Couillard Warns AMM Expansion Goes Too Far in Canada

Former Quebec premier Philippe Couillard has raised concerns that expanded access to medical assistance in dying in Canada may have moved beyond the limits he envisioned when his government introduced Quebec's first law authorizing the practice in 2014.

Couillard, a former neurosurgeon, said he is uncertain whether he would support the original law again because eligibility rules have widened in recent years. He discussed the issue during an appearance on CBC's The House.

"I am not sure I would vote for this law again given the expansion we have seen in recent years," said Philippe Couillard, former Quebec premier.

Couillard said the initial framework was intended for people facing terminal or pre-terminal illnesses with an inevitable fatal outcome. He argued that the current system no longer follows that same boundary.

"At the beginning, medical assistance in dying was clearly reserved for illnesses in a terminal or pre-terminal phase, with a fatal and inevitable outcome. That is no longer the case today," said Philippe Couillard, former Quebec premier.

Quebec expanded access further in 2024 by allowing advance requests for medical assistance in dying. The measure allows some people, including those living with Alzheimer's disease, to make requests before they lose the ability to provide consent.

Couillard recalled warnings he received from opponents of the original legislation, who argued that expanding access could continue after the initial law was adopted.

"Your motivation is good, but you will see, once the door is opened, you will not close it again and it will open even further," said former opponents of the law.

The former premier said he hopes the province did not move too quickly. According to the Commission on End-of-Life Care, medical assistance in dying accounted for 7.9% of deaths in Quebec in 2024-2025, the highest share among jurisdictions cited in the report.

"I hope that we did not act too quickly," said Philippe Couillard, former Quebec premier.

Couillard also said his support for the original legislation was shaped by experiences from his medical career, including patients he treated who suffered severely before the law existed.

"I think of specific patients I knew during my medical career who suffered so much," said Philippe Couillard, former Quebec premier.

Other jurisdictions with legalized medical assistance in dying recorded lower proportions of deaths linked to the practice, according to figures cited from the Commission on End-of-Life Care. The rates were 5.8% in the Netherlands, 3.8% in Belgium, and 2.5% in Switzerland.

The debate continues as the federal government recently decided not to expand medical assistance in dying to people whose only underlying condition is mental illness. The government has still considered future consent options where provinces allow them.

Isabelle Marcoux, a professor and co-director of a medical assistance in dying research consortium, said experts and politicians remain divided over whether mental disorders alone should qualify as a basis for a request.

"There is a lot of disagreement among the different groups of experts and politicians who have examined the issue of whether or not to include mental disorders as a sole factor justifying a request for medical assistance in dying," said Isabelle Marcoux, professor and consortium co-director.

Marcoux said the consortium is studying factors that may explain Quebec's high use of medical assistance in dying, including population characteristics, access to services, social acceptance, and media coverage.

Canada's medical assistance in dying law initially required a person's death to be reasonably foreseeable when it was adopted in 2016. The federal law was later changed after a Quebec Superior Court ruling invalidated that requirement in 2019.