Medical Assistance in Dying Committee on April 13th, 2022

[Jay Potter]

Thank you, Madam Chair.

What I might offer is to recall what the criminal law does: It exempts the practitioner who administers MAID from criminal responsibility. The criminal law would need to provide a level of certainty and a level of specificity to understand, for the practitioner's purpose, when they are able to proceed.

As I mentioned, part of that involves the practitioner being confident that the request remains the voluntary will of the incapable person who is before them. Part of that goes to the content of the request. Is it clear enough? Is it specific enough? How do we know the request still represents the will? Part of it also goes to looking backwards in time when there may have been very different people and treatment teams involved.

I think it's appropriate to know that this can be an area of shared responsibility. As I mentioned earlier, if provinces were not to legislate in this area or not to provide a framework, for example, to store, track, and maintain advance directives, it would be difficult for the provider at the time of offering MAID to be confident that the document that's before them was in fact made by the person and that it was a voluntary expression of that person's interest, etc.

If there's not a—

[The Joint Chair, Hon. Yonah Martin]

Thank you, Mr. Potter.

[Jay Potter]

Okay. Thank you.

[The Joint Chair, Hon. Yonah Martin]

Go ahead, Mr. MacGregor.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you, Madam Co-Chair.

Very quickly, Ms. Hoffman, does Health Canada have data on the number of people in Canada who are under the age of 18 and who suffer from a grievous and irremediable medical condition as defined in the Criminal Code?

[Abby Hoffman]

No, we do not.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Is it possible to get that data? Is work being done to obtain it?

[Abby Hoffman]

It isn't. I think there is some information we could get from the pediatric medical community about incidence. You could find information about, for example, pediatric cancer and the outcomes in terms of morbidity and mortality, but not for most other diseases.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Okay. Thank you.

I would like to get to Mr. Potter.

Mr. Potter, in British Columbia we have the Infants Act, which defines what mature minor consent is. Basically, a health care provider can accept consent from a child if they are sure that the child understands the need for health care, what the health care involves, and what the benefits and risks are.

Is there similar provincial law across the board in Canada and the territories? If we're going to tackle the subject of mature minors, we have to have an understanding of the provincial groundwork we're dealing with.

[Jay Potter]

I understand there's some variation. I'd refer you again to the Council of Canadian Academies' study, because I believe there is a useful summary there that compares the jurisdictions. I understand there is variation, and in particular in some jurisdictions it may not be as specific as the British Columbia statute you mentioned. It may be more a matter of how the case law has evolved and is implemented by common law.

Again, I would commend to you the CCA study, because I think that provides your answer.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Would the Criminal Code have to entertain such a definition in order to have some uniformity?

[Jay Potter]

If Parliament wanted to allow MAID for mature minors, then—

[The Joint Chair, Hon. Yonah Martin]

You have 10 seconds.

[Jay Potter]

—it may need to address what is meant by a “mature minor”. It could do that in relation to provincial legislation or it may need to set out a specific term. It really depends on what the objective of Parliament is in doing that.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you.

[The Joint Chair, Hon. Yonah Martin]

Thank you.

We'll go back to the top of the list. I will invite Mr. Cooper for five minutes.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Madam Joint Chair.

My questions relate to the first and second annual reports. Neither report discusses how many incomplete or inaccurate MAID reports were submitted to Health Canada, and how those were corrected. Could any of the officials comment on how many inaccurate reports were submitted and how that was corrected to ensure accuracy?

[Abby Hoffman]

I can respond to that.

I can't give you an exact number, but I can tell you that for every report that comes to us for every case from each provider, if there is information missing or it appears that an answer may be incomplete, then there is communication back to the provider. In the case of provinces that file reports with us on behalf of all of their providers, there is a conversation that goes on to make sure that the report is actually completed as required.

I will just note that the overwhelming majority of reports come to us from the provinces on behalf of all of the MAID providers who have been active on a case in the period in question. Those provinces often collect additional information of their own, so there is a quality control check on that data before it actually comes to us. Therefore, we're pretty confident that—

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you. I appreciate that. That's helpful, but as you note, some data goes directly to Health Canada and not through a provincial body. The second report that I was reviewing makes reference to an electronic verification system to ensure completeness, but is that it? I understand that these reports take not more than 10 minutes to complete. For example, if a report on its face appears to be complete insofar as all of the boxes are ticked, what's the assurance that the report is in fact complete and accurate?

[Abby Hoffman]

I think that at a certain point in time you have to have some trust in these providers. I think that anyone who has dealt with the MAID community of practitioners has been struck by the due diligence—

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Okay, but I appreciate that—

[Abby Hoffman]

—that these people exercise. If the report is incomplete, we go back to the person who submitted it.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

How do you know if it's complete or not, if there's no additional verification?

[Abby Hoffman]

We are not out there auditing every single—

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

I'm not asking.... Sorry, my time is limited. I don't mean to interrupt.

I'm not suggesting that it would be practicable to audit every single report, but surely there must be some additional check in place to ensure accuracy. What you're telling me, as I understand it, is that there's nothing.