Coercive Control, MAID and Dementia
This article first appeared in the Minden Times and Haliburton Echo in December 2025.
Here’s a conversation you might have with your loved ones over the holidays: do you think that people with dementia should be eligible to make advance requests for MAiD?
(Advance requests are the ability of a person to negotiate ‘when my condition gets to x, I want out of this life’.)
First the Coles notes for context: This debate has been ricocheting around the federal government since 2016 when legislation permitting Medical Assistance in Dying (MAiD) was initially passed. The three key elements were serious and incurable illness, foreseeable death by natural causes, and intolerable suffering. The immediate eligibility carve-outs were mature minors and mental illness.
The field was further confused when Quebec in 2019 removed reasonably foreseeable death as a necessary condition. The federal government in 2021 followed suit, but maintained the exclusion of mental health and mature minors, setting a two-year limit on making legislative changes to address the outstanding questions. A year later, the recommendation was that no legal changes were needed, punting the debate into the pragmatic world. This resulted in repeated extensions; March 2027 is now the date by which legislation must grasp this thistle.
And thorny thistle it indeed is, because of the vulnerability of persons with mental illness to credibly defend themselves. How can an external person judge how intolerable the pain of chronic depression is? How long must a person suffer before their mental condition is determined to be incurable? Is permitting death letting society off the hook for not providing appropriate care?
The dementia issue is even thornier. It is at present incurable. We have no reliable way of determining if it causes intolerably suffering. Furthermore, the condition is by its nature variable within an overall decline, so deciding when the moment of intolerability has been reached is a judgement call – and if advance requests are permitted, the call must be made by someone other than the person whose death it is. Additionally, they must interpret instructions about the manifestations of a disease about which very little is known for sure, including by the person who gave the instructions.
In earlier reading, I came across a physician who had provided euthanasia in the Netherlands since it became legal in 2002. She said definitively that dementia would never be a basis for assisted death because of the moral threat to the physicians who bore responsibility for making the decision. When I think about what is involved in deciding to put a beloved pet down, I have empathy. Enough to absolve doctors of this burden? Perhaps.
The debate about dementia and MAiD will come around this time from the perspective of vulnerability, in the context of a new bill about coercive control of intimate partners. The Elder Justice Coalition is mounting a campaign to ensure that elder abuse is given consideration because it occurs ‘within relationships of trust and dependence’. The Coalition considers people with dementia to be especially vulnerable. Access to MAiD by advance request is off the table until there is assurance that it cannot be abused.
Wow! This dilemma gives me excessive cause for thought. How many people have said to me or in my hearing that if they get ‘like that’, referencing advanced dementia, they want to be put out of their misery, e.g. have access to MAiD? I have even said that of myself, many times.
I feel very strongly that I do not want to be an unbearable burden on my friends and family. But what constitutes an ‘unbearable burden’? Whose definition prevails? Probably not mine, depending on how comfortable I am with my dependency of the moment. How I am dependent and for how long. Whether I think I’ll improve. Whether my cognitive function is up to keeping track of time (unlikely; it’s wobbly even now).
And if not my judgement, whose? Presumably my caregiver. There’s merit in that. I could say my right to dependency ends when it impinges unfairly on the quality of life of another. If I’m fortunate enough that my caregiver knows and loves me, or at least feels a strong sense of duty toward me, that’ll buy me a fair runway of dependency. But for how long? And what constitutes my caregiver’s good-enough quality of life?
And what if I don’t have caregivers who can make more or less free choices about giving of their time and energy - what if I’m dependent on the public purse? What if my caregiving is expensive and my heirs want to spend their/my money another way? Or what if my personal caregiver is not well suited to the job and punishes me for being what I have become (and maybe for what I was before dementia)?
We need answers to those questions – or at least clear guidance about what the answer must entail – before we give free rein to the power to end life.
Enjoy the conversation.
