Health Canada Publishes its “National Conversation on Advance Requests for MAiD
The following is an article written by Paul Magennis and Kim Carlson in their Substack:
On October 29th, Health Canada has finally dropped the” What We Heard” report from its national conversation on advance requests for MAiD. https://www.canada.ca/en/health-canada/programs/consultation-advance-requests-medical-assistance-dying/what-we-heard.html
This isn’t a recommendation document and it doesn’t change the law today. It’s a read-out of what Canadians said in an online questionnaire, a scientific public-opinion survey, and a set of virtual roundtables. Think “temperature check,” not “policy.”
They heard from three streams:
• Online questionnaire: 46,000+ participants (not a representative sample). Useful for seeing the range of views, but full of self-selection on all sides — groups in support of MAiD, like ours, encouraged people to respond, and so did churches and anti-MAiD organizations. Grain of salt required, and the report says exactly that.
• Public opinion research (POR): a random sample of 1,000 Canadians, fielded Feb 3–9, 2025, ±3.1% margin of error (19/20). This is the one to lean on for “what Canadians think.”
• Roundtables: nearly 200 participants across regional and national sessions (providers, disability organizations, Indigenous reps, people with lived experience, provincial/territorial officials, etc.). These give the qualitative texture, and gives us a good look at what real people think and are concerned about.
What jumped out:
1) Broad support for the basic idea.
If you have a serious or incurable condition that will lead to loss of decision-making capacity (think dementias), support for allowing an advance request is ~67% in the public opinion research ~69% in the online questionnaire. That’s remarkably aligned across two very different methods.
In plain language: roughly two-thirds of Canadians support the concept that advanced requests for MAiD should be allowed for conditions like dementia.
There was also a question about conditions that could cause a sudden loss of capacity (example used: high blood pressure that might lead to a catastrophic stroke). Here the online questionnaire is higher at 76%, but the public opinion research is lower at 58% (figure 2 below - copied from the report). So: still majority support in the representative poll, but less than for dementia-type scenarios. You can tell two stories from that split; the scientific poll is the one we’d weight more, which indicates a little less support for the “stroke” scenario.
As for why people support advance requests for MAiD, the usual values show up: individual choice (76%) and a dignified death (73%) ranked top. No surprises there.
2) Implementation anxiety is front and centre.
Nobody’s pretending this would be simple. The report is full of “how would this actually work safely?” questions: creating, storing and accessing requests; what counts as “conditions met”; who activates the process; and how providers can trust they’re honouring the person’s real wishes. These are real-world details we’ll need to sort out, but none of which present an overwhelming barrier.
3) Supports for everyone involved.
This came through loud and clear: patients, families, caregivers and providers all need support — information, counselling, clinical guidance, and practical help. The report ties advance requests to advance care planning more broadly (good), and flags the need for education about what life with capacity-limiting illnesses actually looks like, plus what supports exist. That’s crucial for informed consent.
4) Health-system capacity & equity concerns.
Even before you add advance requests, the system is stretched: palliative care access, primary care, rural/remote services — all need investment. If advance requests become legal, those gaps can’t be ignored. (For context the report also outlines Quebec’s framework and registry model; remember: Quebec allows making an advance request provincially, but provision via an advance request is still barred federally.)
A few places where the report almost sounds like recommendations (it isn’t):
The report very carefully avoids recommending changes — but you can see the contours of what an implementation might need if Parliament ever goes there:
• Standardized templates & clear criteria. Folks want a robust, standardized way to record values, thresholds, and triggers in plain language that clinicians can interpret later. This helps providers trust they’re doing what the person truly wanted.
• Periodic renewal / re-validation. In the questionnaire, ~72% rated it important that people validate the request periodically (e.g., every five years). It would add workload and needs careful design to avoid penalizing people who face access barriers.
• A minimum observation/assessment period at time of provision. Roughly 59% rated it important to have a minimum assessment period to confirm the person is, on a recurring basis, demonstrating the conditions described in their advance request — and otherwise meets MAiD eligibility. The tricky part is defining “how long” without prolonging suffering.
• Trusted third person / activation mechanics. Quebec’s “trusted third” is cited as one model; the report discusses third-party advocacy to alert care teams and help navigate disputes — with safeguards so no one can request MAiD on someone else’s behalf.
The provider dilemma we keep talking about:
A lot of providers (and many of us who teach MAiD) see final consent as a meaningful ethical touchstone. Waiver of final consent already stretches that, where the MAiD provider is acting on a prior wish when the person can’t affirm it in the moment. Advance requests stretch it further. That’s where moral distress can live.
The fix isn’t to ban the possibility outright; it’s to raise the quality bar for the front-end process: robust, specific descriptions of unacceptable future states (“this is the line for me”), good education about disease trajectories, and clear triggers. That’s exactly what the report heard from both providers and the public.
There’s also the perennial “happy dementia” puzzle: if someone appears outwardly content but meets the thresholds they previously set (“If I no longer know my family for a month, if I can’t feed myself…”), what then? The report flags a desire for clear rules so providers have ethically defensible footing — and so people setting up advance requests know how their wishes might be interpreted.
Two quick predictions:
1. Someone will claim this report “recommends” legalizing advance requests. It doesn’t. It’s an input document — explicitly not a set of recommendations. Expect spin; bookmark the methodology page.
2. Opponents will cherry-pick the weakest-looking topline — one questions asks whether people support the current MAiD law as written (criteria + safeguards). That question is noisy (you can support MAiD and still think the current law is too narrow, and therefore “Strongly oppose” the current MAiD criteria). Even there, a majority still supported the current law in that item, but it’s less dramatic than the “advance request” questions — so it’ll be the one that gets airtime.
3. Not a well formed question at all, so doesn’t actually tell us much.
Where we land (for now):
Nothing here feels shocking. The numbers line up with past polling and with what many of us hear in clinics and classrooms: Canadians largely support giving people this option, especially for diseases that predictably remove capacity — and they want careful, workable guardrails. That means better templates, better education, clear triggers, a way to renew, guidance for “trusted third” roles, and clinical support for providers facing hard calls. None of that is beyond us. It just takes real resources and attention to equity — rural and remote communities, Indigenous-led care, and primary care need to be at the centre, not an afterthought.
Bottom line: This report doesn’t move the law today — but it maps the conversation. If Parliament decides to act, the homework is already sketched out.