Euthanasia for individuals incapable of consent at the point of death is to be introduced under new proposals from the Canadian Government, according to Canada’s justice minister, Sean Fraser.
The proposed legislation would change the law so that individuals who have a progressing incurable illness can give their consent to have their lives ended by euthanasia at some future stage, when, it is assumed, they will no longer be able to give informed consent.
These so-called “advance requests” would mean that people may have their lives ended by euthanasia who, at the point of administration of the fatal drugs, cannot give their consent to it.
The Canadian Government has also announced plans, which have been welcomed by Right To Life, to indefinitely exclude people whose sole underlying medical condition is mental illness from euthanasia and assisted suicide. Access for this group had been scheduled to begin in March 2027.
Advance requests have already led to serious issues in other jurisdictions
In one shocking case in the Netherlands, after a lady with dementia made an advance request for euthanasia, she was reported to be “confused” and wanted to live at the time of her death.
Her family had to hold her down, and she was euthanised by force. In the court case that followed, prosecutors argued the doctor did not properly consult with the 74-year-old patient. However, the doctor was acquitted of any wrongdoing by a Dutch court that ruled “all requirements of the euthanasia legislation” had been met.
In April 2020, it was ruled that doctors in the Netherlands can no longer be prosecuted for carrying out euthanasia on dementia patients who have previously given written consent.
In another case from the Netherlands, a woman in her sixties with Alzheimer’s disease had her life ended by euthanasia in 2017 following an advance request in 2011. This is despite the fact that she did not reaffirm her request either orally or in writing at any time before her death. The Dutch Regional Euthanasia Review Committee found the conditions for her advance request were not met.
In a third case, Laurent Boisvert, an emergency physician in Quebec who has ended over 600 lives by euthanasia since the practice was made legal, has already filed seven of these advance requests from his patients who have been diagnosed with Alzheimer’s disease.
It is reported that, in helping his patients make advance requests, his patients included clear instructions about what Boisvert should do if the patient resists euthanasia.
Crossing the line between clear consent and no consent
Health law professor at the University of Toronto, Professor Trudo Lemmens, said, “Introducing advance requests for MAID crosses the line between clear consent and no consent, and so it’s certainly no longer a practice where clear consent is the basis for MAID”.
Alicia Duncan, whose mother ended her life by euthanasia in Canada despite not being terminally ill, called the plan to legislate for advance requests a “Trojan horse”.
“The Liberals plan to bundle the mental illness exclusion with advance requests for MAiD in one bill. No separate votes. MPs must accept both or reject both. Sneaky politics with irreversible consequences”, she said.
Minister of Justice and Attorney General of Canada Sean Fraser said, “Canada has decided to include in its legislation a decision to grant access to medical assistance in dying to people who have provided consent at a time when they still have capacity, but know that they have been diagnosed with an illness that will take that capacity from them”.
“These are not easy decisions but we believe they will be the correct ones”, the justice minister said.
“There will be more details when legislation is going to be tabled subsequently this fall”, he added.
“Advance requests” permitted in Quebec
Such requests are currently illegal in Canada under the nation’s euthanasia and assisted suicide regime, known as Medical Assistance in Dying (MAID). However, they have been permitted in Quebec since 2024 for people who have been diagnosed with a serious and incurable illness leading to incapacity, such as Alzheimer’s disease.
In Quebec, this means that an individual can consent to euthanasia at some future point when that same individual “will no longer be able to consent” to ending their life.
Regarding these advance requests in Quebec, Dr Catherine Ferrier, assistant professor of geriatric medicine at McGill University, stated that the policy is a risk because the people who make an “advance request” may have later changed their mind if they were still able to do so.
“There are huge gaps in consent, and that’s a big concern to me”, she said.
“As you come to terms with your disease, while you get used to the idea of not being able to do all the things you could do before, you’re still happy. The whole idea of predicting what we might want a few years down the road is problematic”, Ferrier added.
Alisdair Hungerford-Morgan, Chief Executive of Right To Life, said “The decision not to extend euthanasia and assisted suicide to people whose sole underlying medical condition is mental illness is welcome. However, Canada’s plans to allow euthanasia through advance requests raise serious concerns. People with conditions such as Alzheimer’s disease could have their lives ended when they can no longer give informed consent”.
“A request made months or years earlier cannot establish whether someone would still make the same decision as their illness progresses. There are serious questions about how any doctor could know whether a person who has lost that capacity still wants their life to be ended”.
“Canada recorded 16,499 euthanasia deaths in 2024. The Government should reject this further expansion and prioritise investment in palliative and social care. People living with dementia and other serious illnesses deserve care, protection and support throughout their lives”.
