One recent evening, Sandra Demontigny tried to write down when she would die.

“I sat down in a corner with a candle next to me, just to create my own bubble, to think and to cry a little,” she said.

She had reflected on this moment for years, desperately hoped for it, fought tirelessly for it. But the words refused to come out. The form before her remained blank. How, exactly, does one decide when to end one’s life?

Canada’s French-speaking province of Quebec last fall became one of the few places in the world to allow a person with a serious and incurable illness to choose medically assisted death in advance — perhaps years before the act, when the person still has the mental capacity to make such a momentous decision.

And Ms. Demontigny — a 45-year-old mother of three, diagnosed in the prime of her life with a rare form of early-onset Alzheimer’s — played a pivotal role in lobbying for the change.

Some facing such a grave health challenge might have withdrawn. But even as Ms. Demontigny (deux-mon-tee-gnee) began losing her memory, she became the face of the campaign to expand the right to die in Quebec.

In front of health ministers and lawmakers, on talk shows, in countless interviews, she spoke of how she had inherited the Alzheimer’s gene carried by her family. She recalled how her middle-aged father, in the last years of his life, became unrecognizable and aggressive. She wanted to die with dignity.

Still, four months after Quebec expanded the right to die, she had yet to fill out the advanced request forms. Choosing death was agonizing enough, but Ms. Demontigny had to declare, in precise details, the circumstances under which the lethal dose would be administered. Should it be carried out when she needs care round the clock? When she no longer recognizes her own children?

“Even though it’s a subject that’s preoccupied me for years, it’s different now because I have to make an official request,” Ms. Demontigny said. “But I’m not changing my mind — that’s for sure.”

Under the new law, an advanced request for assisted death must meet a set of criteria and be approved by two physicians or specialized nurses.

Across the world, only a few countries — including the Netherlands, Belgium, Luxembourg, Spain and Colombia — recognize advance requests for assisted deaths, though, in some cases, not for people suffering from Alzheimer’s or other forms of dementia.

At her one-bedroom apartment, Ms. Demontigny spoke during a two-hour interview often punctuated by the cries of a very voluble siamese cat named Litchi. Her partner, André Secours, was visiting — helping her recall a detail, reminding her of a scheduled phone call in the afternoon or an appointment the following day.

Though only in her mid-40s, Ms. Demontigny moved into the apartment — inside a residence for older people in Lévis, a suburb south of Quebec City — as she needed more help a year ago. She chose to live alone, not wanting to burden her family. Her two older children were already adults, and her youngest went to live with Ms. Demontigny’s former husband.

Her front door was covered with reminder notes. A timer on top of the stovetop range cuts off power automatically. The dresses in her closet were methodically arranged and archived with photos on her smartphone. No system was foolproof, though.

“I’m doing something,” she said, “and Litchi walks past by me, and I follow Litchi and I forget what I was doing.”

Bright sofa covers — brought back from Bolivia, the Democratic Republic of Congo and other places where she had worked as a midwife — hinted at her life before her Alzheimer’s diagnosis at age 39.

Ms. Demontigny decided to become a midwife after the difficult birth of her first child. The obstetrician, she said, performed a procedure without warning her.

“It’s my body — can you at least tell me?” Ms. Demontigny said.

As a midwife, she wanted women to be able to give birth in a respectful and natural environment.

For Ms. Demontigny, there was a direct link between a proper birth and a proper death.

“Life and death resemble each other,” she said.

When Ms. Demontigny learned that she had Alzheimer’s, she slipped into depression but was not surprised. Several older relatives had begun experiencing symptoms of Alzheimer’s at a young age, though they kept the illness hidden as long as they could, out of shame.

Her father started losing his memory in his mid-40s and stopped working at 47. At home, he spent his days wandering, bumping into walls and collapsing from exhaustion. In his final years at a health facility, he licked the floor and acted menacingly, even threatening to kill his son, Ms. Demontigny’s brother.

Like many Québécois families, Ms. Demontigny’s parents had drifted away from the Roman Catholic Church, and Ms. Demontigny considered herself an atheist. And yet, when her father died after years of anguish, she said she felt his soul depart.

