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.
Family Physician and Clinical Professor, Department of Family and Emergency Medicine, Laval University, As an Individual
Thank you for the question.
It is often presented as a choice between MAID and resources for vulnerable or marginalized groups. It isn't a choice between the two, but rather a choice to help marginalized groups and give them all the care and resources they need. This doesn't preclude some patients from exercising the free and informed choice to seek MAID because they feel that their life is no longer worth living. The clear message of the Supreme Court of Canada in the Carter decision must be remembered that the right to life must not be transformed into a duty to live.
All of this stems from the concepts of autonomous decision-making, free and informed choice, and the assessment of an individual's capacity to consent. The judgment involving Mr. Truchon and Ms. Gladu highlighted that vulnerability is not intrinsic to a group of people by virtue of their characteristics, and that this must be assessed on a case-by-case basis.
Why should people with severe disabilities be given the option of MAID? Mr. Truchon and Ms. Gladu have already been asked this question. The judgment in this case is very clearly set out over close to 200 pages. It isn't a choice between MAID and access to resources, but all of this all at once, respecting the free choice of an individual based on their own condition. Indeed, the individual is the only witness to their suffering and what they are capable of tolerating or not.
Conservative
Chris Lewis Conservative Essex, ON
I have one last question for Dr. Naud, please.
What do you think about the stories of coercion that we heard in committee and that are emerging in the news in light of the Netherlands study, which is farther along since the implementation and already has evidence that this is a real issue?
Bloc
Luc Thériault Bloc Montcalm, QC
Excuse me, Madam Chair.
The interpretation isn't working for this question.
Liberal
The Chair Liberal Iqra Khalid
Mr. Clerk, can you just confirm that the interpretation is working properly?
Liberal
The Chair Liberal Iqra Khalid
Thank you, Mr. Thériault, for pointing that out.
I stopped the clock for you, Mr. Lewis.
Mr. Naud, you have 30 seconds to respond. Please go ahead.
Family Physician and Clinical Professor, Department of Family and Emergency Medicine, Laval University, As an Individual
Would it be possible to translate the question to make sure I've understood it correctly?
Bloc
Luc Thériault Bloc Montcalm, QC
Madam Chair, I'd like the question repeated. That was the purpose of my intervention. I don't like to interrupt the witnesses for no reason.
Conservative
Chris Lewis Conservative Essex, ON
Thank you, Madam Chair, and thank you for being so fair with this. It is a very important question.
Dr. Naud, what do you think about the stories of coercion that we heard in committee and that are emerging in news in light of the Netherlands study, which is farther along since implementation and already has evidence that this is a real issue?
Family Physician and Clinical Professor, Department of Family and Emergency Medicine, Laval University, As an Individual
Thank you for your question, Mr. Lewis.
It's important to be very careful when citing studies from other countries. The Netherlands is a different jurisdiction, a different society. Just because a study shows something doesn't mean that it's true and can be trusted.
The coercion we've observed over the past five years, in Quebec and in Canada, isn't in the administration of MAID, but rather, as I mentioned, in the obstruction that certain individuals and institutions oppose free and legitimate access to this assistance. People are being pressured to withdraw a request for MAID or not to apply for it.
Liberal
The Chair Liberal Iqra Khalid
Thank you very much, Dr. Naud.
I will now move on to the Liberal round of questions. I understand that Mr. Virani will have the first minute and then the remainder is for Mr. Maloney.
Please go ahead, Mr. Virani.
Liberal
Arif Virani Liberal Parkdale—High Park, ON
Thank you.
I just want to say thank you to the witnesses. Dr. Gibson, thank you for your expertise on this issue over the past many years. I'm proud to call you a constituent.
Dr. Gibson, the issue of autonomy has came up and you underscored this in your testimony. In Tuesday's meeting, questions were put about the autonomy of persons with disabilities. Allegations of discrimination were put into the record as to the idea that by proposing a bill like Bill C-7, discrimination is being perpetuated against persons with disabilities.
