Ottawa sits just across the river from a province where residents have a legal option that Ontarians, including everyone here in the capital, currently don't: the ability to pre-approve their own medical assistance in dying (MAID) before a diagnosis like dementia takes away their capacity to consent.
Quebec remains the only province in Canada that allows advance requests for MAID, a provision that lets someone with a serious and incurable illness set out, in writing, the conditions under which they'd want the procedure carried out later — even after they can no longer legally consent in the moment. For Ottawa residents watching their loved ones face progressive conditions like Alzheimer's, that option simply isn't on the table.
A federal question with a very local stake
The issue is back in the spotlight as the federal government, headquartered right here in Ottawa, considers whether to expand MAID eligibility to include people whose sole underlying condition is a mental illness. That broader review has reopened the advance request debate too, with disability and end-of-life advocates pushing Ottawa lawmakers to consider allowing the practice nationally, or at minimum encouraging Ontario to follow Quebec's lead provincially.
For Ottawa families, the stakes are personal. Advance requests are most often discussed in the context of dementia: a person diagnosed early enough to still have legal capacity can, in Quebec, specify in advance that they want MAID once their condition reaches a defined point, even if by then they can no longer express that wish themselves. Without that option, Ontario patients and their families are left navigating a much narrower window, one where consent must be reaffirmed right up until the procedure, something a person with advanced dementia often can't do.
Why Ontario hasn't followed Quebec
MAID law in Canada is a shared federal-provincial responsibility. The Criminal Code, set by Parliament in Ottawa, defines who qualifies and under what safeguards, while provinces oversee how the practice is delivered through their health systems. Quebec moved first on advance requests through its own provincial legislation, but because Criminal Code protections around ongoing consent still technically apply nationally, legal experts say Quebec's approach exists in a bit of a grey zone that other provinces, including Ontario, have been hesitant to replicate without clearer federal direction.
That's where Ottawa comes back into the picture. Any national fix would have to come from Parliament, and advocacy groups are lobbying MPs in the capital to attach advance request reform to the broader MAID review already underway. Until that happens, Ottawa physicians and palliative care providers say they're stuck explaining to patients why a provision available a short drive away in Gatineau isn't available on this side of the Ottawa River.
What comes next
No timeline has been set for when, or if, the federal government will act on advance requests as part of its MAID expansion review. In the meantime, Ottawa-based advocacy organizations say they'll keep pushing the issue at the federal level, arguing that where a patient happens to live shouldn't determine whether they get to plan for their own end-of-life care.
Source: CBC Ottawa
