Rebecca Luna, a 49-year-old single mother from Victoria, British Columbia, who publicly shared her battle with young-onset Alzheimer’s disease, died by medical assistance in dying (MAID) on July 25. Luna had begun to notice cognitive decline at age 46 and received her diagnosis two years later. She documented her experience candidly on TikTok, where she accumulated over 90,000 followers. In the days before her death, Luna expressed that she no longer felt safe in her body and chose MAID as a means to find relief as the disease progressed more rapidly than anticipated.

The timing of Luna’s death sheds light on challenges faced by Canadians living with neurodegenerative illnesses who seek MAID. Unlike Quebec, which allows residents with serious, incurable conditions that lead to incapacity to apply for MAID months or years in advance, other provinces require patients to have the capacity to consent at the time of the procedure. This means patients like Luna may feel compelled to access MAID earlier than desired to ensure they can legally consent.

Supporters of expanding access to advance requests for MAID argue that this option should be available nationwide. Helen Long, CEO of Dying with Dignity Canada, called the current provincial disparities “not appropriate,” stressing that advance requests could provide more autonomy and relief to individuals confronting illnesses such as Alzheimer’s. A parliamentary committee recommended in February 2023 that advance requests be authorized under specific conditions, including dementia, signaling growing momentum for legislative reform.

Quebec became the first jurisdiction in Canada to pass legislation allowing advance requests in June 2023, and as of early 2024, over 2,100 individuals had been approved for such requests. The federal government did not challenge the province’s legislation, reflecting a cautious approach amid ongoing national debates over MAID eligibility criteria.

The current federal law permits MAID only for patients with a terminal or incurable physical medical condition. The extension of MAID access to those whose sole condition is a mental illness remains contentious. A parliamentary committee has urged indefinite exclusion of patients with mental illnesses as their sole diagnosis from MAID eligibility. Justice Minister Sean Fraser has pledged to review committee findings and consult stakeholders before determining future policy directions.

The issue of advance consent has also gained attention from legislators such as independent Senator Pamela Wallin, who has introduced a bill in the Senate advocating for nationwide allowance of advance requests. Wallin, whose mother suffered from Alzheimer’s disease, described the experience as a “slow descent into hell,” highlighting the profound emotional toll on families.

Voices in the medical community express reservations about advance requests. Catherine Ferrier, a geriatric medicine specialist at McGill University, cautions against allowing MAID when patients cannot give contemporaneous consent or comprehend the procedure. However, patients living with dementia like Sandra Demontigny from Lévis, Quebec, who witnessed her father’s decline, emphasize the importance of access to advance requests to avoid prolonged suffering and preserve dignity.

National consultations conducted by Health Canada in October 2025 found general public support for advance requests, citing autonomy and choice as key values. Nonetheless, concerns about the ability to ensure informed consent remained prevalent among some participants.

As Canada’s population ages and diagnoses of dementia rise, the debate over advance requests for MAID continues to underscore complex ethical, legal, and medical considerations surrounding end-of-life care.