Advance requests for assisted dying

What are the impacts of banning advance requests for assisted dying? We are working to find out.

The Supreme Court’s 2015 ruling on assisted dying opened the door for a future Canada in which horrific suffering is no longer a life sentence.

The unanimous ruling established assisted dying as a right for competent adults who are suffering intolerably because of a grievous or irremediable illness and who clearly consent to the termination of life. However, the justices on the high court were silent on when consent must be given, leaving the finer details up to legislators and bureaucrats.

The decision not to allow suffering Canadians to make advance requests for assisted dying has created challenges for some individuals who want to exercise their right to die with the help of a clinician. It also threatens to discriminate against people whose medical conditions will rob them of mental capacity as a matter of course. As the leading human-rights charity defending Canadians’ end-of-life rights, Dying With Dignity Canada is working to learn more about the consequences of the ban on advance requests for assisted dying, and we continue to speak out about the impacts on people and their loved ones.

What is an advance request for assisted dying?

An advance request is when a competent person makes a request for assisted dying that could be honoured later, after they lose the capacity to make medical decisions for themselves. Advance requests are allowed in some jurisdictions where assisted dying is legal, including the Netherlands, Belgium and Luxembourg.

There are two general situations in which one might want to make an advance request for assisted dying. Consider the following, imagined scenarios that reflect the real-life challenges that some Canadians encounter:

Janice has terminal cancer and is bedridden at home. Knowing her condition is only going to get worse, she makes a request for medical assistance in dying. After two formal assessments and many conversations with her caregivers, her request is approved.

However, days before she’s set to undergo life-ending treatment, Janice suffers a stroke, leaving her temporarily incapacitated but still very much alive. If she were conscious, she would still want a doctor to help her achieve a peaceful death. But at the moment, she has no way of making her wishes known.

And then there’s Arvin: Semi-retired and in his mid-60s, Arvin has just learned the most alarming news of his life: he has early dementia. He often has trouble remembering coworkers’ names and occasionally leaves the milk jug in peculiar places. Otherwise, life is still good. In fact, Arvin and his wife are planning to sneak in a couple of big overseas trips before travelling becomes too much of a challenge.

Arvin is worried about his prospects for the long road ahead. He is terrified of spending his final days confused and incontinent in the confines of a nursing home, and he wants to access assisted dying before he finds himself in that position.

“But what if I lose competence before I’m ready to die?” Arvin sometimes asks himself. “I don’t want to feel pressure to end my life too early — while I can still enjoy the company of my grandchildren — to ensure that my wishes are carried out before it’s too late.”

Understanding the impacts, educating the public

At Dying With Dignity Canada, we work to understand how people like Janice and Arvin are affected by the ban on advance requests for assisted dying. These insights will be invaluable as healthcare professionals, policy-makers and the general public look at the future of assisted dying in this country.

This is one way in which Dying With Dignity Canada is empowering the public. By giving Canadians the information they need about how they might be affected by the ban on advance requests, we can better equip them to defend their end-of-life rights, today and many years into the future.