Medical Assistance in Dying Committee on May 30th, 2022

[Michelle Hewitt]

Thank you so much for your question.

I think there are many things about the Canada disability benefit that are still unknown, such as eligibility and the amount. There are also things that relate to how much it actually costs, and where the poverty line would sit if you are somebody who is disabled. Research from other countries would say that the line is 40% more for the disabled than for those who don't have disabilities.

The poverty line is the poverty line. A common phrase that I know Mr. Adair has heard me use is that “it's not lollipops and rainbows; it's still the poverty line”. It's a start of where we need to get people to. Mr. Adair spoke of housing. When it comes to treatment, we need people to be able to function so that they can deal with their disability rather than dealing with the double whammy of their disability and abject poverty.

It's a start, but do I think that the Canada disability benefit alone will stop disabled people accessing MAID? My personal opinion is no, that it's one of a package of measures that we need to do as a country.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Senator Mégie.

We will continue with Senator Kutcher.

Go ahead.

[Stan Kutcher, Senator, Nova Scotia, ISG]

Thank you very much, Mr. Chair.

I have three short questions for Dr. Coelho, and then one slightly longer one for Michelle Hewitt.

Dr. Coelho, we have heard that many MAID providers are family physicians. I'm wondering if there is a consensus amongst family physicians that they all should inform patients about MAID even if their conscience precludes it.

[Dr. Ramona Coelho]

I'm so sorry Senator Kutcher; I don't know what you're talking about.

[Stan Kutcher]

What if a family physician feels that in their conscience they shouldn't tell a patient about MAID? Do all family physicians think that every family physician must, at all times, tell patients about MAID being available?

[Dr. Ramona Coelho]

I'm so sorry, I'm struggling. I don't know that there's any consensus on this issue. I am saying that Susan MacDonald and other people at the committee said that it should be part of informed consent, and I'm saying that's a very dangerous principle to apply when we know that there's discrimination in health care, like the B.C. report, “In Plain Sight”, demonstrates.

[Stan Kutcher]

I appreciate that. That's what I was asking, whether there was consensus on that.

The second question, again, is on family physicians. Do they have consensus about MAID being provided to track one patients, as they currently are identified. Is there consensus amongst family physicians that they should be provided with it?

[Dr. Ramona Coelho]

Again, through you, Mr. Chair, Senator Kutcher, I don't actually know. I'm not an academic family physician; I'm a family physician who works, really, on the margins. I do connect with other family doctors who work in marginalized communities. We are all concerned about this. I have no idea, and I can't comment on the consensus of family doctors.

[Stan Kutcher]

Okay. So, you wouldn't know whether there's a consensus, or not a consensus, among family doctors about any aspect of the provision of MAID.

[Dr. Ramona Coelho]

I really wouldn't, so I can't answer the question. I'm sorry.

[Stan Kutcher]

Thank you very much. I appreciate your trying.

Michelle Hewitt, I think that everyone on this committee would agree that poverty and any other social or economic factors should not be the driver for MAID. The expert committee report noted that persons with a disability who request MAID should be offered housing and income assistance and other needed supports.

Would you agree that such safeguards should be provided to any person with disability who requests MAID?

[Michelle Hewitt]

I would say that housing and not having to live in poverty, as well as access to treatment, should be provided to all disabled people, whether they are approaching MAID or not. I believe that disabled lives are worth living, that we contribute to our society in so many ways, and at the moment there is a lot of suffering in the disability community that isn't caused by our disabilities or impairments. It's caused by—

[Stan Kutcher]

I completely agree with you on that. However, our discussion is about MAID.

[Michelle Hewitt]

Right.

[Stan Kutcher]

The question is, if a person is disabled and doesn't have adequate housing and adequate social supports, as part of that MAID assessment, should those be offered to the person? That's the question.

[Michelle Hewitt]

Absolutely.

[Stan Kutcher]

How urgent would that be, in your opinion?

[Michelle Hewitt]

I would say that it's extremely urgent. A person who has got to the position of applying for MAID is already in crisis and would need a lot of support to put those complex pieces in place.

I would hope that's what we would be offering, that there would be a position, a person, a body, who would examine those complex pieces that go into those decisions.

I used the example of my friend Madeline. She knows exactly what she needs in order not to access MAID. She needs the treatment options that she can't afford and that work for her successfully.

[Stan Kutcher]

Right.

So if someone says, look, this is helpful to me and I need it, this should be considered, and every effort should be made to provide that to them.

[Michelle Hewitt]

Absolutely.

[Stan Kutcher]

Thank you very much.

[The Joint Chair, Liberal, Marc Garneau]

Thank you very much, Senator.

Now it's Senator Dalphond's turn.

Senator Dalphond, you have four minutes.

[Pierre Dalphond, Senator, Quebec (De Lorimier), PSG]

Thank you, Mr. Chair.

My question will be for Ms. Hewitt.

You saw the task force report, and I'm sure you read it, as I did. The members of the group expressed consensus on the way the evaluation should be made, and they stressed the importance of socio-economic factors in the thinking process of the requester.

Am I to understand, from what you say, that this is not enough? If what they are proposing to make sure that the assessment rests on proper informed consent and not a short reaction to socio-economic difficulties is not enough, what kinds of other guidelines would you suggest we have to prevent people from requesting—not requesting, but receiving MAID? There's a distinction before requesting it and getting the assessors to agree that you're entitled to it.

[Michelle Hewitt]

I'm sorry, was that addressed to me? I think it was.

[Pierre Dalphond]

Yes. Sorry, I wasn't clear.