“I hadn’t seen him like that, at peace, in at least 10 years,” she said.

While her parents’ generation kept silent about Alzheimer’s, Ms. Demontigny set up a Facebook page in 2019 to describe living with the illness. The social media posts from a mother of three, not yet 40, who had to give up her career as a midwife because of a rare form of Alzheimer’s, resonated in Quebec. She became the spokeswoman for the Federation of Quebec Alzheimer Societies and wrote a book about her experience, “The Urgency to Live.”

Quebec legalized assisted death a decade ago, before the rest of Canada. Under the law, a person had to be in an “advanced state of irreversible decline in capability” and “must expressly confirm their consent immediately” before the assisted death. But the requirements presented a problem for those suffering from an incurable and serious disease like Alzheimer’s, who were likely to lose their capacity to consent.

Dr. Georges L’Espérance, a neurosurgeon and president of the Quebec Association for the Right to Die with Dignity, said Ms. Demontigny helped press to allow for advance requests after becoming the group’s spokeswoman in 2022.

“She played a primordial role,” Dr. L’Espérance said. “It’s fine to discuss these concepts in the abstract. But it’s different when you can link an illness to someone that people can identify with. And Sandra’s an open book and very credible.”

Mr. Secours, Ms. Demontigny’s partner, said fighting for the change had helped fill the void created by her diagnosis.

“She had never expected to commit herself to a cause,” Mr. Secours said. “But that saved her, that gave meaning to her life.”

In the half-decade since her diagnosis, Ms. Demontigny had led a busy life — speaking out, writing a book, becoming a grandmother. She had embarked on a romantic relationship with Mr. Secours, 72, who lived across the street from her old place.

“André talks to everybody, says hello to everybody, he’s very cheerful,” Ms. Demontigny said.

“We were friends, neighbors, in the beginning, then our affection developed,” Mr. Secours said.

Some people, though, asked him why he had chosen to get involved with someone with an incurable illness.

“Even my mother, who just turned 100 and sees very well, told me, ‘André, you’re really not making your life easier.’”

“She doesn’t say that anymore,” Ms. Demontigny interjected.

The couple vacationed in Costa Rica last year and were hoping to go on a safari in South Africa, they said, as Litchi now lay sleeping before the television.

Perhaps it was this, the life she was still able to lead and enjoy, that made it difficult for Ms. Demontigny to put down in writing, as required by law, the “clinical manifestations” that will lead to assisted death.

Because Ms. Demontigny is likely to become incapable of consenting as her illness progresses, the manifestations she describes will “constitute the expression” of her consent in the future.

In fact, she had written in her book that she wanted assisted death to be carried out when certain conditions were met, including being unable to recognize even one of her children and behaving aggressively toward her loved ones. But though she knew exactly what she was going to say as she sat over the documents on that recent evening, she could not bring herself to write it down, not yet.

“I’m not going to change my mind because for me, in my situation, that’s the best possible end,” she said. “But I don’t want to die. I’m not ready. That’s not what I want.”

The president of Germany’s central bank, which on Tuesday reported an annual loss for the first time in more than 40 years, said Germany faced another year of economic stagnation, more gloomy news for a country that is struggling to grow.

“It is not possible to rule out a third consecutive calendar year with no growth,” Joachim Nagel, the head of the Bundesbank, told reporters in Frankfurt.

The comments highlighted the economic challenges facing Germany’s next government. Voters on Sunday gave Friedrich Merz of the conservative Christian Democrats a mandate to form a new government, which he is hoping to do in coalition with the center-left Social Democrats.

The new government will inherit a 2025 budget with a 13-billion-euro ($13.6 billion) hole and an economy riddled with structural problems, including high energy costs, a cumbersome bureaucracy, and an export industry under pressure from rivals in China and the threat of tariffs by the United States.

The government, which will find it hard to borrow more because of strict rules on debt and deficits, cannot rely on any transfers from the Bundesbank, which sends its profits to the state.

