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.
9:15 a.m.
President, Quebec Association for the Right to Die with Dignity
There is also a difference between a minor who is 14 and one who is 16.
These are very difficult concepts and problems, and we should engage in more reflection here.
9:15 a.m.
Conservative
Rob Nicholson Conservative Niagara Falls, ON
Ms. Guy, I don't have a copy of your proposed amendment. I'd be interested in getting it from you. Maybe you have tabled it here; I'm not sure. I don't have it, but if you have some wording for it, that would be interesting to see.
9:15 a.m.
Social Worker and Policy Analyst, Canadian Association of Social Workers
I have it clearly written out in the submission we did online. It's not in the oral notes, but I can certainly provide it.
9:15 a.m.
Conservative
Rob Nicholson Conservative Niagara Falls, ON
I look forward to getting it. Thank you for your testimony.
Those were my questions, Mr. Chair.
9:15 a.m.
Liberal
The Chair Liberal Anthony Housefather
Thank you very much, Mr. Nicholson.
Now we're going to move to Mr. Fraser.
9:15 a.m.
Liberal
Colin Fraser Liberal West Nova, NS
Thank you, Mr. Chair.
Thank you everybody for appearing today and for your testimony. It's very helpful.
My first question is for the Quebec Association for the Right to Die with Dignity, specifically for Dr. L'Espérance.
Certain organizations and members of this committee maintain that a person with mental health issues should consult a psychologist before a physician can provide medical assistance in dying. What is your position on this?
9:15 a.m.
President, Quebec Association for the Right to Die with Dignity
There are two parts to your question.
The first part of your question pertains to persons eligible for medical assistance in dying who have a specific illness and who have been suffering from psychological problems of some kind. In Quebec, these patients must be evaluated by a psychologist and/or a psychiatrist. We completely agree with this requirement and it seems essential to us. The second part of your question pertains to patients with a primary psychiatric disorder. It is still too early to talk about medical assistance in dying for patients with a primary psychiatric disorder.
Society and the medical profession alike must examine this issue much more thoroughly before taking a position. Most psychiatrists are uncomfortable with this even though psychiatric patients are human beings like anyone else.
There is a problem with the diagnosis of psychiatric illnesses, which can vary from one psychiatrist to another, and above all in the prognosis for psychiatric illnesses. This is why we think minors and patients with a primary psychiatric pathology should be excluded from the legislation for the time being. This requires further consideration, in society and in the medical profession alike.
9:15 a.m.
Liberal
Colin Fraser Liberal West Nova, NS
Thank you.
My second question is also for the Quebec Association for the Right to Die with Dignity.
My question is about the phrase “reasonably foreseeable”. The bill currently requires that natural death be “reasonably foreseeable” in order for a person to be eligible for medical assistance in dying. What do you think of this phrase? Do you think a specific time period should be set?
I would also like to hear your views on the flexible approach set out in this bill.
9:15 a.m.
Former Endocrinologist and Palliative Care Doctor, Quebec Association for the Right to Die with Dignity
The phrase “reasonably foreseeable” is certainly open to interpretation.
In palliative care, for example, which is the field that I know the best, we have mostly cancer patients. In their case, it is fairly straightforward because the death of patients who are in palliative care and are in the advanced stages of cancer can be predicted in a reasonable period of time. Defining a “reasonable period of time” is very problematic for people who have chronic and debilitating conditions, such as amyotrophic lateral sclerosis and multiple sclerosis. These illnesses are very painful. They progress very slowly and patients get to the point where they can't take it any longer. They feel there is no longer any reason to live, that life is not worth it any more.
For these patients, it is difficult for the physician to predict how much time the person has left. This is an important issue for these patients. In our opinion, they should have the right to decide to die even if their natural death is not imminent and could be months away. The other issue—which is in the Supreme Court decision—is that these patients are still able to make a decision. They are able travel to Switzerland for assisted suicide in order to die. It is appalling to force them to go to Switzerland and perhaps they go before they are ready. In short, this often precipitates their decision; for this category of patients then, it is important not to impose a specific time period.
9:20 a.m.
Liberal
Colin Fraser Liberal West Nova, NS
Thank you very much.
Would you like to add anything, Dr. L'Espérance?
9:20 a.m.
President, Quebec Association for the Right to Die with Dignity
I would like to address one final point.
The term “reasonably foreseeable” is very vague in medicine. Physicians, even those in palliative care, who claim they can predict how much time a patient has left are always or very often mistaken, unless the patient is at death's door. Two things in life are certain: birth and death. Between them, most of us have to pay taxes. Otherwise, we are very often mistaken. A whole range of criteria and situations must be examined in order to evaluate a patient. This is why it is impossible to predict exactly how much time a patient has left.
9:20 a.m.
Liberal
Colin Fraser Liberal West Nova, NS
I'm going to move now to Dr. Boer.
This law is being proposed in a fashion that would amend our Criminal Code, so it's arising in a criminal context. I just want to make sure I understood you. You were suggesting that basically the law should make it prohibited unless doctors can prove otherwise that they had the grounds to perform medical assistance in dying.
