MAiD Deaths Triple: Who Consents When Dementia Takes Away Capacity?
Canada recorded 16,499 deaths through medical assistance in dying in 2024—about 45 every day. Now Ottawa proposes allowing an earlier request to authorize an assisted death after illness has taken away the person’s ability to consent.
Canadians need to understand what is changing, who makes the final assessment, and what protects a patient who can no longer speak for themselves.
A growing option
Health Canada’s latest annual report provides these revised figures:
| Year | MAiD deaths |
|---|---|
| 2019 | 5,461 |
| 2020 | 7,469 |
| 2021 | 10,066 |
| 2022 | 13,199 |
| 2023 | 15,427 |
| 2024 | 16,499 |
The annual total more than tripled between 2019 and 2024. Growth slowed to 6.9% in 2024, but the number continued to rise. The cumulative total reached 76,475 through December 2024; that excludes deaths in 2025 and 2026.
MAiD accounted for 5.1% of Canadian deaths in 2024. Most recipients—95.6%—had a reasonably foreseeable natural death. Another 732 people did not. Every reported procedure that year was administered by a medical practitioner.
These figures describe MAiD overall. They are not a count of dementia patients receiving MAiD through advance requests. [1]
What Ottawa announced
On October 7, 2026, Justice Minister Sean Fraser announced plans for legislation with two different purposes.
One would indefinitely maintain the exclusion of mental illness as the sole underlying condition for MAiD, replacing the expansion scheduled for March 17, 2027.
The other would permit advance requests from people diagnosed with serious, incurable illnesses that will take away their ability to consent. Dementia and Alzheimer’s disease are central examples. Provinces would decide whether to provide the service.
This was an announcement of proposed legislation. It did not change the law that day or settle the detailed consent safeguards. [2]
Whose consent would authorize death?
An advance request would originate with the patient while they still have decision-making capacity. Later, clinicians would assess whether the circumstances specified in that request and the legal requirements had been met.
That means relying on the person’s earlier consent when they can no longer give informed consent at the time of the procedure. It would not authorize the state to select people for death simply because they have dementia.
Quebec’s existing provincial system illustrates the distinction, although Ottawa’s eventual rules may differ. Quebec permits a patient to appoint a trusted person, but doing so is optional. That person’s role includes alerting the care team; they do not replace the patient’s request with their own consent.
Two physicians or specialized nurse practitioners must confirm that all eligibility criteria are met. A signed request alone is insufficient.
Family approval is not a required eligibility criterion. A designated trusted person must be involved in the assessment discussions and informed of the conclusions. That is different from requiring every relative’s permission—or guaranteeing every relative advance notice of the procedure.
Quebec’s guidance also says an expressed refusal prevents administration and results in cancellation of the request. How refusal or resistance is identified in someone with dementia remains a crucial safeguard to examine. [3]
The questions Parliament must answer
Before approving the federal changes, Canadians deserve clear answers:
- What happens when someone who previously requested death now appears content?
- How will words, gestures or resistance be interpreted after capacity is lost?
- Who must receive advance notice, and is there time to challenge an assessment?
- What happens when relatives and clinicians disagree about suffering or the patient’s specified conditions?
- What dementia care, disability support and relief for caregivers must actually be available?
- How will disputed cases and compliance failures be publicly reported?
There is documented reason to scrutinize inappropriate suggestions. Veterans Affairs confirmed four veterans had MAiD raised inappropriately by one employee. Its investigation concluded the incidents were confined to that employee. This establishes real misconduct, not proof of a nationwide policy to replace care with death. [4]
The rising numbers alone do not prove MAiD is being used to relieve pressure on healthcare budgets. But the question must be asked: does someone have a meaningful choice if death is accessible while adequate care is not?
An earlier signature should never end public scrutiny. When a patient can no longer consent, the obligation to demonstrate protection becomes greater—not smaller.
Sources
- Health Canada: Sixth Annual Report on Medical Assistance in Dying in Canada, 2024.
- Canadian Press, October 7, 2026: Key dates and announced changes; Government announcement and provincial implementation.
- Government of Quebec: Advance requests, eligibility and the role of trusted persons.
- Veterans Affairs Canada: Investigation into inappropriate MAiD conversations.
Prepared using information available October 7, 2026. The proposed federal legislation and its detailed safeguards remain to be examined when introduced.
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