This blog post was originally published on March 17, 2022

Editor’s note: This weekend, we honour and remember Audrey Parker and her legacy on the anniversary of her death. The Halifax native was 57 years old when she died with medical assistance on November 1, 2018, two and a half years after she was diagnosed with an incurable cancer. She made national news in 2018 when she advocated for an important change in MAID legislation – the waiver of final consent. Audrey had been diagnosed with terminal brain cancer and had been approved for an assisted death, but she feared that she would lose capacity before her chosen provision date and lose the opportunity to die on her own terms. Because of a flaw in the legislation, Audrey chose to die November 1, 2018, earlier than she wanted. Her courage to speak out impacted change, and in March 2021, the waiver of final consent was made legal in Canada’s MAID legislation; it is often referred to as Audrey’s Amendment. Audrey Parker spent the last weeks of her life raising awareness about the challenges facing Canadians who have been assessed and approved for assisted dying and “changed the national conversation” around end-of-life choice.

Although much progress has been made before and after Audrey’s passing, there is still work to be done. Today, many people still aren’t eligible because they are in the early stages of a capacity-eroding condition — such as dementia, Parkinson’s, or Huntington’s disease – and cannot put in place an advance request for MAID.

Dying With Dignity Canada believes that advance requests for MAID should be a legal end-of-life option for those diagnosed with a grievous and irremediable medical condition. Visit Advance requests | Dying With Dignity Canada for more information and for how you can let your elected officials know you believe advance requests for MAID should be a legal end-of-life choice for people across Canada.

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In March 2021, the legislation with respect to medical assistance in dying (MAID) changed and broadened eligibility with the passage of Bill C-7. There was strong support for the changes in the law, and Canadians advocated passionately for them. The three main changes in Bill C-7 included: 

• A person’s death does not have to be reasonably foreseeable to be eligible for MAID 
• A person only needs one witness to sign their request for MAID, down from two, and, 
• The waiver of final consent for those whose death is reasonably foreseeable  

Audrey Parker advocated for the waiver of final consent after her diagnosis with an incurable cancer. Audrey chose to die earlier than she would have otherwise wanted because of a flaw in Canada’s assisted dying law; the requirement that the suffering person be competent immediately before their MAID provision. The proposed change was named, “Audrey’s Amendment” in honour of her advocacy. 

“What a tremendous relief it was to see Audrey’s Amendment included in the passage of Bill C-7. We will never know how much extra time we would have had with Audrey. Without the waiver of final consent, she was forced her to choose her death earlier than she wanted. One of her greatest fears was losing mental capacity before she could invoke MAID.  Her advocacy, before her own assisted death, led to this very important change for Canadians and their families” said Kim King, Audrey’s close friend. 

According to Dr. Chantal Perrot, “The waiver of final consent was a welcomed change to the legislation governing MAID when Bill C-7 received royal assent last year. It was a terrific idea in that it allows people who have been assessed and approved for MAID to receive MAID in the event that they lose the capacity to provide consent on the day of their provision.” 

Since March 2021, when the change in the law came into effect, 72 people in Ontario have received MAID using a waiver. More federal statistics will be available in the summer when Health Canada publishes their annual MAID report. 

Dr. Perrot goes on to say, “In my own practice, I discuss the waiver with most of the patients I see whom I find eligible for MAID and whom I believe are at risk of loss of capacity in the near future. Having a waiver in place gives them and their loved ones the assurance that they may receive MAID if they lose capacity, and thus will not have to languish in a state of suffering and incapacity for days, weeks, or even months while waiting for a natural death. I discuss the waiver with both the patient and their loved ones, as the loved ones will have to be more involved in facilitating on the day of the provision if the patient no longer has capacity. I encourage the patient to help me and their loved ones by telling us at what point after the loss of capacity, or under what conditions, they would want to proceed with MAID. I include this detailed information in the agreements that I make with them.” 

Like any new legislation or process, there have been challenges with the application of the waiver that continue to be worked out. Dr. Perrot believes that some of the difficulties with the waiver of final consent provision will be alleviated if and when advance directives for MAID become legal.  

“Many people look forward to this day. In the meantime, we will continue to try to help our patients understand the use of the waiver so that they can have this added assurance and relief of suffering at the end of their lives.”