Naïma Hamrouni (Université du Québec à Trois-Rivières) et Jocelyn Maclure (Université McGill) publient un nouveau chapitre intitulé « Between precedent autonomy and the patient’s best interests: a reasonable path for advance medical assistance in dying requests? ». Ce chapitre figure dans le cadre du Research Handbook on Voluntary Assisted Dying Law, Regulation and Practice (Elgar online, 2025), dirigé par B. White.

Résumé

Medical assistance in dying (MAID) must, at the very least, be voluntary, meaning requested by a person fit to consent to their medical care. In addition, conceived as a medical treatment, MAID may be administered only when a person is suffering from a grievous and irremediable medical condition that leads to an advanced decline in capacities and persistent suffering that cannot be relieved in a manner deemed acceptable by the individual.

Neurodegenerative diseases − such as Alzheimer’s − compromise the exercise of decisional autonomy and the ability to give free and informed consent. Should persons diagnosed with an incurable neurocognitive disease be allowed to make an advance request for MAID? What are the moral foundations of the prior exercise of autonomy, and what are its risks? This chapter will examine advance requests for MAID, drawing upon Dworkin’s foundational argument in favor of granting full authority to advance MAID requests, and offer a reconstruction of the main lines of argument for and against the prior exercise of decisional autonomy. We will analyze these positions’ strengths and weaknesses and argue that, when understood correctly, the most significant criticisms of prior exercise of autonomy argue less in favor of an absolute prohibition of advance requests than for the establishment of clear guidelines for its oversight. While we mainly discuss the recent inclusion of advance MAID requests in Québec, we also briefly refer to five other jurisdictions where advance requests for MAID are possible under specific conditions, namely the Netherlands, Belgium, Luxembourg, Colombia and Spain.