Thank you, Madam Chair.
I believe that the data I will be sharing will be important for the committee to consider. The following comes from my written submitted brief.
By way of background, I am a distinguished professor of psychiatry at the University of Manitoba. I am former chair of the external panel on options for a legislative response to Carter v. Canada. I am also a long-time palliative care researcher who has published extensively on psychological matters pertaining to palliative care.
Bill C-7 proposes the elimination of any waiting period between the time a dying patient is approved for MAID and the administration of MAID. Our research group reported that the will to live can be highly fluctuant over intervals as short as 12 to 24 hours. In fact, 40% of patients who were prescribed lethal drugs in Oregon decided not to take a lethal overdose.
Bill C-7 also proposes to eliminate the requirement that a patient have a reasonably foreseeable death. For patients whose life expectancy can be measured in years or even decades, Bill C-7 recommends a 90-day assessment period. The suicide rate in many chronic conditions is very high. A study of 496 patients with traumatic brain injury, stroke or spinal cord compression reported that most of those who were initially suicidal no longer were three to 24 months later.
Bill C-7 also indicates that it will no longer be a requirement to reaffirm competency at the time of administration of MAID. The Netherlands allows for a euthanasia advance directive for those who fear losing capacity. A survey of 410 Dutch physicians reported that only 3% had ever complied with the advance euthanasia directive. Compliance with an advance directive was almost always raised by someone other than the patient. In 72% of instances, the relatives or representatives did not feel comfortable proceeding with euthanasia, but instead settled on forgoing life-prolonging treatment, as did their physicians.
Finally, while Bill C-7 indicates that mental illness alone is not enough to qualify for MAID, mental illness is often accompanied by medical conditions. Together, this may open up the door to MAID for these patients. A landmark Dutch study of patients with psychiatric disorders who had received euthanasia or assisted suicide in the Netherlands showed that nearly 60% also had medical problems, such as cancer, cardiac disease, stroke or neurological disorders. They suffered from depression, psychosis, grief and even autism, conditions that require exquisite and concerted psychiatric care.
In conclusion, the data suggests caution regarding the following legislative amendments. One, the data indicates that the wish to die and the desire for death in the context of terminal illness can fluctuate widely over time. Hence, some period for reflection would seem prudent. Two, the wish to die amongst patients suffering from non-imminently life-threatening conditions, including chronic illness and disability, is not uncommon and can fluctuate over the course of months to years. When the determinants of a wish to die in patients living with these chronic conditions or disabilities are addressed, suicidality can wane. Three, the data strongly indicates that neither physicians nor relatives feel comfortable providing MAID to patients who are unable to state their wishes or convey that they are suffering intolerably. Four, eliminating the provision of a reasonably foreseeable death opens the door for patients with various chronic medical conditions and disabilities, including those with concurrent mental illness.
All of these facts are critical in understanding and mitigating the suffering of those who have lost their will to live.
Thank you for your kind attention.