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“Charlie is told that he has Alzheimer’s disease. His doctor sits down with him to discuss his health care options and what his future could look like with the disease. Charlie learns that he will likely lose his ability to make decisions about his health care in the future. Later, after thinking about it further, Charlie decides that should his health decline rapidly and he starts experiencing intolerable suffering after he has lost capacity to make health care decisions, he would like to have MAID provided.”

That is the hypothetical included in Health Canada’s What We Heard report, which follows the government’s national consultation regarding advance requests for euthanasia.

Charlie’s advance requests, the report goes on to explain, could specify certain conditions under which to euthanize him, such as not being able to feed himself, not being able to get out of bed, or not being able to recognize his children for over a month.

An advance request is a formal declaration made by a person who retains decision-making capacity, stating that they wish to receive euthanasia if specific conditions are met after they lose the ability to make decisions for themselves. In Quebec, the only Canadian jurisdiction that allows advance requests, the person must have a diagnosis of a capacity-limiting illness (such as dementia) before making an advance request.

 The Criminal Code prohibits euthanasia by advance request. A key element in Canada’s euthanasia law is that a person must consent immediately before being euthanized. The only exception is through a waiver of final consent, where a person consents at the time the euthanasia death is scheduled, even if they are no longer capable of giving consent when that date arrives. But despite Quebec’s flagrant violation of the Criminal Code, euthanizing someone based on an advance request remains illegal.

Yet advance requests appear to be the next big push for euthanasia expansion in Canada.

National Consultation on Advance Requests

In December 2024, the federal government announced that it would launch a national conversation on advance requests for euthanasia. At the time, they also released a questionnaire asking Canadians to share their perspectives. As ARPA explained at the time, that questionnaire did not provide many opportunities to explain answers or to share a full perspective. Some of the questions seemed to assume advance requests would be allowed and simply asked about safeguards that would be necessary to protect people who give advance requests. There was little opportunity to oppose advance requests. In fact, some anti-euthanasia groups encouraged their supporters not to fill out the questionnaire due to its pro-euthanasia framing. Health Canada’s “What We Heard” report does not offer recommendations or outline next steps. Instead, it summarizes the main themes and takeaways from the online questionnaire, public opinion research, and virtual roundtables. Like the questionnaire, parts of the report seem to present foregone conclusions.

The report begins by explaining that euthanasia is a ‘health service.’ Although this is increasingly how doctor-assisted death is portrayed, we cannot forget that it is an exception to homicide in the Criminal Code. The report goes on to say that Canada’s euthanasia law “has been carefully designed with stringent criteria and safeguards to affirm and protect the inherent and equal value of every person’s life.” Notably, these are the very criteria and safeguards that the government keeps removing to make more people eligible to die at the hands of their doctors.

Results

The government received 46,000 responses to the questionnaire. These respondents were 90% English-speaking Canadians, 75% women, and 66% from urban areas. Fifty-six percent of respondents support Canada’s current euthanasia law, while 38% oppose it. The public opinion research component of the consultation included a randomly selected sample of 1,000 participants. And the roundtables included 200 participants from a variety of organizations.

The report compiles the information into four main themes. First, people generally support advance requests, in principle. In the case of a condition that will lead to a loss of capacity, 69% of questionnaire respondents were supportive. That number increased to 76% in the case of a condition that could lead to loss of capacity, such as high blood pressure that could lead to a severe stroke.

The most common value guiding one’s thinking about advance requests was individual choice about end-of-life care, at 76%. Dignified death followed closely at 73%, with protection of vulnerable people at 51%, and sanctity of life at 39%.

The second theme highlighted concerns about implementing advance requests safely. Of course, while many additional safeguards would be important if Parliament legalizes advance requests, the reality is that advance requests cannot be implemented safely. There is no way for a person to know what their life will be like in the future, and it is impossible to give valid consent to death in future circumstances, especially when they will lose the capacity to consent and be unable to change their mind.

In response to a question about the importance of a person making an advance request voluntarily, only 71% of respondents said it is “very important or important.” That means nearly 30% support involuntary euthanasia in certain circumstances. Meanwhile, 41% expressed fears that a person might feel pressured by family or others to sign an advance request. This is important because, once an advance request is signed and a person has lost the capacity to consent, the doctor and family members decide when it is time for the person to die.

The third theme was the need for supports for patients, families, caregivers and health care providers, including education, counselling, and mental health services. This would also include support for understanding and making advance requests.  

The final theme was the need for greater health system capacity, highlighting a supposed need for more access to euthanasia and more euthanasia providers. Some rightly noted the need for palliative care and other supports that help people not choose advance requests, even if they are legal.

Concerns

While the consultation results support advance requests, they may not accurately reflect Canadians’ wishes. First, the results of a questionnaire and roundtables do not necessarily reflect Canadians’ views broadly. It only represents the “keeners” who took the time to participate.

The randomly selected sample of 1,000 people for public opinion research would be the most representative. The problem with this research, however, is that the polling questions do not define advance requests clearly. Advance requests are complicated, even for those of us who pay close attention to the issue of euthanasia in Canada.

Second, Health Canada gets to choose what is presented because they are writing the report. For example, the report includes 13 direct quotes from roundtable participants. One selected quote reads “End of life. My body, my choice. No dignity in dying a natural death. Die in a manner of one’s choosing. My decision for me only!”

The report does share opposition to advance requests, briefly. The bulk of it is focused on what would need to be done to implement advance requests.

Moving Forward

Euthanasia is always the wrong answer for suffering. And euthanasia by advance request adds more problems as it devalues the lives of Canadians with dementia and similar illnesses.

To go back to the hypothetical example at the beginning of this article, if Charlie’s doctor sits down with him to discuss his care options and what his future looks like with his illness, the doctor’s words can have a massive impact. If the doctor indicates that life will be full of suffering and MAID is a viable option, that may influence Charlie’s wish to die. But if the doctor talks about how people with Alzheimer’s can live happy, fulfilling lives, and discusses the care and supports available, Charlie may desire to live despite his condition.

As euthanasia spirals to include disability, mental illness, and potentially capacity-limiting illnesses, more Canadians may realize the inherent problems with offering death to the vulnerable. Recent research found that Canadians generally remain satisfied with the scope of Canada’s MAID law, although they do not necessarily understand what it entails. Notably, though, the number of Canadians who oppose euthanasia in every circumstance increased from 12% to 18% between 2023 and 2025. Additionally, 42% are opposed to euthanasia for mental illness, and 46% are opposed to euthanasia for disability (which is already legal).

To date, the only bill in Parliament to legalize advance requests is a Senate bill, not a government bill. The government has not said whether it wishes to legalize advance requests. But the conversation continues, and we need to be prepared for the next battle as we advocate for care for vulnerable Canadians, rather than ending their lives.