Evidence of meeting #13 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 alan.
A video is available from Parliament.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Could the host please allow me to be unmuted? Thank you. I am now unmuted. Yes.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you very much, Madam Co-Chair.
I just want to thank both Ms. Nichols and Ms. Romaire for different but very compelling testimony.
What is very apparent, as you said, is that there is a need for clear safeguards with actual national standards that can be kept across the country so that provinces don't make up their own. I think that is what we are hearing from a lot of people. We don't have those right now, and provinces may or may not, as Ms. Romaire is telling us. In Alberta, even though she was eligible, she couldn't get palliative care. She couldn't get anything she needed.
I agree with you and I want to thank you both, because the tragedy of actually being able to have MAID or of not wanting MAID.... There really need to be clearly defined guidelines and clear patterns of practice that are decided on across the country and not locally by provinces.
I wonder, Mrs. and Mr. Nichols, if you could answer me. You are getting nothing from the college of physicians in B.C., no information.
As an Individual
They actually said they were not going to involve us in their investigation, but they would use all the information to do it behind closed doors. They could be doing something that we're not aware of. I did send them another email saying that the nurse who had filled out Alan's assessment was also the one who euthanized him. I said that was kind of a conflict there, especially having a nurse come up with some kind of assessment of his natural death when really nothing was done.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I think that, basically, the college of physicians is responsible for physicians' practice, whether physicians are practising within the guidelines or whether physicians are malpractising, so that, as you said, may be exactly what the college is doing behind closed doors, because there had to be psychiatrists looking after him, not just nurses. Were there psychiatrists looking after him? Who was his attending psychiatrist in the hospital?
As an Individual
He was in the psychiatric ward at the hospital. We went there. They gave him antidepressants for a couple of days, and then he was transferred to the PATH unit. Then the MAID team brought in their own psychologist. They didn't use the hospital's psychiatrists or the psychologists from when he was in the psychiatric ward. They brought in their own and just did whatever and made their simple evaluation.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I am so sorry to hear of your trials and the pain you must be feeling right now.
Ms. Romaire, your testimony tells us exactly what I think we are hearing.... I am so glad that we're hearing from people on all sides of the spectrum, who wanted MAID, did not want MAID, etc.
I think you are pointing out to this committee—and what we're hearing from you is—that we need to call for clear, distinct practice guidelines nationally, across the country.
Now that is a difficult thing, because the provinces are responsible for practices and patterns of practice, not the federal government. This is a problem. Provinces will decide what they want to decide, and we've seen two different problems, one in Alberta and another in British Columbia.
Thank you. I don't want to ask you any more questions, because you were both pretty clear in your testimony.
I think it is really important that the right people and trained people do MAID assessments, and that the person who is seeking MAID has, as an advocate, a physician who knows their life and what their problems have been and can advocate for that.
Mr. and Mrs. Nichols, it seems that in your case, it did not happen.
Our problem, as a committee, is that we're going to have to look at.... Given that the patterns of practice and practice guidelines are provincial in jurisdiction, it's going to be very difficult for the federal government to have national standards of practice. However, the colleges of psychiatry and physicians may be able to do something about that, because they can be responsible for setting clear guidelines of practice.
I want to tell you how sorry I am to hear of your pain on top of pain, almost adding insult to injury, in both of your cases.
Thank you for testifying, and thank you so much for being so honest and clear with us. I appreciate it.
The Joint Chair Hon. Yonah Martin
Thank you, Dr. Fry. Thank you again to the witnesses.
Next we will go to Monsieur Thériault for five minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
Thank you to Mr. and Mrs. Nichols as well as Ms. Romaire for sharing their stories, which were quite moving and very troubling.
In their opening statements, they told us about the struggles they have faced. A few short minutes isn't enough time to adequately understand and unpack the deficiencies in the system. The bottom line, as I understand it, is that something happened that shouldn't have.
In 2019, Mr. and Mrs. Nichols, MAID was not available to people with mental disorders under the law, so I don't have any questions for you.
Ms. Romaire, you pointed to a problem that has also come up in Quebec.
In terms of end-of-life care, Quebec was one of the first places to authorize medical assistance in dying for people with terminal illnesses. The province even set up a commission to oversee the administration of MAID, the Commission on End-of-Life Care. The commission's job is to oversee MAID responses and to hold all practitioners involved in MAID cases to account.
