On Queer Aging and Endings: in conversation with Christian Schulz-Quach

For Christian Schulz-Quach, working with death has never been only about endings. As a psychiatrist and palliative care physician at University Health Network, and an associate professor at the University of Toronto in the department of psychiatry and the Institute of Health Policy, Management and Evaluation, he has spent over two decades exploring how people find meaning in the face of serious illness and mortality.

Having trained and worked in both Europe and Canada, Schulz-Quach says that his work has always lived at the intersections — “between medicine and psychoanalysis, between clinical care and systems change, between different countries and cultures.”

Through his leadership of the sexual and gender diversity in cancer (SGDc) care program at Princess Margaret Cancer Centre, he works to make health care more inclusive and affirming for 2SLGBTQIA+ communities.  

Recently, Schulz-Quach stepped into a new creative chapter with the release of his first documentary, On Queer Aging and Endings, which was selected for the BFI Flare: London LGBTQIA+ Film Festival 2026.

He spoke to writer Julia Soudat about the experience of confronting mortality, the power of storytelling through film, queer resilience, and the importance of seeing people in their full complexity.

What first drew you to medicine? Early on, did you expect to focus so heavily on death and end-of-life care?

No, I didn't. I came to medicine wanting to help people, to heal — the usual reasons. But in 2003, while I was still in medical school, my aunt died from leukemia at age forty-two. I was twenty-three, and circumstances meant I was the only family member present during her final hours. That experience — witnessing someone I loved die — changed everything for me. Shortly after, a nurse invited me to help prepare her body before the rest of my family arrived. That encounter taught me something medical school hadn't: that there's a dimension to caring for dying people that goes beyond clinical knowledge. Working with mortality became a way of finding meaning after profound loss. It's less about death itself and more about learning how to be genuinely present with people during the most vulnerable moments of their lives.

Were there moments when working with dying patients — or those providing care for them — that changed how you understood death and aging?

Many moments. What changed my understanding most were systematic attempts to explore how people make meaning around mortality.

One formative experience was leading large public discourse projects in Germany. The first, "30 young people talk to dying people and their relatives," invited young people to have filmed conversations with dying patients and their families and made these conversations publicly available online. What surprised me wasn't just what happened in those intimate conversations, but afterwards — young people posted drawings of the patients they'd met, wrote about their deaths weeks later, shared their grief publicly. Recipients from around the world would engage in dialogue about mortality in ways that felt unprecedented.

We followed this with "30 Gedanken zum Tod" (30 thoughts on death), where we interviewed thirty individuals representing different perspectives on death confrontation — professionals who encounter death intellectually like judges and theologians, those who relate to death through caring like paramedics and physicians, and people facing their own mortality like seriously ill patients and their families.

These projects taught me that the so-called "death taboo" isn't inevitable. When you create space for genuine conversation, people want to engage. Confronting death has a paradoxical quality — it's both anxiety-provoking and profoundly meaning-making. I've noticed this in almost every colleague in palliative care. We're drawn to this work not despite its difficulty, but because proximity to mortality clarifies what matters most.

What does working closely with death teach you that medical training alone does not?

Medical training teaches you to solve problems, to intervene, to fix what’s broken. It doesn't teach you how to sit with what can't be fixed. Working closely with death teaches you that presence itself is a form of care — sometimes its most important form.

One of the most significant things I've learned is what gets called the "diversity phenomenon" at the end of life — this existential gap between someone who's dying and those of us who accompany them as witnesses. Their experience takes place outside the realm of what we can fully understand or empathize with. Medical training doesn't prepare you for that unknowing. It doesn't teach you that saying "I don't know" or simply being quiet can be more helpful than trying to explain or reassure.

Many clinicians, especially those frequently working with death or trauma, deal with emotional distance or burnout. What helps you stay engaged in this area of work?

Most important has been having access to spaces where I could talk about what this work does to me. Early in my career, I sought out psychoanalytic training not just to become a better therapist, but because I needed a framework for understanding my own responses to mortality. That ongoing supervision and self-exploration has been essential.

Creative expression has mattered too. I've used photography and filmmaking as ways of exploring my relationship to death. Making On Queer Aging and Endings was partly about finding a different language for these experiences that clinical language alone can't capture.

Equally important: family, friends and chosen family. The queer community has taught me about resilience and joy in the face of loss in ways that professional training never could. Queer joy isn't separate from this work; it's what makes it sustainable.

I want to be honest: staying engaged requires institutional support that isn't always there. When health-care systems don't create space for reflection or processing difficult deaths, people burn out. I've had to be intentional about seeking those spaces out and building them into programs like the SGDc. The work itself also sustains me — being close to mortality clarifies what matters and keeps me from taking relationships or time for granted.

What does good end-of-life care look like for queer and trans people, and where do health-care systems often fall short?

I think at its core, good care is about being seen and honored for who we are. Through our work in the SGDc program, we've tried to articulate this as working with patients “to understand your unique situation, what is most important to you, and what could be helpful to you, your caregivers and your chosen family.”

Chosen family matters enormously. Good end-of-life care for queer and trans people needs to recognize that the people at someone’s bedside might not be related by blood or marriage, but they are family. Health-care systems have historically struggled with this, sometimes creating painful situations where chosen family members are excluded from decision-making or even from being present. That exclusion compounds grief and isolation in ways that are hard to fully articulate.

It also means that identity doesn’t become irrelevant when someone is seriously ill or dying. A trans person needs their name and pronouns respected, their gender identity honored by all staff — not erased at the most vulnerable time of their life. One of the things I worry about most is queer and trans elders in nursing homes or long-term care feeling they have to go back into the closet to be safe. Aging and dying shouldn’t require hiding who you’ve been your whole life.

The failures I see happen at multiple levels — structural, interpersonal and often unintentional. Systems tend to apply heteronormative frameworks almost by default, assuming biological family, traditional milestones and conventional relationships. These assumptions don’t account for how many people actually live, love, grieve and find meaning.

Good care means having clinicians who understand our relationships, our histories and our community-specific experiences — the AIDS crisis, ongoing health disparities, the resilience we’ve built. It means creating spaces where LGBTQIA+ patients can be open about their lives without having to educate their health-care team or brace for judgment.

What do you hope people take away from this film?

More than anything, I hope queer folks feel seen. I hope people come away with a sense that queer aging and dying can be generative, creative, even joyful — not despite serious illness, but as part of a fully lived life.

I also hope the film creates space for conversations we don't have often enough. Queer spaces can sometimes avoid talking about aging and endings, but I've found that when we create space for these conversations, something remarkable happens. People stay afterward to talk, to share their own experiences of loss and grief and to find connection through these topics.

The screenings have become unexpected moments of collective witnessing — spaces where queer and trans people can see ourselves in Esben Esther and Elsa's story and feel less alone. That sense of recognition, of being seen in our full complexity, feels deeply affirming.

Ultimately, I hope people leave with the understanding that queer and trans lives deserve to be witnessed all the way through — not just celebrated in youth, but honored in elderhood and endings. That our stories of mortality matter. That we can imagine a world in which we face death queerly, on our own terms, surrounded by chosen family and held by community.