Justice Committee on Nov. 10th, 2020

[Krista Carr]

No. We're against the systemic discrimination of allowing people to be euthanized or put to death on the basis of their disability, when they can't get the supports they need to live well within their communities.

They may very well find themselves in the medical system, with the suffering they're experiencing being caused by the lives they are living, while they can't get the supports they need to live the lives they want to live. The medical system alone cannot get those supports for them, so having access to ending one's life, as opposed to being able to live a good life....

If somebody is already dying, we already have it in the legislation, or if they're already suffering intolerably and their death is reasonably foreseeable, they can access MAID anyway. Anyone can do that. What we're doing with track two, Bill C-7, is singling out one particular charter-protected group of Canadians and saying it must be so terrible to live their lives that we're going to assist them to end them when they show up in the system and need supports to live. I know we're not necessarily doing it intentionally, but that is what happens. We have examples, which I'm happy to send, of case after case of exactly this thing.

[Luc Thériault, Bloc, Montcalm, QC]

Ms. Carr, after all, it is not to you or me or anyone else that the patient must define their tolerance threshold. That is what self-determination and respect of a person's dignity are about.

It is true that we must fight for people to have the best possible care, but at the end of the day, you will agree that it is up to patients themselves to determine their tolerance threshold and make that decision.

[The Chair, Liberal, Iqra Khalid]

You have 20 seconds, Ms. Carr.

[Krista Carr]

Having respect for people means trying to make their lives tolerable and bearable, the same way we do for any others who are not identified as having a disability and who try to commit suicide or end their life. We intervene in every possible way we can to help make their lives better.

[The Chair, Liberal, Iqra Khalid]

Thank you, Ms. Carr.

Thank you, Mr. Thériault.

We're moving on now to Mr. Garrison.

Mr. Garrison, you have six minutes. Please go ahead.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Madam Chair.

I want to thank all the witnesses appearing before the committee today.

I also thank the members of the disability community and their advocates for their passionate presentations, both today and away from this committee table. I believe we need to hear more on these issues. That's why, as I've said before, I am disappointed that we have not yet started the statutory review of medical assistance in dying, which I believe deals with some of these larger issues being raised today.

The court decision took reasonable foreseeability off the table, whether we like that or not. Whether it has been appealed or not, I believe it would likely be upheld in the higher courts, so what we're left with is an attempt to deal with that decision and to deal with some other urgent issues in medical assistance in dying.

I want to turn back to Ms. Campbell, who raised issues I've heard a lot about in my constituency, which include relieving suffering caused by the 10-day waiting period and also by the inability to waive final consent. I believe those are urgent things we must deal with, which justify a speedy consideration of Bill C-7. Could you say a few more words about those issues, Ms. Campbell?

[Julie Campbell]

Patients who call me are not calling me the first time they have ever considered medical assistance in dying. These are people who have really considered.... They've often been in the health care system for a long time and have been presented with many options. They are knowledgeable people, who have evaluated their own values and experiences. Many of them have discussed this thoroughly with their family before calling. They're not jumping at making that phone call, but they are making the call to determine what other options may be available to them so they can best consider those, so I think they're frustrated with then having to wait another 10 days once they've come to that decision.

Advance consent is the one I actually hear the most about. I hear that more from patients who are really at risk of losing their capacity, such as in the Audrey Parker case. I also hear it from many community groups who are really concerned that, should they be in that position in the future, those rights would not be available to them.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you.

In testimony from Dr. Daws, who is also a MAID assessor and provider, she said to the committee, and also in her written brief, that she didn't meet anyone who wanted to commit suicide. She didn't meet anyone who wanted to die. She met people who wanted to deal in a dignified manner with what nature was presenting them with. Can you comment on your experience with this?

[Julie Campbell]

Yes. My experiences are very similar. If I could give my patients anything, I would give them life, but life isn't necessarily the option they're being presented with. When they look at their different options, they're considering MAID as one of those options, but many of them are choosing between very hard choices. My wish for them to be better certainly doesn't make that so, although I would do everything I could to assist with that.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I know that time is very short, but could you give us a very brief comment on the role of witnesses? We sometimes seem to assume that witnesses are judging whether the assessment has been correct, when in fact they're judging the identity and the signatures on documents, I believe. Can you tell me if I'm correct with that?

[Julie Campbell]

You are. The witnesses generally are independent volunteers with no medical contacts whatsoever. They're simply noting that the person signed that form or directed a third person to sign on their behalf when they're not able to do so.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Madam Chair.

In the interest of time, I'll conclude my questions there.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Mr. Garrison. You still have a minute and a half, but that is okay.

In that case, we'll move on to our second round of questions. We'll start with Mr. Cooper.

