Justice Committee on May 9th, 2016

[The Chair, Liberal, Anthony Housefather]

I'm sorry, I'm just trying to work my way through this. It's the first time I've seen it.

Paragraphs (b) and (a) are reversed. In essence, that's what you're doing. You're reversing the order of paragraphs (b) and (a) that were in the amendment to this.

[Ted Falk, Conservative, Provencher, MB]

I'm not sure why they reversed it. They just did that.

[The Chair, Liberal, Anthony Housefather]

I'm going to give everybody time to read this.

[Ted Falk, Conservative, Provencher, MB]

We had testimony from several witnesses on some of the implications of prescribing a concoction people could take home and self-administer at their own discretion and when they were prepared to do that. What this would do is indicate that a nurse practitioner or medical practitioner needs to be present at the time it's done. That's a good idea for several reasons. We're not dispensing harmful medications unnecessarily that could end up sitting in somebody's medicine cabinet for years. We were told that possibility exists today, and that people have very lethal doses of medications in their medicine cabinets. We were also told that between 30% and 40% of individuals who pick up those prescriptions don't use them. There is a danger of people being coerced into it. Perhaps, at the time the prescription was filled, it was something the person wanted to do. All of a sudden, in the course of contemplating this action, there's been a change of heart and a change of mind. If there is no one present during the administration of it, there is the possibility that someone could be coerced into it. If somebody has some nefarious intentions, that could happen. In the worst-case scenario, if that drug were left unattended and someone else had access to the medication, it could have lethal implications for individuals not intended—

[The Chair, Liberal, Anthony Housefather]

I would like to hear your arguments as to receivability, in one sense. Maybe it is a simple question to you. The way I understand (b) is this. I believe what it is now saying is that the only way a medical practitioner or a nurse practitioner can administer a substance causing death is if the person is physically incapable of self-administering. Is that the intention—that somebody who is in the hospital, for example, could not have a doctor or nurse help them with the procedure if they are physically capable of doing something themselves?

[Ted Falk, Conservative, Provencher, MB]

Correct. If they have the ability to do it themselves, they should do it.

[The Chair, Liberal, Anthony Housefather]

I am having issues with receivability, because it radically changes the definition in the law. I want us to keep thinking about that. In the meantime, let's have the debate on the substance while I think about that.

Mr. Rankin.

[Murray Rankin, NDP, Victoria, BC]

I certainly appreciate and respect Mr. Falk's motivation for this. I think I come to a different conclusion on the merits, though. Yes, it is true that, in the evidence we heard, 30% to 40% of the people never use the medication prescribed. However, the point that was made over and over again was the fact that they had the choice. As they said, finding that the door was not locked was one of the key things that made people, in fact, not take the medication.

I also don't know why we would limit it so people have to have the supervision of a medical practitioner in the circumstances. I think many people have talked about having all the conditions met and having addressed the issue of coercion—which is critical, but which we address through so many other safeguards in the bill. I wouldn't want to change the spirit of what we are trying to create here by requiring a stranger—a medical practitioner or someone—to necessarily be there. I think it changes the bill significantly. I don't think the issue of coercion—which I am very alive to—is really addressed significantly, because we have so many other safeguards that do that job.

I will be voting against the amendment, if it is acceptable.

[The Chair, Liberal, Anthony Housefather]

I am still pondering that.

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

I agree with Mr. Rankin's point, which is well made.

The only other thing I would say is that we did hear evidence, as well, that pharmacists, of course, dispense medication that, if improperly taken, would perhaps have lethal implications. This happens all the time.

I think it is unnecessary, and for the reasons Mr. Rankin gave, I will vote against it.

[The Chair, Liberal, Anthony Housefather]

I have one question for the officials. Do you consider this a substantive modification to the definition? Maybe that shouldn't be what I ask. It changes the definition. How does that affect the bill, based on the change of definition?

I am still struggling with receivability.

[Joanne Klineberg]

I will start by saying that the way I think we would read this is that it would set as the default mode of medical assistance in dying the self-administration by everyone who is capable. Then, for those who are not physically capable, the administration of the substance by the practitioner would be possible. It is addressing the modality of the provision of medical assistance in dying.

I think in previous appearances we indicated that addressing these kinds of modalities was something the medical colleges or provinces and territories could do. It is really a policy choice about the latitude that the committee considers should be there. Our colleagues from Health Canada might be able to opine on whether it might create some access issues, if it is structured in this way.

On the substantive question, that is a good question.

[The Chair, Liberal, Anthony Housefather]

Thank you very much for your help.

I don't know if Health has anything they want to add.

