Dementia is a “qualifying, stand-alone diagnosis” for euthanasia in Canada, provided people have the capacity to make a reasoned decision and don’t lose capacity before they want their lives ended, according to Canada’s medical assistance in dying (MAID) providers.
Canadian children’s author Robert Munsch, who turned 80 this summer, revealed in a profile in The New York Times this week that, shortly after being diagnosed with dementia in 2021, he applied, and was approved for, MAID.
While the celebrated author has chosen to die by MAID, his daughter Julie Munsch later made it emphatically clear in a Facebook post that her father “IS NOT DYING.”
“My dad is doing well but of course with a degenerative disease it can begin to progress quickly at any point,” Julie wrote of her father, who has Parkinson’s as well as dementia.
Message from Julie Munsch
My father IS NOT DYING!!!
Thanks to everyone and their well wishes, however, my father’s…
Posted by Robert Munsch on Tuesday, September 16, 2025
may have created some confusion over what Canada’s law says about MAID, dementia and advance requests for euthanasia.
Munsch himself acknowledged “I have to pick the moment when I can still ask for it,” and worries that if he loses capacity before then, his wife Ann will be “stuck with me being a lump.”
A reported 19,666 requests for MAID were made by Canadians in 2023; 15,343 were provided an assisted death, bringing the total number of MAID deaths in Canada at that point, since the practice was legalized in 2016, to 60,301.
Dementia was reported as a medical condition in 241 people who received MAID in 2023, according to the federal government’s most recent
.
Slightly less than half (106) reported dementia as the sole medical condition. Here’s what you need to know about dementia and Canada’s MAID rules.
What is dementia?
It’s an umbrella term that covers symptoms affecting brain function caused by neurodegenerative disorders.
Between April 2022 and March 2023, nearly 487,000 people aged 65 and older were living with diagnosed dementia in Canada, according to
; nearly 99,000 people 65 and older were newly diagnosed with the disease.
Alzheimer’s is the most common form, accounting for 60 to 70 per cent of all dementia diagnosis.
Dementia is considered a major neurocognitive disorder. It is not a mental illness. Canada’s MAID law excludes people suffering exclusively from mental illnesses, an exclusion in the Criminal Code that’s set to be lifted in March 2027.
According to Health Canada, “a person with dementia may request and receive MAID as long as they meet eligibility criteria.”
What are the eligibility criteria?
According to
from the Canadian Association of MAID Assessors and Providers, dementia can be a “qualifying, stand-alone diagnosis for MAID if capacity to make reasoned and considered decisions about one’s health care has not yet been lost.”
All dementia syndromes are “progressive and ultimately fatal diseases,” CAMAP’s guidance states, and people with it are on an” irreversible trajectory toward death.”
Capacity should be considered lacking, the group wrote, if “any one of these following four domains is deficient: the ability to communicate a choice (even with appropriate help); ability to understand the relevant information; ability to appreciate the current situation and its consequences; and ability to reason about treatment options and their consequences.”
People don’t have to communicate verbally, CAMAP said. They can communicate through aids like a letter board that allows people who can’t speak to spell out words by pointing at letters on a board.
People with dementia must be of sound mind during their eligibility assessments, as well as in the final, immediate moments before death is administered.
However, determining capacity in people with cognitive decline “remains a clinical challenge,” CAMAP said. There’s no gold standard.
What’s more, outside Quebec (and we’ll get back to that), euthanizing someone “in the absence of capacity is a serious offence in the absence of a valid waiver of final consent.”
What’s a waiver of final consent?
A written agreement between the requester — the person seeking MAID — and their MAID provider allowing that doctor or nurse to administer MAID on or before a specific date should the person lose capacity for any reason.
Essentially, it waives the requirement that the person give expressed consent immediately before a lethal injection.
Waivers are only available to people whose natural deaths are considered reasonably foreseeable and are at risk of losing capacity. They include a specific date, and MAID can only happen on or before that date, and not after.
Is a waiver of final consent the same as advance requests?
No.
Last year, in defiance of Canada’s Criminal Code, Quebec amended its legislation to allow people, under certain conditions, to make an “advance request” for MAID.
The change allows someone diagnosed with a serious and incurable illness that will lead to incapacity, like Alzheimer’s disease, to give their consent to receive MAID in the future.
Fresh consent need not be obtained in the moments before they are euthanized.
However, a person can’t make a request in case they get a diagnosis of dementia one day.
Quebec’s new provisions took effect last October. As of Sept. 4, more than 1,400 advance requests have been approved, t
While providing MAID pursuant to an advance request is illegal under Canada’s Criminal Code, Quebec has instructed its prosecutors not to pursue charges against doctors, provided they comply with the Quebec legislation.
In 2023, a special parliamentary joint committee on MAID recommended the Criminal Code be amended to allow for advance requests under certain circumstances.
The federal government launched consultations and a “national conversation” last fall. A report on the key findings was due to have been published in the spring.
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