Days before her death, Rebecca Luna shared with her more than 90,000 followers on TikTok that she no longer felt safe in her body. She said it had come to the point where she would access medical assistance in dying.

The 49-year-old from Victoria, B.C., who earned a devoted online audience by candidly sharing her experience with young-onset Alzheimer’s disease, died on July 25.

Ms. Luna was a single mother of two, who started to notice cognitive decline at the age of 46. She was diagnosed with Alzheimer’s two years later.

The disease, which causes memory loss, progressed more quickly than expected, prompting her to seek MAID last month. Losing the ability to consent would have put the procedure out of reach.

“I did not want this,” she said in a recorded message posted to her social-media account on July 22. “What I want is relief.”

Quebec is the only province that allows residents with serious and incurable illnesses that lead to incapacity to seek MAID months or years in advance. Quebeckers with conditions such as Alzheimer’s can get early approval for MAID – before their illnesses cause them to lose capacity.

That means such patients elsewhere in Canada, including Ms. Luna, feel pressed to die earlier than planned so they have the capacity to give consent, advocates say. Critics, however, caution against advance requests because those patients would not be able to offer final consent before ending their lives, and may be frightened in their last moments.

Helen Long, chief executive officer of Dying with Dignity Canada, said it is not appropriate that one province offers this to its residents and others don’t.

Advance requests should be available across the country, she added.

“We hear from people about this every day.”

The push for legislative change to allow advance requests was supported by a parliamentary committee in February, 2023. It recommended that the requests should be available under certain circumstances, such as if a patient has Alzheimer’s.

In the fall of 2019, The Alzheimer’s Society of Canada recognized the right of patients who want to seek advance requests for MAID. This marked a change for the non-profit that advocates for people with dementia, which used to oppose advance consent for MAID on the grounds it could put vulnerable people at risk.

“We respect the right of all persons with dementia to advocate for their individual best interests, including advocating for access to MAID through advance requests,” the society says on its website.

Canadian children’s author Robert Munsch has publicly shared why living with a neurodegenerative disease creates a conundrum about timing for his own MAID procedure. The 81-year-old has dementia and lives in B.C.

“I have to pick the moment when I can still ask for it,” Mr. Munsch told The New York Times last fall.

Quebec passed legislation allowing advance requests in June, 2023, and the federal government did not challenge the province.

Earlier this year, Quebec confirmed that 2,100 individuals have been approved for advance requests in the province since it began granting them in October, 2024. It is unclear how many advance-request procedures have been administered.

Currently, the country’s Criminal Code only allows patients to seek MAID if they suffer from a terminal or incurable physical medical condition. This spring, access to MAID for patients whose sole underlying condition is mental illness was the subject of political debate at a special parliamentary committee.

A majority of committee members said in a report that individuals whose sole condition is mental illness should not be eligible for MAID, and the law should be amended to indefinitely exclude these patients.

Justice Minister Sean Fraser has promised to review the committee’s work, as well as dissenting opinions, and speak to stakeholders before deciding on the government’s next steps.

Pamela Wallin, an independent senator, has legislation at second reading in the Senate that calls for changes to the Criminal Code to allow patients to access advance requests for MAID.

Ms. Wallin watched her late mother, a former school teacher, struggle with Alzheimer’s disease. It was like witnessing her mom’s “slow descent into hell," she previously told the Senate.

She has also noted that public support for advance requests is mounting, especially as the population ages and more people are diagnosed with dementia.

In October, 2025, Health Canada found through national consultations that advance requests are “generally supported.”

“Throughout the roundtable discussions, a number of participants indicated that people want the option of being able to make advance requests, in keeping with their values around personal autonomy and choice over their health care needs,” a summary of the consultations said.

However, the department said that some participants shared concerns about allowing MAID when patients are not able to offer final consent.

Catherine Ferrier, a family doctor and assistant professor in geriatric medicine at McGill University, shares this concern.

Dr. Ferrier worries about patients not being able to give consent at the time of a procedure or being able to understand what is happening to them.

Sandra Demontigny, who has early onset Alzheimer’s, has a different perspective. The mother of three from Lévis, Que., advocated for her home province to make advanced requests available.

Ms. Demontigny told The Globe and Mail earlier this year how she is haunted after witnessing her father’s decline with the disease, including hearing him groan while unable to speak. She does not want her own children to see her in this state.

“I really don’t want to live like that,” she said this winter, knowing her health would continue to deteriorate.

“I cannot put my children through that.”