{"id":476057,"date":"2026-02-18T15:31:07","date_gmt":"2026-02-18T15:31:07","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/476057\/"},"modified":"2026-02-18T15:31:07","modified_gmt":"2026-02-18T15:31:07","slug":"quebecs-advance-request-maid-program-offers-a-complicated-example-for-other-jurisdictions","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/476057\/","title":{"rendered":"Quebec\u2019s advance-request MAID program offers a complicated example for other jurisdictions"},"content":{"rendered":"

Open this photo in gallery:<\/a><\/p>\n

Sandra Demontigny in a common area in her building in Levis, Que., on Monday. Ms. Demontigny was diagnosed with early onset Alzheimer\u2019s at the age of 39 and her advance request for MAID has been approved.Andrej Ivanov\/The Globe and Mail<\/p>\n

Sandra Demontigny, a 46-year-old mother of three from L\u00e9vis, Que., was diagnosed with Alzheimer\u2019s disease eight years ago. Her father had also had Alzheimer\u2019s, his mind slipping until his eventual death. Not wanting to suffer a similar fate, Ms. Demontigny made that wish known by signing a form, one only available to residents in her province.<\/p>\n

A little over a year ago, Ms. Demontigny learned she was approved for a medically assisted death that could be carried out months or years in the future. Her advance request for medical assistance in dying (MAID) details how she wants her life to end when Alzheimer\u2019s takes away her independence \u2013 and when she\u2019s unable to verbally relay her wishes.<\/p>\n

\u201cI really don\u2019t want to live like that,\u201d she said, knowing the nature of her disease means her health will continue to deteriorate. \u201cI cannot put my children through that.\u201d <\/p>\n

Ms. Demontigny is among more than 2,100 individuals in Quebec who have been approved for an advance request since the province began granting them in October, 2024. This means they will be allowed to access MAID months or years from now, to be carried out when they no longer have the capacity to consent. It is unclear how many advance request procedures have been administered.<\/p>\n

Ontario woman calls for reform after her son \u2018shopped\u2019 for MAID approval in B.C.<\/a><\/p>\n

Canada is considered to have some of the most permissive MAID laws globally, prompting fierce debate over who should qualify for a physician-assisted death. As the law stands, patients qualify if their deaths are reasonably foreseeable or they have an incurable condition.<\/p>\n

In recent months, a number of cases have landed in court and sparked calls for reform, including from an Ontario mother of a 26-year-old who struggled with mental illness and was approved to die by MAID in B.C.<\/a> Ottawa has delayed<\/a> until 2027 a decision on whether people whose sole condition is mental illness can qualify for the procedure.<\/p>\n

The reach of MAID in Quebec goes further than anywhere else in the country: It is the only jurisdiction where residents diagnosed with a serious, incurable illness that leads to incapacity,<\/a> such as Alzheimer\u2019s, can apply for advance MAID requests. Internationally, advance requests can also be made in Spain and Colombia. In the Netherlands, patients can write advance directives to spell out their wishes should they lose the ability to consent to MAID.<\/p>\n

Open this photo in gallery:<\/a><\/p>\n

Ms. Demontigny with her cat Madame Litchi. Although her condition has recently started declining, she is still very capable and has not yet set a date for MAID.Andrej Ivanov\/The Globe and Mail<\/p>\n

Proponents argue Quebec\u2019s approach offers valuable insights on how it could be expanded elsewhere, especially as the population ages and more people are diagnosed with dementia. Critics argue it is problematic because patients can\u2019t offer consent just before the procedure occurs. <\/p>\n

Last March, the United Nations Committee on the Rights of Persons with Disabilities recommended <\/a>that Ottawa not support advance requests and that it should repeal MAID<\/a> for anyone without a terminal illness. The committee\u2019s main reason, as stated in a report, is that \u201cinequality and discrimination cause and compound \u2018suffering\u2019 for persons with disabilities,\u201d and that inadequate social supports can lead them to disproportionately seek advance requests for MAID.<\/p>\n

Charter challenge over religious exemptions to MAID goes before B.C.\u2019s Supreme Court<\/a><\/p>\n

The federal government did not challenge Quebec over Bill 11, which was passed in its legislature in June, 2023, but it has also not amended the part of the Criminal Code that requires<\/a> patients to have capacity to consent immediately before MAID is provided. The only exception to this rule concerns individuals close to death who have been assessed as being eligible and have a date in place to receive MAID.<\/p>\n

Several groups, including the Alzheimer\u2019s Society of Canada, have argued that those living with dementia should have access to advance requests. <\/p>\n

Meanwhile, Pamela Wallin, an independent senator, has a bill before the Senate advocating for changes to the Criminal Code. She previously told the Senate that witnessing a decline in her mother, a former schoolteacher who had Alzheimer\u2019s disease, was like watching a \u201cslow decent into hell.\u201d<\/a> <\/p>\n

