Just as one debate over euthanasia is being settled, another is emerging over Canada’s plans to allow people to consent to medical aid in dying (MAID) at some future date when they are no longer of sound mind.
asserted
they → settle → mind
In a surprise move this week, federal Justice Minister Sean Fraser announced the Liberal government is fine-tuning a bill to be introduced sometime this fall that, in addition to placing an indeterminate hold on MAID for mental illness alone, would decriminalize “advance requests” for doctor-administered death.
asserted
that → announce → death
Critics say the government is preparing to cross a new line, this one based on the fundamental principle of consent.
asserted
government → say → consent
Performing euthanasia on the basis of a person’s advance request “will mean that people will receive MAID when they no longer understand what is happening to them,” said Trudo Lemmens, a University of Toronto professor of health law and policy.
asserted
Lemmens → perform → law
Another thorny ethical concern: who makes the final call that it’s time to act on an advance request once the person has lost the capacity to decide for themselves?
asserted
person → make → themselves
The Criminal Code generally requires that a person have the capacity to consent to receive MAID immediately before death is administered.
asserted
death → require → MAID
The Liberal government is proposing to change that.
asserted
government → propose → that
Here’s a look at why that’s making some people nervous.
asserted
people → ’ → ?
Advance requests would allow people who have been diagnosed with a serious and incurable disease that will eventually lead to incapacity to draft a document outlining the specific conditions under which they would prefer to die, which would then be provided after they have lost capacity.
asserted
they → allow → capacity
In its report following a “national conversation” on the issue, the federal government offered the hypothetical example of a man named “Charlie” who, after being diagnosed with Alzheimer’s disease, “decides that should his health decline rapidly and he starts experiencing intolerable suffering after he has lost capacity to make health care decisions, he would like to have MAID provided.”
asserted
MAID → follow → decisions
His advance request would set out conditions that, for Charlie, would constitute “endurable and intolerable suffering,” a formal criterion for MAID.
asserted
that → set → MAID
That could include not being able to feed himself, get out of bed or recognize his children.
uncertain
That → include → children
If these conditions were to arise, the advance request would state that it would be his explicit wish to be provided MAID.
asserted
it → arise → MAID
The Criminal Code currently requires that a person have capacity to give explicit, final consent before death.
asserted
person → require → death
The only exception involves people who are close to a natural death and have already been approved for MAID and have a date set, but are at risk of losing capacity before the scheduled date.
asserted
date → involve → date
In those cases, people can sign a waiver of final consent.
asserted
people → sign → consent
In March, Alberta became the only province to explicitly ban advance requests for MAID.
asserted
Alberta → become → MAID
Fraser said it will be up to provinces to decide whether to allow people to make advance requests.
asserted
people → say → requests
On Oct. 30, 2024, Quebec joined the Netherlands in accepting advance requests for people diagnosed with dementia and other serious conditions that will lead to incapacity.
asserted
that → join → incapacity
However, as the Montreal Gazette’s Aaron Derfel has reported, with no amendment to the Criminal Code, many MAID providers in Quebec are anxious about being prosecuted, despite the province’s directive to criminal prosecutors that pursuing doctors who comply with the provincial law would “not be in the public interest.”
asserted
who → report → interest
Even then, about 3,000 advance requests have now been added to a Quebec registry; between 30 to 40 deaths have been performed under the directives so far.
asserted
deaths → add → directives
What have Canadians said about advance directives?
asserted
Canadians → say → directives
According to the federal government’s recently conducted national conversation on the issue, an online questionnaire completed by more than 46,000 adults between December 2024 and February 2025 found 69 per cent supported advance requests for people diagnosed with a serious or incurable condition that will lead to a loss of capacity.
uncertain
that → accord → capacity
Twenty-six per cent said they oppose them.
asserted
they → say → them
Some participants in roundtable discussions said final consent is “an essential guardrail.
asserted
consent → say → discussions
Without it they said that vulnerable individuals would be at risk,” according to the report.
uncertain
individuals → say → report
Some questioned how people can make a truly informed decision, given they don’t know for certain what they’ll be experiencing in the future.
asserted
they → question → future
Likewise, some wondered how to manage circumstances “where the person meets the conditions set out in their advance request but appears to refuse MAID after they have lost capacity.”
“Euthanasia for people who are incapacitated is a very, very delicate matter,” Montreal family physician Laurence Normand-Rivest said this week at a press conference on Parliament Hill organized by the Euthanasia Prevention Coalition.
asserted
Rivest → wonder → Coalition
“They don’t have the privilege to consent at the moment where we kill them,” Normand-Rivest said.
asserted
Rivest → have → them
“They show a lot of resistance.
asserted
They → show → resistance
They need to be sedated.
asserted
They → need → ?
They don’t want an injection, and to have an IV …
asserted
They → want → IV
People think it will be a peaceful death but in fact we see a lot of struggle and battle when doctors euthanize incapacitated patients,” she said.
asserted
she → think → patients
Dr. Laurent Boisvert, a MAID provider and president of Quebec’s Dying with Dignity association, said that, in his experience, deaths performed under advance requests aren’t nearly so disturbing.
asserted
deaths → die → requests
He has personally performed three or four such MAID provisions.
asserted
He → perform → provisions
“I didn’t have this type of problem, but I know that at some point I can be in front of a patient who is quite aggressive, who doesn’t want to be touched and we need to sedate this patient” in order to insert the IV, Boisvert said.
asserted
Boisvert → have → IV
“But calling this a distressing procedure, I don’t think so.”
asserted
I → call → this
People can appoint one or two trusted people — a spouse, an adult child — to make sure their advance request is respected, he said.
asserted
he → appoint → people
In conversations with colleagues, “it seems that it has worked well (with) no big problems at this time,” Boisvert said.
asserted
Boisvert → seem → time
On the morning of her death, the doctor secretly slipped a sedative into the woman’s coffee.
asserted
doctor → slip → coffee
…and 27 more, not listed.
The Aporia
