were in favour of the extension of MAiD to incapacitated persons and people suffering from mental illnesses, or if they were in favour of various currently legal end-of-life interventions for those populations.