Canada’s potential expansion of medical assistance in dying (MAiD) to include advance requests is being hailed by many as a triumph of autonomy. But beneath this misleading veneer lies the grave risk of elder abuse. When the stakes are life and death, our duty must be to protect the vulnerable, not create pathways that could expose them to harm.
An advance request would allow a person to ask that MAiD be provided in the future, after they have lost capacity to consent and once certain conditions are met. While a recent federal “What We Heard” report suggests that Canadians are “generally supportive” of advance requests, majority opinion does not make it morally sound or safe.
For good reason, advance requests are prohibited under the Criminal Code, as the line between mercy and manipulation can blur with dangerous ease.
Imagine an older woman with dementia who develops a urinary tract infection, a common, treatable and underdiagnosed condition that can cause temporary delirium. In that fleeting confusion, her son persuades care providers to interpret her advance request as consent to hasten death. His charm conceals impatience for an inheritance, turning what was meant as a safeguard for dignity into a tool for exploitation.
Elder abuse in Canada affects roughly one in 10 seniors and is often fueled by isolation, dependency and broken trust. Introducing MAiD advance requests would hand abusers another avenue, cloaked in the language of compassion.
People can be pressured into signing, especially amid family strain, caregiver exhaustion, or financial motives. Once signed, a request can be interpreted as a standing wish for death, even when the person might later experience comfort, joy or connection.
Many Canadians take solace in controlling the terms of their dying, but how many mistaken deaths are we willing to tolerate in the name of personal choice? No system can fully prevent coercion or undue influence when vulnerability and power imbalance are at play.
The impulse to sign an advance request frequently arises at moments of deep vulnerability, often after a new diagnosis or when facing long-term care. Fear, grief and uncertainty can make death seem like the only form of control. This is compounded by a society that too often devalues older people, especially those with dementia.
Earlier this year, a United Nations committee warned Canada against allowing advance requests for MAiD, citing the heightened risk to people with disabilities. As Parliamentarians consider Bill S-231, which would permit such requests, they must weigh not just public opinion but the very real moral and practical risks. Expanding MAiD sends a chilling message that people with dementia are less valued and less worth protecting.
To truly honour dignity, we should focus on improving dementia care, expanding supports, and creating care homes that foster respect and belonging.
Recognizing the value of every life, regardless of illness or dependence, is not only a moral imperative but also a necessary safeguard against elder abuse, and one that lawmakers have a responsibility to uphold.
Heather Campbell Pope is founder of Dementia Justice Canada, a small nonprofit dedicated to safeguarding the rights and dignity of people with dementia.
