Justice Committee on May 4th, 2016

[Wanda Morris]

We polled our members on this question. Eighty per cent of them were in support of advance consent, for example, in cases of dementia.

I think this is fundamental to how we apply assisted dying legislation. Are we truly going to be patient-centred and give people what they want?

There was a time when doctors didn't even let their patients know they had a diagnosis of imminent death. I think we've really moved from that to a time of being patient centred.

My colleague suggested that she felt every patient's life had value, and I commend her for that, but really isn't it up to the patients themselves to decide whether they want to continue living in a state where they clearly don't? I think we can be very specific with the wording and the direction of advance consent, laying out particular criteria so we can tightly control it, but I think it is fundamental.

[Murray Rankin, NDP, Victoria, BC]

I want to give you an opportunity as well to comment. One of your colleagues on the panel talked about the need for “prior authorization by a superior court”, a judicial authorization. Could you comment on that issue?

[Wanda Morris]

That's just a fundamentally flawed comment. What we know from other colleagues working right now with individuals who are choosing assisted death is that it is an onerous and expensive and deeply daunting prospect to go before a court. To me, to add on that layer of administrative and bureaucratic and legal procedure is not necessary. We have already gone above and beyond the procedures required in any other case of informed consent. To go farther than that provides no real benefit but imposes a substantial burden on people who are already grievously ill and dealing with great suffering.

[Murray Rankin, NDP, Victoria, BC]

Can I have one more question , or am I out of time?

[The Chair, Liberal, Anthony Housefather]

You will be over the time, but if you get a one-word answer....

[Murray Rankin, NDP, Victoria, BC]

It's for Dr. Blackmer.

We're struggling with conscience protection in the committee and how to do it, and I noticed you carefully said, “to the extent constitutionally possible”.

Do you have a legal opinion on whether we can do it in this federal law?

[Dr. Jeff Blackmer]

I'm not a lawyer, but having spoken to a lot of lawyers about this, I've received the interpretation that this would not be possible. If the committee feels otherwise and there is a possibility otherwise, we would support that possibility, certainly.

[The Chair, Liberal, Anthony Housefather]

Thank you very much.

Mr. Hussen.

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

I'd like to begin by asking a question of Dr. Ferrier. I'd like to begin by highlighting a section of your submission for the Physicians’ Alliance against Euthanasia. It says that since “the vast majority of desires for death are caused by mental illness”, suicide prevention through treatment of such illness and treatment of the self-harm inflicted by suicidal persons are part of the daily practice of many doctors.

I'm curious to know whether you have any research that indicates that the vast majority of desires for death are caused by mental illness.

[Dr. Catherine Ferrier]

I don't have any particular study at my fingertips, but I can tell you that this is the experience of essentially all doctors ever.

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

Secondly, you also spoke, on the next page of your submission, about there being no justification for imposing any duty to implement this political decision on Canadian doctors and institutions.

Do you feel that Canadian doctors would be forced to conduct medical assistance in dying?

[Dr. Catherine Ferrier]

In Quebec right now, doctors who are not willing to conduct it themselves are obliged to send the patient along a path that will ensure that it will be done. That, to me, is similar to what Dr. Blackmer said about Ontario, which requires referral directly to someone who will do it. Most people who object to euthanizing patients would also object to sending patients to their deaths, not because of our own needs but because we think it is contrary to the needs of our patients.

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

Mr. Racicot, have you any opinion on that?

[Michel Racicot]

The doctors also have a right to freedom of conscience, and a doctor who feels that he or she should not do that for his or her own conviction and for the good of the patient should not be obliged to do it and should not be obliged, either, to refer to someone who will do it, as is the case in Quebec.

It is very important, if we have to have this law apply equally and similarly across the country, that this committee recommend that the objection of conscience, both for individuals and institutions, be implemented. I personally think that you have the jurisdiction, because it's, in theory, within your jurisdiction over criminal law.

In Quebec at the moment, certain hospitals do not perform abortions, and they are not forced to perform abortions, but they are forced to perform medical aid in dying. This is why we need the institutions to be protected as well.

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

Dr. Ferrier, you gave as your opinion that at least for the organization we should limit medical assistance in dying to those who are in the last stages of terminal illness. What about those who are suffering through an incurable illness or disease, who are in irreversible decline and great suffering, and who wish to make that decision?

[Dr. Catherine Ferrier]

I think we have to look after those people.

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

What if it's their expressed desire to—

[Dr. Catherine Ferrier]

Well, if it is their expressed desire... I mean, this law is going to pass and there will always be somebody who will be willing to help them.

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

According to your submission, if we limit it to only those who are in the last stages of terminal illness, those folks would not have access to their choice.

[Dr. Catherine Ferrier]

I think we have to remember that we're talking about killing people, and this is not a medical treatment; it's not some kind of panacea that is going to solve everybody's problems. This is something that we've always been able to do and society always made the choice to not do this, and there are many other things that we can do for people. People who really, really wanted to die in the past have found ways of reaching their goals without involving the medical profession.

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

This is for the Canadian Medical Association, either one of the representatives.

I'd like to know if you have any concerns with respect to Bill C-14 and whether patients will have difficulty accessing medical assistance in dying as it moves forward.

[Dr. Jeff Blackmer]

That's a very important question. I would point out that when we've done surveys of the membership in the CMA, somewhere around 30% of physicians have said that if this becomes legal they would be willing to participate. That may sound, on the face of it, low; it's actually not. That equates to tens of thousands of physicians. In Oregon, it's less than 0.6% of physicians who participate in assisted dying. In terms of the numbers alone, access won't be a problem. The problem is connecting patients who qualify with willing practitioners.

You can imagine that most physicians aren't willing to put their names out there to advertise that they're going to be participating in this; there are security and safety concerns. What we need, and what the CMA has been calling for, is a system to help connect patients who qualify for assisted dying with practitioners who are willing to provide the service. At the same time this means the physicians who don't want to participate, or don't want to refer, can have their conscience rights protected. It's a way to satisfy both situations.

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

How would that system operate?

[Dr. Jeff Blackmer]

There's actually a system in Alberta, at the current point in time, that the Alberta government has been working on where physicians can register with a central registry and say they are willing to participate. Patients, or a health care provider, can call that number and find out more information about the legislation and about the service, but also be connected, where appropriate, with a willing provider. They put that in place because of the situation they had where a patient in Calgary was not able to find a willing provider and had to travel outside of the province, even though there were many physicians in Calgary who could have assisted. We desperately need this type of a system to make sure that we connect patients and providers.

[Dr. Cindy Forbes]

I want to also echo those comments. I can honestly say the most common question I get from my colleagues who know that I've been involved at this level is, do you know who's going to provide the service? They may be willing to refer, but at this point in time they have no idea how, and as Dr. Blackmer pointed out, it's unlikely we're going to have a directory or a list published somewhere. This concept of a central referral, coordinating system would be essential when June 6 arrives, that physicians would know there's a system; that patients would know there is a system. There would be no confusion and it would pave the way to access for the people who really should be accessing the service.