Evidence of meeting #11 for Justice and Human Rights in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A video is available from Parliament.
NDP
Murray Rankin NDP Victoria, BC
To Dr. Boer, you noted in your response to my colleague Mr. Fraser that you had grave concerns with the “reasonably foreseeable” language. You said that “reasonably foreseeable” had no specification.
What would you suggest, then, when you spoke of a requirement of life expectation? It wasn't clear precisely what you thought we might do to change that very vague expression in Bill C-14?
Professor, Ethics, As an Individual
Let me just add that we have had conscientious objection in the Netherlands from institutions also. For example, from my research I know that in 41,000 cases of euthanasia, there was not one Muslim. Why then would we oblige a Muslim nursing home to provide that kind of care? I don't see it, and I think it's a matter of a tolerant society that you know that this house will not provide this kind of help, and you will have to make your arrangements and go to another one. We have autonomous citizens, and they know what institution to choose.
In regard to your question, can you repeat just one word, because—
NDP
Murray Rankin NDP Victoria, BC
The word was “foreseeable”. You said there was no specification in that phrase. How would you fix it?
Liberal
The Chair Liberal Anthony Housefather
Are you able to hear?
His question related to your comment on the reasonable foreseeability, in proposed new paragraph 241.2(2)(d) of the requirements. You had suggested perhaps a time frame of three or six months in terms of.... He's asking you to clarify what it is you're suggesting.
Professor, Ethics, As an Individual
Thank you. I did understand that.
Of course, I know and have indicated that I know that there are many problems. There are moral problems in setting a time limit. For example, why would we give euthanasia to lady A and not to Mr. B? I know there are problems, but you have to draw the line somewhere. Then, of course, there are medical problems, because how can you tell that the prognosis of this patient is, for example, not more than six months?
I would just suggest that, as in some places—in Oregon, for example, and in Switzerland—you make some kind of time frame just out of the embarrassment of not knowing what the best solution is. My point is only that having no [Technical difficulty—Editor] at all leads to euthanasia cases, of which the friend of mine who had the operations is just one example.
Liberal
Chris Bittle Liberal St. Catharines, ON
Ms. Guy, I appreciate your response. We heard from the Department of Justice yesterday, and they made a distinction between suicide and medical assistance in dying, in that if medical assistance in dying is legalized, it becomes a different act from counselling suicide. That being said, is there still a preference in your organization that there be an increased level of clarity, even though the department's position would be that such an amendment as you requested isn't required?
Social Worker and Policy Analyst, Canadian Association of Social Workers
If it were made clear in some sort of addendum or other publication directly from the Department of Justice or the federal government that absolutely, counselling professionals, regulated professionals, social workers—that sort of encadre, en Français, that group of professionals—are exempt, I don't think there would necessarily be a reason for it to appear specifically in the legislation. We just weren't sure whether it would or not, so in the interest of protecting the public as well as our members, we were looking for more clarity on that.
Liberal
Chris Bittle Liberal St. Catharines, ON
To the Quebec Association for the Right to Die with Dignity, I have a concern with respect to the 15 clear-day waiting period, which may in fact be 16 or 17 days. I was wondering if you could comment.
My concern comes from the fact if someone declares that they're enduring suffering, why must they wait two weeks or more to receive that? Again, I appreciate the necessity for perhaps a cooling off period, but I was wondering if you could comment on that specific provision.
President, Quebec Association for the Right to Die with Dignity
First of all, a 15-day waiting period is problematic. Why not 13 or 18 days? For a patient who is very close to death, this makes no sense.
Secondly, the vast majority if not all patients with a terminal illness have had plenty of time to think about their problem. It is not a decision that is made in 15 days.
A 15-day waiting period can be problematic, for instance, if the patient is suffering a great deal, is competent and gives consent to receive medical assistance in dying. If a well-intentioned physician then administers barbiturates or morphine to the patient to relieve pain, the patient might no longer be competent to give consent when the physician visits again, owing to the high doses of narcotics.
To my mind, this is problematic.
Former Endocrinologist and Palliative Care Doctor, Quebec Association for the Right to Die with Dignity
In palliative care, there are major fluctuations in a patient's condition: one day the patient is fine, the next they are delirious and, three days later, they are fine again. This makes it very difficult.