Mr. Nagel was speaking after the release of the central bank’s annual report, which showed a loss of €19.2 billion last year, the bank’s first loss since 1979.

Since interest rates have risen, central banks around the world have faced losses stemming from the high interest they pay on deposits versus the low returns they receive from low-rate bonds bought during past crises. The Bundesbank stopped transferring money to the government in 2020, building reserves to offset losses.

Sabine Mauderer, the first deputy governor of the central bank, said that losses would continue, making the bank “unable to distribute any profit for an extended period of time.”

The Bundesbank stressed that it maintained a “sound” balance sheet, buttressed by some €260 billion worth of gold, which has recently soared in value. And despite the economy’s “stubborn stagnation,” Mr. Nagel pointed to Germany’s stable institutions, “adaptable” companies and skilled work force as strengths that would help the country return to growth.

But the past three years have been marked by political instability — or a “lack of political reliability,” as Mr. Nagel put it — that has rattled consumers and investors.

“Germany needs an effective government as soon as possible,” the central bank chief said, calling for “smart economic policy to enable the economy to get back on track.”

Sometimes, silence speaks louder than song.

That’s the hope, at least, for more than 1,000 musicians who released a lyric-less album on Tuesday to protest the British government’s proposal to expand the ways that developers can use copyright-protected works to train artificial intelligence models.

The album, which was created by artists including Annie Lennox, Billy Ocean, Hans Zimmer and Kate Bush, is not exactly silent: It features recordings of empty studios, which the artists say represent “the impact we expect the government’s proposals would have on musicians’ livelihoods.”

There are footsteps and rustles — is that a door closing? a page turning? a fly? — but only the most out-there contemporary composers would refer to the sounds as songs.

“Doesn’t that silence say it all?” Kate Bush, who contributed to the album, said in a statement, adding, “If these changes go ahead, the life’s work of all the country’s musicians will be handed over to A.I. companies for free.”

Under the government’s proposals, artists would have to opt out, or “reserve their rights,” to keep their works from being used to train A.I. The window for public comments on the proposal, which is part of a broader government consultation on copyright and artificial intelligence, was set to close Tuesday night.

“Opt-out shifts the burden of controlling your works onto the rights holder,” said Ed Newton-Rex, who organized the album and is the chief executive of Fairly Trained, a nonprofit that certifies generative A.I. companies for the training data they use.

“Basically,” he said, of the current government proposal, “it flips copyright on its head.”

Even as some artists experiment with artificial intelligence, many fear that developers are inappropriately using their work without compensating them. (Publishers and journalists are also concerned: The New York Times has sued OpenAI and Microsoft for copyright infringement of news content related to A.I. systems. OpenAI and Microsoft have denied those claims.)

The album — titled “Is This What We Want?” — has 12 songs, each of which has a one-word title that together spell out the sentence: “The British government must not legalize music theft to benefit A.I. companies.”

Only some of the artists who were part of the album project directly contributed to the audio, Mr. Newton-Rex said, although he said that all shared in the credits.

Mr. Newton-Rex and other critics fear that artists may not even know if their work is being used to train the A.I. models. He said that he had previously run opt-out schemes at generative A.I. companies, which he called an “illusion,” in part because copyrighted work can spread so quickly online that creators can lose control of it.

Powerful A.I. developers have repeatedly shown that they are willing to skirt copyright law to train systems. And Britain, desperate to revive its sluggish economy, is aggressively trying to court A.I. developers. Prime Minister Keir Starmer recently said he plans to push Britain to be “the world leader.”

The country has already signaled its willingness to break with the European Union and some of its other allies, like Australia and Canada, in its attitude to the technology. At a recent A.I. summit in Paris, Britain sided with the United States in declining to sign a communiqué calling for A.I. to be “inclusive and sustainable.”

Now, Britain is arguing that a “competitive copyright regime” is part of what is needed to “build cutting-edge, secure and sustainable A.I. infrastructure.” The proposals, which were announced late last year, call the current system unclear and say that it is hampering innovation for both A.I. developers and artists. Britain argues that the proposed changes are meant to give artists more control over the way their work is used and more opportunities for payment.

