On Tuesday, Justice Minister Sean Fraser unveiled proposed legislation that would allow advance requests for medical assistance in dying (MAID) in provinces and territories that enact their own advance request legislation. The bill also indefinitely bans MAID for mental illness.
In an advance request, a person with capacity to make medical decisions describes the circumstances for receiving MAID in the future, when they cannot consent.
Under the proposed legislation, individuals would need to be diagnosed with an illness that is reasonably expected to cause them to lose their ability to consent in order to make an advance request. To later be eligible, they would need to have lost their ability to consent, and be repeatedly experiencing the “clinical manifestations” of their illness listed in their advance request, the legislation says.
If the bill passes, Canada would join Belgium, Cambodia, Luxembourg, the Netherlands and Spain in allowing advance requests for MAID.
Doctors, ethicists and dementia advocates have told Canadian Affairs in recent weeks that advance requests present several challenges.
Provincial discussions
Currently, advance requests are illegal under the Criminal Code, although Quebec has allowed them since 2024 for patients diagnosed with diseases such as Alzheimer’s.
Under federal law, individuals must consent immediately before MAID is provided, unless they have signed a waiver of final consent (which is typically made for individuals whose deaths are imminent).
This means people with dementia and Alzheimer’s can currently only qualify for MAID if they can consent when they make their request and immediately before MAID is administered.
Under Ottawa’s proposed legislation, provinces and territories would need to pass their own legislation to allow advance requests.
“[The federal government] will leave to [the provinces and territories] to determine the extent to which they wish to embrace the next frontier on medical assistance in dying,” Fraser said.
“From my point of view, this is going to be the start of a national conversation that will largely play out at the provincial level.”
Alberta passed legislation earlier this year that would ban advance requests for MAID. That legislation is not yet in force.
Doctors would not be allowed to administer MAID under an advance request in jurisdictions that do not allow advance requests for MAID, Fraser told reporters.
In a statement, Dying With Dignity Canada, a national charity that advocates for MAID access, called Ottawa’s approach to advance requests “fundamentally flawed.”
“By requiring provinces and territories to adopt further legislation before advance requests are allowed in their jurisdiction, the federal government has effectively given each province and territory a veto on advance requests,” its statement said.
Coercion concerns
Cathy Barrick, CEO of the Alzheimer Society of Ontario, says advance requests could keep individuals with Alzheimer’s and dementia from opting for MAID sooner than they otherwise would.
“[Individuals] can potentially choose to live longer with dementia, knowing that they have a safety net to be able to access MAID when they want it,” Barrick said in an interview earlier this month.
But safeguards are needed to ensure individuals do not opt for MAID because of abuse or insufficient supports for them or their caregivers, she says.
“It would be extremely tragic if people were making a decision about MAID based on the fact that they can’t get the support that they need,” she said.
A 2025 report from the Ontario chief coroner’s office said patients with dementia who were approved for MAID were more likely to report suffering from fear, loss of dignity or feeling like a burden than other MAID patients.
Heather Campbell Pope, executive director of Dementia Justice Canada, wrote the government last week, recommending that all advance requests undergo an independent legal review when they are drafted to ensure elder abuse is not a factor.
She also thinks it may be helpful to require a second legal opinion be provided before MAID is administered.
These added procedures may be a “barrier” for some people accessing MAID, Campbell Pope said in an interview earlier this month. But the need for public accountability when ending someone’s life outweighs that risk, she says.
“It certainly merits the state to do some due diligence before a fatal, irreversible mistake is made.”
Dr. Catherine Ferrier, a family doctor and associate professor of geriatric medicine at McGill University, says she always asks patients about their social situations and still sometimes misses cases of elder abuse.
“Coercion is very, very subtle,” she said in an interview earlier this month. “Elder abuse is behind the scenes.”
Ferrier, who does not practise MAID, says she does not think advance requests can be implemented safely and should not be allowed.
Evaluating suffering
Ottawa’s proposed legislation does not include requirements for independent legal scrutiny of advance requests.
However, it does require that a doctor or nurse practitioner be of the opinion that an individual is experiencing “enduring and intolerable physical or psychological suffering” in the present.
Some medical ethicists say it is impossible to reliably predict what someone will consider as suffering in the future.
Tim Christie, a medical ethicist and professor at Dalhousie University, says individuals’ perceptions of suffering changes over time.
Doctors “can’t pretend” that what someone said they wanted in the past is what they will want later, he said in an interview earlier this month.
Christie has raised concerns about people being approved for MAID because of suffering that could have been relieved. Advance requests could increase problems that already exist with MAID in Canada, he says.
“We have a choice of whether we want to do it well, or we want to do it badly,” he said.
“The way that we’ve implemented MAID so far has been very bad. I have no reason to think that we’re going to do a better job with the advance [requests].”
Trudo Lemmens, a health law professor at the University of Toronto who has studied advance requests in other countries, does not think advance requests can be implemented safely.
“They raise profound ethical and legal concerns,” he said earlier this month.
Advance requests cross the line into administering MAID without consent and allowing others to determine when someone should have MAID.
Sedation
In Quebec, patients with advance requests can be sedated before MAID is administered.
Sedation removes a person’s ability to make health-care decisions. Lemmens says this practice violates the United Nations Convention on the Rights of Persons with Disabilities, which Canada has signed.
In 2025, a United Nations committee said Canada should not allow advance requests for MAID, noting the practice violates the disability rights convention.
On Tuesday, Canadian Affairs asked Fraser and Health Minister Marjorie Michel why the government proceeded with advance requests against the United Nations’ objections.
In response, Michel pointed to a 2025 Health Canada consultation that showed many Canadians support advance requests for MAID.
“People were ready to talk about advance requests,” she said. “This is why I’m hopeful, even if we are not forcing provinces to opt in, the conversation will happen.”
Ottawa’s proposed legislation says that if a person refuses MAID by words, sounds or gestures, the MAID cannot proceed. Involuntary responses to contact do not count as refusal, the legislation says.
If there is any doubt about a patient’s refusal to have MAID, they must wait at least 30 days before MAID is attempted again.
In an email, Campbell Pope said she had concerns that the legislation does not specify how many times that 30-day waiting period can be used.
“The legislation does not set a limit,” she wrote. “In other words, how many times does the patient have to keep refusing before we stop trying to kill them?”
