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.
The Joint Chair Hon. Yonah Martin
Okay.
In fact, Mr. Barrett, in round two of this second round, it's your turn to have three minutes.
Conservative
The Joint Chair Conservative Michael Barrett
Thank you, Madam Co-Chair.
Palliative care must be made available to any patient who's thinking about MAID. It needs to be a safeguard for folks who feel like they don't have any other option. Through the testimony today, we have heard that a significant number of people are only able to discuss palliative care on the day of their MAID request or after their request is made. This is in addition to the gaps that have been identified across the country in palliative care.
When people aren't offered proper palliative care, or they're not afforded time for consideration or to make an informed decision before their request for MAID, does this not point to a systemic non-compliance with MAID safeguards?
Senior Executive Advisor to the Deputy Minister, Department of Health
If the question is addressed to me, Mr. Barrett, I'll try to respond.
I don't think this is a systemic disregard for the legislation. The legislation says that someone can only give informed consent to receive medical assistance in dying after they have been informed of the means that are available to relieve their suffering, including palliative care. That is the requirement. There's no specific requirement that says when that palliative care service should have been offered to the person.
MAID is not set up to address every perceived—or, for that matter, real—deficiency in health care service delivery in Canada. It could not possibly take on that role. Palliative care has been given an important and prominent place in the original MAID legislation and in the new legislation. People who come forward for MAID are a product of all of their circumstances, including the kinds of services that they have had.
The sense that we have—and this is concerning for a different reason—is that the majority of people who come forward for MAID have had very positive interactions with the health system, for the most part. They are more likely to have been able to take advantage of what the system provides. The people whose experiences with the health system are negative are not the ones, by and large, who are coming forward for MAID.
Conservative
The Joint Chair Conservative Michael Barrett
Thank you. I just have about 30 seconds left.
I am curious about the accountability measures that are put in place when the federal government provides funds to the provinces for palliative care. Does that money stay in a palliative care envelope, or is it blended into administration or promotion of MAID?
While I don't think you have time to answer that, I wonder if you might be able to provide some of those details to the committee in writing prior to our preparing our report.
Senior Executive Advisor to the Deputy Minister, Department of Health
I can do that, but I can tell you now that I don't see that money is being diverted from palliative care to the promotion of MAID. I don't think that's currently happening.
The Joint Chair Hon. Yonah Martin
Thank you.
Next we have Mr. Anandasangaree for three minutes.
Liberal
Gary Anandasangaree Liberal Scarborough—Rouge Park, ON
Thank you, Madam Chair.
I want to focus my question to Ms. Banerjee.
Ms. Banerjee, would it be safe to say that from a disability lens, you have extensive engagement with the disability community in Canada?
Director, Office for Disability Issues, Employment and Social Development Canada
We do have extensive engagement with the disability community, not specifically related to MAID, but more in terms of the disability inclusion action plan that the government is working on.
Liberal
Gary Anandasangaree Liberal Scarborough—Rouge Park, ON
What are the overall perceptions, apprehensions and feelings toward MAID? Could you maybe give a sense of what the different perspectives are within the disability community with respect to MAID?
Director, Office for Disability Issues, Employment and Social Development Canada
The impression we have is that there are many different views throughout the disability community. Parts of the disability community very much want to have access to MAID. There are concerns from other persons with disabilities and from organizations about making sure to also have adequate access to supports and services.
It's quite divided throughout the community. I know that a priority of our department and of our minister is to make sure that the different voices are heard through the process.
Liberal
Gary Anandasangaree Liberal Scarborough—Rouge Park, ON
There have been a number of reports in the media about apprehensions. Could you talk about what kinds of fears exist?
Extending MAID to people with disabilities has been an issue of contention, but it does appear to be inconclusive. Can you give us some concrete suggestions as to what kinds of safeguards could be put in?
I don't know if you're in a position to do that today, but certainly you're welcome to submit further evidence by writing. Maybe you could give us a bit more in terms of the type of feedback you received, as well as what some of the safeguards are that may be required if MAID is extended.
Director, Office for Disability Issues, Employment and Social Development Canada
It might be better if I look into the data in more detail and get back to you on it, along with some other follow-up I have.
Acting Senior Counsel, Department of Justice
If there's 10 seconds, Madam Chair, I would like to add to this.
Acting Senior Counsel, Department of Justice
When Bill C-7 was passed, the safeguards related to a death that was not reasonably foreseeable included a safeguard that required the person to be offered consultations with various professionals, including disability support services. That was part of, as I understand it, responding to concerns that were expressed by the disability community. There is obviously much more that can be said on this issue.
The committee could look to members of that community and to disability rights organizations to provide evidence to inform its considerations.
The Joint Chair Hon. Yonah Martin
Thank you.
Next we will have Mr. Thériault for two minutes, followed by Mr. MacGregor.
Go ahead, Mr. Thériault.
Bloc
Luc Thériault Bloc Montcalm, QC
Okay. Thank you.
As outlined in the report by the Council of Canadian Academies on advance requests, “[advance directives] may include the advance consent to, or refusal of, specific treatments ... such as foregoing the use of blood and blood products ... resuscitation in the event of cardiac or respiratory arrest, or refusing artificial nutrition and hydration”. It is already possible to give advance directives. They are regulated and applied in Quebec and the provinces. However, advance requests are only for MAID. In this regard, the report states that “a legal regime for ARs for MAID, established in federal criminal legislation, would form one part of the regulatory picture in Canada; practical implementation would depend on provincial and territorial legislation, as well as professional regulatory schemes”.
Given that people are already used to dealing with advance requests, would expanding MAID to include advance requests pose much fewer practice and implementation issues?
The question is for Mr. Potter.