Canada's laws on medical assistance in dying are currently being debated in Parliament, and changes may be coming soon. Find out what's been happening with the recently proposed changes to legislation.
What is dementia?
Dementia is an umbrella term that describes a series of different diseases or
conditions that affect a person’s brain. Symptoms can include memory loss and changes in mood and behaviour, as well as difficulties with thinking and language that are severe enough to interfere with a person’s daily living.
Dementia is progressive, which means the symptoms will gradually get worse over time. Eventually, it is also fatal.
A diagnosis of dementia does not immediately mean a person is unable to make their own decisions. Many people living with dementia live full and active lives for some time after diagnosis. As dementia progresses, however, people with the condition will eventually become unable to make decisions about their own treatment and care.
The needs of people living with dementia at the end of life are unique and require special considerations. Family members and healthcare providers often need to make difficult decisions on behalf of people living with dementia in the later stages of the disease.
What is medical assistance in dying (MAiD)?
Medical assistance in dying (often shortened to MAiD) is a medical procedure that involves the administration of medications to intentionally and safely end the life of a person who meets strict legal criteria, at the person’s request2.
MAiD became legal in Canada in 2016, when Parliament passed Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying). The legislation allows for two types of MAiD in Canada, both intended to relieve suffering and ensure quality of living and dying:
- The direct administration of medications or substances by a healthcare provider to end the life of a person at their request.
- The self-administration of medications or substances by a person to end their life, prescribed by a healthcare provider and at the person’s request.
How can I find out if I am eligible for MAiD?
If you’re a person living with dementia and would like to know if you are eligible for MAiD, we recommend speaking with your healthcare provider. Usually, this would be your family doctor.
If you do not have a family doctor, you may speak to the physician or nurse practitioner who is most responsible for your care. You may also ask other members of your care team to connect you with a care provider who can speak with you about your request.
How many medically assisted deaths occur in Canada?
- In 2019, there were 5,631 cases of MAiD reported in Canada, accounting for 2.0% of all deaths.
- Cancer (67.2%) was the most common underlying medical condition of persons who received MAID, followed by respiratory (10.8%) and neurological (10.4%) conditions.
These statistics are taken from Health Canada’s First Annual Report on MAID in Canada (2019). The report contains information collected from MAiD practitioners and pharmacists.
Has anyone with dementia ever received MAiD in Canada?
There have been a few publicly identified cases where a person living with dementia has received MAiD in Canada. Dementia can be considered a qualifying diagnosis for MAiD if the person meets the necessary requirements. For a person to receive MAiD, they must:
- Be able to make informed decisions (refer to Can a person with dementia receive a medically assisted death under the current eligibility criteria? for more information);
- Be in an advanced state of irreversible decline in capability; and
- Have a death that is reasonably foreseeable.
Can a person with dementia receive a medically assisted death under the current eligibility criteria?
Under the current law, a person in the advanced stages of dementia will likely not be able to legally consent to MAiD.
Consent to MAiD requires the person to have the capacity to make informed decisions. This means the person must be able to demonstrate:
- Choice. The person must be able to make and express the choice themselves.
- Understanding. The person must understand their illness, what to expect and their treatment options, as well as the risks and benefits of MAiD.
- Appreciation. The person must have insight into how the information provided to them about MAiD and other treatment options applies to their personal circumstances. For example, the person should have insight into why they’re requesting MAiD, how they feel MAiD would help them, and any risks to MAiD.
- Reasoning. The person should be able to demonstrate that there was logical reasoning behind their choice.
The person’s capacity to provide informed consent will be assessed by a healthcare provider.
The effects of dementia in its advanced state may impair a person’s capability to make an informed decision about their end-of-life care.
Can a person in an early stage of dementia request access to MAiD for when they reach a later stage of the disease?
Advance requests are not permitted under the current legislation at this time. The law states that a person requesting MAiD must have the capacity to provide consent immediately prior to the procedure.
In January 2020, the federal government launched an online consultation for possible amendments to MAiD laws in Canada. Feedback to the consultation resulted in strong support for allowing people living with dementia to have a medically-assisted death prior to losing their decision-making capacity.
What is happening with MAiD right now?
The federal government has introduced changes to the medical assistance in dying law to comply with a Québec court ruling that the “reasonably foreseeable death” clause in the original MAiD legislation was unconstitutional.
Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), amends the Criminal Code to remove “reasonably foreseeable death” as a requirement and “introduce a two-track approach to procedural safeguards based on whether or not a person’s natural death is reasonably foreseeable.” This will ease eligibility rules for those who are near death and retain more stringent rules for those who are not.
The bill also proposes to allow eligible persons “the waiver of final consent” when their death is in the reasonable future and they may lose mental capacity before MAiD can be provided.
