Where do you want to die?

A recent poll asked Quebecers where they wish to spend their final days. The results may surprise you.

Would you prefer to die at home? If so, and you’re in the minority, at least in Quebec. According to a 2021 survey of a thousand Quebecers aged 65, fewer than one out of two favour spending their final days in their own home.

The survey was conducted by Léger Marketing for an interuniversity team of four experts in the field: Isabelle Van Pevenage , a sociology professor at Université de Montréal and researcher at the Centre for Research and Expertise in Social Gerontology (CREGÉS); Valérie Bourgeois-Guérin , a psychology professor at Université du Québec à Montréal; Marianne Kempeneers , a sociology professor at UdeM; and Patrik Marier , a political science professor at Concordia University.

Closing life’s final chapter

In Quebec, the survey suggests, 71 per cent of people would prefer to spend the end of life in the comfort of their own home, but only 49 per cent want to actually die at home.

A person at the end of life is "someone who has been diagnosed with an incurable medical condition and whom doctors believe will die within a year," Van Pevenage explained.

"This end-of-life period typically lasts from a few weeks to several months, during which the person’s health and autonomy gradually decline. It is followed by the ’active dying’ period, which includes the terminal phase of the illness and death itself. There is generally a greater need for care during this phase, as the patient’s clinical condition becomes unstable and their loss of autonomy accelerates. The person is in the last hours or days of life."

Hospices often overlooked

Palliative care homes are sometimes left out of the discussion but they were the second choice of respondents to the survey: 22 per cent said they would want to spend the end of life in a hospice and 37 per cent would prefer to die there.

In all, 93 per cent of respondents said they would prefer to spend the end-of-life period at home or in a hospice, and 86 per cent said they would prefer to die at home or in a hospice.

"The problem is, not everyone has equal access to palliative-care homes," Van Pevenage said. "Admission often depends on having a certain prognosis. People with cancer are generally the ones who qualify for hospice care, so many seniors suffer a form of social exclusion from hospices."

The female perspective

The survey results also differ significantly by gender: 61 per cent of men would prefer to die at home compared with only 39 per cent of women. Van Pevenage suggests it may be because women don’t want to burden their loved ones.

Women are also less optimistic than men about having their end-of-life wishes fulfilled. About 32 per cent of women who want to spend their final days at home believe they will be able to do so, and 36 per cent of women who want to die at home believe it will be possible. For men, the numbers are 45 per cent and 44 per cent respectively.

Van Pevenage draws on French sociologist Bernard Lahire ’s theories on social mobility to explain the gap between men’s and women’s viewpoints. Asking why disadvantaged youths are less inclined to pursue higher education, Lahire suggested that "what is not objectively accessible does not become subjectively desirable."

An educational divide

The survey also found that Quebecers with more education are more likely to want to spend the end of life at home and to die at home. They’re also more optimistic that those wishes will be fulfilled.

It is important to note that the survey was conducted during the COVID-19 pandemic, and that highly educated respondents were less prone to say that COVID-19 influenced their choice of home as the place to die.