Medical Assistance in Dying Committee on May 30th, 2022

[Dr. Ramona Coelho]

If you heard me in Bill C-7, I proposed several safeguards, including never raising it with a patient, as they do in Australian legislation. People should be able, in their professional integrity, to decline things.

For scientific data, for example, with patients with disabilities, where we know the outcome takes years, there was an MP Green who tried to put forward an amendment to make sure that psychosocial issues were not the reason people were getting MAID. That was voted down.

I feel that the MAID regime is really dangerous.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Have you put these suggestions in writing and submitted them to the committee?

[Dr. Ramona Coelho]

I did send a brief on May 6, and it is still not up in the written testimony.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Is everything you've just said contained in there—all of these suggestions you're talking about?

[Dr. Ramona Coelho]

I can resend you my testimony on Bill C-7, if it's helpful, Madam Chair.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

If you want to do that, that would be useful.

My question is then for everybody. I'm running out of time, and I apologize.

I recently attended a presentation at a palliative care facility. It was interesting to me, because they said that at the beginning when MAID first became the law in Canada, 12 out of 12 doctors at the facility were opposed to it. Six months later, six were accepting, and now all 12 are accepting it because that's what the patients wanted.

My question to all three of you is: Has there been any change in the thinking in the disability community over the last number of years?

I'll start with you, Mr. Adair.

[The Joint Chair, Hon. Yonah Martin]

There's less than a minute, so perhaps two of the witnesses could answer that, Mr. Maloney. We'll have Mr. Adair first.

[Bill Adair]

I don't know that there's been any growth in that area that I'm aware of. You'd have to ask others who have more information and expertise.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Ms. Hewitt, what about you?

[Michelle Hewitt]

I would also say that I don't have data to support it, but certainly anecdotally, people within the disability community are talking about MAID more often and seeing it as a response to societal conditions more than medical conditions. They feel that they're suffering and that there is a solution to it. They're not getting that solution; so, therefore, it's MAID.

[The Joint Chair, Hon. Yonah Martin]

Thank you very much.

Next we'll have Monsieur Thériault.

Mr. Thériault, you have the floor for five minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

Thanks to the witnesses for their testimony, which will help us in our deliberations.

I'll go to you first, Mr. Adair.

I want to thank you because your association is important. It shocks the collective imagination when someone in his or her twenties suddenly suffers a spinal cord injury. It causes a radical change to that person's life.

The handicap is obviously a social one, but the disability is individual. Where there's an individual disability, whatever it may be, the social handicap must made as insignificant as possible. It's a constant struggle, and you strive to make these disabilities less and less debilitating. However, I imagine it's still a shock.

You'd like to have stronger safeguards. I understand that. As a health professional, do you think the safeguard of avoiding any discussion of MAID with the patient immediately following the shock would be helpful to you and your patients?

[Bill Adair]

The best safeguard is to work with the family and with the person who has the new injury and connect them with families and individuals who have gone through this initial phase of terrifying shock in many ways, and have gotten through that and have rebuilt amazing lives. Many lives are, as I said before, stronger and more satisfying than they were before the injury.

Certainly not mentioning the option of MAID to people with new injuries would be preferable, and just not having it available until people have had an opportunity to test life and to find out the kind of dreams they can build and will be able to pursue in their new life.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Adair, don't you think it's good medical practice not to suggest that option following a traumatic shock of that scope?

I obviously agree with you that these people must be cared for in the best possible way and assisted in considering their life prospects and how they can contribute to society. I understand all that. As you said, the process you describe may extend over two, three, five or seven years.

Can you see how, in the minds of some people who have gone through that process for five or six years, medical assistance in dying might be the only possible option, despite all your good care?

[Bill Adair]

The first point is that I don't think MAID should be mentioned or offered to people when they are in acute care or even in rehabilitation after sustaining a spinal cord injury.

Do I think people, down the road after seven years or eight years...? It is, again, a situation where it's important to look at all the variables. It's a hypothetical situation. I can't say it would be a good thing or not.

I can say that I have not witnessed that. I have witnessed that after people turn the corner and rebuild their dreams and their lives, suicide is not something they turn back to, other than if they face multiple compounding problems in the social supports area. Housing is a major theme. The issues of affordable, accessible housing and living in poverty are crushers. They crush people's souls.

I think it's also important to say, sir, that I don't speak for everyone with a spinal cord injury. Each person is an individual who ultimately has a right to decide, if there is in fact informed choice and a real choice.

[The Joint Chair, Hon. Yonah Martin]

Thank you very much, Mr. Thériault.

Next, we have Mr. MacGregor.

You have the floor for five minutes.

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

Thank you very much, Madam Chair.

Ms. Hewitt, I'd like to start my questioning with you.

