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.
President, Physicians’ Alliance against Euthanasia
Certainly a lot of people we treat for depression in geriatrics and in primary care have many other physical illnesses that could be their excuse for requesting MAID.
Liberal
The Chair Liberal Iqra Khalid
Thank you very much, Mr. Moore.
We'll now move on to the Liberals for five minutes. I believe Mr. Virani and Mr. Sangha will be splitting their time.
Mr. Virani, go ahead.
Liberal
Arif Virani Liberal Parkdale—High Park, ON
Thank you very much, Madam Chair. I'll try to be very quick. I have a couple of clarification points.
I think there's been a narrative about the legislators on the committee being in a position to “take away people's lives”; I think that's the way it was put. I think in fact what the legislation does—and did in the past, and continues to do—is allow people to be empowered to make decisions about their own lives. The autonomy and the taking is done by the individuals concerned, not by the legislators here. That's the first point.
The second point is that former chief justice Madam Beverley McLachlin was cited in the testimony here. I think it's important, because it talked about equality rights and persons with disability. Madam Chief Justice McLachlin was part of the unanimous court in the Carter decision, which talked about the Constitution requiring an ending of suffering in order to alleviate people's concerns and grant them autonomy. I think it's important that the record reflect that.
I have a question that I want to put specifically to Mr. Villeneuve and Mr. Chochinov.
I'll say parenthetically, Mr. Chochinov, that I appreciate your underscoring the connection between gun control and the prevention of suicide. I believe all parties should be very conscious of that and of the important need for gun control.
We have the nurses represented by you, Mr. Villeneuve, and earlier this question was put to you, Dr. Chochinov. I will now put this to both of you: If pressure is ever deemed to have occurred—duress, influence, undue pressure—I would presume that this should be investigated, reported to authorities, and indeed prosecuted if it comes to that. In your context, Mr. Villeneuve, and yours, Dr. Chochinov, do you have evidence of any such prosecutions occurring in this country with respect to nurses or with respect to doctors?
Mr. Villeneuve, the question is to you first.
Chief Executive Officer , Canadian Nurses Association
We do not have that evidence. For nurses, that conversation is a very sacred one. In critical care units, including organ donation and other very difficult conversations. I did not see pressure or coercion ever happening; in fact, it was much, much more the opposite.
I'll turn it over to our other speaker.
Distinguished Professor of Psychiatry, University of Manitoba, Canadian Society of Palliative Care Physicians
I can't say that I know of evidence of overt coercion, but there's a form of covert coercion that we need to think about. People who are sick and nearing the end of life, or who are in pain or living with the encumbrances of physical illness begin to feel a burden to those around them. There are subtleties of coercion whereby they begin to feel that it becomes not their right but their obligation to their families to alleviate them of the distress they're living with.
Therefore, as to overt coercion, no, but there are subtleties of coercion. They feel the internal pressure that maybe this is something they need to do or ought to do for the sake of their family, which is suffering during the course of their approaching end of life. That is a dynamic that I have seen played out.
Liberal
Arif Virani Liberal Parkdale—High Park, ON
That's an important point, but the question I asked you was about medical professionals. You're a psychiatrist in Manitoba. Have any medical professionals been prosecuted for direct or indirect coercion?
November 12th, 2020 / 1:15 p.m.
Distinguished Professor of Psychiatry, University of Manitoba, Canadian Society of Palliative Care Physicians
Not to my knowledge, no.
Liberal
Liberal
Ramesh Sangha Liberal Brampton Centre, ON
Thank you, Madam Chair.
I'm glad to see the CNA appearing on this matter. The CNA has recommended the inclusion of a provision for an additional period of review by a committee after five years. Why is this required? What do you want to say on that?
Chief Executive Officer , Canadian Nurses Association
Our view as nurses is that this change in the Criminal Code is perhaps the most profound one in the history of our country. I'm old enough to remember that we once had a state in which the only person who could end your life was the state. Nobody else could do it.
We are now in the position where we have flipped that around to where the state cannot carry out capital punishment to end a life, but in this very sacred space on earth, a doctor can enter into that arrangement with a patient. It's a profound change in our culture that we haven't begun to understand yet, and we believe it should be reviewed on a regular basis.
Liberal
The Chair Liberal Iqra Khalid
Thank you very much for that.
