Honourable senators, I rise today to speak to Bill S-231, An Act to amend the Criminal Code (medical assistance in dying).

I support Senator Wallin and thank her for both her unwavering advocacy as well as her very moving speech, which reflected her personal angst and pain. Thank you, Pamela.

Allowing advanced requests for medical assistance in dying for those who are diagnosed with dementia and who wish to make their intentions known while they still have the capacity to do so is, in my opinion, a reasonable expectation. It is also based on my experience in managing the complexities of dementia in all its guises as a family physician who managed a long-term care unit for over 30 years.

Colleagues, this is not an easy subject. It touches the deepest questions of autonomy, dignity and compassion. It invites us to reflect on what it means to live — and, yes, what it means to die — with respect and choice.

Let me emphasize, colleagues, my deeply held respect for those of you who may hold a view contrary to my own.

Across this country, thousands of Canadians are living with dementia. It is one of the most feared diagnoses, not only because of what it takes from the person afflicted but also because of what it takes from the people who love them: memory, recognition and personality. The things that make us who we are can fade slowly and painfully. Families often describe this as a long goodbye.

And yet, for many, the most distressing aspect is not the disease itself but the loss of control that comes with it. Canadians who support advanced requests say, “I don’t want to be kept alive when I no longer know who I am.” However, under our current law, that wish cannot be honoured. Once a person with dementia loses the capacity to consent, they lose the legal right to access an advanced request, even if they made a clear and well-considered request in advance.

As a result, many individuals face an impossible choice: They must either seek MAID earlier than they would otherwise wish, while they still have the capacity, or risk being denied it altogether if they wait too long. This is not a choice, in my opinion, consistent with compassion or common sense.

Honourable colleagues, this issue is not new. Parliament has wrestled with it since the very beginning of the MAID debate. The Council of Canadian Academies studied advance requests in depth. Polls consistently show that a large majority of Canadians — upward of 80% — support allowing advanced requests in cases of dementia. The voices calling for the change are not abstract. They are our neighbours, friends and loved ones. They are physicians, nurses, ethicists and families who have lived through the heartache of watching someone they love endure years of decline long after that person has said, “Please don’t let this happen to me.”

We have already taken important steps. In 2021, with Bill C-7, Parliament expanded access to medical assistance in dying, or MAID, and removed the requirement that a person’s natural death be reasonably foreseeable. That legislation also committed the government to further study the question of advance requests. However, since then, progress has been slow, and Canadians are waiting.

This is not about rushing a decision; it is about respecting the deeply held wishes of competent adults who want to plan for their future with both honesty and dignity.

The ethical foundation for advance requests is clear: The principle of autonomy, the right of each individual to make informed choices about their body and life, does not evaporate with the onset of cognitive decline. It is the same principle that underlies the consent to surgery, treatment and, ultimately, MAID itself.

Critics sometimes worry that allowing advance requests could put vulnerable people at risk. That concern is legitimate and must be addressed through strong safeguards. Advance requests must be voluntary, informed, written, witnessed and clearly tied to pre-specified conditions, such as the loss of the ability to recognize loved ones, communicate or live without constant distress.

We should remember that health professionals have upheld rigorous standards of assessment, ethics and accountability. We can and must trust them — and we can trust Canadians — to approach advance requests with the same care.

Honourable colleagues, other jurisdictions have shown us the way. The Netherlands, Belgium and Spain have frameworks for advance requests for assisted dying. In those countries, experience has shown that clear rules, professional oversight and open communication can protect both autonomy and safety.

In my own practice, I reflect on and consider the person who sits with me as their physician, with their spouse and their children, and says:

When I no longer know you, when I can no longer feed myself, when I am no longer the person you love — please honour my wish for peace.

To deny that person the ability to make such a choice is to deny the very essence of self-determination that is a human right. This is not about forcing a choice on anyone. It is about extending choices to those who want it.

No one should be compelled to make an advance request, but for those who seek the comfort of knowing that their future suffering will not be prolonged against their will, the law should not stand in the way.

Colleagues, as senators, we are called to bring both wisdom and compassion to difficult questions. Let us move forward together, guided by empathy, respect for human dignity and the voices of Canadians who have asked us to listen.

Honourable colleagues, these are conversations we are going to continue to have even after this bill has gone through this chamber. I urge you all to consider three areas as we continue this discussion.

The first, which this legislation addresses in part, is explicit legislation for advance MAID requests for those with dementia and similar conditions while competent. Let a living will carry the weight of the law, waiving final consent if predefined triggers — like loss of capacity or intolerable suffering — are met, overseen by ethics boards and closely monitored.

The second is mandatory integration of palliative and dementia-specific care in MAID assessments. No one should view death as the only viable option when housing, respite or therapy could ease the burden. Let us invest in the Alzheimer Society of Canada’s call for national dementia strategies, ensuring that MAID is always a choice and not a funnel.

The third — and perhaps the most critical — is rigorous safeguards against coercion. We must require independent assessors for all dementia-related requests, prioritizing the patient’s “own words and reasoning,” as the Ontario commission has advised. Let us reject any slide towards nonconsensual proxies. Proceeding with a direct voice is not compassion; it is peril.

Colleagues, dementia robs 76,000 new Canadians annually of their stories, independence and very essence. We owe them a system that honours foresight and not fate. Let us extend this promise without eroding life’s protections. Debate this, amend it, advance it — before yet another family whispers, “What if we’d acted sooner?”

Advance requests in cases of dementia are not about hastening death. They are about ensuring that the final chapter of life is written with the same autonomy, integrity and care that we all value throughout our lives.

Colleagues, for many Canadians and their families, this issue is deeply personal. They are not asking for the right to die; they are asking for the right to decide. Let us have the courage to give them that choice.

Thank you. Meegwetch.