Consent is the core safeguard in assisted dying; when cognition is fragile and the clock is running, that safeguard is both the most important and the easiest to get wrong.
At a Glance
- The Stegemann dispute turns on two questions: Was she capable of informed consent, and did she give final express consent—or was a lawful waiver in place?
- Ontario’s MAID framework requires capacity, voluntariness, and a last-moment opportunity to withdraw; a narrow waiver can replace final consent in Track 1 cases if strict conditions were met in advance.
- Her family alleges prior religious objections and no final verbal “yes”; a physician, they report, deemed her capable and said she consented.
- This case sits in a wider pattern: hundreds of Canadians each year receive MAID under a waiver of final consent after losing capacity, magnifying documentation-versus-bedside tensions.
What this controversy is actually about: capacity, voluntariness, and the last safeguard
Medical Assistance in Dying (MAID) in Canada rests on three pillars that are conceptually simple and operationally exacting: decisional capacity, informed and voluntary consent, and a final opportunity to withdraw immediately before the procedure. In Ontario, when death is reasonably foreseeable (Track 1), a patient may—while capable—enter a written arrangement that waives the need for final express consent if they later lose capacity, provided they do not show refusal or resistance at the time of provision. Those conditions are demanding by design; the waiver is a substitute for last-moment consent only if earlier, fully capacitated consent is robustly documented and specific to timing and conditions.
The Stegemann dispute centers precisely here. Her family says she had earlier rejected MAID on religious grounds and that no final verbal confirmation was obtained. They have pursued oversight and investigative avenues to test whether consent at any operative step was valid. On the other side, family accounts also report that a physician emerged from a capacity assessment saying Stegemann was capable and had consented to proceed. Those are not peripheral facts; they are the fulcrum on which legality and ethics turn.
How the legal safeguards are supposed to work
Under the Criminal Code and provincial practice standards, MAID eligibility requires that two independent clinicians assess capacity and confirm criteria. Capacity, in this context, is not global intelligence; it is the ability to understand relevant information and appreciate reasonably foreseeable consequences of the decision. It is decisional, task-specific, and time-specific. Clinicians must also ensure voluntariness—free of coercion or undue influence—and obtain informed consent to the intervention itself. Immediately before provision, the practitioner must give the person a chance to withdraw and ensure express consent—unless a Track 1 waiver of final consent, executed while capable, is in place and the patient shows no refusal or resistance at the bedside.
The waiver pathway is narrow but used. It anticipates deterioration after an approval decision with a scheduled provision date. The written arrangement documents that the patient, while capable, accepted MAID on a particular plan and understood they might lose the ability to consent later; if so, clinicians can proceed on the pre-authorized plan—again, only absent contemporaneous refusal or resistance.
The competing narratives in the Stegemann case
According to family accounts in multiple outlets, Stegemann had previously declined MAID for religious reasons and did not provide a final verbal affirmation on the day of death. They report being assured that a clear last-moment “yes” would be required; instead, they say she remained silent at the critical juncture. They have asked authorities to examine both capacity and the presence or absence of a valid final-consent waiver. These assertions, if accurate, would strike at MAID’s procedural heart.
Countervailing details also come from family recounting: a physician reportedly assessed her, told relatives she had capacity, and stated she had consented to proceed. Practitioners and the facility, as reported in secondary coverage, have not publicly detailed their documentation, and are understood to maintain that consent was lawful. Those statements, if supported by the contemporaneous MAID record—written request, dual assessments, approval, and any executed waiver—would align with statutory safeguards as currently structured.
Why this dispute keeps happening: the paper trail versus the bedside moment
When MAID eligibility intersects with frailty and fluctuating cognition, two truths collide. First, Canadian law presumes capacity unless shown otherwise; assessments are specific, and people with serious illness can still be capable decision-makers. Second, capacity can change quickly—over days, hours, even within a conversation. That volatility is exactly why the final-consent step, or a tightly conditioned waiver, exists. The problem is evidentiary: families remember words, affect, and silence; systems document checklists, signatures, and capacity rationales. When those diverge, trust frays.
This is not an anomaly. Health Canada’s 2023 annual report recorded 594 MAID deaths under a waiver of final consent following loss of capacity. Each such case requires a prior, capable approval, explicit counseling about the risk of capacity loss, a scheduled provision plan, and the absence of refusal or resistance at the time of provision. The scale underscores that last-moment capacity loss is a routine reality and that the waiver is now a meaningful, not marginal, feature of practice.
Brigitte Stegemann was 83 years old, a Christian grandmother and, according to her family, a woman who had previously refused Medical Assistance in Dying (MAID) because it conflicted with her faith.
Her family says that two days before her death, she became extremely distressed… pic.twitter.com/3tyC4bQp5Q
— “Sudden And Unexpected” (@toobaffled) September 21, 2026
Where the real policy debate belongs
Three concrete questions deserve sustained attention beyond any single case. First, how should final consent be operationalized to balance respect for earlier, capable choices against the moral salience of the last conscious moment? Requiring a verbal “yes” is clean but can exclude people who decisively chose MAID yet lost speech or lucid attention hours before the scheduled time. The waiver solves that problem but raises a countervailing risk: families may perceive silence—or distress—as withdrawal without a mechanism to translate that perception into a formal stop.
Second, what counts as refusal or resistance when capacity is gone? Ontario guidance directs practitioners not to proceed under a waiver if the person shows refusal or resistance. That phrase needs operational clarity—gestures, agitation, prayer, or silence can be ambiguous when neurological status is unstable. Building standardized, documented bedside protocols—structured observation checklists, second-practitioner concurrence, and, where feasible, brief video attestation—could narrow the interpretive gap without turning dying into a deposition.
Documentation, transparency, and the path to restoring trust
The third question is procedural transparency. The strongest antidote to memory-versus-record disputes is a precise, auditable paper trail that maps to the lived bedside moment. That means contemporaneous capacity notes specifying the patient’s own words, not just a competency conclusion; clear recording of voluntariness checks; explicit counseling about capacity loss and the waiver’s implications; and, on the day of provision, a structured record of the opportunity to withdraw and whether any refusal or resistance was observed. For Track 1 waivers, attaching the signed written arrangement, the scheduled date, and confirmation that all statutory predicates were met is essential practice risk management as well as ethical care.
National reporting can help. Canada’s annual MAID reports have improved data quality over time, including on waiver use, but the public conversation still runs ahead of the available detail. Publishing aggregate, de-identified case characteristics around waiver-of-final-consent use—timing from approval to provision, reasons for capacity loss, frequency of bedside uncertainties—would elevate the debate from anecdote to pattern recognition, allowing policy to target where failure risks actually cluster.
What to watch
In cases like Stegemann’s, conclusions hinge on the primary record: the written request, dual assessments, capacity rationales, approval decision, any executed waiver of final consent, and the bedside documentation of the final opportunity to withdraw or the absence of refusal or resistance. If those documents align with statutory requirements, the legal framework will likely be found intact—even as families grieve how the last moments felt. If gaps surface—no valid waiver, ambiguous capacity assessment, or inadequate bedside documentation—then regulators and coroners have both the mandate and the tools to intervene. Either outcome strengthens the system when it is surfaced quickly and explained clearly.
Sources:
canada.ca, tools.cep.health, journals.sagepub.com, ontario.ca, camapcanada.ca
