Evidence of meeting #20 for Health in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was regulations.
A recording is available from Parliament.
Conservative
Patrick Brown Conservative Barrie, ON
Okay. Are there any other comments in general about the consultation? Were your organizations consulted, or was it just the one organization that was missed?
Programs Consultant, Canadian AIDS Society
It would be interesting to see who the 900 were that were consulted. The Canadian AIDS Society was not, nor any of our member agencies, or it would have been brought to our attention.
Surprisingly enough, Dr. Levy wasn't consulted or didn't know, according to his testimony.
It would be interesting to see who they were.
Conservative
Patrick Brown Conservative Barrie, ON
Yes, and as I said, because this has gone over such a long time, it would be interesting to find out from some of our colleagues...with the previous prime ministers and health ministers, that this was embarked upon.
I want to delve into and touch upon whether any of your organizations have looked at the standards in different countries. How do the Canadian regulations compare to some of our colleague nations around the world? Have you done any research?
Conservative
The Chair Conservative Joy Smith
Time has passed, so perhaps you could just briefly answer Mr. Brown's question.
Who would like to take that?
Mr. Plater.
Chair of the HIV and Hepatitis Committee, Canadian Hemophilia Society
I know from the information I've been privy to through some presentations that there was consideration of the American situation. One of the issues is that there's some—it's very limited, but there's some—suggestion of some cross-border transport of organs, in particular, and I know there's more around the tissue area, but there was an attempt to have some lining up with that. Other than that, I don't know.
In terms of your first point, though, I think it's a very good one. NGO organizations have a difficult time keeping on top of all the possible opportunities to give advice. At the same time, I recognize that it's hard on the inside to recognize, across a large country like this, everybody you should ask for input. This was a process where input was invited, but if you're not aware of the invitation because you're not able to regularly monitor these systems, it's hard to get the information back and forth, even over an 11-year process.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Let me add to what Patrick has just said. Not only is it likely that if you weren't on the regular list of people to be consulted about organs, you wouldn't have received the notice, but also, based on our information, there was no reference to the exclusionary criteria in a specific sense, so people wouldn't even know that this list actually said, “Exclude men who have had sex with men in the preceding five years.”
We know the standard reference in the regulations was not attached to the gazetted regulations. We know it was not posted with the electronic version of the regulations, and it's not easily accessible online. So who the heck would have known? And you didn't receive any direct notice. It tells me that we need to go back to the drawing board and start again and make sure that everybody is consulted properly.
I want to ask Nigel and others a question around the contradictions of this government. On the one hand, it appears to be ready to be real tough in excluding men who have had sex with men in the preceding five years from ever donating organs. These are men who have no evidence of high-risk behaviour; they could have monogamous relationships with one man in a longstanding marriage, yet they're excluded. But an organization like Kali Shiva, in Winnipeg, which helps deal with high-risk populations in terms of HIV and AIDS—I've read the Winnipeg statistics, and we're dealing with a high incidence among women and aboriginals and sex trade workers, and so on—has been cut back in its funding by the federal government because it does too much work on harm reduction. Maybe you can give us some enlightenment on that point.
Also, let me raise the issue of the precautionary principle, which seems to be the modus operandi of the government on this issue, even though there are no risk factors associated with gay men necessarily. They don't want to talk about all the other high-risk areas, such as multiple sex partners, unprotected sex, use of a sex trade worker, and so on, but they'll single out men who might have a monogamous relationship. How do you justify use of the precautionary principle around that when in fact when it comes to things like bisphenol A, which is a hormone disrupter that could cause breast and prostate cancer, the government says, “Well, we're going to wait and see if there's any harm done,” even though the science is in?
Maybe some of you could explain some of those issues and say whether or not you agree, first, that we need to amend the regulation consistent with scientific facts, as Dr. Levy said; secondly, that we need to establish a strong national organ transplantation agency, with a registry; and thirdly, that we need to consult broadly with experts before instituting changes through legislation.
Jump in.
Conservative
President, Egale Canada
Certainly we would hope they would use science to decide what are the most appropriate risk factors to assess. It doesn't matter what government is in power.
We certainly would be interested in participating in any amendment that occurs with the procedure.
Director of Programs, Canadian AIDS Society
I just want to respond to the point you made around organizations such as Kali Shiva, which has seen funding cuts. I think that is probably an issue that the health committee could explore separately. But certainly the discussion of harm reduction, in terms of transplant and transmission, is one the Canadian AIDS Society has a lot of experience with, and we would be very interested in exploring that further with you and sharing more information if you need it.
Chair of the HIV and Hepatitis Committee, Canadian Hemophilia Society
I would add this: don't go back to the drawing board; take the very good work that's been done and work with it. Your idea about adding people who pay money for sex is definitely one of those tweaks that needs to be in place. I'm always looking for more resources to prevent the spread of any of these infectious diseases.
