I would first of all say that the procedural tools you find in the Council of Canadian Academies' report focus on issues of communication, even at the level of guaranteeing that persons are respected in their future choices when they are no longer the same person or have the same interests.
As Professor Bernier has shown—and also the work with her colleague Professor Régis, at the Université de Montréal—in the context of advance requests, we know already it is very hard to predict in advance what we will think, what will happen and what kind of interests we will have. That's one issue that is already not guaranteed by the procedural tools.
The procedural tools certainly do not address broader societal concerns, such as the fact that we're crossing the line into allowing third parties to decide whether a person is now suffering intolerably and whether the person's life can be ended. We're crossing a line, which impacts also on our perception of cognitive disabilities more generally. If we do it for people who, before becoming cognitively disabled, say that they will want to die because they will lose dignity, what do we say to people who currently have cognitive disability and have not made that choice?
We're crossing a line into a practice that undermines a fundamental commitment to allowing persons with cognitive disability to be treated with respect and dignity and to be involved in the decision-making. The international Convention on the Rights of Persons with Disabilities emphasizes that. It's not the case that when someone has cognitive decline, you can say, “Oh, in the past you made this decision and now we will ignore your current identity and interests and give you surreptitious medication against your explicit consent and then end your life.” These issues cannot be solved by procedural means.