Daniel Zekveld is a Policy Analyst with the Association for Reformed Political Action (ARPA) Canada.New legislation tabled by the federal government this week will stop the pending legalization of MAID for mental illness. But at the same time, it will legalize MAID for people who lack mental capacity to consent, provided they make a request before they lose mental capacity.Currently, the Criminal Code requires consent immediately before a person is euthanized. The only exception is if the person already has a date scheduled for MAID, waives final consent, and loses capacity before the scheduled time.Advance requests would allow a person diagnosed with a serious illness like Alzheimer’s or dementia to “consent in advance” to being euthanized after they can no longer give consent. For example, someone might ask to be euthanized at whatever point in the future he can no longer feed himself, get out of bed himself, or recognize loved ones. Bill C-41 notes that the person must have described, in the advance request, the clinical manifestations that “they anticipated would cause them enduring and intolerable suffering.”Advance consent is not informed consent. The person who has not lived through his future condition does not know what he will want when the time arrives. Many people change their minds after requesting MAID because of changes to their circumstances, health, or mental health.Proposed safeguards around advance euthanasia requests in the legislation will be inadequate, as the wishes of a patient who has lost capacity are difficult, if not impossible, to determine. Doctors and nurses are left to determine subjectively whether a person who cannot communicate their present wishes is suffering intolerably and wants to die. In the Netherlands, advance euthanasia directives are rarely carried out due to doctors’ unease about ending the life of someone who cannot give current consent. When they are acted on, some doctors first surreptitiously administer sedatives to dementia patients so they won’t resist. In one study, a Dutch physician stated: “It is more humane to slip Dormicum in his coffee than to hold him down.”.Already in Canada, consent requirements can be murky. Earlier this year, a Canadian woman was euthanized despite her cloudy cognitive state. The woman’s granddaughter says she did not want to die, and the case is currently under police investigation.But despite existing concerns around consent in Canada and abroad, the federal government is set to permit advance euthanasia requests if a province or territory implements a framework for them.In an announcement prior to the tabling of legislation, Minister Fraser noted that “People want desperately to be able to know that they’re not going to subject their families to pain and suffering.”Dementia and other capacity-limiting illnesses are difficult. But people with these conditions require care and support, not MAID. Already, people with dementia have higher rates of feeling like a burden on loved ones. But they also often rate their quality of life higher than their caregivers do. Canada must not encourage the feeling of being a burden by devaluing the lives of those who have lost capacity to consent.Indeed, elderly Canadians are already at risk of abuse. They are especially vulnerable when they can no longer make their own decisions. In a statement on advance requests from Dementia Justice Canada, a spokesperson noted that “A court can undo a will that was unduly influenced… But once MAiD is provided, there is no meaningful remedy if we later find that the person was pressured to make the advance request, that they had changed their mind, or that they are going along with it because of pressure or coercion. It is simply too late.”.Advance euthanasia requests forfeit future consent, delegating a future life-and-death decision to third parties, based on their interpretation of what you put on paper at some point in your past.Another argument in favour of advance requests, as noted by Minister Fraser, is “So people can live out their remaining years rather than being put in a position where they fear the need to take that decision prematurely.” In other words, permit advance requests so people do not feel the need to die by MAID while they can still consent.But this idea presents a false dichotomy — euthanasia now while you can still consent, or euthanasia later when you have lost capacity to consent.There is a third option: to receive care and support to live well despite the illness. In Ontario’s review of MAID deaths, 86% of dementia patients who died by MAID had not received palliative care. Far too often, MAID is seen as the solution to suffering despite other available options.Given the many problems Canadians have seen within Canada’s existing MAID regime, we cannot expect advance euthanasia requests to suddenly be “safe” for vulnerable people. Canada must not permit MAID without present consent. Daniel Zekveld is a Policy Analyst with the Association for Reformed Political Action (ARPA) Canada.
