Justice Committee on May 2nd, 2016

[Philip Emberley]

Thank you for the question.

There are concerns. These medications have not been used therapeutically for quite some time. We're talking about barbiturate drugs that in the past were used in therapeutic doses to help people sleep. We understand that the companies that used to make these medications are no longer doing so.

In doing a search for the drugs that are used in other jurisdictions, such as Oregon and in the Netherlands, namely secobarbital and pentobarbital, we found that they are no longer available in Canada. They are being made in limited quantities in the U.S., but to our knowledge they're not available in Canada as of this time. We're very concerned, as pharmacists would be, that the drugs that were to be used would be available and not shorted or lacking.

[Ahmed Hussen, Liberal, York South—Weston, ON]

Have you any ideas on how that could be addressed?

[Philip Emberley]

Well, I think it's important that Health Canada would make the necessary provisions to allow manufacturers to import these drugs from other countries where they are being produced.

[Ahmed Hussen, Liberal, York South—Weston, ON]

Thank you.

[The Chair, Liberal, Anthony Housefather]

Thank you very much, Mr. Hussen.

Mr. Rankin is next.

[Murray Rankin, NDP, Victoria, BC]

Thank you to all of the witnesses for coming this evening.

My first question will be to you, Mr. Emberley.

We've heard today in testimony that in the case of self-administration, the moment of prescription of a medication that a patient may take at home is when the medical assistance in dying is provided.

The question I have for you is whether you think pharmacists are capable of making the capacity assessment required to accept that the patient's consent at that moment is valid. The witnesses said today that it could be a pharmacist who gives some medication months and months earlier to a patient, who might have it in her closet for a long time and then finally take it, but the last person who has to assess whether she's in fact giving express consent would, of course, be the pharmacist.

Are your members trained to make that kind of capacity judgment?

[Philip Emberley]

Well, first, we feel that there are a number of unanswered questions that the pharmacy profession needs to address. What we will say, though, is that we do not believe it's within the scope of practice for pharmacists to make a judgment on capacity. We feel it's important for pharmacists to know that a patient has met the criteria for assisted death, but we do not feel that pharmacists are in a position to make that determination of capacity.

[Murray Rankin, NDP, Victoria, BC]

But we heard that that's precisely what they may have to do. That's one of the safeguards that's specifically listed in new paragraph 241.2(3)(h) of the list of safeguards in the bill. I'm putting to you that this might be a deficiency in the bill, if that's what the government is expecting.

[Philip Emberley]

It would be a concern, and we're definitely working with the pharmacy regulators in Canada to take this discussion further. If that were indeed the case, there would be much conversation that would definitely be necessary.

[Murray Rankin, NDP, Victoria, BC]

That's because of the huge civil liability issues, wrongful death issues. Presumably you've talked about being satisfied that there's criminal liability protection, and I think they've done a good job on that, but civil liability in that circumstance would be horrendous.

[Philip Emberley]

Absolutely.

[Murray Rankin, NDP, Victoria, BC]

Yes.

This is a question to both Dr. Cohen and Dr. Lemire.

Dr. Lemire, in your testimony you mentioned the problem of an unexpected loss of capacity during the 15-day waiting period.

To both of you, how commonly might this be expected to occur for patients whose natural death is reasonably foreseeable? From the perspective, then, of both the psychologist and a family doctor, will this unexpected loss of capacity be a rare event, or is it actually quite common for those nearing the end of life, and therefore a serious flaw in this bill?

[Dr. Francine Lemire]

We need to have an understanding about natural death being reasonably foreseeable. Are we talking two weeks, a month, three months, six months, a year? Greater clarity around that would be important.

If we're talking about a six- to 12-month window, there is lots of room there, and that deterioration may be much less predictable. If we're talking about a shorter interval of time, the deterioration would certainly be more likely and riskier from that assessment perspective.

[Murray Rankin, NDP, Victoria, BC]

Dr. Cohen.

[Dr. Karen R. Cohen]

It's going to vary a fair bit on the conditions. Dr. Lemire used the example of multiple sclerosis. I worked as a rehab psychologist for many years with people who have acquired conditions affecting the brain and spinal cord, like MS. One of its hallmarks is its course can be very unpredictable, so it may be very difficult to say when someone who has motor problems primarily as a result of their MS then acquires cognitive ones.

[Murray Rankin, NDP, Victoria, BC]

The words you used, Dr. Lemire, were “seek greater clarity”. Then in your testimony, when you gave the example of MS and reasonably foreseeable natural death you said, “Some specificity around this criterion is needed.” Are you suggesting there needs to be an amendment to clarify that for the purposes of this law?

[Dr. Francine Lemire]

We believe that statement does require clarification. We appreciate wanting to be comprehensive and allowing the latitude to the relationship between provider and patient to have the conversation and be able to do this, yet at the same time, providers will want to have an estimate of time.

[The Chair, Liberal, Anthony Housefather]

You have 25 seconds.

[Murray Rankin, NDP, Victoria, BC]

Thank you. I can't ask my question in 25 seconds, Mr. Chair.

[The Chair, Liberal, Anthony Housefather]

I appreciate that.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Can I have his 25 seconds?

[The Chair, Liberal, Anthony Housefather]

Right now it's Ms. Khalid.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Thank you very much for this presentation. You have transmitted very insightful words to us today.

Mr. Emberley, you referred to a third party or an independent body with respect to pharmacists providing the drug. Do you see a problem in remote geographical locations where there is only one pharmacy, say, servicing a rural community? How do you think such a body would affect both instances?

[Philip Emberley]

We think that is a very important question. The provincial regulatory bodies are in the process of drafting guidelines for their members, and this is a very important consideration. They have to drill down on some of these specifics because they need to take the need of their populations into consideration. This is an area they will need to home in on quickly to ensure that accessibility is optimized.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Thank you.

To all the panellists if possible, we've heard a lot of questions and concerns from all our honourable members with respect to conscience rights, capacity, the administration of the bill, and the big underlying question is whether the bill's administration is going to be consistent throughout the country.

What are your thoughts on the provincial approaches and whether the provinces will be able to come together with a consistent approach to the administration of death?