October 21, 2026

By Jamie Towey

On Wednesday, October 7, Canada announced it will indefinitely suspend its longstanding plan to allow euthanasia for mental illness under its Medical Aid in Dying (MAID) program. But keep the champagne corked. The Liberal government surreptitiously accompanied this announcement with another proposal: euthanasia via advance directives. Advance directives are an important component of healthcare, particularly for older adults and people with disabilities, especially those experiencing severe cognitive decline. They allow patients to name a healthcare agent to act in their stead and specify the kind of medical care they wish to receive or forego in the event of serious illness. Not only does Canada’s latest MAID foray undermine advance care planning, but it makes plain a longstanding goal of the “right-to-die” movement: euthanasia for dementia.

On its face, the logic of advance requests for euthanasia is incoherent. Euthanasia and assisted suicide laws in most countries are founded on the idea of competency, that individuals who choose to intentionally end their lives are making a rational, informed decision. Since advance directives only go into effect once individuals can no longer express their wishes or have lost mental capacity, death by means of an advance directive precludes contemporaneous consent. This conundrum is part of what dissuaded the Canadian government from pursuing its plan to legalize MAID for mental illness in the first place.

Unfortunately, logic is yet another causality of Canada’s MAID regime. The intended victims of this legislation, people with Alzheimer’s and dementia have long been targets of the so-called “right-to-die” movement. Decades ago, when assisted suicide and euthanasia were still fringe ideas, the California-based British expat Derek Humphry wrote a do-it-yourself-guide to doing yourself in. He called it, Final Exit, and includes charming chapter titles like “Self-Delivery Using a Plastic Bag,” followed by “A Speedier Way: Inert Gases.” But Humphry gave substantial space to the topic of “incompetence,” and specifically Alzheimer’s Disease. Humphry, who founded The Hemlock Society, strongly endorsed euthanasia by advance request in this pioneering book.

Humphry wasn’t alone in this respect. His Michigan friend, the ghoulish pathologist Jack Kevorkian, dispatched his first victim, Jane Adkins, due to her Alzheimer’s diagnosis. Humphry’s successor in the American assisted suicide movement, Oregon’s Barbara Coombs Lee, dedicated a chapter of her book Finish Strong to “escaping” dementia. To Coombs Lee, these diseases make you a “different person,” one whose life is not worth living.

Humphry’s embrace of euthanizing the mentally incompetent is conveniently avoided by Coombs Lee’s Compassion & Choices (C&C), the direct descendant of the Hemlock Society. Since euthanasia stands no political chance in the United States (for now, at least), C&C today does not advocate for euthanasia by advance request, but it does recommend “voluntary” stopping eating and drinking (VSED) by advance request. I put voluntary in quotes since someone in the throes of dementia cannot voluntarily stop eating and drinking, a process that can be extremely painful.

C&C is quite keen on making this resource available to people with dementia. Two years ago, it secured a partnership with the Alzheimer’s Association, only for it to flame out spectacularly once the news went public. Recently, it touted the story of Cheryl Hauser, a longtime assisted suicide advocate who asked her family to starve her to death once she had advanced Alzheimer’s. Watch the documentary of her final hours. The anguished cries of Ms. Hauser as she sobs, “I don’t understand what we’re doing!” are hard to forget.

Meanwhile, in the shadows of peer-reviewed academia, the concept of VSED as a bridge to assisted suicide is becoming mainstreamed. In this scenario, a patient could starve themselves for a time and then be approved for assisted suicide since their depleted physical state would cause death within six months, thus meeting the legal standards for assisted suicide. America already has seen three individuals approved for suicide on the grounds of “terminal anorexia”, and this year, a Hawaii resident successfully used VSED as a bridge to assisted suicide eligibility. Groups in Washington and other states now provide VSED advance directives, and earlier this year, the Virginia legislature considered a bill to legalize assisted suicide that would require patients to document their request for death in an advance directive.

Assisted suicide and euthanasia for dementia are not only a dystopian possibility in Canada, or a perverse reality in the Netherlands and Belgium, where they already are legal. They pose a legitimate threat to America’s established medical practices with advance directives. Communicating a wish for an intentionally hastened death well in advance of the onset of dementia prevents care for the patient and accompaniment by family members, and invites government and insurer cost-cutting pressures. With the elderly accounting for nearly a quarter of the US population in the coming decades against the backdrop of Medicare, Medicaid, and Social Security’s dwindling life expectancy, these pressures will become more acute.

Canada’s attempt at a back door legalization of killing grandparents in cognitive decline may soon come through America’s front door.

(The views expressed herein are those of the author and do not necessarily reflect the views of Aging with Dignity and/or its Board of Directors.)