I find it actually to be quite the converse, and so do Senator Petitclerc and a former Conservative cabinet minister who is himself a person with disabilities, Steven Fletcher. In the Truchon decision, they looked at this particular idea and said that, if you deny persons with disabilities the ability to make a decision autonomously about when they pass, you're in fact discriminating against them in contravention of the charter.
Given your expertise in bioethics and autonomy, could you comment in 60 seconds on this aspect of the Truchon decision, and how it intersects with what we heard at committee on Tuesday?
Director and Sun Life Financial Chair in Bioethics, University of Toronto Joint Centre for Bioethics, As an Individual
I think there are a few things here. One is to recognize that we often think about autonomy as individual, but many of our decisions are made in thinking about the people around us. It's a social concept of autonomy, which we all experience in our day-to-day lives. I think there are reasonable concerns that there may be social influences around a voluntary choice.
That said, one of the most interesting things coming out of the first annual report of MAID in Canada, which came out fairly recently, was that it showed that, of those individuals who actually needed disability supports, almost 90% were receiving them at the time they received MAID.
I think what we're seeing is that, on the one hand, we may have a resource access question, but on the other hand, we are also seeing persons with disabilities exercising their autonomy and making a choice for MAID, knowing that they also have supports around them. There may be different issues in play here, not a single issue that we need to be concerned with.
Liberal
November 12th, 2020 / 11:35 a.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thanks, Madam Chair. I'll try to abbreviate my questions.
My first question is for Mr. Roberge from the CBA, and perhaps Justice Rochon could comment.
You've made it clear that the CBA's position is that mental illness should not be excluded in this legislation. As I read your submissions, you support your position in part by saying that this hasn't been fully debated yet, which in my opinion would lead me to the opposite conclusion. I'm a little confused about that.
The second thing you said is that it's going to be challenged constitutionally. Well, part of the reason we're having this discussion is that it has already happened, and I fully expect it's going to happen again in the future.
Perhaps you could expand a little further on why you think mental illness should not be excluded.
David E. Roberge
Here's what I would say on behalf of the CBA. We believe that the response to vulnerability issues is to ensure there is informed consent. When discussing the issue of people with mental illness, clearly the issue of those people being vulnerable is being raised.
In Carter, the Supreme Court of Canada accepted evidence that vulnerability can be assessed on an individual basis by physicians. While recognizing that risks “are already part and parcel of our medical system”, the court noted that those issues are resolved through the assessment of informed consent on an individual basis.
The issue, in the CBA's view, with excluding all persons with mental illness from the MAID legislation is that contrary to what the Truchon decision has concluded, inferring vulnerability on a collective basis, in reference to a group seen as vulnerable people, may not adequately reflect the diversity of circumstances among that group. That's why we support a more patient-centric approach. That's why we also believe that the exclusion of all people with mental illness is a subjective constitutional challenge.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
I may not give Justice Rochon an opportunity to respond. I'm going to ask my second question because I'm running very short of time.
I was a lawyer for some time before I did this, and I used to hire medical experts to give opinions. In my experience, the divergence of opinion is much bigger when it comes to the psychiatric realm than it is with other illnesses, which is why I am concerned about removing the mental health exclusion.
One of the other points you make in your submission is this piece with respect to experts, saying that it's not necessary. I understand the context if you're living in a remote community and whatnot. I grew up in Thunder Bay. I can appreciate that. My concern is this. Given the expressions of concerns on the mental illness side, are you suggesting that a general practitioner, for example, could give an opinion on mental illness in a MAID situation? Courts don't allow doctors to give opinions outside their area of expertise. I would think the threshold in this situation would be equally as high, if not higher.
David E. Roberge
On behalf of the CBA, I think it's really a case-by-case approach.
The concern that the CBA has with this blanket requirement is that, again, it may have a disproportionate impact on some individuals. Our position is to support the patient-centric approach that has been adopted by the Québec Superior Court in Truchon.
Liberal
The Chair Liberal Iqra Khalid
Thank you very much.
We will now move on to Monsieur Thériault for six minutes.
Go ahead, Monsieur Thériault.