The mandate of our committee is actually quite broad. We were appointed to review the provisions of the Criminal Code relating to medical assistance in dying and their application, but we're also including things like mature minors, advance requests, mental illness, the state of palliative care in Canada and also the protection of Canadians with disabilities.

When you think of that last part—that the protection of Canadians with disabilities is part of our committee's mandate—what comes to mind for you with regard to that instruction to this committee from the House of Commons?

[Michelle Hewitt]

For me, that part of your mandate is why I asked to be a witness at this committee. I strongly believe that, as a nation, we're not protecting disabled people at the moment. I strongly believe that you cannot advance with the expansion of MAID until we've dealt with some of those issues.

For example, 7% of the people living in our long-term care facilities are younger disabled people who have no other option but to live there. I can tell you that they don't want to be there. Of course, the person I talked about, Sean, who passed away through MAID before Bill C-7, did not want to be there either, and he chose MAID over living in long-term care. That tells me that we are not protecting these people.

This is a real concern to me as someone with MS and someone who advocates for the MS Society, as well as Disability Without Poverty. We're not providing these basic societal conditions so that disabled people are able to have a choice about their futures. An institutional life somewhere that is designed for 85-year-olds with dementia when you're in your thirties or your forties—and, as Mr. Adair talked about, you're often in this rehab phase where your situation is new to you—is crushing. On top of that, you're going to be living in poverty.

Here in B.C., in our long-term care homes, the average amount of care a day is 3.28 hours. That's not per person, that's an average. If there's somebody in the facility who needs more time, such as that person with severe dementia who needs time, they are not getting those 3.28 hours. They're getting substantially less.

For people with MS, fatigue needs and so on... I know many people for whom the fear of long-term care would...they would prefer to choose to be eligible for MAID, and it seems that the eligibility is happening at the moment.

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

You made a great deal of separating intolerable suffering from a medical condition versus a person's social conditions. We don't want to speak with a broad brush for everyone. Everyone's different and it's a very subjective term.

For you, thinking about the safeguards at a bare minimum, what do you want to see in terms of protections, so that social conditions are not influencing a person and that they are looked after? They may still feel that their medical condition, despite all the supports they may have, is still leading them to a life of intolerable suffering.

What's the bare minimum that we need to be aiming for as a country?

[Michelle Hewitt]

Madeline, who I talked about, is a friend of mine. I know that you're in B.C. and Madeline is in B.C. She has treatment options that have worked for her, and they have now been removed because she can't afford to pay for them.

If there is a track record of treatment that works, the removal of that treatment cannot, therefore, lead to MAID. I believe that where the person is able to state what they need to have that intolerable suffering removed, those should be in place before they become eligible for MAID. If we cannot do that as a country, we must return to that original sense of MAID being towards the end of life for terminal conditions, and we have to fix those conditions for disabled people.

[The Joint Chair, Hon. Yonah Martin]

Thank you.

I'll now hand this over to my fellow chair for the round of questions by senators.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Senator.

We will now go to the round of questions from the senators.

Since some senators had to leave the meeting, the first three senators will have four minutes each.

We will begin with Senator Mégie.

Go ahead, Senator Mégie.

[Marie-Françoise Mégie, Senator, Quebec (Rougemont), ISG]

Thank you, Mr. Chair.

Thanks to the witnesses for providing us with this information.

My first question is for you, Dr. Coelho, and I would ask you to answer briefly.

When I practised medicine, one of my patients had multiple sclerosis. He suffered greatly and had only vestigial mobility in his fingers as he tried to bring his hand up to his mouth. He asked me to do nothing and to let him die if one day his heart stopped beating. One day his heart did stop and we reanimated him. He later told me that he was happy we had done so, that he was all there mentally and that he didn't want to die.

Do you have those kinds of patients?

If we were to transport that patient 20 years forward to the present, to 2022, would that kind of patient request medical assistance in dying?

I'd like you to paint a picture here, but briefly, because I also have a question for Ms. Hewitt.

[Dr. Ramona Coelho]

I will try my best, and thank you for the question.

Through Mr. Chair, I would say that I also did home care for people with severe mental health addictions, dementia and disabilities in Montreal before I relocated to London. Many, many times I've accompanied people through suffering—medical and psychosocial suffering—and they were able to overcome this and be super happy to be alive. Most of it required time. The CLSC system in Montreal was amazing when I was there. We had PSWs and a whole care team, and we were able to abate those death wishes.

[Marie-Françoise Mégie]

Thank you.

My next question is for Ms. Hewitt. Mr. Adair may answer it too, if he wishes.

I know you've seen the letter that 43 senators signed in January 2022 asking the federal government to promote Bill C‑35. The purpose of that bill was to create the Canada disability benefit. Do you think that introducing a guaranteed basic income for persons with disabilities would be enough to prevent them from requesting medical assistance in dying?