Justice Committee on May 9th, 2016

[The Chair, Liberal, Anthony Housefather]

Excellent.

Let the record note that I put my thumbs up.

Mr. Falk, will you move that on behalf of Mr. Genuis?

[Ted Falk, Conservative, Provencher, MB]

I so move.

[The Chair, Liberal, Anthony Housefather]

Mr. Genuis, over to you to speak to your motion.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

There has been a lot of discussion in the context of this debate about the importance of palliative care. I think there is a consensus about the importance of palliative care. There's nobody who is against palliative care here.

It has been a matter of concern among the different witnesses, both at the special joint committee and the study here at the justice committee, that there is not adequate palliative care in this country right now. I think there's a consensus about that and various proposals and plans for addressing that deficiency.

What this does is ensure that somebody who is seeking euthanasia, suicide, or whatever you want to call it, is consulted, is given the information about available palliative care. When I talk to people about this issue, so often people may talk about pain in a certain context being unmanageable and I happen to know, because of my connection to the medical profession, that pain in that particular case is not unmanageable, but perhaps was not managed well in that particular context.

A concern I have is that people will think their pain is unmanageable and they will think they cannot be helped, when in fact they can.

Based on a consensus around the importance of palliative care and also making sure that people have proper information about what is available in terms of pain management, I think that asking that people have some consultation and information about palliative care is important.

I want to note that this doesn't slow down the timeline at all, so I wanted to remove that little phrase to clarify that point. The legislation obviously has people visiting a physician already; they have to have consultations with various physicians. Therefore, including the assurance of receiving detailed information about available palliative care options, the fact that there's already a waiting period for someone, even in the midst of that waiting period to be able to get that information, I think, clearly isn't going to slow down anyone's access to this service, but it does provide an important safeguard so that people know exactly what their alternatives are before they take this very final step.

[The Chair, Liberal, Anthony Housefather]

Thank you very much.

Mr. Falk.

[Ted Falk, Conservative, Provencher, MB]

Again, this is an issue for a final check on whether palliative care is an issue and whether they've had the full consultation to see whether there's any further palliative care that could be extended or would make it foreseeable for those individuals to avoid making this decision. This is a very permanent decision that they're making and we want to make sure that all the options have been explored.

I think it's a great amendment. Again, it's another safeguard.

[The Chair, Liberal, Anthony Housefather]

Thank you.

Mr. Rankin.

[Murray Rankin, NDP, Victoria, BC]

I hesitate to speak against the proposed amendment because I know it to be well intentioned. The reason I'm speaking against it is, I suppose, twofold. First, it comes up as a condition for eligibility. That is, the way it's put in the bill, where it fits in the bill, is that this would be a condition precedent to actually being able to be eligible. It bothers me to think that in every case, particularly for those people living in remote communities, they would be denied their ability to take advantage of this service unless they could find a medical practitioner who could describe, perhaps non-existent, palliative care options.

The minister herself told us 15% to 30% of Canadians may have access to palliative care. I would have thought that the practitioner, or those people who counselled, encouraged, or persuaded people about the service in the past, who talked to them—social workers, psychologists and the like—would have talked about that. Health care practitioners would have already done that as part of what normal team medicine is in the 21st century, so I don't think it's necessary. But it troubles me that we would make it an absolute bar to doing so, where it may be difficult to obtain that advice.

[The Chair, Liberal, Anthony Housefather]

Mr. Cooper.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

I certainly take Mr. Rankin's point about the fact that palliative care is not available, according to the minister, to 70% or 80% of Canadians, and I think that's a problem. But as I read this amendment, all it is saying is that a medical practitioner would provide information to the patient to make them aware of palliative care. It doesn't require a patient to undergo palliative care as a prerequisite. It is really informational in nature. Of course, it doesn't seem to indicate that a palliative care doctor or practitioner is required to oversee the consultation with the patient.

[Murray Rankin, NDP, Victoria, BC]

I'm sorry, but that's not what the section would say. It says they have consulted a medical practitioner regarding palliative care options. It's a condition that they consult somebody who, in Nunavut, they may have a lot of trouble finding, let alone a nurse practitioner, which I notice is absent as well. I find it to be unworkable.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Can I make a quick comment, and I'll make it without necessarily closing off? I think it is important to acknowledge telephone consultations happen regularly with physicians, especially in remote communities, and could easily happen in this case since what's required is not a physical exam. It's simply a verbal consultation about available palliative care options, so that should hopefully address Mr. Rankin's concern about access, at least as far as that goes.

[The Chair, Liberal, Anthony Housefather]

I have a receivability question.

