Seven years into an early onset Alzheimer’s diagnosis, Sandra Demontigny’s home is full of reminders.
A routine chart stuck to her apartment door prompting her to take her keys and bag. Post-it notes and family photos flood the fridge. A medication alarm beeps in the kitchen of her independent seniors’ living facility in Lévis, Que.
Demontigny might forget dates, times and daily tasks that were once second nature, but the 46-year-old still remembers what led to her prominent role in advocating for the expansion of medical assistance in dying (MAID) in Quebec.
It was just after her diagnosis in 2018 — a moment she had dreaded for decades after seeing her father suffer from genetic early onset Alzheimer’s.
“I decided that if one day I have this disease, I don’t want to go through that,” she said.
Demontigny made headlines across the country and internationally for her plea for advanced requests for MAID — even participating as a witness in a federal 2022 special joint committee.
She argued she should be allowed to choose MAID while she was still capable of consenting to care.
In October 2024, Quebec moved forward with its plan to authorize early requests for medical assistance in dying despite concerns raised by the federal government.
As the province marks 10 years since MAID was legalized through Bill 52, experts say Quebec continues to be a leader in the space and Demontigny hopes it can help set an example — pushing the rest of Canada to follow suit.
“Try to fight too,” she said. “I was afraid that I [would] miss the train.”
For Demontigny’s son Sacha Fontaine, it was no surprise his mom became a figure in the movement to expand MAID. He says she didn’t have much of a choice.
“She had to do this work or else she was going to be imprisoned in her own body,” he said, sitting on the couch in his mom’s apartment.
“More than this, I think it was a fight for us because we’re going to be next,” he added, referring to the genetic condition making some members of his family predisposed to early onset Alzheimer’s.
Elderly people might die with the disease, but not always from the disease, says Demontigny. But getting diagnosed in her 30s, she says “the body is good, it’s just the brain is bad.”
Hanging her head low, holding back tears, Demontigny recalled how her 53-year-old father forgot how to swallow and died of aspiration. She remembers him crawling on his hands and knees near the end, walking into walls and constantly crying, all while being unable to talk.
“It’s hard,” she said, taking a pause. “It’s scary for the people around… for the dignity of the person.”
In January 2025, in her apartment, Demontigny signed her form for advanced consent for MAID among her friends, witnesses and doctors.
She’s now one of 1,747 people who have successfully made an advanced request for the procedure in the province between Oct. 30, 2024 and Dec. 7, 2025, according to the Health Ministry.
In 2024, the federal government repeatedly expressed concern about Quebec moving forward with advanced consent before it modified the Criminal Code. But Ottawa said it would not challenge the Quebec law.
A year prior, a report from the Special Joint Committee on Medical Assistance in Dying made 23 recommendations, including that the Canadian government amend the Criminal Code to allow for advanced requests following a diagnosis of a serious and incurable medical condition, disease or disorder leading to incapacity.
Days before Quebec started accepting requests in 2024, federal Health Minister Mark Holland said the pursuit of criminal charges for assisted dying is overseen by provincial law enforcement and reiterated that advanced requests are still considered an offence according to Canada’s Criminal Code.
But Quebec had instructed its prosecutor’s office to not pursue charges against doctors who process those requests.
Meaning while the practice conflicted with the Criminal Code, Quebec could move forward.
Last fall, the federal government launched what it called a national conversation to hear perspectives on advanced requests. Its report, published in October 2025, did not provide recommendations but found that while the principle was generally supported, there was concern about how it could be implemented safely.
In an emailed statement, Ian McLeod, spokesperson with the Department of Justice Canada, says the government is “carefully considering the findings.”
“[MAID] is a deeply personal and complex choice that touches people and families at difficult and often painful times in their lives. The Government of Canada is committed to ensuring our laws reflect Canadians’ evolving needs,” read the statement.
Jocelyn Downie, a professor emeritus in the faculties of law and medicine at Dalhousie University, says Quebec has shown leadership from the very beginning on this issue.
“Put bold and italics and asterisks on that non-partisan approach that they took to this issue,” she said.
“It’s absolutely a case study in legislators demonstrating leadership on an important social policy issue of the day and it stands in stark contrast to the federal Parliament,” she said.
Over 6,000 people received MAID between April 1, 2024 and March 21, 2025, representing 7.9 per cent of deaths in the province, according to Quebec’s end of life commission report.
Marie-Ève Bouthillier, professor of clinical ethics at Université de Montréal, is trying to figure out why this number is so high — the highest in the world.
The principal co-investigator of a research project that began in 2024, Bouthillier says initial results point to several contributing factors, including Quebec’s rates of religion, democratic processes creating dialogue across the province and Quebec’s integrated health system and accessibility.
“There’s a sort of demystification maybe or proximity with MAID that makes it more appealing,” she said.
It’s difficult to put a finger on one specific factor explaining Quebec’s position on MAID, says Dr. Mona Gupta, a psychiatrist and a researcher at the Centre hospitalier de l’Université de Montréal.
The MAID assessor who also led the federal Expert Panel on MAID and Mental Illness says Quebecers have an openness to exercising personal choice in a range of different social practices.
“Whether that’s marriage or common law marriage. Whether that’s abortion rights,” she said. “So in that respect, in any case, that’s one plausible hypothesis.”
Quebec was the first province to offer the right to a medically assisted death, legalizing the practice in December 2015 — just before the Supreme Court of Canada unanimously overturned a legal ban on doctor-assisted suicide — Carter V. Canada.
The hesitancy to move forward federally contradicted public support, which Downie referred to as “enormous,” even a decade ago.
“It has only grown since then. I don’t know that there’s anything that Canadians agree on more than assisted dying,” said Downie.
Over three-quarters of Canadians support the law on MAID, according to a 2024 Léger report on the practice. But the report found the highest proportion of support in Quebec, at about 86 per cent.
Demontigny says she’s met a few people who tell her they don’t agree with her stance or decision.
“My answer is easy: I have my life, you have your[s],” she said.
She says her decision is not about wanting to end her life — it’s about having the choice to do so. Without it, people in her situation have taken their own lives, she says.
“They know that it will get harder and harder and harder and they will lose dignity,” she said.
“It’s just important to have the choice.”
