Recently, the federal government announced that it would launch a “national conversation” on advance requests for euthanasia. The government is asking Canadians to participate by filling out a questionnaire. This questionnaire must be completed before February 14, 2025. We encourage you to respond to the questionnaire and have given some related context and suggestions below.  

What are Advance Requests? 

Advance requests, if legalized, would allow someone who does not currently want to die to outline circumstances under which he or she would want to die in the future. Those circumstances would be specified in a written document. Advance requests are particularly relevant for people experiencing cognitive decline. With advance requests, a person diagnosed with early stages of dementia could outline in what circumstances they want to be euthanized if their condition worsens so that they lose the capacity to give consent.  

Advance requests for euthanasia are currently prohibited in the Criminal Code. Prior to euthanizing a patient, a medical professional must ensure that the patient has given express consent and has an opportunity to withdraw their request for euthanasia. The only permitted exception to this rule is through a waiver of final consent, where a patient has already been assessed and approved for euthanasia but risks losing capacity to consent prior to the day of the scheduled death.  

Background 

Advance requests are an expansion that pro-euthanasia advocates have been pushing for a while. The issue has been raised both in the House of Commons and the Senate without gaining much traction. So why is the federal government advancing the issue now?  

The province of Quebec played a key role in pushing the government to permit advance requests. In 2023, Quebec passed a law that, among other things, would allow advance requests in the province. Through much of 2024, Quebec pressured the federal government to allow advance requests so their provincial law could come into effect. Since the federal government did not expand euthanasia to include advance requests, Quebec decided to permit them anyways by the end of October, in violation of the Criminal Code.  

While the federal government could have challenged Quebec’s decision to violate the Criminal Code, and should prosecute any doctor who administers euthanasia on the basis of an advance request, they have chosen instead to start this national conversation on advance requests.  

Problems with Advance Requests 

In addition to the problems with euthanasia generally, advance requests create a unique set of problems.  

• People are giving doctors a license to kill them in the future, based on their present fear of a future condition. A person diagnosed with dementia can live well for years. That person has never lived through the future stages of the condition and cannot know what their life will be like in the future.  

• Once a person reaches the point indicated in an advance request, they might no longer wish to die. They could easily be happy in their circumstances despite cognitive decline. But once the person has lost the capacity to consent, the doctor may still decide when it is time to end the person’s life.  

• An advance request requires a doctor to make a subjective interpretation about whether the condition described in the request has been met.  

• When doctors suggest that a patient sign an advance request, it sends a message that the lives of those who have lost decision-making capacity are no longer worth living. The government ought to protect people with cognitive decline, rather than passing a law that devalues their lives. (Note that people with dementia already receive euthanasia – however, they may only be euthanized prior to losing capacity to consent.) 

• Nearly 50% of people euthanized in 2023 noted they felt like a burden on family or friends. When people are led to believe they will be more of a burden after further cognitive decline, they may feel pressured to sign an advance request.  

How to Participate in the Questionnaire 

The questionnaire says that it aims to “hear your views on advance requests for MAID, whether they should be permitted and, if they were to be permitted, what potential risks, safeguards and supports should be considered.” However, it’s mostly multiple-choice questions to gauge your level of support or opposition. There is little opportunity to really share your perspective. For example, one question states “What values guide you when thinking about advance requests for MAID?” The options include “Individual choice about end-of-life care, dignified death, sanctity of life, and protection of vulnerable people.” Interpreted correctly, we could check all the boxes. However, there is no opportunity to explain your answer.  

• Questions 1-6 gauge your level of support for euthanasia generally, followed by support or opposition to advance requests and what guides your thinking on the issue. These are fairly straightforward, and we encourage you to fill them out.  

• Questions 7-8 and 10-13 ask about various possible safeguards that should or should not be applied in the case of an advance request. However, these questions seem to assume advance requests would be allowed and simply ask about safeguards. You may select how important you think these safeguards would be. However, we would suggest that you select ‘prefer not to say’ and give further explanation in question 9.  

• Question 9 gives opportunity to expand on what safeguards are important. Ultimately, if advance requests were permitted, every possible safeguard would be important. However, the greatest possible safeguard to protect people with cognitive decline is to refuse to allow advance requests. Even if you were to answer no other question in the questionnaire, that is the message we want to send to the federal government through this consultation.  

Nearly 1 in 20 deaths in Canada are now due to euthanasia. Yet the federal government continues to consider further expansion. Take this opportunity to ask the government not to allow advance requests and respond to the questionnaire before February 14, 2025.