Excellent.
This provision that we are amending is described as being distinct from the notion of an advance directive, but it still applies the same general principle, which is the idea that a person can consent in advance and say what their future self would do or would want under certain circumstances. That has all of the same problems as the advance directive I talked about.
This legislation already accepts the principle that still-present consent should overrule past consent. It says that if a person in the process of having euthanasia or medical assistance in dying administered to them in the moment reacts in some way, if they evidently show that they are not interested in what's happening, then the process must at that point stop.
That's a good principle, to say at least that if you're going down this somewhat dangerous road of advance consent that you at least accept that contemporaneous consent in theory overrules advance consent, except there's nothing here to require that the patient be told in the moment what's actually taking place.
As the law is written right now, if a person is already on an IV, then the contents of that IV could be altered such that death could be administered, and there would be no legal requirement that the person be consulted, be spoken to or be told what is happening in the moment. Something could be put in their food or in their IV, and on the basis of their advance consent, that would be considered totally legal.
The public's first response to hearing about this idea of what could happen might well be that it's just crazy that anyone would do that. Of course, no doctor would do that. We can hope that people would be reasonable, surely, and the reasonable thing to do in the moment is to, of course, consult with the person and to say to them, “Okay, sir or ma'am, is this something you still want? You had expressed this desire three months ago. Based on your circumstances right now, is this something you want to proceed with, and can we facilitate this moment in some way that's meaningful for you? Should we invite your family?” Those would all be the reasonable things to do.
I think it stands to reason that if we accept that that is what should happen in every case, then we should put language in the law, and we should put in place a safeguard to ensure that would happen in every case. That's what this amendment proposes to do. It proposes to put language into the legislation that prescribes the procedure by which there is at least a check-in with the person in the moment to confirm whether their desires are still consistent with their desires of the past consent.
Maybe the question that follows as well is whether this is consistent with the principle of advance consent, because if you're asking the person in the moment, then why have advance consent at all? The purpose of advance consent was to respond to the possibility that a person would experience some decline in cognitive function such that they would not be able to make that decision at that future point.
If today I think that I want to have MAID on February 20, and I worry that my cognitive ability by that point might be such that I'm not able to consent on that day, then I can give the advance consent now for that date based on present irremediable suffering.
Then, on February 20, maybe that decline I worried about will have taken place and maybe it won't have taken place. Either way, if I've lost cognitive function or my cognitive function has declined, then in that moment I will still be asked, but if I'm not able to answer or to understand, then my prior wish will suffice.
The effect of this amendment, in total with the existing section, is that it allows the prior wish of the person to be inserted into the moment, in place of a lack of response one way or the other. However, it does not overrule contemporaneous consent, and that contemporaneous consent, to be meaningful, is sought. That's what the amendment seeks to do. It provides a safeguard. We've talked a lot about safeguards. This is an example of a safeguard that the legislation needs in order to function well.
It's been interesting listening to the conversations around the whole concept of safeguards. Some members will come up with the idea that we trust health care providers and that these kinds of safeguards—provisions like this—aren't necessary because we would trust that people who are in these situations will do the sorts of things we would categorize as reasonable.
The reason we have safeguards—recognizing that there are tens of thousands of physicians in this country, and on top of it, there are nurse practitioners who are authorized to perform medical assistance in dying as well—is that we cannot guarantee that everybody in every case will do the right thing. That's why we need safeguards.
We've heard testimony that suggests there are cases in this country, and many of the people who have been impacted by those cases have come before this committee.... I don't doubt that there are people who have been impacted by cases like that who have not come forward for whatever reason. It's probably a small minority of the cases of people who were impacted where people have actually come forward.
We've heard testimony before this committee of people who have been in situations where it was made clear to them that the doctor, or some other member of the staff or people in that institution, thought that MAID was something they should go for. It is very troubling to me that we have cases where the system is saying that person should have MAID and suggests it. There was a case, and I can't recall the specific name, where a mother was told that in not wanting MAID for her daughter, she was being selfish. The same was being told to individuals themselves. We have cases where a person's very natural and very healthy—I would argue—desire to live is being described by the system as an act of selfishness. I think that should speak to the need for safeguards.
If you have a case where the system, physicians or people in a “care situation” think that a person should be receiving medical assistance in dying and the person has made the advance request.... Suppose it's a situation where the patient is viewed as difficult by their caregivers for whatever reason. When it comes to the day when that advance request is set to terminate—where the end point was set be—I would submit that in that kind of a case, this sort of safeguard is especially necessary.
If it is the paternalistic view of somebody else that MAID is something that this person should have in the moment, I wonder how much less likely it is that they will actually do that proper consultation, do that “reasonable” thing, and ask the patient, “By the way, you made this advance request. Today is the day. Are you ready? Are you sure? Is this something you want to proceed with?”
That's where we come to safeguards. We listened to the testimony of people like Mr. Foley. I believe the committee heard from Ms. Hyatt, a young woman with a disability who had the experience of going into a hospital with, in the scheme of things, a relatively minor complaint. She was asked in the moment if she was sure she wanted the care. This is the lived experience of many people who testified before this committee.
I find it striking as well, then, when we talk about the need for safeguards, that this committee has heard from many different disability organizations that have raised these concerns and that have flagged the problems in the legislation. I think all of the disability rights organizations, at least all of the ones I've been able to hear in following this committee, have spoken about the need for safeguards and the concerns they have with the legislation as written, the need for amendments and the need for amendments that protect people's fundamental rights.
I would like to say as well that if we're going to properly consider amendments like this, we've missed the opportunity to hear from so many other people. Conservatives have been proposing that we actually hear from a broader range of witnesses. We missed that opportunity because of the way in which the government disrupted the parliamentary calendar and then created this artificial timeline after the fact.