We need a bill, and the bill passed sets out the minimum criteria. Above all, the objective was to prevent abuse. The patient's consent is therefore essential. That said, there will certainly be amendments because these provisions very often do not apply in real life. For example, most patients in their final days are comatose and can therefore not give the consent they had already given. This is an important point to be amended.
President, Quebec Association for the Right to Die with Dignity
I would like to add a final word, if I may.
As you can imagine, these patients don't show up at their doctor's office one day asking for medical assistance in dying. That is not how it works at all. Many stakeholders are involved, including social workers and nurses, who are with patients 24 hours per day. It's team work. All these people are on site and discuss patient cases. The patients can talk to them.
Liberal
Chris Bittle Liberal St. Catharines, ON
Dr. Boer, I'd like to clarify an item that Mr. Nicholson was talking about, namely the pressure that doctors are feeling. Are you speaking about societal pressure and pressure from patients? Is that the pressure you're speaking about?
Professor, Ethics, As an Individual
It's both, basically. I think there's general pressure from society, so to speak, that sees euthanasia and sees death as the best solution to very severe suffering. I see the pressure on doctors, from the many dossiers I've read, where patients say, “Doctor, I have seen the documentary on television. Euthanasia for patients like me is now allowed, so you'd better do it.” That's a direct pressure from patients.
Then there's a second pressure, and that's of course the pressure from relatives. I do understand that. For relatives, seeing the suffering of a beloved may be just as traumatizing as the suffering the patient has to undergo himself. For example, the end-of-life clinic that has been established in the Netherlands now has about 450 euthanasia cases a year. From my research, it has become clear that in 60% of the cases it was the family members who brought the patient to the clinic in order to be helped. So yes, there's strong pressure, I think.
Then there is maybe a third sort of pressure, and that is the internalized pressure of a patient. I have seen about one in 10 cases where the patient motivates his euthanasia request on the basis that he wants to save his relatives from having to see his suffering. What you see is that the relatives in that case do not put up opposition to that observation of the patient. Rather, they say, “Well, that is very friendly of you. We may find a way to have you have euthanasia.” But I would say that the natural reaction of family members to such a motivation would be, “No, please, Mother, don't ask for euthanasia. It's too much for us. It's your life. We will do whatever.” Do you see...?
Liberal
The Chair Liberal Anthony Housefather
We have about four minutes left with this panel. We'll do a speed round, which means that if anyone has any very short questions....
But to the panel, confine yourselves to very short answers—one or two sentences, okay?
Speed round, Mr. Falk.
Conservative
Ted Falk Conservative Provencher, MB
Dr. L'Espérance, in your testimony you used the word “terminal”. You also interchanged it with the word “grievous”. Would it add greater clarity to the bill and be of benefit to change the references that are used, changing the terminology of “grievous” to “terminal”?
President, Quebec Association for the Right to Die with Dignity
There are two kinds of diseases we're talking about here. There are terminal diseases, which are usually very clear, such as cancer, etc., and non-terminal diseases, which are chronic and debilitating diseases. That's why I think there should be both terms, because it's really not the same clinical reality.
Liberal
Colin Fraser Liberal West Nova, NS
Very quickly, Dr. Boer, I was going to ask you earlier this follow-up question. To your knowledge, has there been any litigation, or any conviction, or any reprimand of a physician who performed, perhaps improperly, medical assistance in dying in the Netherlands experience?
Professor, Ethics, As an Individual
Of 42,000 cases, 75 times the report of the doctor was sent to the public prosecutor. However, not not in one single case has the public prosecutor decided to prosecute, because the doctor normally says he will never do it this way again.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
To Dr. Boer, it's my understanding that in the Netherlands, similar to what is proposed in this legislation, two physicians can decide whether a patient is eligible for physician-assisted dying. One of the concerns that has been raised is doctor shopping. Could you perhaps comment on whether that has been a problem in the Netherlands?
Professor, Ethics, As an Individual
Yes, that happens in two respects. First, there is doctor shopping in respect to the fact that we now have the end-of-life clinic, which means that when your home doctor, your own doctor, will not provide you with euthanasia because he does not think the criteria have been fulfilled, you can then go to the end-of-life clinic and they will provide you as much support for your wish as possible. That's a kind of shopping.
The second kind of shopping is shopping for a second opinion doctor, which means that if the first consulting doctor says “no”, you can go to another one or another one or another one. When you have found one that says “yes” you are not obliged to include all four reports. You can just include the one report of the doctor who says “yes” in your report.