In my case, it's always the patients who bring up medical assistance in dying. Many of my patients who have neurocognitive disorders or other pathologies tell me they want to die. Many will ultimately decide not to request medical assistance in dying. Some discuss medical assistance in dying merely to express the fact that they want specific treatment for a particular problem. Some will go so far as to request medical assistance in dying, but it always comes from them.
What I meant to say earlier is that people want to wait as long as possible, until the very last minute, before requesting medical assistance in dying. In some cases, they won't say it's time until they think they're completely losing their mind. They think that, if they wait another two or three months, they'll probably lose their capacity and will no longer be able to obtain medical assistance in dying. If they could make an advance request, that would relieve this distress and concern, and they'd be able to continue living longer.