Evidence of meeting #7 for Justice and Human Rights in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was maid.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Clerk of the Committee  Mr. Marc-Olivier Girard
Jennifer Gibson  Director and Sun Life Financial Chair in Bioethics, University of Toronto Joint Centre for Bioethics, As an Individual
Alain Naud  Family Physician and Clinical Professor, Department of Family and Emergency Medicine, Laval University, As an Individual
André Rochon  Retired Justice of the Québec Court of Appeal, As an Individual
Michael Villeneuve  Chief Executive Officer , Canadian Nurses Association
Anne Boyle  President, Canadian Society of Palliative Care Physicians
Harvey Chochinov  Distinguished Professor of Psychiatry, University of Manitoba, Canadian Society of Palliative Care Physicians
Bonnie Brayton  National Executive Director, DisAbled Women's Network of Canada
Catherine Ferrier  President, Physicians’ Alliance against Euthanasia

12:55 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

I don't think so.

12:55 p.m.

President, Physicians’ Alliance against Euthanasia

Dr. Catherine Ferrier

You are talking about patients who request it. That's another question and it's not relevant—

12:55 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

However, Dr. Ferrier, in order for him to make the request, he must be aware that he has that option.

12:55 p.m.

President, Physicians’ Alliance against Euthanasia

Dr. Catherine Ferrier

I don't think there's a problem with that, because he's continually bombarded with information about it, particularly by the media. On the other hand, for our part, we have a hard time defending the option of continuing to live.

You can ask everyone who has been involved in palliative care for the last 40 or 50 years. You mentioned Cicely Saunders the other day, as well as Balfour Mount. So far, all palliative care organizations see promoting death as something that is not part of palliative care but as a waste of valuable time. We have also heard testimony about the patients' possible momentary despair and the fact that the desire to die can fluctuate greatly from moment to moment and from day to day.

Life has a greater value than death. Death is inevitable, and palliative care recognizes this. I think saying so is not the same as saying that it is time to stop.

12:55 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Okay.

Some people claim that we, as lawmakers, should agree that physicians can refuse to refer a patient to another physician.

Do you agree?

12:55 p.m.

President, Physicians’ Alliance against Euthanasia

12:55 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Does that not violate your code of ethics?

12:55 p.m.

President, Physicians’ Alliance against Euthanasia

Dr. Catherine Ferrier

The college of physicians has amended its code of ethics to open the door to medical assistance in dying. In my view, and by age-old medical tradition, taking a person's life is not providing them with care.

Personally, I refer patients to those who will provide them with care that will help them, not care that will do them harm. Sometimes patients ask us for procedures, operations or medications. If we feel that that will do them harm, we refuse. I could give you thousands of examples but I feel that everyone is aware of them.

If a surgeon refuses to do a certain operation, he is not going to refer a patient to another surgeon who will do it. No way. Surgeons can tell patients that they are free to consult other surgeons if they wish. But one surgeon is not going to refer a patient to another surgeon if he is going to harm that patient.

12:55 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

That's talking about a surgical procedure. It's not talking about the end of a human being's life

12:55 p.m.

President, Physicians’ Alliance against Euthanasia

12:55 p.m.

Liberal

The Chair Liberal Iqra Khalid

Thank you very much, Monsieur Thériault.

We'll now move to Mr. Garrison for six minutes.

Go ahead, Mr. Garrison.

12:55 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Thank you very much, Madam Chair.

With apologies to my colleagues, at the beginning of each panel, I feel obligated to point out that many weeks ago I introduced a motion on the Order Paper in the House of Commons calling for the commencement of the statutory review, which would have both the mandate and resources to deal with some of the very important questions that have been raised here with regard to palliative care and people living with disabilities.

This time I would also note, though, that if we do not proceed with Bill C-7, then court decisions will guide the medical practice on medical assistance in dying.

We've heard a lot from physicians, as we should, about the issue of medical assistance in dying, but today we also heard from nurses.

I would like to turn to Mr. Hamza, because I think he's raised some issues that we haven't heard about before in our inquires. I know one of his recommendations is dealing with the question of whether nurses and nurse practitioners will be in jeopardy if they raise the issue of medical assistance in dying with patients.