[Helen McElroy, Director General, Health Care Programs and Policy Directorate, Strategic Policy Branch, Department of Health]

I would agree with my colleague from Justice that it could create access issues. It may also reflect on the autonomy of individuals who wish to operate on their own steam, shall I say, in particular circumstances. I think those two things could be considered, as well.

[The Chair, Liberal, Anthony Housefather]

I think this is how I'm going to rule. The interpretation clause of the bill is not really the place to put a substantive amendment, and I think this is a substantive amendment to definitions, but I would like err on the side of giving the committee discretion, if they think this is really wonderful, on voting on it.

I'm not going to rule it out of order at this point. I will let Mr. Falk close by defending it, and then it will be up to the committee whether you want to change the definition or not.

Mr. Falk.

[Ted Falk, Conservative, Provencher, MB]

Thank you, Mr. Chair.

As amended before including the nurse practitioners in these clauses, I think it actually strengthens the bill and puts the onus back on the patient who has requested the procedure. You are asking to die. You have the ability to make it happen. We're willing to give you the cocktail that will facilitate that. We have given you the legal ability to do that. We're just going to make sure that you administer it properly.

I think there's a lot of danger in mis-administration when it comes to self-administering at home. What if they don't take the whole thing, they take half of it? There are just too many opportunities for things to go sideways if there's not a medical practitioner or medical nurse present at the time of administration.

If the person has the ability to self-administer, they should do it. This is physician-assisted suicide, and we're providing medical aid in doing that. That's what this is.

[The Chair, Liberal, Anthony Housefather]

We're going to the vote on the amendment, CPC-5.3.

(Amendment negatived: nays 6; yeas 3 [See Minutes of Proceedings])

We now move to CPC-7 by Mr. Kmiec. Will somebody move it so Mr. Kmiec can speak to it?

Mr. Nicholson. Thank you very much.

Mr. Kmiec.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

The reason I'm moving this amendment is just to bring greater clarity to what we mean by the practice of medicine, just trying to stay within the spirit of the Carter decision. I'm using the example I know best, Alberta. Alberta has a Health Professions Act. The professions that are involved in health care are regulated by one act, and they have regulations that are separated out for each of them.

I have the definition here actually of what is a medical professional. Psychiatrists—we were debating that Liberal motion—is within the definition of a person practising medicine in the province of Alberta. But it goes on to other ones as well including plastic surgeons, general pathologists, doctor of osteopathy so chiropractors. It includes things like dermatologists, osteopathic practitioners. I just feel that to stay within the confines of the Carter decision we should then add “as a registered physician”.

I used to be the registrar for the human resources profession in the province of Alberta. Our act is voluntary so people don't have to conform to it. We're regulated by the Societies Act there. But the other professions have an act they conform with.

I think it also would allow the different provincial governments to determine how best to regulate access, and what types of physicians and medical professionals would be able to provide this form of health care. This should be only the physicians, not everybody, so a dermatologist wouldn't be able to do the procedure. I just think it brings greater clarity by amending the definition.

[The Chair, Liberal, Anthony Housefather]

Thank you very much.

Debate.

[Colin Fraser, Liberal, West Nova, NS]

I'd like to ask a question to the department just for clarity. Medical practitioner, as I understand it, is a term that's used elsewhere in the Criminal Code, and defines it as a physician.

Is that correct?

[Joanne Klineberg]

A qualified medical practitioner is a term that's in the impaired driving provisions of the Criminal Code. These are people, I think, who can do the Breathalyzer or something related to taking breath samples.

It's defined as a person duly qualified by provincial law to practise medicine so we adopted the same definition.

I think I would also note that there's subparagraph (7), which talks about the practitioners having to comply with any applicable provincial laws or guidelines and so on. It's always open at the provincial level or the medical college level to be saying that certain types of people who might otherwise meet the definition are not entitled to engage in medical assistance in dying.

[The Chair, Liberal, Anthony Housefather]

Does anyone else wish to intervene?

Mr. Kmiec, do you wish to close?

[Tom Kmiec, Conservative, Calgary Shepard, AB]

I'll just say that this amendment would basically make clearer what we mean by “medical practitioner” to make sure that only people who are physicians as determined by the college that regulates them are actually doing it and not, as an example, dermatologists.

[The Chair, Liberal, Anthony Housefather]

Understood. We'll now go to the vote on Mr. Kmiec's amendment.

(Amendment negatived [See Minutes of Proceedings])

We will now move to CPC-7.1.

[Ted Falk, Conservative, Provencher, MB]

Mr. Chairman, I'll withdraw that motion.