{"id":268845,"date":"2020-10-27T10:30:49","date_gmt":"2020-10-27T14:30:49","guid":{"rendered":"https:\/\/policyoptions.irpp.org\/issues\/medical-assistance-in-dying-bill-an-important-step-forward-for-canadians-with-dementia\/"},"modified":"2025-10-07T23:15:47","modified_gmt":"2025-10-08T03:15:47","slug":"medical-assistance-in-dying-bill-an-important-step-forward-for-canadians-with-dementia","status":"publish","type":"issues","link":"https:\/\/policyoptions.irpp.org\/fr\/2020\/10\/medical-assistance-in-dying-bill-an-important-step-forward-for-canadians-with-dementia\/","title":{"rendered":"Medical assistance in dying bill an important step forward for Canadians with dementia"},"content":{"rendered":"<p class=\"dropcap-big\">On October 5, 2020, the federal Minister of Justice introduced <a href=\"https:\/\/parl.ca\/DocumentViewer\/en\/43-2\/bill\/C-7\/first-reading\">Bill C-7<\/a> to amend Canada\u2019s medical assistance in dying (MAiD) legislation. Parliament will debate this bill over the coming weeks, aiming to bring the legislation into force by December 18. One critical question about this bill for hundreds of thousands of Canadians is its implications for people with dementia (most commonly caused by <a href=\"https:\/\/alzheimer.ca\/en\/about-dementia\/what-dementia\/dementia-numbers-canada\">Alzheimer\u2019s disease<\/a>). The short answer is that more people with dementia will have access to MAiD, since the legislation allows an advance request for the service <em>before<\/em> the loss of decision-making capacity.<\/p>\n<p><strong>MAiD for people with dementia who still have decision-making capacity<\/strong><\/p>\n<p>Nothing in Bill C-7 changes the fact that some people with dementia (who still have decision-making capacity) are legally permitted to receive MAiD. Under the <a href=\"https:\/\/www.parl.ca\/DocumentViewer\/en\/42-1\/bill\/C-14\/royal-assent\">current law<\/a>, a\u00a0person\u00a0can\u00a0receive\u00a0MAiD <em>if<\/em> they have decision-making capacity and:<\/p>\n<ul>\n<li>they have a serious and incurable illness, disease, or disability;<\/li>\n<li>they are in an advanced state of irreversible decline in capability;<\/li>\n<li>that illness, disease, or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and<\/li>\n<li>their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.<\/li>\n<\/ul>\n<p>People with dementia (even as their sole underlying medical condition) can meet these criteria. Dementia is a\u00a0serious and incurable illness, disease,\u00a0or disability (\u201cmajor neurocognitive disorder\u201d).\u00a0A person with dementia can be in an advanced state of irreversible decline in capability\u00a0before\u00a0losing decision-making capacity.<\/p>\n<p>It\u2019s also important to note that\u00a0the law doesn\u2019t require that the decline in capability be caused by the incurable condition \u2013 for example, it could be caused by something such as severe frailty.\u00a0 Dementia or the\u00a0person\u2019s\u00a0state of decline can cause enduring physical or psychological suffering that is intolerable to the person and cannot be relieved under conditions the person considers acceptable.<\/p>\n<p>An <a href=\"https:\/\/www.canlii.org\/en\/on\/onsc\/doc\/2017\/2017onsc3759\/2017onsc3759.html\">Ontario court decision<\/a>, the <a href=\"https:\/\/cpsns.ns.ca\/wp-content\/uploads\/2018\/12\/ProfessionalStandard_MedicalAssistanceInDying_Dec2018.pdf\">College of Physicians and Surgeons of Nova Scotia<\/a> and of <a href=\"https:\/\/www.theglobeandmail.com\/files\/editorial\/News\/nw-na-maid-1011\/marywilson-decision.pdf\">B.C<\/a>., and <a href=\"https:\/\/camapcanada.ca\/wp-content\/uploads\/2019\/05\/Assessing-MAiD-in-Dementia-FINAL-Formatted.pdf\">clinical practice<\/a> that has developed around MAiD have all underscored that dementia can make a person\u2019s natural death reasonably foreseeable. Therefore,\u00a0assuming that an individual with dementia still has decision-making capacity, they can be eligible for\u00a0MAiD under the current law <em>and<\/em> the proposed new legislation. These individuals give final consent immediately prior to the provision of\u00a0MAiD.<\/p>\n<p><strong>Advance requests for MAiD<\/strong><\/p>\n<p>Under the current law, a person with dementia cannot receive MAiD after they have lost decision-making capacity \u2013 individuals must have decision-making capacity immediately prior to the provision of MAiD.<\/p>\n<p>However, under Bill C-7, a\u00a0person\u00a0with dementia will be able to receive\u00a0MAiD\u00a0<em>after <\/em>they have lost decision-making capacity<strong><em>.<\/em><\/strong> Bill C-7 introduces a \u201cfinal consent waiver.