Evidence of meeting #2 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 health.
A video is available from Parliament.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Senator Martin, I believe I have five minutes following Mr. Thériault.
The Joint Chair Hon. Yonah Martin
I apologize. I thought I had completed that round. Yes, Mr. MacGregor, you will have five minutes.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much.
My question is to Ms. Hoffman, and it's again on the subject of mental illness.
We know that the guidelines.... The amendment is coming into force soon. It will come into force next year.
Actually, I'm going to switch my question, because we have Ms. Banerjee here.
My question to you is on the subject of persons with disabilities. Do you have information to share with the committee on the population in Canada who are currently living below the poverty line?
Director, Office for Disability Issues, Employment and Social Development Canada
I actually don't have it off the top of my head, but I can send that information. That is information that we do have, and I can find that information.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
It would be appreciated if you could provide a submission to the committee, a brief in written form.
Director, Office for Disability Issues, Employment and Social Development Canada
Sure.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you.
Ms. Hoffman, I'll turn to you. I'm going to switch it up to stay on the subject of advance directives on medical assistance in dying. We know that there has been a 2021 report on the dementia strategy for Canada, and a lot of the report also touched on the stigma associated with people living with dementia.
Because our understanding of people living with dementia is going to be a central facet in Parliament's discussion on advance directives, I guess my question to you is this: From Health Canada's perspective, how is our understanding evolving in that respect? What are we learning in this day and age about people who are living with dementia, the stigma associated with it and the strategies that are now coming into place to assist people who are living with this disease?
Senior Executive Advisor to the Deputy Minister, Department of Health
Thank you, Mr. MacGregor.
I'm not an expert on dementia or specific neurodegenerative diseases writ large, but I could make a couple of general comments nonetheless.
I think the discussion about dementia and the associated illnesses that have similar symptoms and manifestations is very helpful in reducing stigma. One now can imagine more acceptability of people with dementia when they are living with that disease for a significant portion of the time, in terms of being able to live in the community and having some sort of interaction, etc., outside of an institutional context.
I think the situation is changing, without overstating how quickly there is that sort of stigma reduction or, for that matter, the capacity for families to actually maintain in their own home support for a person living with dementia. I think it's still the case that there comes a point when that is extremely challenging and, unfortunately, very impractical, even with the best supports in the world.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you.
I just want to sneak in a quick question on the mental health aspect.
The last two years of the pandemic have brought about a rise in mental health issues in Canada in terms of the number of cases that we're identifying. I guess what I want to know is this: When does a mental health condition become a basis for getting medical assistance in dying? That's with the understanding that they have to be in an advanced state of irreversible decline that has to cause enduring psychological suffering.
What strategies is Health Canada putting in place to ensure that people who have a mental health issue are not advancing to a state that meets those conditions? Can you inform the committee of the kinds of strategies that we're putting into place? Do we have adequate funding? Is this something that we need to address more in Canadian society?
Senior Executive Advisor to the Deputy Minister, Department of Health
Well, despite actions, whether it's the mental health transfer to provinces or other specific initiatives, the reality probably is that we all know—we read it in the papers all the time—friends, neighbours and other families who are dealing with these challenges. Particularly for people with what I would say are lower acute conditions that may, as you're suggesting, deteriorate further in the absence of care, in mental health services there is a problem of the adequacy and sufficiency of intervention services.
That is something that I think all governments are working on, but as you have noted, through the pandemic it's become evident that particularly—but not only—among young people, there is kind of a pandemic of maybe COVID-related mental illness, or maybe it's just coming to the fore—
The Joint Chair Hon. Yonah Martin
Okay. Thank you, Ms. Hoffman.
That's five minutes at this time.
Senior Executive Advisor to the Deputy Minister, Department of Health
Thank you.
The Joint Chair Hon. Yonah Martin
Also, I need to ask the committee about an earlier point of order from Mr. Anandasangaree to have 15 minutes for us to meet in camera. If I hear agreement with that point of order, the clerks will prepare a new link that will be given to us for the last 15 minutes. I know that we will have our witnesses until 5 p.m.
Until then, we'll continue with our order of speakers, so I'm going to turn this over.... First of all, before we do that, do we have agreement for that?
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
On a point of order, Madam Chair, I don't believe the request included that it be held in camera. I think it was simply that we use the last 15 minutes to discuss some issues. That would save time, because if we have to click off and click on, we're going to lose another 10 minutes. That makes a big difference.
The Joint Chair Hon. Yonah Martin
I see.
Mr. Anandasangaree, was that your request? Was it just to use the last 15 minutes?
Liberal
Gary Anandasangaree Liberal Scarborough—Rouge Park, ON
I did not request that we go in camera. Thank you.
The Joint Chair Hon. Yonah Martin
I misunderstood. Thank you for that clarification.
I will turn this over to Mr. Barrett, my co-chair, for the questions from senators.
Conservative
The Joint Chair Conservative Michael Barrett
Thank you, Madam Co-Chair.
Next we go to Senator Mégie for four minutes.
Please go ahead, Senator.
Senator, Quebec (Rougemont), ISG
Thank you, Mr. Chair.
Ms. Hoffman, I'd like to come back to the regulations that will allow for the collection of more disaggregated data on racialized people, people with disabilities and so on.
Are these regulations in the works? If so, when will they be ready? Also, how will this data inform the government's future policy decisions on MAID?
Senior Executive Advisor to the Deputy Minister, Department of Health
Thank you, Senator. I can respond to that question.
The regulations are being written now. We expect that in the next six weeks, they will be published in what's called Canada Gazette, part I. The regulations will be in place. There will be a further consultation period, and the final regulations, we expect, will be published in the fall. That means they will take effect on January 1, 2023.
This may seem like a long time, but what that means is that for all of the calendar year of 2023, we will have this considerably more detailed data. However, it also means that this data will not be available until the end of the first six months of 2024. How will the data help? That will depend also on what requesters are prepared to disclose. They may choose not to disclose this data, but as I mentioned before, we will use this data in conjunction with other research and linkages to other data to try to better understand how the intersection of different forms of inequality may be manifested in the MAID system.
Senator, Quebec (Rougemont), ISG
Thank you, Ms. Hoffman.
I will now move on to a completely different topic, which is palliative care budgets.
Discussions have already taken place to try to determine whether it was the lack of palliative care that prompted people to request MAID, but it turned out not to be quite that.
As you mentioned, 80% of people who requested MAID had access to palliative care. However, this sometimes causes hesitation in my circle. Even if the form indicates that a person has received palliative care, it isn't clear what level of palliative care is involved, whether the person received palliative care for only three days or for a long period of time.
Do the forms that MAID providers fill out tell you a little more about this? Does it say anywhere that a person has actually received palliative care or has only had one meeting with a palliative care team, for example?