You have five minutes. Go ahead.

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

Thank you very much, Madam Chair, and thank you, witnesses, for your very helpful testimony.

I want to direct my first question to Mr. Sikkema and Mr. Schutten, as well as Mr. Berger.

In the Supreme Court's Carter decision, the court adopted the pronouncement of the trial judge, wherein the trial judge stated that risks associated with physician-assisted death “can be identified and very substantially minimized through a carefully-designed system” that imposes strict limits.

We have heard some fairly compelling testimony about how vulnerable persons could be put at risk as a result of the removal of important safeguards passed in Bill C-14. Can you speak to any charter issues that you see in that context, Mr. Sikkema, Mr. Schutten or Mr. Berger?

[Ken Berger]

Perhaps I could respond to that very intuitive question.

The charter also involves “the right to life...and security of the person”, which seems to have been forgotten. Clearly, the trial judge in the Truchon case did not, in my opinion, pay sufficient attention to that. The fact is, as you mentioned, that there need to be strict limits. The problem, as I was mentioning earlier, is that this is a subjective decision based on potential influence and coercion. All we have here is government questionnaires with leading questions.

With respect to anyone who is making a decision—the MAID assessors—there's the risk of confirmatory bias. If they believe that assisted dying is right, they are more likely not to see issues with capacity, not to see issues with the consent and not to see coercion, because they think what they're doing is something humane and right. So there need to be robust, strict protections here, including not only substantive protections of only doing it near end of life, but having committees decide this, and not a physician who's actually doing the act, because they're more likely to find that what they're actually doing is correct. There need to be substantive safeguards and procedural safeguards that are strict and rigid.

Thank you.

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

Thank you for that.

Mr. Sikkema, I'll give you a chance to weigh in on my question as well.

[John Sikkema]

I'll add to what Mr. Berger said. I think the expert report of Dr. Madeline Li in the Lamb case is quite instructive on this. She actually developed and oversees the MAID program at the University Health Network in Toronto. In her expert report, she describes the case of a woman who had bone cancer and depression. She was assessed by two experienced MAID providers, not by her oncologist and a psychiatrist, and they approved her for MAID. She changed her mind during the 10-day waiting period and decided to do palliative care instead.

Later, during another crisis, she requested MAID again and her MAID providers decided again that she was eligible. They apparently had no concerns about her ambivalence. Then she ended up changing her mind again during the next waiting period. You're talking about the waiting period not mattering as a protection. This is right there in an expert report by someone who designed the system in Toronto. It's quite remarkable. I recommend looking at that expert report.

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

Do you have any comments on charter issues, specifically?

[John Sikkema]

My colleague André is on the call. He's writing a paper about how practically this means that the criminal law does not protect your life as strongly—I'm speaking for him here—when you have a disability or a chronic illness, because your death wouldn't be investigated to the same extent. We talked about equality earlier on this call. I can't get MAID because I'm not disabled, so the disability equality angle has kind of two sides there. I think that's important to recognize, that section 15 goes the other way, too.

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

Thank you.

[The Chair, Liberal, Iqra Khalid]

We'll now move on to Mr. Zuberi until the end of this panel.

Go ahead, Mr. Zuberi.

[Sameer Zuberi, Liberal, Pierrefonds—Dollard, QC]

I want to thank all the witnesses for joining us today.

I wanted to put this question to Mr. Foley and others who want to contribute to this.

Essentially, I know that many of you are advocating against opening up MAID to non-reasonably foreseeable deaths. I appreciate that. It's something we're considering. However, I want you to open up. Let's say for a moment that we actually do consider non-reasonably foreseeable deaths. In your opinion, how do we protect those with disabilities, from your vantage point, and vulnerable persons?

It's for Mr. Foley and others who would like to contribute.

[Ken Berger]

Madam Chair, I don't believe it's possible to protect the disabled if you open it up. There are already cases with the existing law demonstrating that the disability community is in danger and this is just going to exacerbate that. In my respectful submission, without limiting it to close to death, there is no way of limiting it.

[Sameer Zuberi, Liberal, Pierrefonds—Dollard, QC]

Thank you.

Just very quickly—I have another minute—would anybody want to actually flesh this out? If we open it up, how could we protect disabled persons? I feel this is really important, given what we're studying.

[Roger Foley]

The current safeguards are already failing under Bill C-14. Taking away those safeguards, there's absolutely no way to protect vulnerable and disabled persons from a wrongful assisted death. I'm disabled, and I know that if you pass Bill C-7, I won't survive and there'll be thousands of wrongful deaths. You'll see the numbers pile up. So I urge you to please not allow this regime to continue to slide.