Conservative
The Chair Conservative Joy Smith
We're close to the time. Unless you have any other comments, you've got about 40 seconds. No?
Mr. Fletcher.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Thank you, Madam Chair, and I'd like to thank the witnesses for coming today.
I think it was Mr. Tremblay who explained what they do in Quebec for families who donate members' organs, and I think that is an excellent suggestion. I hope we can include that in our final report as something that all provinces should do.
I have met Mr. Plater before because we dealt very closely in getting compensation for hepatitis C victims who received tainted blood outside 1986 and 1990. When I was health critic, the stories about how those people were denied were just terrible. I don't want to get too partisan, but it was the scandal of scandals. I think we want to avoid that type of situation. I think everyone wants what's best for the recipients, because they're the ones who need help the most.
I want to correct a few things that have been said. Mr. Alexander, the Canadian AIDS Society was definitely consulted by Health Canada, and we can provide you with all the specifics afterwards if you wish, but your organization was definitely consulted.
A fundamental issue here deals with.... There is an exemption available for organ donations. Men who've had sex with men are not banned from providing their organs. I want to read what has been said by Health Canada officials in a previous meeting:
...Health Canada does not prevent anyone from being considered as an organ donor. Despite the identification of risk factors based on science, an exceptional distributional provision in the regulations allows transplant of an organ from a donor considered to be at higher risk, provided that the transplant physician judges it to be in the patient's best interest and the recipient gives their informed consent.
We're doing the best we can, and the regulations do allow flexibility in exceptional situations. So it seems the balance has been established.
I want to get your comments on the exemption, and maybe a reaction is not necessary.
I would also point out that some concern is being expressed that the exclusion criteria of the cells, tissues, and organs regulations are unconstitutional. In 2007 the issue of consultation validity was of men having sex with men. The screening criteria was considered by the Ontario Court of Appeal in the context of the charter challenge to the semen regulations. The Court of Appeal found the MSM exclusions were not substantively discriminatory and the court emphasized that the health-based rationale for the exclusion criteria is a logical one.
Given that the exclusion criteria are less stringent for CTOs, and given the prevalence of infectious disease transmission, and given that the CTO regulations contain a mechanism that enables the use of CTOs even if they're initially excluded, how could it reasonably be concluded that one exclusion criterion is unconstitutional?
Conservative
The Chair Conservative Joy Smith
Mr. Fletcher, could I interrupt you for a moment? Your time is running out.
Conservative
Conservative
The Chair Conservative Joy Smith
There's no time for answers now. I'm sorry.
Mr. Temelkovski, it's time for you.
Liberal
Lui Temelkovski Liberal Oak Ridges—Markham, ON
Thank you very much.
I was hoping Steven would sing a song in the meantime there.
Thanks to the presenters. I have three questions.
Number one, could Mr. Tremblay and Mr. McCutcheon tell us about the Italian program and how they moved from population- to risk-based behaviours?
The second question is about court challenges. Mr. McCutcheon mentioned that he'd used the court challenges program before. Nigel also mentioned that. Maybe you can tell us a little bit more about the court challenges program and your inability to use it, or about that program not being available.
Number three, if I read Stephen Alexander's and Kim's behaviour correctly when Steven Fletcher was noting that they had been consulted, I read that they had not. Maybe they could tell us if had been or had not been, and Mr. Fletcher can table the report that says they met and what they met about.
Thank you.
President, Canadian Organ Donors Association
Would the member be so kind as to repeat his question. I didn't understand it.
Liberal
Lui Temelkovski Liberal Oak Ridges—Markham, ON
It is in regard to the Italian program of moving from population-based to risk-based behaviours.
Was it Mr. Alexander? Yes. I'm sorry.
Programs Consultant, Canadian AIDS Society
I don't know the exact process they went through. I just know they have, especially with blood donation, moved from a population criterion to a risk-behaviour criterion. There has been documentation also on solid organ donation in that area.
President, Gai Écoute Inc.
I made a passing reference to the Court Challenges Program because I was asked what our organization intended to do. Community groups like mine do not have the resources to undertake court challenges. In the past, the program allowed groups to take their fight to court, but it has since been abolished.
With your permission, at this time I would like to respond to a comment from Mr. Fletcher about the Annex and the regulations. In my opinion, the criteria are properly set out in the regulations. Homosexuals are permitted to make organ donations. The problem lies with the Annex which, as I see it, is not consistent with the regulations. The Annex refers to exclusion criteria. Is sexual orientation a criterion for excluding someone? I even feel that the title of the Annex is incorrect. It should refer to criteria. Behaviour would be a criterion. Sexual orientation is not a criterion.
President, Egale Canada
I'd like to go back to what Mr. McCutcheon was saying about the court challenges program. We certainly found it to be a very valuable program that allowed groups such as ours to dialogue about important charter issues. In this case, I don't believe we're faced with a charter issue, but certainly its elimination has limited the voice that groups such as ours have in the Canadian courts.