Can you elaborate on your concerns in that area, Mr. Hamza?

1 p.m.

Chief Executive Officer , Canadian Nurses Association

Michael Villeneuve

Sure, and I'll just tell you that my colleague, who is Ms. Hamza, was unable to be with us.

1 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Oh, I'm sorry.

1 p.m.

Chief Executive Officer , Canadian Nurses Association

Michael Villeneuve

No, that's fine. That's just for your records. She's lovely, though.

Yes, we have concerns in a number of areas. However, as I've been listening to the very interesting comments today, I want to explain that patients have very intense, intimate conversations with nurses in ways that are hard to describe.

I've spent most of my clinical practice over the first 20 years of my career in neurosurgery, spinal cord injuries, brain injuries, many of the kinds of things we've been talking about, and patients and families will often say something to a nurse at three o'clock in the morning in the quiet darkness that they wouldn't say anywhere else. We have many times raised issues on tough things, abortion, treatment decisions, why they are refusing chemo when it could help them.

In the study we've been doing over the last three years, in preparation for the larger review, nurses told us that they feel hamstrung by that, and if there were opportunities, we'd counsel people on the broad range of services in health care, whether we're in a women's clinic or a neurosurgery clinic and so on.

I'm worried that it might be framed as advice that “you should”; it's rather, “Is this something you've thought about?” Very, very often [Technical difficulty—Editor] and people will not raise it for a long time. We want nurses to be protected, so that they can have those conversations about the possibility that it may be in the patient's mind.

1 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Thank you very much. I apologize for missing the switch in witnesses. My only excuse is that on the west coast I have to start very early here.

Can you say more about the other issue you raised around knowing or being connected to other practitioners or assessors? I'm assuming this is a large problem in smaller centres.

1 p.m.

Chief Executive Officer , Canadian Nurses Association

Michael Villeneuve

It is. We have been concerned about what might happen, for example, in many indigenous communities where there may only be one or two providers, often just nurses—not “just” but nurses versus physicians, I should say. However, that's a bit of an extreme.

The example I will share is that I have just finished my term of two years as the board chair here at the Winchester District Memorial Hospital in eastern Ontario. As a rural person of 20 years or so now, I can tell you that everybody knows everybody. Yes, we can certainly make a phone call and have an external assessor from a different community come in, but all our physicians know each other and they know the nurses and so on. We are concerned that could hamper the process and hold it up.

Physicians and nurses are deeply ethically bound to a certain code of behaviour. Knowing or not knowing the other provider should not lead to coercion or conspiracy, if that's the fear.

1 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Thank you very much.

Madam Chair, in the interest of time, I will conclude my questioning there.

1 p.m.

Liberal

The Chair Liberal Iqra Khalid

Thank you very much, Mr. Garrison. That was very generous of you, at a minute and a half.

I will now go to Mr. Manly for two and a half minutes.

Go ahead, Mr. Manly. Your time starts now.

1 p.m.

Green

Paul Manly Green Nanaimo—Ladysmith, BC

Thank you very much.

I would like to thank the witnesses for appearing today.

I have a question for Dr. Chochinov about suicide ideation. We should be looking at different types of diseases or declines in health, and parsing them out to provide different timelines for different people. Some of these diseases have an obvious rate of decline. We have talked about people becoming quadriplegics. Obviously, that's not a continued state of decline. That is an accident or something that has cut somebody off.

Would you see amendments that would maybe look at the state of decline? What would you see for amendments that might work in these kinds of situations?

1:05 p.m.

Distinguished Professor of Psychiatry, University of Manitoba, Canadian Society of Palliative Care Physicians

Dr. Harvey Chochinov

It's a difficult question because we're trying to address the issue of suffering and how we can respond to patient suffering, and we're using a tool that is particularly crude, which is euthanasia or assisted suicide.

Suicidal ideation is not uncommon in the general population. There was a Canadian study that showed about 13% of people over the course of their lifetime will experience suicidal ideation. About 4% of them will go on to have plans, and about 3% of them will in fact make an attempt. However, the rate of completion is only about 14 out of 100,000, so suicide continues to be relatively rare when you think about it in the context of the number of people who have suicidal ideation.