My question, Mr. Genuis, is about the physician who is checking afterwards, and has to to check to make sure all of the requirements of subclause 241.2(1) were met, which would now include your proposed paragraph (f). How is it your view that the physician or nurse practitioner would check to see the other physician, if it was a different physician, informed the individual of all of the full range? Would one of them have to call or correspond with the other physician to make sure a full range of options was provided, or are you presuming it's always one of the two referring physicians, the nurse practitioner or medical practitioner, who are involved? That's going to help me clarify how receivable this is.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Sure. Mr. Chair, I don't think this is a problem at all. When it goes to a second physician, that physician is going to have to receive some kind of documentation from the first physician. The only way you demonstrate there were two doctors is if the second doctor knew about the first doctor, so it would be not at all onerous to include in whatever that correspondence was a line to acknowledge that the required information about palliative care had been provided, or that the required information about palliative care hadn't been provided, in which case the second physician would have to provide that information.

[The Chair, Liberal, Anthony Housefather]

You're seeing it as one of the two. You're seeing this being done by one of the two.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

In the event that neither of them felt competent to do the procedure, it would require a third physician. I can't imagine that happening in the vast majority of cases, but, on Mr. Rankin's concern about access, this is the kind of thing, unlike.... I presume the meetings with the two physicians who are signing off on this will require in-person meetings and some kind of physical examination. A consultation with respect to palliative care options would clearly not require a physical examination. It could be done very easily remotely. To suggest that added a degree of an onerous condition, that was substantially greater than the existing conditions, doesn't make a lot of sense to me.

[The Chair, Liberal, Anthony Housefather]

I'll check that it is receivable.

Is there any further discussion or debate?

(Amendment negatived [See Minutes of Proceedings])

I believe amendment CPC-13.1 should be next, which is Mr. Falk.

[Ted Falk, Conservative, Provencher, MB]

This amendment has to do with safeguards and final checks. The amendment says quite concisely that part of the conditions is that the patient has received the written consent of the Minister of Health to the administration of medical assistance in dying. This is of a serious nature. This is a bill that gives physicians and nurse practitioners the exceptional ability to legally administer a lethal dose of a cocktail of medicine to kill somebody. It is nothing short of that. It's nothing short of killing someone, and that requires a lot of seriousness, and it requires a lot of oversight. This amendment says that it needs ministerial sign-off. It's very clear, and very simple.

[The Chair, Liberal, Anthony Housefather]

Mr. Bittle.

[Chris Bittle, Liberal, St. Catharines, ON]

It seems to be another amendment, though perhaps well intentioned, that just creates layer upon layer to make medical assistance in dying inaccessible to a large number of people, and this goes toward that. To require that makes it inaccessible, and it goes against the spirit of what the Supreme Court wanted in Carter.

[The Chair, Liberal, Anthony Housefather]

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

I have another concern with this. I agree with Mr. Bittle. It is creating another barrier, another layer to overcome in accessing medical assistance in dying, which the court clearly says is something that should be available to Canadians in certain situations.

I don't know what expertise the Minister of Health would have in signing off on this. I note as well that it would be a minister of health as a politician, a political person, who would then be making decisions in this regard after the court has already ruled that it's something that has to be accessible for certain Canadians.

I have a couple of different problems with that, and I can't support the amendment.

[The Chair, Liberal, Anthony Housefather]

Mr. Warawa.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

The committee has said no to prior judicial oversight. The only form of oversight at this point...and the Carter decision...were that we had a regime with strict safeguards, including enforcement. To this point, Bill C-14 does not have that oversight, other than two physicians or two nurse practitioners. But there is no oversight—no judicial oversight, no oversight whatsoever. We're relying on two people of that competence to end a life, to assist in the ending of a life of an individual at the individual's request.

If we want to amend this, I'd be in favour of amending it, but you would need...and we heard this from testimony. I'm thinking of the special committee; I'm not sure if this committee heard that from the witnesses. There was an encouragement to make sure you do not have the physicians putting themselves in a very dangerous position where the government of the day says that in this case, if there was a charge or a complaint made against a physician or a nurse practitioner, they did this inappropriately. Maybe a family member would not be happy with how the situation was handled, and now we have these physicians in a very dicey situation where they could be charged with homicide.

The encouragement was to have some sort of oversight. I think this is an attempt to provide some oversight—if not judicial, because of concerns it would delay, then in another way.

In the spirit of what is being attempted here, if we don't want a minister of health, is there an appetite to have any oversight? I think it's needed. We've heard that it was needed. Without it, you're going to leave physicians vulnerable to possibly being charged. I appreciate the spirit of it. Maybe we need to find another way.

The other thing, Mr. Chair—and I think it's salient—is that we have one approved amendment to this point. It was a Liberal amendment—and that's good. It was a good amendment; it actually got unanimous support. But that was it. I think that when we, through the discussion, through the debate, highlight some needs for changes, we need to seriously consider them and amend them, if appropriate.

[The Chair, Liberal, Anthony Housefather]

Mr. Falk.