\u201cIf you don\u2019t know who your family is, if you don\u2019t know who you are, then that sense of self is gone,\u201d she said in an interview. \u201cPeople are simply asking for the right to make that decision while they still can.\u201d<\/p>\n

Open this photo in gallery:<\/a><\/p>\n

Ms. Demontigny shows two pictures of her father, one before his Alzheimer\u2019s diagnosis and another later in his life as his condition declined.Andrej Ivanov\/The Globe and Mail<\/p>\n

Ms. Demontigny had publicly advocated<\/a> for Quebec to grant advance requests, and she believes those in other provinces should be able to access it, too.<\/p>\n

Last fall, Canadian children\u2019s author Robert Munsch, 80, described to The New York Times the dilemma he and others with dementia face outside Quebec. <\/p>\n

\u201cI have to pick the moment when I can still ask for it,\u201d Mr. Munsch said<\/a>. Otherwise, he said, his wife will be stuck with him as a \u201clump.\u201d <\/p>\n

Ms. Demontigny and her companion, Andr\u00e9 Secours, feared she would have to live while incapacitated. In the fall of 2024, she met with physician Georges L\u2019Esp\u00e9rance and filed the paperwork that November. Ms. Demontigny learned the request was approved last January. <\/p>\n

Mr. Secours knows it will be difficult for those close to Ms. Demontigny to see her condition deteriorate. He draws comfort from knowing the next steps are planned. <\/p>\n

Open this photo in gallery:<\/a><\/p>\n

A scheduling memory aide in Ms. Demontigny\u2019s home to help her time management.Andrej Ivanov\/The Globe and Mail<\/p>\n

Ms. Demontigny is still able to maintain her independence but he sees signs that her disease is slowly taking it away: She loses track of what she\u2019s doing; language is more difficult; she\u2019s tired; and she is increasingly losing her short-term memory.<\/p>\n

Dr. L\u2019Esp\u00e9rance, president of the Association Qu\u00e9b\u00e9coise pour le Droit de Mourir dans la Dignit\u00e9, Quebec\u2019s chapter for the Right to Die in Dignity, has administered about 200 MAID procedures, mostly for those whose deaths were foreseeable. <\/p>\n

He has also been part of the process of applying for advance requests in Quebec with five patients, including Ms. Demontigny. Each request is specific to the wishes of individual patients who are suffering from neurodegenerative conditions. <\/p>\n

Dr. L\u2019Esp\u00e9rance, a 74-year-old former neurosurgeon and medical-assisted death provider, sits with patients and their trusted loved ones through multiple conversations, and to fill out the paperwork.<\/p>\n

Open this photo in gallery:<\/a><\/p>\n

Dr. Georges L\u2019Esp\u00e9rance is the president of Quebec\u2019s chapter for the Right to Die in Dignity.Andrej Ivanov\/The Globe and Mail<\/p>\n

Patients need to consider when they would like their lives to end and make those wishes clear. It takes time to speak to them to determine their own limits in keeping with their own values, Dr. L\u2019Esp\u00e9rance said. Many, he added, do not want to live after they can no longer feed themselves or use the bathroom independently.<\/p>\n

Public opinion polling commissioned by Dying with Dignity Canada has shown significant support among Canadians for advance requests. National consultations<\/a> conducted by Health Canada also found advance requests to be \u201cgenerally supported,\u201d according to a summary<\/a> released in October. Some participants, however, voiced concerns about moving ahead in the absence of final consent.<\/p>\n

Still, Catherine Ferrier, a family doctor and assistant professor in geriatric medicine at McGill University, urges caution. She works in a geriatric clinic and sees patients with dementia. Dr. Ferrier is concerned about patients not being able to offer consent at the time of a MAID procedure, nor being able to understand what is taking place in the moment.<\/p>\n

\u201cI don\u2019t think that this is adequate consent,\u201d she said. \u201cIf you try to stick a needle into a person with advanced dementia, they\u2019re going to resist. So either you have to sedate them or you have to hold them down to put in the IV.\u201d<\/p>\n

Ms. Demontigny sees it differently. She recalls hearing her father\u2019s groans when he was unable to speak and how he could only move around on his hands and knees before the end of his life. <\/p>\n

She does not want to endure that herself, nor does she want her children to see her like this. <\/p>\n

\u201cI don\u2019t want to do the same.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Open this photo in gallery: Sandra Demontigny in a common area in her building in Levis, Que., on…\n","protected":false},"author":2,"featured_media":476058,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[47],"tags":[192,13849,79],"class_list":{"0":"post-476057","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-environment","8":"tag-environment","9":"tag-pleasemod","10":"tag-science"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/476057","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=476057"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/476057\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/476058"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=476057"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=476057"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=476057"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}