National consultations on advance requests for medical assistance in dying found it is “generally supported,” a new report says, but participants voiced concerns about moving ahead with the procedure in the absence of final consent.

Advance requests would allow individuals to give their informed consent to MAID while they still have the capacity to do so before they want to receive the procedure.

Health Canada said its national consultations were designed to allow an opportunity to hear from patients, provincial and territorial governments, First Nations, Inuit and Métis peoples, as well as medical providers and the public. As part of this process, roundtables were held and an online questionnaire was available online.

Advocates say advance requests for MAID must be considered with an aging Canadian population. In June, 2023, Quebec became the first jurisdiction in the country to grant advance requests through its passage of Bill 11 in the National Assembly. The federal government did not challenge the bill.

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Health Canada’s newly released report identified four key findings from the consultations: advance requests are “generally supported”; participants are concerned about how advance requests could be accommodated without final consent; respondents want to see supports for patients, families, caregivers and health care providers; and greater capacity in the health system for end-of-life care is needed.

“Throughout the roundtable discussions, a number of participants indicated that people want the option of being able to make advance requests, in keeping with their values around personal autonomy and choice over their health care needs,” the report said.

“Health care providers observed that some of their patients have been surprised to learn that advance requests are not already available under the current MAID framework.”

The report says results showed Canadians support advance requests for people diagnosed with a serious or incurable condition that will lead to a loss of decision-making capacity. It noted 69-per-cent support among online respondents and 67 per cent in public opinion research.

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Some participants said they oppose advance requests, the report said. For a capacity-limiting condition, 26 per cent of questionnaire respondents and 17 per cent of public opinion research respondents were opposed.

In Canada, MAID can be accessed only under specific conditions laid out in the Criminal Code. A person must have a serious and incurable medical condition, be in an advanced state of irreversible decline in capability and be experiencing “enduring and intolerable suffering.”

Medical practitioners are permitted to conduct assessments and to provide medical assistance in dying if specific criteria are met.

The law requires a person have the capacity to consent to receive MAID immediately before it is provided, except in limited circumstances. The only exception is when individuals who are close to death have been assessed as being eligible for MAID and have a date in place to receive it.

In February, 2023, Parliament’s Special Joint Committee on MAID recommended the law be amended to allow for advance requests under certain circumstances. In response, the federal government said advance requests were a complex issue that required further consultation and study.

Dying with Dignity Canada, a charity that advocates for end-of-life rights, has called on the federal government to introduce legislation on advance consent.

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The organization says it has data that show the majority of Canadians support advance requests for MAID for individuals who are diagnosed with capacity-diminishing conditions.

It also says advance requests for MAID would alleviate much uncertainty and “needless suffering” on the part of thousands across this country who have seen loved ones endure a lengthy decline.

The Alzheimer Society of Canada says it supports the right of people living with dementia to have autonomy over decisions including the ability to make an advance request while they are still able.

Some physicians have raised concerns about advance consent for MAID. Catherine Ferrier, a family doctor and assistant professor in geriatric medicine at McGill University, has said patients won’t know what their experience will be and therefore cannot be fully informed.