Ask the Expert: With regards to physician-assisted suicide in Canada, can patients with dementia who are competent to make decisions choose this as an option for the future when the disease significantly worsens?

At the present time, people with dementia would not be eligible for "medical assistance in dying" (the official name for physician assisted suicide) for a number of reasons. First, the person requesting medical assistance in dying must be capable at the time the request for assistance is made, as well as the time the assistance will be administered. This would likely rule out many patients with dementia who might maintain capacity to make the decision early in the disease, but will almost certainly lose capacity as the disease progresses. Secondly, in order to be eligible, the person requesting medical assistance in dying must have a "grievous and irremediable" condition. While Alzheimer's disease and most other dementias would certainly be considered irremediable (in other words irreversible and for the most part untreatable), the term "grievous" would likely not be met. "Grievous" has been defined as "unbearable physical and mental suffering" and for most patients, since insight into their deficits and disabilities is lost early in the disease, there is neither mental, nor physical suffering in dementia.

The process of arranging for medical assistance in dying does vary from province to province, and every case may be different, so it is always worthwhile to discuss future planning with your physician. There are also many alternative care options that can help ease suffering at the end of life and might be preferable to medical assistance in dying. Finally, while the discussion above applies to the current Canadian legislation (which also requires that individuals be at least 18 years of age to request medical assistance in dying), this could change in the future depending on legislation and/or supreme court rulings.  

Professor Nathan Herrmann

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair in Geriatric Psychiatry

Head, Division of Geriatric Psychiatry
Sunnybrook Health Sciences Centre