For those deemed to be near death, the bill will eliminate the 10-day wait period after being approved for an assisted death and drop the requirement that a person must be able to give consent a second time immediately before receiving the procedure. The government is working toward a deadline of February 26, 2021 to pass this bill.
Parliament will also conduct a statutorily required evaluation of the original MAiD legislation. This review will be extensive and is expected to begin in 2021. It will likely consider the possibility of expanding the law to allow for people with more complex cases to make advance requests for a medically assisted death.
Is the Alzheimer Society supporting advance requests for MAiD?
The Alzheimer Society recognizes that people living with dementia are individuals – first and foremost. They have the same rights as everyone else, including the right to participate in decisions about their life and care. We respect the rights of all people with dementia to advocate for their individual best interests, including advocating for access to MAiD through advance requests.
The Society has a position statement on MAiD. It was approved by the national Board of Directors in October 2019.
Read our full statement on medical assistance in dying (PDF).
Do MAiD recipients have access to supportive services such as palliative care?
Health Canada’s First Annual Report on MAID in Canada (2019) reports that the majority of people who received MAiD in 2019 (82.1%) received palliative care services.
What is the Alzheimer Society doing to support the end-of-life wishes of people living with dementia?
The Society’s role is to educate, inform and support people living with dementia and to honour their rights and their choices. Here’s how we support the end-of-life wishes of people living with dementia through advocacy, education and research:
As a member of the Quality End-of-Life Care Coalition of Canada (QELCCC), we work with other organizations to increase public awareness and improve access to quality end-of-life care for all Canadians. The Alzheimer Society will continue to ensure that people with dementia are represented when changes to government policy are being considered.
The Alzheimer Society provides people living with dementia and their families with the support and information needed to make informed decisions about their care, including at the end of life. We encourage people with dementia and their families to put an advance care plan in place as soon as possible after diagnosis.
The Alzheimer Society Research Program (ASRP) funds innovative research that brings us closer to a future without dementia, and that improves the quality of life and care for people with dementia. The ASRP has funded researchers who study end-of-life care options for people with dementia, including research that explores Canadians’ attitudes toward MAiD for people with dementia.
How can I make my opinion on MAiD heard?
MAiD and advance requests for people living with dementia are complex issues with no easy answers. It’s important for the Alzheimer Society of Canada to be aware of what Canadians think about MAiD. Whether you are in favour or against, we are here to listen to you.
You can also make your voice heard by contacting your Member of Parliament: https://www.ourcommons.ca/Members/en.
More useful links and resources
Medical assistance in dying. Alzheimer Society of Canada, October 2019. Our full position statement on this topic.
First annual report on medical assistance in dying in Canada, 2019. Health Canada, July 2020. This report lists the numbers behind medical assistance in dying (MAiD) in Canada, broken down by province and territory, for the 2019 calendar year. This provides the most comprehensive portrait of MAID in Canada to date.
Medical Assistance in Dying (MAiD) in Dementia. Canadian Association of MAiD Assessors and Providers, 2019. This paper provides a comprehensive overview of eligibility requirements for medical assistance in dying (MAiD) in Canada, helping healthcare providers assess whether a patient living with dementia can access MAiD should they request it.
Medical Assistance in Dying: Information for patients and loved ones. The Ottawa Hospital, 2019. This short, three-page summary provides concise answers to frequently asked questions about medical assistance in dying (MAiD) in Canada. Please note that this information does not reflect the latest changes to MAiD discussed in Parliament, and does not discuss dementia.
Dying with Dignity Canada. Through advocacy, public education and personal support, it is Dying With Dignity Canada's mission to ensure Canadians have access to quality end-of-life choice and care. Their website includes resources on advance care planning, palliative care and medical assistance in dying (MAiD).
Medical assistance in dying. Government of Canada. On this governmental page, find information about medical assistance in dying (MAiD), including eligibility, how the request process works and the latest news on possibly changing legislation.
Proposed changes to Canada’s medical assistance in dying legislation. Department of Justice, March 2020. This governmental webpage describes the recently proposed changes to Canada's Criminal Code involving the legislation on medical assistance in dying (MAID).
The state of knowledge on advance requests for medical assistance in dying. Council of Canadian Academies, December 2018. This report examines the complexity of advance requests for medical assistance in dying (MAID), considering scenarios that may prompt an advance request for MAiD, evidence from related practices in Canada and abroad and other topics related to the issue.
What we heard report: A public consultation on medical assistance in dying (MAID). Department of Justice, March 2020. This report summarizes the findings from government consultations with the public regarding the topic medical assistance in dying (MAiD), setting the table for possible changes to legislation on MAiD in Canada.