In response to a request for comment, the Department for Science, Innovation and Technology said that Britain’s current copyright structure is holding both artists and A.I. companies back from full innovation. But it also noted that no decisions had been finalized and that it would consider the responses it received before setting out next steps.

Britain’s consultation process, in which the government asks for public input at the early stages of policy proposals, is designed to take in feedback and often leads to revisions.

As the consultation period ended on Tuesday, British artists and publishers released a series of protests. Several newspapers featured identical campaign images across their front pages that read: “Make it fair: The government wants to change the U.K.’s laws to favor big tech platforms so they can use British creative content.”

The musicians Paul McCartney, Elton John and Dua Lipa, the novelist Kazuo Ishiguro and the actor Stephen Fry were among the artists who signed a letter in protest that was published in The Times of London.

“There is no moral or economic argument for stealing our copyright,” the artists wrote. “Taking it away will devastate the industry and steal the future of the next generation.”

Speaker Mike Johnson toiled on Tuesday to find the votes to squeeze the G.O.P. budget resolution through the House, facing potential defections from centrist Republicans fearing the plan would tee up deep Medicaid cuts and conservatives who want to slash federal spending even more deeply.

Mr. Johnson announced an evening vote on the budget outline, whose approval would clear the way to enact the major elements of President Trump’s domestic agenda, but it was not clear whether he would be able to muster the votes to adopt it.

At a news conference at the Capitol on Tuesday, Mr. Johnson said Republican leaders were “very close” to winning the votes they needed to do so, but signaled the vote could slip to later in the week.

“There may be a vote tonight,” he said. “There might not be.”

It was a familiar conundrum for the speaker, who is working to quell discontent from both flanks of his fractious conference, all while dealing with a razor-thin majority that will accommodate almost no defections. If all members were present and voting, Mr. Johnson could afford to lose no more than a single Republican, and a handful have already said they are against the measure.

Approval of the budget plan is a crucial first step for Republicans to smooth the way through Congress for a massive fiscal package using a process called reconciliation, which allows such bills to steer clear of a filibuster and pass the Senate on a simple majority vote.

The House blueprint calls for legislation that would add roughly $3 trillion to the deficit over a decade, while teeing up deep cuts in spending on health care and food programs for low-income people. That would help pay for $4.5 trillion in tax cuts. It also calls for raising the debt limit by $4 trillion.

At least five conservatives on Tuesday morning said they planned to vote against it.

“It’s insane,” said Representative Thomas Massie of Kentucky. “We’re going to increase the deficit with this. Why would I vote for that? You can’t cut taxes without cutting spending, and they’re not really cutting spending.”

At the same time, Republicans in swing-seat districts have said they are uncomfortable approving a plan that could lead to major cuts to Medicaid and food stamps. The budget does not specify precise cuts, but it lays out broad spending targets by committee that dictate where Republicans must find the money to finance their tax cuts.

For example, the plan instructs the Energy and Commerce Committee, which oversees Medicaid and Medicare, to come up with at least $880 billion in cuts. It would not be possible to find anywhere approaching that amount of money without slicing deeply into at least one of those programs.

“I’m still making my point all the way to the end about the need to protect the services that are important to my district,” Representative Juan Ciscomani of Arizona, said as he left a closed-door meeting of Republicans on Tuesday morning to discuss the plan. “Obviously, this is only the beginning. This is where the real fight actually begins to protect the services that I’ve been fighting for, while also delivering on the promise of slashing down the size of government.”

Republican leaders in recent days have huddled with those skeptical lawmakers and tried to assure them that they will not ultimately be asked to approve deep cuts to those programs. They have argued the House urgently needs to approve the blueprint — which does not carry the force of law — in order to move the reconciliation process forward.

“The question before us now is, what will move us in the right direction: failure, or a partial success?” said Representative Dusty Johnson, a South Dakota Republican who leads the centrist Main Street Caucus. “I think we’re going to come together around the idea that failure is the wrong option, and a partial success is far preferable.”

Maya C. Miller contributed reporting.