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
No, that's not what I'm saying. I'm just saying it's a very complex issue, and we also need to balance that child with other children who may use MAID to complete suicide or may use MAID—
Senator, Saskatchewan, CSG
But I'm really trying to not have that category. It's not a balancing act of how many people are in each category. I'm talking about children who are well supported, who have had access to all sorts of treatments and support, psychologically and medically, and who have come to a decision.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
In my clinical practice, I haven't come across cases in which all of those boxes have been checked, so, unfortunately, I don't know—
Senator, Saskatchewan, CSG
Okay. I don't know how much time we have left. Is there a moment for Professor Carnevale to respond?
Liberal
The Joint Chair Hon. Yonah Martin
I have a question for each of our witnesses as well.
Dr. Montes, your story demonstrates the incredible ability of children to overcome life suffering with support. And as we know from prior witnesses, psychosocial suffering is not irremediable in those struggling with mental illness issues or disability and often can be remediated with good care and support.
Can you speak about the impact that social injustices such as bullying and trauma may contribute to a desire to die? Do you have concerns that the root of a MAID request by youth might be overlooked by a MAID assessor, especially if they don't have expertise in these specialized fields? Would you comment on that, please?
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
Thank you for your question.
Yes, we have a study called the adverse childhood experiences study. It shows that children who have undergone traumatic events in their childhood are three times more likely to have depressive symptoms and have a very increased risk of suicide. So one of my concerns is that with these children, there may be abuses, and it's very difficult to parse out what the actual root cause of the request is. These children do very well with supports and actually can overcome these challenges like those in my story. I've seen many children in my practice who, with the right support, have been able to overcome the trauma, but in those crisis moments, it's very difficult to ascertain this, and it is very concerning. It's something we need to really consider before moving forward.
The Joint Chair Hon. Yonah Martin
Thank you.
Mr. Carnevale, you mentioned the importance of safeguards, but I want to know whether you could articulate some of those if you haven't yet done so.
Clinical Associate Professor of Pediatrics, Memorial University, As an Individual
At this point, I—
The Joint Chair Hon. Yonah Martin
That was for Mr. Carnevale.
That's regarding the safeguards and whether you want to specify what you were referring to in your testimony.
Professor and Clinical Ethicist, As an Individual
I described a little bit before in a French reply.
The safeguards that are commonly referred to and that are also described in my report are the way in which we evaluate decisional capacity, mindful of some of the concerns that Dr. Montes has raised, to make sure that those are all properly assessed and evaluated.
I think the other big one that is commonly looked at and is in place as well in the Netherlands and Belgium is the situations under which parental corroboration might also be needed.
I'd also like to highlight that in the cases I've been involved in involving minors, in which there were questions about MAID, these were very different from situations in which a minor might be seeking contraception. When we're looking at life-limiting illness, it's very, very uncommon that we're speaking only with the minor. They have significant care requirements, and my experience has usually been that it's the parents who've actually sought the possibility of MAID for their minors. As I said to Mr. Thériault before, it's very uncommon in those kinds of situations that the minor is asking for their life to end, for treatment to be stopped so that they would end where there's a categorical objection on the part of the parents.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you very much.
I want to thank you, Professor Carnevale and Dr. Montes, for coming tonight. Thank you for answering our questions and providing your testimony. I know it's late for you. It's particularly late for Dr. Montes, who's in Newfoundland. It must be about 11 o'clock there now.
Again, we very much appreciate your taking the time and giving us your candid commentary. Thank you.
With that, panel three is completed.
Colleagues, if you could hang around, we have to talk about what's left between now and June 23. I'll do this very quickly. We're in a situation where, in all likelihood, we will have two more meetings. One will be next Monday and the other the following Monday, which is June 20. It doesn't look like we're going to get a Thursday night meeting, because the BOIE wants to meet on...at the moment, for both of those.
As you know, on June 13 we're going to look at the draft of the interim report on mental disorders that is currently being put together, which we have to table by June 23. We'll have the whole three hours to do that. The following Monday, we've reserved two hours, hopefully to finalize it, and then we'll have a subcommittee meeting that will look at what's ahead of us, only in the broadest terms. There have been a lot of questions asked about where we go from here after we rise for the summer.
That's just to let you know the schedule. Now here's the complicated part.
You're going to get the interim draft report this Friday, the one that we have to table by June 23. It will be provided this Friday. It will be considered on Monday. That can be a very involved process, as we know. It's a very tight turnaround time, so what we're asking you to do is to look at that report and to essentially be ready to discuss it in specific terms on Monday night. That means a little bit of weekend homework. This is so that we are in a situation where we're trying to ensure that we're going to be ready to finalize the report at the very latest on June 20.
It's a very tight turnaround time. If there are huge revisions to the report next Monday, that will also mean that we'll still have quite a ways to go on June 20, when we look at the final draft, or hopefully the final draft.
Any changes to that second version, the version that will come after June 13, will have to be minimal, or the work involved to present the report in the House cannot be completed prior to June 23.
We're hoping that, if there's wording you want to add or change, you'll come with that specific wording and, if possible, provide your commentaries to the clerk by noon on Monday. That way there's also a chance to translate it, in some cases. It may or may not be ready by Monday night, but at least the analysts will have an idea of what you're really going for.
All of that is to say that you're going to get the report on Friday, and we're hoping that you'll provide commentary on Monday. Our strategy is to try to make sure that we get most of it done Monday night. That way, we can just do the cleanup the following Monday, because we have only two meetings left.
The Joint Chair Hon. Yonah Martin
Yes.
I see Senator Wallin's hand, but perhaps I can add to what MP Garneau has said.
In terms of next Monday and our proposed revisions or additions, if we're ready to read them at the meeting, we can get the interpretation as we read. That will facilitate the tight timeline in which we have to work. It does require some homework on our part so that next Monday we're ready to discuss the revisions and edits.
Liberal
The Joint Chair Liberal Marc Garneau
Hopefully, we'll be saying “this is what I propose” and reading it so that everybody hears it, as opposed to saying “I think we should change it to something like this”, which unfortunately means extra work to decide what that should be, which has to be looked at the following week. Being as precise as you can be on Monday night would be great.
Go ahead, Senator Wallin.
Senator, Saskatchewan, CSG
I want to say a word about the legislation because one of the witnesses raised it.
This legislation is not designed to be pre-emptive. It's a bit of reality. The Senate takes a little bit longer than the House of Commons to do things, and we will not get to this issue until the fall.
It was important to get it on the record so that those who wanted to address it could, but we won't be doing anything pre-emptive. This is just an FYI.
Thank you for the moment.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator Wallin.
Is there anything anybody else wants to add?
Thank you to everyone for another very long evening.
This meeting is adjourned.