Perfect, thank you.
I'm here to present the position of the Collège des médecins du Québec, where I've been working for a year and a half as an inspector in the Professional Inspection Division.
In light of the progress being made in granting access to medical assistance in dying and developments over the past few years, the Collège struck a working committee made up of clinicians. The committee began reflecting on MAiD in April 2021 and submitted its report in December 2021. The report was then endorsed by the board of directors.
I will now outline the findings and recommendations of the committee and the board.
First—and this has to do with the federal government, but also the Quebec provincial government— the Collège would like to note the harmonization issues between Quebec and Canadian law. The mismatch in choosing certain words causes confusion among health care providers.
For example, the Canadian legislation talks about an “illness, disease or disability”, while the Quebec legislation does not. It's causing many issues when it comes to interpreting the law. In addition, it could disqualify people who would normally be entitled to MAiD, based on which side of the Ottawa River they call home.
With respect to access to care, the working committee first looked into access to MAiD for persons with neurocognitive disorders, or progressive dementias. The committee and the Collège's board of directors supported advance requests when an individual becomes aware that they inevitably risk losing their faculties due to a progressive illness. People must therefore be able to submit an advance MAiD request, even if that means it is made several years prior to taking any action.
The second area for consideration had to do with MAiD individuals presenting a mental health issue only. Once again, the board of directors endorsed the recommendation that MAiD should only be available to people with a serious and persistent mental health condition for which treatment has been attempted and for which the individual sees no other outcome. Of course, this requires further thought about how to implement it. We need to make sure that the law is interpreted correctly and access to care respects people. We also need to make sure that all the necessary and possible care has been offered to an individual with mental health issues. In our current health care system, we know that access to mental health care can be problematic.
The third area for consideration was access to MAiD for emancipated minors between the ages of 14 and 17.
With support from the board of directors, the committee recommended that emancipated minors be able to apply for MAiD in conjunction with their parental authority or guardian. The pain that these young people may suffer must be taken into account; the suffering may become intolerable and it may no longer make sense in certain situations. The same is true for babies from birth to one year of age who come into the world with severe deformities and very serious syndromes for which the chances of survival are virtually nil, and which will cause so much pain that a decision must be made to not allow the child to suffer. In that respect, the committee highlighted the Netherlands' and other countries' experience. This avenue could be explored.
Finally, the committee considered the burden of living some elderly people carry. In geriatrics, we call it failure to thrive. For these individuals, life no longer makes any sense. Among other things, the fragility of life, diminished physical capabilities and existential pain become intolerable burdens. The committee and the Collège endorsed the idea of undertaking thorough reflection on this.
This is a topic that remains sensitive for the public and one for which we currently do not have clear answers on our side. Yet we want to be able to continue to have a joint reflection with learned societies and the general public to see under what circumstances this may be an option.
So I've presented to you here quickly, in a few minutes, the result of the reflections of the college's working committee, reflections that have been endorsed by its board of directors. The committee's work lasted six months, but it followed many years of reflection and work around this topic.
I am available to answer questions from committee members and provide clarifications.