Evidence of meeting #11 for Medical Assistance in Dying in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was minors.
A video is available from Parliament.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
You're asking if I would?
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
That's outside my area of expertise. I don't practise oncology, so I'm not able to comment on that. However, what I can comment on is that it's very difficult to discern whether or not they're requesting this because of a lack of access to care. In my clinical experience, a lot of the times—
Senator, Nova Scotia, ISG
No. I'm sorry. This is not lack of access to care. It's a simple question.
This is a competent patient who refuses treatment for terminal cancer. Would you accept that patient's decision—and that of the parents? Answer yes or no.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
I'm not able to comment on that, Senator Kutcher.
Senator, Quebec (De Lorimier), PSG
Thank you, Mr. Chair.
My question is for Dr. Montes.
Maybe it's a variation on the same theme that I'm following up on Senator Kutcher's questions.
I understand that you feel concerns about access to MAID by those who are under 18 and maybe even at a higher age. Would you feel less concerned if access was limited to the first track, which is for those whose death is imminent? In such a case, a person would come with a clear medical diagnosis that they are going to die within a few months or weeks. That person is going through unbearable suffering, according to that person. That person is 17 years old, wants to have MAID and the parents, who you have spoken with, are saying that yes, they agree the child has suffered enough.
Are you saying that we should deny access in such a case and oblige the person to go through unbearable suffering?
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
I am advocating for is that, in some cases, we have to practise what we call harm reduction. If it's a very high-risk situation, we have to protect children and adolescents during their developmental time because it's a very vulnerable time where they take a lot of high-risk decisions, so—
Senator, Quebec (De Lorimier), PSG
Yes, I understand. I'm sorry to interrupt, but the time is limited.
The harm reduction principles for a group are fine, but that individual here is suffering irremediably and is near death, so it's no longer a harm reduction principle. It's a matter of whether we should respect the desire to put an end to the unbearable suffering.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
I've been listening to other panels. There have been a lot of stories of abuses of the safeguards, so it's just too high risk for me.
Again, I'm going to stick with my argument, which is total prohibition due to the biology and due to the lack of access to services and palliative care right now.
Senator, Quebec (De Lorimier), PSG
You don't care that, in a sense, you discard the best interests of the child?
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
There are some things that are just so high risk. We have age limits for alcohol, marijuana, illicit drugs and even driving because we know that children are highly vulnerable in this stage of development.
Senator, Saskatchewan, CSG
I'd like to get some thoughts from both of you on this. We'll start with Dr. Montes.
As you said, you were listening to the testimony. We've discussed this notion of decisional capacity versus actual age. As someone who works with children under 18 all the time, would you agree that there are children who are nine, 12, 14 or 17, but who have life experiences or who have lived with profound illnesses or pain, who might well be in a place to have the ability to make key decisions, perhaps in some cases as well as or even better than somebody who's 45 or 70 and who doesn't make wise decisions? Is that possible?
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
Thank you for the question.
That is definitely possible, but a lot of the time, from my clinical experience, these requests are very hard to parse out. A lot of the time, it's actually due to social stigma, poverty or a very difficult home life. It's very difficult to piece out what is really going on. Yes, definitely that is possible, but—
Senator, Saskatchewan, CSG
Let's take an example where that's not the case. We have lots of situations where young children are very well supported by families and they come to a decision on their own because they might have been living through any kind of illness for quite some time. They've decided that this is not going to get better, it's not going to change and it's not fixable. Because they have that personal experience—that life experience that you agree is so important when talking to children—they could come to that decision with their parents' blessing or at least concurrence. They're capable of doing so.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
It is so difficult to live with a chronic illness. I take care of many families, but we need to also consider the possible abuses so that the children who are suicidal and who are looking for a way to complete suicide.... We haven't discussed that.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
Right.
Senator, Saskatchewan, CSG
We have to make a distinction, because not everybody is in that category.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
Right.
Senator, Saskatchewan, CSG
We have lots of other situations. I'm just trying to focus on this, because obviously if there are big social concerns or they have no access, that's a different set of problems.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
Yes, it's just very difficult in practice to parse that out, and the decision is too high risk because it's irreversible and it results in death.
Senator, Saskatchewan, CSG
So you would just say that the child, regardless of their lived experience, should not be allowed to make those decisions?
