Thank you so much for the invitation to join you today. As noted, I'm affiliated with the University of Toronto, but in 2015 I co-chaired the provincial-territorial expert advisory group on physician-assisted dying. In 2017-18, I was co-chair of the Council of Canadian Academies' expert panel on medical assistance in dying, and chaired the working group on advance requests for MAID. Today I am speaking as an individual drawing from these experiences and my disciplinary background in ethics and health policy.
I had the privilege to meet with this committee in spring 2016 in relation to Bill C-14. Over the last few weeks, I've been reflecting on how much has changed in four and a half years and how better prepared we are to contemplate amendments to the legislative framework for MAID in Canada with some confidence. In 2016, we did not have any Canadian experience to draw from, and relied on experience from other jurisdictions. We did not yet have systems and care processes in place to offer MAID to eligible persons and needed to build these. We did not know what actual effect the introduction of MAID would have on Canadians. Would it displace palliative care? Would it make people more vulnerable and not less?
Today, with the benefit of almost five years' experience, we have learned that MAID can be provided safely and compassionately to Canadians. We have Canadian evidence to draw from. We have the lived experience of Canadian families, caregivers and clinicians to shed light on its practice. We have heard from community groups and individual citizens about how, and to what extent, MAID fits within a continuum of supports for persons who are suffering.
Bill C-14 sought to outline a legislative framework, including eligibility criteria and procedural safeguards, but sought ultimately, to the greatest extent possible, to respond to Canadians' suffering whilst balancing the autonomy of persons seeking MAID on the one hand and the interests of vulnerable persons in need of protection and those of society on the other. The project of striking the right balance of these values-based commitments continues today.
Many of the comments from witnesses and organizations who have appeared before this committee have drawn attention to the suitability and appropriateness of key safeguards, both those that are in the current legislative framework and those that are being contemplated in Bill C-7. Such current safeguards, such as the 10-day reflection period and the requirement of final consent, were introduced in order to ensure that only those Canadians who wished MAID actually received it and to protect and promote their autonomy.
Experience of the last four and a half years has shown that the effect of the safeguard may not have been what was originally intended. On the one hand, we have heard from clinicians about some patients who have forgone pain medication and endured preventable suffering in order to sustain their capacity to provide final consent. On the other hand, we have also learned from clinicians, families and caregivers that persons seeking MAID are most often not ambivalent about their choice. In the words of a member of the public who emailed me in December 2015 and who was facing a life-limiting illness, “no patient is going to reach such a decision and request lightly”. Hence, the removal of the 10 clear days and final consent seemed to be a good step forward toward striking a new, appropriate balance in safeguarding Canadians who have already been found eligible for MAID.
There is little doubt about the importance of safeguards to protect vulnerable persons who might, as per the original preamble to Bill C-14, be induced in moments of weakness to end their lives. A lesson we may draw from our experience of the last four and half years is that in developing safeguards, we must be especially attentive to the potential impact of the safeguards, notwithstanding their intent to protect. We must be especially wary of a safeguard if it may reasonably have the effect of rendering some persons more vulnerable. The protection of vulnerable persons turns on safeguarding competence, voluntariness and consent. Exclusion of otherwise competent persons may be justifiable in limited circumstances if there is a strong case to be made from the perspective of justice. Failing this, though, these exclusions violate the autonomy of competent persons of such groups and unjustly force these individuals to remain in a state of enduring and intolerable suffering.
For these reasons, we may wish to consider whether the 90-day reflection period will, in fact, be protective or may instead contribute toward enduring suffering of persons who are already found to be eligible for medical assistance in dying.