Alzheimer’s and early assisted dying: 119 requests in 2 months

Since October 30, people who have been diagnosed with a serious and incurable illness leading to incapacity, such as Alzheimer’s disease, can submit an advance request for medical assistance in dying.

This is a unique expansion in Canada of eligibility for medical assistance in dying (MAID). Accompanied by a doctor, the patient must list in a form the clinical manifestations linked to his illness which must be considered once he is incapable of consenting to the medical procedure performed years later.

According to figures obtained from the Ministry of Health, the volume of requests remains modest.

Since October 30, there have been 119 advance request forms for medical assistance in dying submitted to the registrywrites a ministry spokesperson.

Some doctors and researchers feared last fall an explosion in anticipated requests, beyond the 6,000 patients who obtained medical assistance in dying last year.

Not automatic years later

A doctor in the Laurentians, Dr. Danielle Michaud knows from experience that it is necessary to be patient with these patients and their families, and also to be vigilant, because sometimes the patient’s condition is such that he is already too late to provide informed consent.

I have already met several people and a large portion of them were simply not eligible, because they were unfit to make a decision for this advance requestexplains the doctor, who has offered medical assistance in dying since 2017.

You have to arrive with big, big ears, be in an open position, start from the principle that you are starting a conversation and you don’t know how it will end. […] And at some point, you realize that OK, we’ve been going around in circles for an hour and a half and the person doesn’t understand.

We must also explain to patients that the majority of them will not have their MA because the law requires that the patient be very unwell. […] and most of the time, our Alzheimer’s patients are not sufferingcontinues Dr. Michaud.

A similar story in the Quebec region, where Dr. Alain Naud suggests improvements to the online form so that the patient understands that it is, in the end, a doctor who will decide, years later, whether he will the front with the AMM.

It is mentioned that no matter what you write as a statement of your condition, it does not guarantee that you will receive medical assistance in dying, because there will have to be two health professionals when the time comes who validate that you suffer from constant and intolerable physical suffering and psychological suffering which cannot be alleviated.

This represents a big problem which risks being unsafe for patients who will fill out this form to make an advance request.estimates Dr. Naud, palliative care doctor at the University Hospital of Quebec.

I expect that, in the course of 2025, we will see a few more advance requests arriving, from the moment when there have been improvements, when it will be better known to everyone, between other health professionals.

Two orphan requests at the CHUM

To date, two CHUM patients, out of the 22 establishments consulted, had not yet found a doctor to write their advance request.

Article 31 of the End-of-Life Care Act provides that the patient’s file must be sent to the CEO of the establishment if the doctor refuses to complete the form.

For its part, the insurer of doctors in Canada indicates that it has received 20 requests for advice from Quebec doctors. Since October 2024, the Canadian Medical Protective Association (CMPA) has encouraged any physician who plans to provide MAID following an advance request to first contact the CMPA.

Furthermore, clarifications have been made to the process and the form on the RAMQ website.

According to our information, some doctors have been refused scanned handwritten requests.

On the RAMQ side, they say they have received a few dozen calls and emails from doctors since the registry was put in place in October 2024.

In the opinion of Dr. Naud, many professionals will choose to stay on the sidelines until things become clearer and simpler.

Elsewhere in Canada, a national consultation continues on advance requests for medical assistance in dying. The Alzheimer Society of Canada encourages people to participate. Due February 15.