Thank you, Madam Chair, and good morning, everyone.
I am Julie Campbell. I speak today as a MAID assessor and provider, and also from my experience coordinating, navigating and providing leadership in this area. I want to commend this government on the thoughtful investigation that's been undertaken to understand this work and, most importantly, our patients. I am also very pleased with how inclusive ministers have been in their language in recognizing the important work of both nurse practitioners and physicians.
Each month I speak to more than 140 new patients and families and present to community groups. By far the top concerns expressed to me are the lack of advance consent and the 10-day reflection period, so I am grateful to see these addressed. I am also grateful for the changes around witnessing requests. Patients requesting MAID should be afforded the same privacy rights as patients for any other medical procedure. Allowing care providers to sign is a positive step for this confidentiality. A specific statement allowing virtual witnessing would be beneficial.
I do this work, as do most of my colleagues, because we can make a difference in reducing suffering for patients who feel this is the right personal choice for them given their circumstances, their values and their experiences. I want to share with you a few key reflections that I feel are important for the implementation of this legislation at the front line.
Patients in rural areas may benefit most from the option of oral self-administered MAID. This is because patients can be assessed virtually, and our knowledge of this and its safety has been tested during this pandemic. For one particular patient who received oral self-administered MAID in a remote community, their prescriber was a significant distance away. They were monitored by local physicians and nurses who maintained communication with the prescriber. This supports the conscience rights of clinicians and supports patients to receive access in remote areas. I believe Bill C-7 should be amended to require the presence of a regulated health care professional authorized to pronounce death, rather than limiting the physical presence to the prescriber.
In the area of Ontario where I most frequently work, I calculated the number of unique providers of MAID in the past 12 months. I counted 49. However, 12 of the 49 assessors completed 84% of the 307 MAID provisions that year. The majority of MAID work is done by a small number of providers who have garnered expertise in this work through their experience. This highlights how we need to continue the current practice of careful, thoughtful patient-centred assessments, where an assessor reaches out to colleagues with various expertise when they feel that's needed. Should the wording require the same person to have expertise in the condition and have expertise in MAID eligibility assessment, some of our most complex patients will surely not have access due to the complexity of their condition or the number of qualified assessors in their area. This causes delays and enduring suffering where consultation, when needed, could maintain safeguards without compromising equity of access.
It is imperative that the wording defining “grievous and irremediable medical condition” be left without amendment, as these criteria are understood among MAID assessors. This would maintain that the suffering could be related to either the illness, disease or disability or the advanced state of decline and need not be related to both.
I would also like to ensure that Bill C-7 provides the same safeguards and supports for patients with respect to advance consent. This would allow an authorized alternative signer to make the written advance consent at the direction of the patient when the patient is unable to sign and date for themselves.
Lastly, I would be remiss if I did not mention that at the heart of implementing this federal legislation is collaboration with provincial governments. Inequities of access for patients exist regionally, provincially and nationally due to these differences. Examples include coverage for oral secobarbital, scope-of-practice limitations that are either provincially or employer-based, support for travel to remote areas, and remuneration for nurse practitioners. The law will only provide Canadian patients choice if it can be implemented.
I appreciate your time and I thank you for your hard work.