The situation you described, what happened to you, has to do with MAID requesters not having access to palliative care no matter what their stage of illness, whether terminal or pre-terminal.
That's what you experienced, and that's what you shared with us today.
You could qualify for MAID, but you said that it would be tremendously helpful if you could also receive palliative care. Some witnesses told the committee that palliative care was available, not just for a terminal illness, but also prior to that stage.
Ms. Romaire, I'd like to hear your views on this. I want to be sure I understood everything you said. You were told that you weren't eligible for palliative care because you had requested MAID.
Do I have that right?
Liberal
The Joint Chair Liberal Marc Garneau
Actually, I think the reason was that she did not have a life-threatening illness.
Bloc
Luc Thériault Bloc Montcalm, QC
As I understand it, Mr. Chair, the reason that Ms. Romaire does not qualify for palliative care is that she requested MAID. She does, however, qualify for MAID.
Ms. Romaire, I'd like to hear your answer. Please go ahead.
As an Individual
I was denied palliative care because I did not have a terminal diagnosis. That was the reason I was given.
Bloc
Luc Thériault Bloc Montcalm, QC
Very well.
I gather that the first time you requested MAID, you did not qualify. The second time you requested MAID, you were told that you did qualify. Since you were not terminally ill, or at the end of life, you were denied palliative care.
Do I have that right?
As an Individual
I am approved for MAID. I requested palliative care before I requested MAID, and I was denied because I didn't have a terminal diagnosis. After I requested MAID and was approved for MAID, I again asked for palliative care and was denied, again because I did not have a terminal diagnosis. I don't know if it would have helped.
Bloc
Luc Thériault Bloc Montcalm, QC
Regardless, if you had had access to palliative care, you would have had help dealing with your pain and suffering. You would have had that support.
My comment about Quebec had to do with the fact that people who are terminally ill—which is not your situation—are denied palliative care.
For that reason, a new bill was brought forward, and its passage would have meant that palliative care facilities would be required to provide care to people who had requested MAID.
Putting people who request MAID and people who request palliative care in two different categories is a widespread practice, not just in your province, but also in Quebec.
We regularly hear from witnesses that palliative care is the answer to all their problems, that people would not request MAID if they had access to palliative care. While that may be true, people who are waiting to die still need compassion and supports.
That was the point I was trying to make. I understand what you are saying, Ms. Romaire.
Thank you.
The Joint Chair Hon. Yonah Martin
Thank you.
We'll now go to Mr. MacGregor for five minutes.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much, Madam Co-Chair.
Mrs. Nichols, I'd like to start with you. I'll echo the words of my colleagues in thanking you for coming before our committee and sharing a very personal story about Alan.
For Alan, in 2019, it would have been under the old Bill C-14 regime.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
I brought up the bill because of course it was subsequently changed—the Criminal Code—with Bill C-7. I guess from our perspective as federal legislators, in your opinion, is there something that was missed in how the safeguards are written out in the Criminal Code, or is this more on the side of the medical profession? Could you answer that for us?
As an Individual
Well, we have criteria for MAID. In Bill C-14, there are definite criteria for MAID, and Alan did not meet the criteria for MAID, medically or according to the laws that are set by legislation. He did not meet those. He didn't meet the criteria, because he didn't have a foreseeable death. He was admitted under the Mental Health Act as a danger to himself.
I don't know.... There needs to be a law put in place to protect people from being administered and put into a hospital against their will, don't you think, for that in itself? Then, to actually be offered MAID, and transferred and bounced around a hospital, and kept from his family....
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Was your family ever able to get access to the signed documents by the two independent physicians who would have been involved in the process?
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Okay.
I appreciate your sharing your story. I don't have a lot of time, unfortunately.
I'd like to turn to you, Ms. Romaire. I'd also like to take this opportunity to thank you for appearing before our committee and sharing your personal experience.
As you relayed to my colleague, you were denied palliative care because even though you have been approved for medical assistance in dying, your condition is not terminal. I'm just wondering, Ms. Romaire, if you look at the services that would have been given to you had you been approved for palliative care, whether that would have any bearing or impacts on your decision with respect to medical assistance in dying. I just want to put that into some context. Is there anything you can share with us?