Did I understand you correctly?
9:20 a.m.
Professor, Ethics, As an Individual
Yes, I think that what you are stating is correct. The Dutch word for society is literally samenleving, which means living together. This means that the society per se has to protect the life of those who belong to the community. Any act that intends to kill a person should be justified on an individual basis. Some doctors experience that as burdensome. On the other hand, the criteria for euthanasia are so clear nowadays because the review committees have made a jurisprudence so that this is no longer experienced as a serious problem. But you are right: a doctor can never be certain before he has received notification from the review committee that he will not be prosecuted.
May 3rd, 2016 / 9:20 a.m.
NDP
Murray Rankin NDP Victoria, BC
I'd like to start, if I may, with you, Dr. Faure. Thank you for coming, and thank you for your support of the joint Senate-House recommendation number 7 on advance directives. I appreciated your words about that.
I believe that Quebec's Bill-52 initially contemplated advance directives but then didn't go there. Could you explain why and what motivates your support for that recommendation of the joint committee.
9:20 a.m.
Former Endocrinologist and Palliative Care Doctor, Quebec Association for the Right to Die with Dignity
In the beginning it was written that way.
The first version of the bill that was tabled included many points that we considered important. Through discussion, the political parties were able to come to an agreement. It was example of real dialogue. Partisan politics did not come into play. It was discussion among human beings.
Concessions were gradually made to ensure that the bill passed. The issue of advance directives was difficult for some to accept. So they decided to pass a bill that was acceptable for the time being. There would be other opportunities to discuss the issue further.
The bill should certainly be amended because this issue is extremely important to the public. With the huge number of people getting older, people have fears about how their lives will end. This issue is extremely important to our association. The bill will have to be amended.
9:25 a.m.
NDP
Murray Rankin NDP Victoria, BC
Therefore, I wondered if you would agree with what Professor Pewarchuk wrote yesterday inThe Globe and Mail, that to not have the advance directives “would create an environment where those with progressive terminal disease must choose to end their lives prematurely, or risk enduring the full natural course of the illness”.
I presume you would accept and agree with that?
9:25 a.m.
Former Endocrinologist and Palliative Care Doctor, Quebec Association for the Right to Die with Dignity
Exactly, yes.
9:25 a.m.
NDP
Murray Rankin NDP Victoria, BC
My next question is for you, Dr. L'Espérance. I want to ask you about the protection of medical practitioners in Quebec on grounds of conscience. We've heard a lot about that here. Some have suggested that we need to clarify it in this federal law.
Maître Ménard told us that was in provincial competence from a legal perspective, but of course your perspective is medical. I want to ask, number one, if there have been any problems with conscience in the protection of doctors. Number two, you made a distinction between an individu and an organisation. I presume you're saying that institutions should not be allowed to have conscience protections, but individuals should. Do I understand you correctly?
9:25 a.m.
President, Quebec Association for the Right to Die with Dignity
Absolutely.
On the first question, no, there's no problem in Quebec with—
conscientious objection.
It's something that is absolutely natural and it's perfect.
Whatever the reasons for conscientious objection, it is perfectly normal.
In Quebec, a physician who refuses to provide medical assistance in dying has a duty to refer the patient to the administration of an institution, which must in turn find a physician to provide that assistance. This is exactly the same problem we faced 40 years ago with abortion. It's exactly the same thing. It is perfectly normal.
I would say, however, that an institution cannot conscientiously object, especially a public institution. In the case of a private institution, be it Catholic, Muslim, Jewish or of any other religion—regardless, it makes no difference—, if it is completely private, it must have the right to set certain rules. In our opinion, though, if it receives public funding, it must comply with the patient's wishes.
An institution has a duty to provide care to patients, and medical assistance in dying is the ultimate act of compassionate care. If the physician does not wish to provide it, that's fine, but they must refer the patient to someone else.
9:25 a.m.
Former Endocrinologist and Palliative Care Doctor, Quebec Association for the Right to Die with Dignity
I'd like to add another point quickly.
From the time discussions began, I have been sorry to see that the patient is often forgotten. Ultimately, the core issue is the dignity of the patient, of the individual. We should do everything to help the patient. Issues related to physicians and so forth are important, to be sure, but the core issue is often forgotten.
9:25 a.m.
NDP
Murray Rankin NDP Victoria, BC
I appreciate your focus on the patient. The reason we talk about it, of course, is that the Supreme Court said in the Carter decision that individual medical practitioners, on rights of conscience, need not perform the service, and we're trying to clarify whether the bill needs that protection.
I want to say, Dr. L'Espérance, that I agree entirely with you. Institutions are different from individuals, and taking money at the same time as denying people constitutional rights is really quite unthinkable.
9:25 a.m.
President, Quebec Association for the Right to Die with Dignity
If I may say so, I am happy to let the legal experts decide whether conscientious objection should be included in the amendment of the Criminal Code. I am not a lawyer, but it should not, to my mind, be part of the Criminal Code. It should certainly be part of the legal framework though.