MONTREAL -- A coroner's inquest into deaths in Quebec long-term care homes during the first wave of COVID-19 was dominated Tuesday by debate over whether medicating certain residents to alleviate their suffering amounted to euthanasia.

The discussion came a day after a doctor from Montreal's Jewish General hospital told coroner Gehane Kamel that some of the long-term residents who died of COVID-19 would likely have been saved with oxygen or rehydration treatments.

Dr. Vinh-Kim Nguyen testified Monday such treatments weren't always available in the understaffed and under-equipped long-term care homes, adding that there were "numerous obstacles" preventing doctors from transferring residents to hospital. Instead, Nguyen said the only available treatment in the homes was often respiratory-distress protocols intended for people at end of life, which consisted of a strong cocktail of drugs used to reduce suffering.

"These are protocols that lead to death … it was in fact euthanasia," he testified on Monday.

On Tuesday, another witness, Dr. Marjorie Tremblay, insisted the protocols don't cause death.

Tremblay, a palliative care specialist who developed the protocol, said the medication was used to ease suffering. Its effects include "controlling respiratory rhythm," "managing anxiety," and controlling and preventing rattling in the lungs, she said. In the case of COVID-19, she added, the medication also helps prevent contagion by reducing coughing.

Tremblay said the treatment can be stopped if the patient improves.

"We have to stop thinking that morphine kills," she told the inquiry. "It's COVID that killed the patients."

The protocol pioneered by Tremblay specifies that there should be continuous evaluation of the patient's state based on several criteria and under the supervision of a doctor.

But on Tuesday, both Kamel and another coroner assisting her, Dr. Jacques Ramsay, questioned whether the directives were always followed to the letter during COVID-19's first wave.

"Your protocol implies a medical presence, which was not always necessarily in place," Ramsay said, expressing concern that some patients' symptoms may actually have stemmed from conditions such as dehydration.

Because the protocol itself doesn't cure patients with the virus, it is only supposed to be given to patients who are assigned to a lower level of care after refusing more aggressive treatment.

But Kamel pointed out that in a chaotic situation, the usual checks and balances are not always in place.

Witnesses have told the inquiry that workers at long-term care homes had called residents' families to convince them to agree to a lower level of care for their loved ones, often without explaining the consequences of that choice.

Kamel said Tuesday that Tremblay's protocol presumes that families have been properly consulted and the patients' levels of care have been properly reviewed. But she pointed out that the reality during COVID was that doctors "weren't present for the most part," and that families were no longer allowed inside the care homes.

Kamel strongly suggested tightening the rules surrounding the use of the protocol.

The coroner's inquest is examining the deaths of elderly and vulnerable people who died in residential settings during the first months of the COVID-19 pandemic. The intent is not to assign blame, but to come up with recommendations to prevent similar tragedies.

About half of Quebec's COVID-19 deaths during the first wave occurred in long-term care homes, and some 92 per cent of people who died between Feb. 25 and July 11, 2020, were 70 and older, according to the province's public health institute.

This report by The Canadian Press was first published Nov. 2, 2021.