Medical Assistance in Dying Committee on May 30th, 2022

[Luc Thériault, Bloc, Montcalm, QC]

Your seventh recommendation is “to require that discussions on medical assistance in dying be initiated only by patients”. Your eighth recommendation is to “consult the immediate family when assessing a medical assistance in dying application” for cases involving an intellectual disability. I believe that these are measures that should be part of medical practice. Do you get the impression that the assessors or providers would not be receptive to that?

It seems to me that the medical community would be altogether prepared to talk with the families. It goes without saying.

[The Joint Chair, Hon. Yonah Martin]

Be very brief, please.

[Samuel Ragot]

Absolutely. I agree.

I think it's mainly about avoiding applications being made as a result of pressure from medical staff or elsewhere, and which could result from a certain form of ableism towards these people. It's a matter of protecting them against having their lives undervalued, and being placed under undue pressure.

[The Joint Chair, Hon. Yonah Martin]

Mr. MacGregor, you have five minutes.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you very much, Madam Chair.

Mr. Saulis, I'd like to start with you and thank you for appearing before our committee and offering an important indigenous perspective on this conversation we're having.

You very correctly outlined the disparities that exist and the intergenerational trauma that is still there. I know I see it in communities where I live, among the Halkomelem-speaking people, the Coast Salish and the Nuu-chah-nulth nations.

I've gotten to know many elders in my time as a member of Parliament, and the hurt is there; it's just below the surface.

When you look at the calls to action that were released so many years ago, and particularly the health calls to action, calls to action 18 to 24, do we need to frame this conversation about medical assistance in dying with that frame in mind, the fact that so many of these calls to action, particularly on health outcomes and the supports and services that are available for first nations, Inuit and Métis across Canada are still so substandard? Can you expand on that, please?

[Conrad Saulis]

I think the calls to action are an excellent blueprint for moving forward together with indigenous peoples. I think there is always a need for continuing dialogue between jurisdictions, federal and provincial, and indigenous nations, whether they be first nations, Métis, or Inuit. Dialogue and conversations are what's needed.

The health calls to action, absolutely, are definitely things to utilize and to be benchmarks as we move forward. I think there needs to be a lot of caution and concern, though, with regard to moving forward with anything that speaks to or is about medical assistance in dying and indigenous peoples.

Sam's comments were about social indicators being things that can be misleading, because indigenous people have such a vastly different quality of life, substandard quality of life. When you talk about indigenous persons with disabilities and indigenous youth, like I said in my presentation, we're talking about the most vulnerable people in Canadian society.

At the same time, of course, we always have to take into consideration missing and murdered indigenous women and the outcomes of that. I think the calls to action can be one thing, but there's a lot more. There are probably things even going back to the Royal Commission on Aboriginal Peoples, to be very honest with you. Dust that off and look it over. We live in today's society as well, so the people who are in the know, so to speak, always have to be included and involved.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

You mentioned the murdered and missing indigenous women. It was remiss of me to not mention the calls for justice that are in that report, as well, which have some important overlap.

Madam Co-Chair, I'm pretty close to the end of my time, so I'll thank Mr. Saulis for his intervention and cede the rest of my time.

[The Joint Chair, Hon. Yonah Martin]

Thank you, Mr. MacGregor.

Again, thank you to our witnesses.

I'll turn this back to our co-chair for a round of questions from senators.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Co-Chair.

Like the last time, the first three senators will have four minutes. We'll begin with Senator Mégie.

You have the floor for four minutes, Senator.

[Marie-Françoise Mégie]

Thank you, Mr. Chair.

Thank you to the witnesses.

My questions could be for all the witnesses, but one or two of them might be able to answer.

Normally, a doctor or any other health professional could explain the various treatment options to a patient, whether for palliative care or intensive care. However, the anecdotal evidence reported not only by the media, but also by witnesses, gives me the impression that these people requested MAID or were forced to request it.

How do you, as someone with a disability, feel about this?

Do you have the impression that no matter where you go, you'll be pressured to apply for MAID, when you're the person who should be deciding?

Is that something you're concerned about?

I'm not sure who might want to answer my questions.

[The Joint Chair, Liberal, Marc Garneau]

Perhaps we could begin with the representatives of the Quebec Intellectual Disability Society.

Please go ahead.

[Samuel Ragot]

While that's a very difficult question to answer, I would nevertheless say that ableism is insidious. It's not openly displayed, or explicitly referred to, very often. It's something that shows in attitudes, social judgments and obstacles that people come up against in society. It can sometimes occur in the medical field, of course.

It bears repeating that the services available are inadequate. As we have been able to see, there's a shortage of staff in hospitals. Our health services are in a terrible state, particularly after the pandemic. This can indirectly result in resorting to MAID rather than providing services. That's something we often hear on the ground.

[Marie-Françoise Mégie]

If you were offered this option, you could refuse it, couldn't you?

[Samuel Ragot]

If another option were available, then yes, but very often that's not the case.

[Marie-Françoise Mégie]

Would another witness like to answer my questions?

Perhaps Ms. Landry could give us her thoughts on the matter.

[Jocelyne Landry]

Thank you for your question.

In my father's case, no one offered him this option. It really was a personal initiative. He requested MAID. As I mentioned earlier, the process ended up taking much longer than we've been talking about here. The people were very professional. They also spoke to him about it, questioned his initiative and returned repeatedly to ask the same questions again to make sure that's really what he wanted. They also wanted to make sure that he had not been pressured by anyone.

They always showed respect. They made sure that it was really what he wanted. Needless to say, his medical record left little doubt. He was suffering and no longer had any quality of life. Dad was a bon vivant. He never talked about dying until he was really at the end of his tether. He was suffering, and clearly at the end of life. He might have lived for a few more months.

[Marie-Françoise Mégie]

Thank you.

Do I have a few seconds left, Mr. Chair?

[The Joint Chair, Liberal, Marc Garneau]

There isn't really any time left, Senator, unless all you're looking for is a short reply.

[Marie-Françoise Mégie]

Yes.

I don't want to be told that it's just wishful thinking, but if the government were to do everything possible and adopt proactive measures to do away with all the obstacles and systemic inequalities, do you think that people who are already being treated unfairly in terms of access to healthcare would experience the same unequal treatment in terms of access to MAID?

[The Joint Chair, Liberal, Marc Garneau]

To whom are you addressing this question?

[Marie-Françoise Mégie]

To Ms. Duranleau or Mr. Ragot.

[Samuel Ragot]

Could you repeat the question?

To be honest, I'm not at all sure that I understood it.

[Marie-Françoise Mégie]

I'll give you a shorter version of it.

Given all the systemic inequalities faced by certain groups, then just as these groups have more trouble gaining access to care and services, how come they have easier access to MAID?

[Samuel Ragot]

It's because the measure is not expensive and it's easy to organize and offer it to people. It's a straightforward measure that requires less systemic effort. It requires less effort in terms of bias and requires less money from the government. It's just easier. Some people, and I'm not saying that it's our position, have use the term “eugenics”. That's a term to be used with extreme caution, but it's something to think about.

[The Joint Chair, Liberal, Marc Garneau]

Thank you very much.

Senator Kutcher, it's over to you.