**Title: Report Raises Concerns Over MAID for Dementia Patients**

A woman in her late 80s with dementia received medical assistance in dying (MAID) after a family member initiated the request, according to a recent report. The woman’s life was ended after a MAID provider determined she had given her final consent, based on her ability to repeat a question and squeeze the provider’s hand.

This case is one of several highlighted in a report from the Ontario Chief Coroner’s MAID Death Review Committee. The report raises significant questions about the approval process for MAID among individuals with dementia, particularly regarding whether proper assessments are conducted to determine their capacity to consent.

Dr. Ramona Coelho, a family physician and committee member, noted, "What really stuck out to me is that people with dementia are choosing MAID for feelings like loss of dignity, perceived burden, emotional distress, and fear." She emphasized that palliative care could address these feelings of existential suffering. However, the report indicates that only 13.6% of dementia patients who opted for MAID in Ontario during 2023 and 2024 received palliative care, compared to 82.3% of those who received MAID for other reasons.

Canadian author Robert Munsch, diagnosed with dementia and Parkinson’s disease in 2021, shared his experience in a New York Times profile. He stated that under Canadian law, individuals must be able to actively consent on the day of their death. "I have to pick the moment when I can still ask for it," he explained, expressing concern about his wife potentially having to care for him in a diminished state.

The report, titled "Navigating MAID with Persons with Dementia," revealed that 103 assisted deaths were reported in Ontario in 2023 and 2024, where dementia was identified as the primary condition causing suffering. This accounted for about 1% of all MAID deaths during that period. The committee noted that requests for MAID involving dementia require careful consideration of eligibility criteria, capacity assessment, and informed consent.

The report highlighted that individuals with dementia reported higher levels of suffering related to loss of dignity, perceived burdens on family, emotional distress, and loss of independence compared to those with other causes of death. Notably, they reported less frequently suffering from inadequate pain control.

Among the cases discussed was that of a woman referred to as Mrs. 6F, who had moderately advanced dementia. Nine months before her MAID request, she was hospitalized after multiple falls and required assistance with daily activities. During her hospital stay, she expressed a wish to die, which led her care team to initiate a referral for MAID.

Initially, Mrs. 6F chose to move to long-term care instead of pursuing assisted death. However, four months later, she renewed her request for MAID. At that time, she was largely bedbound and experiencing additional physical symptoms, including shortness of breath and pain, along with psychological distress related to her cognitive decline.

The MAID provider assessed her eligibility in a single meeting with a family member present. The provider noted that Mrs. 6F experienced significant existential suffering and was clear about her desire not to continue living in her current state. However, there were communication challenges during the assessment, and her cognitive impairments were not well documented.

On the day of the procedure, Mrs. 6F was reportedly overwhelmed by the presence of additional visitors, prompting the removal of some individuals to create a calmer environment. Final consent was determined based on her ability to repeat the consent question and squeeze the provider’s hand. While some committee members felt this indicated she could communicate a choice, others expressed concerns that repeating a question does not necessarily demonstrate understanding of the decision.

The report also raised concerns about the potential for undue influence when family members facilitate the MAID process. Members urged practitioners to engage directly with individuals requesting MAID and to document their own words and reasoning.

In another case, a man with Alzheimer’s disease was approved for MAID while suffering from an abdominal infection and delirium. His caregiver was unable to continue providing care, and he faced a transition to long-term care. He was assessed and approved for MAID on the same day by two evaluators. Some committee members suggested that MAID requests should be deferred during periods of medical instability or significant life transitions.

The findings indicate that individuals with dementia may be accepting a lower threshold for capacity assessments than is typical in other healthcare situations. While some committee members argued for a high threshold for determining capacity for MAID, others believed it should align with standards applied in other medical contexts.