\u201d That is,\u00a0a person who has lost decision-making capacity can nonetheless receive\u00a0MAiD\u00a0if,\u00a0before losing decision-making capacity:<\/p>\n<ul>\n<li>they have a serious and incurable illness, disease, or disability;<\/li>\n<li>they are in an advanced state of irreversible decline in capability;<\/li>\n<li>that illness, disease, or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable;<\/li>\n<li>their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining;<\/li>\n<li>they meet all of the\u00a0procedural\u00a0safeguards set out in\u00a0the legislation;<\/li>\n<li>they enter into an arrangement in writing with the medical practitioner or nurse practitioner that the medical practitioner or nurse practitioner would administer a substance to cause their death on a specified day;<\/li>\n<li>in the written arrangement, they consent to the administration by the medical practitioner or nurse practitioner of a substance to cause their death on or before the day specified in the arrangement if they lost their capacity to consent to receiving MAiD prior to that day;<\/li>\n<\/ul>\n<p>and if, before the provision of MAiD:<\/p>\n<ul>\n<li>they did\u00a0not demonstrate, by words, sounds, or gestures, refusal to have the substance administered or resistance to its administration; and<\/li>\n<li>the substance was administered to them\u00a0in accordance with the terms of the arrangement.<\/li>\n<\/ul>\n<p>A person with\u00a0dementia can get to\u00a0the point at which they still have decision-making capacity, but their state of decline has become advanced and irreversible, their suffering has become enduring, intolerable, and irremediable, and their natural death has become reasonably foreseeable. Once they reach that point, they can\u00a0enter into an arrangement\u00a0with\u00a0a clinician, specifying a day for\u00a0MAiD, and\u00a0MAiD\u00a0can be provided on or before that day if they have lost\u00a0decision-making capacity prior to that day. In this way, Bill C-7 will make it legally permissible for some people with dementia to make an advance request for MAiD.<\/p>\n<p>It is important to note that Bill C-7\u2019s proposed amendments relating to advance requests for MAiD do not go as far as recommended by the <a href=\"https:\/\/www.health.gov.on.ca\/en\/news\/bulletin\/2015\/docs\/eagreport_20151214_en.pdf\">Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying<\/a> or the <a href=\"https:\/\/www.parl.ca\/DocumentViewer\/en\/42-1\/PDAM\/report-1\">Special Joint Committee [of the House and Senate] on Physician-Assisted Dying<\/a>. The Expert Advisory Group and Special Joint Committee both recommended that people be given access to MAiD through advance requests made after the diagnosis of a grievous and irremediable condition, but <em>before<\/em> the onset of intolerable suffering.<\/p>\n<p>Still, the proposed amendments, if passed, would be a significant step in the right direction. The public would appear to agree \u2013 79 percent of the more than 300,000 Canadians who responded to <a href=\"https:\/\/www.justice.gc.ca\/eng\/cj-jp\/ad-am\/wwh-cqnae\/index.html\">government consultations<\/a> on MAiD supported the idea of advance requests where \u201ca person is diagnosed with a medical illness that, over time, will affect their mind and take away their decision-making capacity, such as Alzheimers disease.&#8221;<\/p>\n<p>Some people with dementia would no longer be forced to make a cruel choice \u2013 to die earlier than they would have liked (through MAiD or suicide) in order to avoid the loss of decision-making capacity (and therefore loss of eligibility for MAiD), or to live through all of the remaining stages of dementia experiencing enduring, intolerable, and irremediable suffering.<\/p>\n<p><span class=\"image-caption\">Photo: Shutterstock.com, by AimPix.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>On October 5, 2020, the federal Minister of Justice introduced Bill C-7 to amend Canada\u2019s medical assistance in dying (MAiD) legislation. Parliament will debate this bill over the coming weeks, aiming to bring the legislation into force by December 18. One critical question about this bill for hundreds of thousands of Canadians is its implications [&hellip;]<\/p>\n","protected":false},"featured_media":278357,"template":"","meta":{"_acf_changed":false,"content-type":"","ep_exclude_from_search":false,"apple_news_api_created_at":"2025-10-08T03:15:50Z","apple_news_api_id":"3d1127cd-5a75-47de-9791-57bfef06a53f","apple_news_api_modified_at":"2025-10-08T03:15:50Z","apple_news_api_revision":"AAAAAAAAAAD\/\/\/\/\/\/\/\/\/\/w==","apple_news_api_share_url":"https:\/\/apple.news\/APREnzVp1R96XkVe_7walPw","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":[],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false},"categories":[9387,9372,9377],"tags":[8450],"article-status":[],"irpp-category":[4251,4286],"section":[],"irpp-tag":[7082],"class_list":["post-268845","issues","type-issues","status-publish","has-post-thumbnail","hentry","category-elaboration-de-politiques","category-recent-stories-fr","category-sante","tag-assisted-dying-fr","irpp-category-politique-sociale","irpp-category-sante","irpp-tag-aide-medicale-a-mourir"],"acf":[],"apple_news_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Medical assistance in dying bill an important step forward for Canadians with dementia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/policyoptions.irpp.org\/fr\/2020\/10\/medical-assistance-in-dying-bill-an-important-step-forward-for-canadians-with-dementia\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medical assistance in dying bill an important step forward for Canadians with dementia\" \/>\n<meta property=\"og:description\" content=\"On October 5, 2020, the federal Minister of Justice introduced Bill C-7 to amend Canada\u2019s medical assistance in dying (MAiD) legislation. 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