La démence et l’AMM
Résumé
Les évaluateurs et les prestataires de l’aide médicale à mourir (AMM) seront amenés à rencontrer des patients atteints d’une forme de démence de deux manières différentes. Dans un premier cas, ils pourront être amenés à évaluer un patient atteint de démence, mais dont le diagnostic principal à l’origine de la demande d’AMM repose sur une autre maladie sous-jacente, telle qu’un cancer ou une insuffisance cardiaque. Dans le second cas, la demande d’AMM peut découler directement de la démence elle-même. Comprendre le contexte dans lequel l’AMM est dispensée en cas de démence peut s’avérer utile pour les évaluateurs et les prestataires de l’AMM. Nous aborderons également ici le diagnostic de la démence à proprement parler, afin d’aider les évaluateurs et les prestataires de l’AMM dans leurs échanges avec les patients et leurs familles concernant ce diagnostic complexe.
Références
MAiD Death Review Committee. MAiD Death Review Committee (MDRC) Report 2025-2: navigating MAiD with persons with dementia [Internet]. Ministry of the Solicitor General, Office of the Chief Coroner. Toronto, ON: 2025 [cited 2026 Mar 5]. Available from: https://macdonaldlaurier.ca/wp-content/uploads/2025/09/MDRC-Report-2025.2_Dementia_Final.pdf
American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th edition. Washington, DC: American Psychiatric Association Publishing; 2022.
Simmons JG, Reynolds G, Kekewich M, Downar J, Isenberg SR, Kobewka D. Enduring physical or mental suffering of people requesting medical assistance in dying. J Pain Symptom Manage. 2022;63(2):244-250.e2. doi:10.1016/j.jpainsymman.2021.08.010
Henry M, Alias A, Bisson-Gervais V Liu JY, Dargis L, Gauthier L, et al. Medical assistance in dying in Canada: a scoping review of the concept of suffering. Psychooncology. 2023;32(9):1339-1347. doi: 10.1002/pon.6196 .
Dewing J. Personhood and dementia: revisiting Tom Kitwood’s ideas. Int J Older People Nurs. 2008;3(1):3-13. doi:10.1111/j.1748-3743.2007.00103.x
Lees C, Andrew MK. MAiD for geriatric syndromes: special considerations. Healthc Manage Forum. 2023;36(3):162-165. doi:10.1177/08404704221141048
Pellerin R, Tapp D, Filion C, Castonguay-Paradis S, Bravo G, Robert G. Knowledge, attitudes, and representations of caregivers of individuals with major neurocognitive disorders regarding palliative and end of life care: a narrative literature review. BMC Palliat Care. 2025;24(1):223. doi:10.1186/s12904-025-01862-8
MAiD Death Review Committee. MAiD Death Review Committee (MDRC) Report 2024-3 Navigating vulnerability in non-reasonably foreseeable natural deaths [Internet]. Ministry of the Solicitor General, Office of the Chief Coroner. Toronto, ON: 2024 [cited 2026 Mar 5]. Available from: https://www.ocswssw.org/wp-content/uploads/MAiD-Death-Review-Committee-Report-2024.pdf
Pesut B, Hall M, Thorne S, Variath C, Sharp H, Wiebe G. Decisional vulnerability and it’s impact upon voluntariness in the assessment of eligibility for Track 2 MAiD: a report of a knowledge exchange [Internet]. The University of British Columbia: November 20-27, 2025 [cited 2026 Mar 5]. Available from: https://pesut-lab.sites.olt.ubc.ca/files/2026/02/Decisional-Vulnerability-and-Voluntariness-Knowledge-Exchange-Report-2026.pdf
Nielson G, Chaimowitz G, Freeland A, Lachmann M, Mathew N, Riggin L. Capacity assessments and voluntariness in the context of MAiD legislation: the role and responsibility of psychiatrists [Position Paper]. Canadian Psychiatric Association. 2023. Available from: https://www.cpa-apc.org/wp-content/uploads/2023-CPA-MAID-Capacity-Position-Paper-ENG-Final-V8.pdf
Canadian Association of MAiD Assessors and Providers (CAMAP). Assessment of capacity to give consent for medical assistance in dying (MAiD). Review and recommendations [Internet]. CAMAP 2020 [cited 2026 Mar 5]. Available from: https://camapcanada.ca/wp-content/uploads/2022/02/Capacity-assessment.pdf
Lachmann M. Capacity to consent to MAiD. Journal of Ethics in Mental Health. 2017;10(II). Available from: https://irp.cdn-website.com/c0d44f22/files/uploaded/JEMH_final_Reflection-i.pdf
Canadian Medical Protective Association. Updated Quebec MAiD Legislation. October 30, 2024 [cited 2026 Feb 28]. Available from: https://www.cmpa-acpm.ca/en/news/2024/updated-quebec-maid-legislation
Bravo G, Trottier L, Rodrigue C, Arcand M, Downie J, Dubois MF, et al. Comparing the attitudes of four groups of stakeholders from Quebec, Canada toward extending medical aid in dying to incompetent patients with dementia. Int J Geriatr Psychiatry. 2019;34(7):1078-1086. doi:10.1002/gps.5111
Nix HP. Operationalizing the intolerable suffering criterion in advance requests for medical assistance in dying for people living with dementia in Canada. Camb Q Healthc Ethics. Published online May 22, 2024. doi:10.1017/S0963180124000264
Quebec National Assembly. Bill 11, An Act to amend the Act respecting end of life care and other legislative provisions. 1st session, 43rd Legislature. June 7, 2023 [cited 2026 Mar 5]. Available from: https://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-11-43-1.html
Varaith C, Peter E, Cranley L, Godkin D. Health care providers’ ethical perspectives on waiver of final consent for medical assistance in dying (MAiD): a qualitiative study. BMC Med Ethics. 2022;23(1):8. doi:10.1186/s12910-022-00745-4