We will now go on, for two and a half minutes, to Mr. Thériault.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you very much, Madam Chair.
Dr. Boyle and Dr. Chochinov, just now, you stated that eliminating the 10-day period could drive patients towards death. The elimination applies to patients whose death is imminent, we agree.
Witnesses have told us that, in their medical practices, that is a long process, especially for patients in terminal phases like those with cancer. The problem is that palliative care cannot completely manage the pain.
From the time that palliative care has undesirable effects and the patient ends up in a situation where a request for medical assistance in dying is made, how is the elimination of the 10-day period not linked to the desire to not have the patient suffer anymore? Why would that be considered driving them towards death given that, basically, no physician wants to drive anyone towards death, whether they are dying or not? You don't seem to be trusting your colleagues.
President, Canadian Society of Palliative Care Physicians
Thank you, Mr. Thériault.
We don't disagree that people need to have their rights respected. That's very true. The challenge is that unless people have access to palliative care to help relieve...and we know that universal access to palliative care does not exist in Canada, and that issue needs to be addressed.
Regarding the reflection period, even people with a reasonably foreseeable natural death sometimes need time to address their suffering and have their symptoms addressed, and they may change their minds. It is contextual, as Dr. Chochinov has mentioned, and we need to make sure that we have legislation that addresses that.
Liberal
The Chair Liberal Iqra Khalid
Thank you very much.
I will now move on to Mr. Garrison for two and a half minutes.
NDP
Randall Garrison NDP Esquimalt—Saanich—Sooke, BC
Thank you very much, Madam Chair.
I want to go back and assure folks that I did get a notice of the change of witnesses at 5:14 a.m. my time, so I apologize once again.
One more recommendation you had was about the preliminary assessment clause. I would like to give you time to talk about that, because we have not heard about that in oral testimony from other witnesses.
Chief Executive Officer , Canadian Nurses Association
I'll be very frank. We looked at it several times and we had trouble understanding what it meant. I figure when a group of nurses with graduate degrees can't agree on what it seems to mean, that's probably a problem. Is it adding a layer? Is it adding another point of accountability? Could it slow things down? Is it meant to be the first conversation?
We believe it's fixable. We think the way it is now is unclear. I will leave it at that for others to speak.
NDP
Randall Garrison NDP Esquimalt—Saanich—Sooke, BC
Thank you very much for that.
As you mentioned before, often nurses are the front line, the first contact when it comes to patients grappling with the end of life or with irreversible decline.
I wonder if you could say more than you said before about the difficult situation that arises from the way things are currently configured, which puts nurses in as the first line of contact.
Chief Executive Officer , Canadian Nurses Association
You feel as though you have one hand behind your back if you can't raise certain issues. We talk to patients, for example, about why they would refuse cancer treatment that could cure them. Some people don't go along with the decisions we wish they would go along with.
I can assure you that in dealing with a lot of nurses across the country, those of sound mind have not run into any who want to rush into any situation and introduce this. What we heard from experts doing this was that we felt we couldn't have a full conversation. We couldn't even raise this issue.
Eighty-six percent of Canadians in the polls say they want to talk about it. They want the legislation there. We have talked about it for 30 years. The public is not informed on the details, but they are certainly ready to have these conversations, yet we're telling Nurse Betty with a master's degree that she can't talk about it. We have to fix that.
Liberal
Conservative
Chris Lewis Conservative Essex, ON
Thank you very much, Madam Chair. I appreciate the moment.
A lot has really come to light today on a lot of different fronts. We had fantastic witnesses in both the first and the second rounds. Obviously, I'm really happy that our colleague from the Green Party attended as well. I thought his comments were rather insightful. I believe that's the first time he has had an opportunity to come to this committee. Excuse me if I'm wrong.
I guess equally as impressive was Mr. Virani. He was the one who suggested very powerfully that we give him a voice, and unanimously there it went.
As well, Madam Chair, even you very eloquently earlier on allowed for extra time for the first round of questioning.
My point is this, Madam Chair: I believe that as a committee we are running past an opportunity to have one more meeting. I think we would do a huge disrespect to our indigenous disability community if we don't, as well as our vulnerable women. I heard that point very loudly and clearly from Ms. Brayton.
Madam Chair, I would like to move that notwithstanding the decision of the subcommittee for four meetings, we have one more meeting for two hours, and I would like a recorded vote on that, please.