As I was pointing out and as Dr. Ferrier pointed out, there are conditions like spinal cord injuries, stroke and head trauma, and we know if we follow these patients over time, as much as 24 months after the fact, they can continue to be suicidal. I think we're going to have to look at individual illnesses and the trajectory of suicidal ideation in order to know how to shape legislation, if it's even possible.

Again, I would suggest that the reasonably foreseeable death at least provides a differentiation between MAID, which is medical assistance in dying, and suicide, which is for people who no longer want to face the prospect of further life.

1:05 p.m.

Liberal

The Chair Liberal Iqra Khalid

Thank you very much. That brings you to your two and a half minutes, Mr. Manly.

At this time, prior to going into our second round of questions, I seek the consent of the committee to go five minutes Conservative, five Liberal, two and a half Bloc, and two and a half NDP. Can you give me a thumbs-up for us to continue in that way?

Mr. Garrison, I don't see your thumb. I want to make sure you're okay. All right. We will go ahead, then.

I have Mr. Moore next for five minutes.

Go ahead, Mr. Moore.

1:05 p.m.

Conservative

Rob Moore Conservative Fundy Royal, NB

Thank you, Madam Chair, and thank you to all the witnesses today for their important and relevant testimony.

Dr. Chochinov, I have a question for you. We've heard from witnesses who are especially concerned about the impact this bill will have on persons with disabilities. We heard this week from groups representing persons with disabilities. There's been some discussion here about those for whom death is not reasonably foreseeable. Number one, when death is reasonably foreseeable, there's removing the 10-day waiting period, but when death is not reasonably foreseeable, there would be a new 90-day period. We've heard from several people that this is wholly inadequate, the 90-day period, because some people may have barely begun treatment.

Could you provide any insight around this 90-day period between when someone could request MAID or be assessed for MAID, and then receive MAID, when their death is not reasonably foreseeable?

1:05 p.m.

Distinguished Professor of Psychiatry, University of Manitoba, Canadian Society of Palliative Care Physicians

Dr. Harvey Chochinov

Again, the 90 days is a problematic time frame. I come back to the Manitoba study that I mentioned. This was a study that looked at groups of people who had suffered from some physical ailment, and from the time of diagnosis and 90 days hence they found that these people were at their maximum in terms of suicidal ideation. We know that there is a period of adjustment after one has had a change in one's physical status as a result of physical or mental illness that can manifest itself as a wish to die.

There's the other study I mentioned, and I think it's worth looking at the numbers. There are studies that have followed people who have had strokes or who have suffered disabilities as a result of spinal cord injuries or head traumas for as long as two years after the fact. Interestingly enough, when you look at those people who were initially depressed and then received treatment for depression, you see that all of them will go from a state of being suicidal to a state of no longer being suicidal.

Again, I would underscore that in the case of people whose death is not reasonably foreseeable, what these people need are disability supports and a limitation of access to means, because we know that the more people have access to means, such as guns.... Just as a side note, the suicide rate in the United States is more than double that in Canada. It's thought that it's probably because of access to guns.

If we limit the access to means and if we provide people with treatment, we know that people will renege on their suicidal ideation. As a psychiatrist, I have worked with people who had chronic suicidal ideation, even over periods of years. They continue to struggle, but what one does in good psychiatric care is give an unwavering commitment that we will be there with that patient, and we engage in a relationship with that patient, and these individuals have gone on to lead productive lives. They are loved and they do love. They have raised families and they have a meaningful existence.

1:10 p.m.

Conservative

Rob Moore Conservative Fundy Royal, NB

Thank you, Doctor.

Dr. Ferrier, it was mentioned in testimony today that there's a distinction with those whose only underlying issue is one of a mental nature. The point was made today that there are often other underlying mental conditions for people in that situation. Can I get your comments? My concern.... This is only our fourth day of witness testimony, and unfortunately it's scheduled to be our last day of witness testimony. We've seen a real outpouring of testimony from people in vulnerable communities about the impact that this has and the message it sends to those Canadians who are living with disability. Do you have any comment on that?