Thank you, Mr. Chair.

Good morning, everyone.

I am a neurologist specialized in the diagnosis and care of persons living with dementia, Alzheimer's disease in particular.

Over the years, many persons without symptoms but at risk of dementia in the future because of their family history, or with mild symptoms, spontaneously asked during office visits whether they can write advance requests for medical assistance in dying if they reach a certain stage of their condition. Some even signed a document, with their spouse, written with the help of their family, knowing that the document was not yet valid. Some persons even said that if they did not have the option of giving advance directives in order to receive medical assistance in dying, at a predetermined stage of a disease like dementia, they would seriously think of suicide at the time they received that diagnosis. I would add that there is medical literature on this subject. There is thus a real need expressed by a segment of the population that is openly discussing this with family members.

The difficulty I foresee is not so much the fact that these persons have to write a document with the help of the family or a notary, for example. Rather, it is the clarification of which stages of dementia might create problems when their advance choice is put into effect.

Allow me to explain in greater detail.

There are very advanced stages in Alzheimer's disease. No one wants to live until the very severe stage, defined as absence of verbal communication and independent ambulation, double incontinence, and very high risk of aspiration pneumonia. This is a terminal stage of dementia in which death is expected within 12 months.

On the other hand, if a person expressed a desire to receive medical assistance in dying before that terminal stage, but after being declared incompetent, in other words, at a moderate to severe stage of dementia, it might be harder to obtain a consensus between the designated representative and the clinical team once the disease has progressed to the preselected stage.

Finally, after receiving a diagnosis of Alzheimer's disease, a person might decide to receive medical assistance in dying while still competent, thus in a mild stage of their condition. At that stage, I believe the person's choice is clear and valid.

To start the dialogue with the committee, I ask it to consider the stages of the disease in their deliberations and help people to plan for carrying out their choice at the appropriate time.

Thank you for your interest in this important issue.