Should dementia patients be able to make advance requests for medical assistance in dying?

As the number of dementia patients in Canada continues to rise, calls to allow advance requests for medical assistance in dying (MAID) are also growing.

is similar to Controversy over expanding MAID to include only those with mental illnessIt’s another sign that the Canadian government isn’t finished delving into the complexities of end-of-life procedures.

There is currently a Petition before the House of Commons Request to amend the Criminal Code to allow people facing a capacity-limiting diagnosis to request MAID in advance.

It was sponsored by Yukon Liberal MP Brendan Hanley and had more than 16,000 signatures as of Tuesday morning.

“Pre-ordering allows you to say, ‘I know I’ll get there eventually, but I’m not there yet. But when I get there, this is what I want to happen,'” said Helen, CEO of Dying with Dignity Canada. long.

“I’ve seen a lot of people in long-term (care) homes waiting to die,” said Jennifer Peyton, 70, of Woodstock, Ontario, who, despite her good health, worries about her life. “It’s God’s waiting area.” Options on the road.

“I’m terrified I’m going to end up like this,” Peyton said. “I’m healthy now, but you never know when it will come.”

According to an Ipsos poll published last July, support for MAID pre-applications for individuals diagnosed with a serious, incurable condition remains high.

Pie chart around question support.  82% support it.
The Ipsos poll was conducted on behalf of Dying With Dignity Canada. A sample of 3,502 Canadians aged 18 or older were interviewed for the Ipsos I-Say panel from June 7 to 12, 2023. For comparison purposes only, a random sample of the same size would carry a margin of error of +/- 1.9 per cent. Point, 19 times out of 20. (Ipsos/Death with Dignity Canada)

Dementia cases are expected to rise

the The Alzheimer’s Society of Canada expects this to happen by 2030 The country is expected to see a 51% increase compared to 2020 in the number of new dementia cases each year.

An estimated 6.3 million people in Canada will develop, live with, and/or eventually die from dementia between 2020 and 2050.

“Canada has an aging population… and they’re always singing the blues about health care costs,” Peyton said. “I know it sounds harsh, but I think there are a lot of people…in the family (who) don’t want to stay in that family.”

Canada officially legalized MAID through legislation in 2016. Currently, anyone can asked maid If their death was “reasonably foreseeable” under what is known as the first pathway, or if they were suffering from a “serious and irreversible condition”, the second pathway.

As of now MAID is not available in Canada through pre-orders.

However, in February 2023, the Special Joint Parliamentary Committee on Medical Assistance in Dying Produced a report Which recommended “the Government of Canada amend the Criminal Code to allow advance applications following the diagnosis of a serious and incurable medical condition, disease or disorder resulting in disability.”

“I’m a Christian,” Peyton said. “It doesn’t bother me one bit to end my life under these circumstances. For me, this is not murder, it is release.”

last June, Then the Ministers of Health and Justice, Jean-Yves Duclos and David Lametti, responded To recommend expanding MAID to include advanced applications by saying that the issue needs further consultation and study before the government considers adopting it.

In an email to CBC News this week, a Health Canada spokesperson reiterated that statement.

A woman wearing a red jacket poses for a photo, her hands folded in front of her
Helen Long is CEO of Dying with Dignity Canada. (Submitted by Death by Dignity Canada)

Can dementia patients currently access MAID?

A dementia patient can receive MAID, but “it can be very difficult from a timing perspective,” said Long, an advocate for advance orders for both patients with and without a diagnosis of a serious, incurable medical condition.

“Right now, you have to have sufficient capacity to continue to make health care decisions for yourself, but you also have to reach the eligibility requirements in terms of being at an advanced stage of suffering,” she said.

“Dementia is a complex condition for MAID to evaluate for,” said Dr. Viren Naik, an Ottawa-based MAID assessor and provider.

“It’s a delicate balance…finding that balance when (the evaluator) feels comfortable that the person meets the eligibility criteria but…before they lose eligibility.”

watched MAID expansion was recently postponed:

What another delay means for people waiting for MAID

The federal government wants another pause on allowing Medical Assisted in Dying (MAID) requests for those suffering solely from mental illnesses. CBC’s Christine Perak explains the divide among doctors and what it means for patients who have waited years to make a decision.

Canadians support pre-orders

the most recent Ipsos survey From July 2023, 82% of Canadians were found to support advance requests for people diagnosed with a serious and untreatable condition, down slightly from the previous year’s results.

The poll, conducted on behalf of Dying With Dignity Canada, also found that 72 per cent of Canadians support an advance order without a diagnosis.

last June, Quebec has approved pre-orders for MAID. The provincial government said it could take up to two years to process the application.

A report issued by the Council of Canadian Academies I found that Colombia, Spain and the Netherlands all allow pre-orders. Belgium and Luxembourg allow advance directives, but only when the person is unconscious at the time of the procedure.

Louise McMullen, 90, said: “Until this becomes available to humans in this country, I think it is abhorrent.” She and her husband of 55 years live alone on a rural property near Guelph, Ontario.

“We treat our dogs better because we can be offended when their lives are not worth living,” she said.

The old woman with short white hair is smiling at the camera
Louise McMullen, 90, from Wellington, Ontario, wants the right to end her life if she develops dementia and can no longer cook food safely. (Submitted by Louise McMullen)

McMullen is in relatively good health, but like most people her age, she has undergone initial screening for dementia and is currently on a waiting list to see a geriatrician.

If at some point the diagnosis suggests dementia, McMullen hopes to place an advance order.

“The medical system is already overwhelmed,” McMullen said. “If I’m living a good life and I’m happy, why shouldn’t I die peacefully in my own time instead of having to go through all this physical deterioration and being a burden on so many other people?”

Part of the problem is knowing when to honor someone’s request, Naik said.

“Unfortunately, dementia affects people differently,” he said. “So what’s challenging for a clinician providing MAID is that they always need to feel comfortable that the person is suffering.”

There is another existential and philosophical quandary for MAID evaluators, Naik said.

“I think the person who issued this directive 20 years ago knows what he wants, but is this the same person in front of you?”

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