How Quebec Left the Church and Became the World Leader in Assisted Dying

The wood-paneled wall, surrounded by surfaces in muted white and blue, gave the room the feel of a boutique hotel. A lone bird flew near an iceberg in a framed photograph above a coffee maker, a stereo system and a landline.

But the sofas and armchairs were oriented not toward the wall-mounted TV but toward the medical bed at the center of the room. A large plastic container for used syringes hinted further at the place’s purpose: a facility for medically assisted dying.

The room was inside a new palliative care center in Lanaudière, a region of Quebec where 13 out of 100 people die through assisted death. That is the highest rate in the province, itself the world leader in assisted deaths, according to Canadian and Quebec government reports. Built with money from private donors and run by the provincial government, the center reflected two elements that have propelled Quebec to the top: assisted death’s integration into the public health care system, and its broad public support.

Since Quebec pioneered assisted dying in Canada in 2015, it has fueled a profound social transformation in the French-speaking province. Choosing to die, on one’s own terms and without suffering, is now seen as an individual right in a society that has rejected the Roman Catholic Church’s teaching that euthanasia is a grave sin.

“This is a social phenomenon that has grown exponentially,” said Dr. Louis Daigle, an emergency physician in Lanaudière who has administered 662 medically assisted deaths since 2017. “A lot of people now idealize this way of dying, with dignity, so much so that I think there is a belief that there are now two good ways to die: either suddenly or with medically assisted dying.”

The rapid increase — 8 percent of all deaths in Quebec are now from assisted dying, compared with 5 percent in Canada overall — has raised questions in and outside of the province. Opponents in France, which is now debating assisted death, have pointed to Quebec as a cautionary tale: a society that embarked on a slippery slope toward the expansion and normalization of assisted dying.

Quebec’s Commission on End-of-Life Care, which oversees assisted dying in the province, reviews each case after death to ensure it adhered to the law, said its president, Dr. Lucie Poitras.

Unlike in the rest of Canada, Quebec society — lawmakers, health officials, ethicists, and patients and religious groups — held an official public debate lasting several years before legalizing assisted dying in 2014, Dr. Poitras said. That built a societal consensus around “the importance of autonomy or control over one’s death, which is very strong here,” she said.

“Quebec’s rate is higher than anywhere else in the world,” Dr. Poitras said. “Does an optimal rate exist? I don’t think so.”

But even some supporters say that the province needs to take a hard look at what has made it the global leader after only one decade, leapfrogging countries with long-established assisted dying laws like the Netherlands.

Manuelle Légaré, a well-known television producer, recently created a play, “Club Sandwich Mayonnaise,” about the assisted death of her father, the comedian Pierre Légaré. The play hit a chord by asking sensitive questions: Was assisted dying still a last resort? Did lack of adequate health care push people toward it? Did Quebec widen access too quickly — at the start, for those with a terminal illness, extending in recent years to people with chronic illnesses or dementia?

“I wanted to call a timeout,” Ms. Légaré, who otherwise supports assisted dying, said in an interview. “Yes, we had a big debate before we legalized it, but it’s evolved without asking too many questions.”

Researchers point to a host of reasons. In the province, it has been framed from the start as a way to die in dignity, avoiding terms like “euthanasia” or “assisted suicide” used in some European countries. In Quebec, only doctors or nurse practitioners can administer an assisted death, while elsewhere only the patient is allowed to perform the final act.

“In jurisdictions where doctors write a prescription but patients have to take it themselves, the rates are much lower,” said Isabelle Marcoux, a University of Ottawa professor and a leader of a network researching assisted dying in Quebec.

Assisted dying is covered fully by Quebec’s public health insurance. Doctors are allowed to initiate conversations with patients about assisted dying as an end-of-life option, whereas patients must bring it up first in places like Australia and some American states, said Marie-Ève Bouthillier, a bioethicist at the University of Montreal who is also a leader in the research network.

But experts say that the rapid increase cannot be separated from the history of modern Quebec. In a social transformation known as the Quiet Revolution, the province’s historical French majority began moving away in the 1960s from the Catholic Church, which had exercised a grip on most aspects of their lives. Within a generation, a once deeply conservative and religious society defined itself through its social progressivism.

The Catholic Church has been the biggest opponent of assisted dying in Quebec, arguing that it is morally wrong to end life even to relieve suffering and that such acts cannot be considered care.

In what many experts regard as a continuing rejection of church teachings, assisted dying is highest in regions with heavy concentrations of French Québécois, like Lanaudière, which stretches 150 miles northeast from the suburbs of Montreal into the forests of central Quebec. Lanaudière’s death rate from assisted dying, at 13.4 percent, is much higher than the provincial average of 7.9 percent.

In Lanaudière, assisted deaths are concentrated in the region’s northern half, where a quarter of the predominantly French Québécois population is 65 or older, compared with 21.7 percent for the province at large.

Dr. Daigle, who has carried out 662 assisted deaths, said he often hears references to religion among his patients, most of whom are over 80 and have late-stage cancer.

“They say that when they were growing up, they were told that they had to suffer to go to heaven, but now they say that makes no sense at all,” Dr. Daigle said. “They came to realize at some point that the old values made no sense, that there was no point in suffering like that.”

The shift toward assisted dying has found concrete expression in the new Palliative and End-of-Life Care Center in Saint-Charles-Borromée, a suburban town about 50 miles northeast of Montreal. When a charity, the Northern Lanaudière Health Foundation, reached out to locals to help build a palliative center — with a room for assisted dying — it quickly raised the necessary 8 million Canadian dollars, or about $5.8 million.

A donor, Jean-François Champoux, the president and chief executive of St-Michel Sawmill, said the center would make the region more attractive and help companies recruit workers.

“A few years ago, it wouldn’t have been possible to even talk about this,” said Mr. Champoux, 48, who gave $73,000 worth of lumber toward the construction.

For years, palliative care physicians opposed assisted dying, though many have now accepted it, said Dr. Virginie Plante, who practices both at the center.

The change was also the result of a 2023 Quebec law that required palliative care centers to include assisted dying among its services.

At the palliative care center in Saint-Charles-Borromée, three employees oversee a central system that receives all assisted dying requests in the region. More than 300 people have died at the center since its opening last September.

“Instead of at home or in a hospital, they come here, they’re welcomed, it’s peaceful, they have their space to die with dignity,” said Caroline Léger, the center’s director.

Claude Rivest and Georgette Robillard donated about $150,000 toward the center after several people close to them selected assisted dying.

Ms. Robillard, 89, said she immediately understood when her brother made that choice as pancreatic cancer racked his body.

“There was no chance that he’d be cured,” she recalled. “It was better to accept it than see him suffer.”

A longtime employee with terminal cancer had also recently chosen assisted death, in part to prevent his ailing wife from getting worse through the strain of caring for him.

“I don’t think the good Lord wants us to suffer like that; the good Lord, it seems to me, must be good,” said Mr. Rivest, 85, who said he moved away from the church over the years but still watched Sunday Mass on TV. “He must understand that suffering for another month or two doesn’t do anyone any good.”