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.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
You just said that non-compliance is very low. On what basis do you reach that conclusion in the absence of national data?
Senior Executive Advisor to the Deputy Minister, Department of Health
That is based on reports from provinces and territories about MAID cases in their jurisdiction. They have responsibility for enforcement and compliance, so it would be natural that we would rely on data about their activities.
As I say, in most cases this involves a hands-on approach to every single MAID case.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
Thank you. Are you able to quantify what “very small” is?
Senior Executive Advisor to the Deputy Minister, Department of Health
To our knowledge, it would fewer than 10.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
That's interesting, because in its April 2019 report, the commission on end-of-life care in the province of Quebec ruled that 13 cases didn't comply with the law. Are you saying it's 10 cases in the province of Quebec? The end-of-life commission report cited 13 cases.
I would further note that in Ontario, the chief coroner's office announced a review of 2,000 cases in which the coroner raised “compliance concerns with both the Criminal Code and the regulatory body policy expectations, some of which have recurred over time.” It doesn't sound to me like these are minor issues.
Senior Executive Advisor to the Deputy Minister, Department of Health
I would make a distinction—
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
At the end of the day, if you're not monitoring compliance in the law, what are you monitoring?
Senior Executive Advisor to the Deputy Minister, Department of Health
Madam Chair, if I could respond to that, I'll simply say that we are monitoring the practice of MAID in Canada and fulfilling our role as the federal government.
Compliance, as I said, is the responsibility of provinces and territories. I would also note that in the early days of MAID, there might have been some administrative shortfalls, and that's not to say that they might not persist among some new providers.
If we're talking about whether a statement had the correct date or the date was omitted or something of that nature, I'm distinguishing in terms of cases in which there might be some reason to believe that there had been a significant misstep—
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
All I would say in the time I have is that the number you cited—10—understates the findings of non-compliance in one province in one year.
Senior Executive Advisor to the Deputy Minister, Department of Health
I'm referring to serious non-compliance, not to administrative missteps that are inconsequential to the actual eligibility decision and the decision by the provider to proceed with MAID.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
The non-compliance was non-compliance with the law, and that law is the Criminal Code.
The Joint Chair Hon. Yonah Martin
Thank you, Mr. Cooper.
We'll go next to Mr. Maloney for five minutes.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thanks, Madam Chair.
Thank you to both of the witnesses for being here today, for your presentations, and for everything you've done to get us to the point we're at now, which I think Mr. Potter quite accurately pointed out is very complicated.
I'm going to address two of the topics we're dealing with, which are mature minors and mental disorders. I'm putting them together because I think they present, when we are dealing with them, an issue in common, which I'm going to call objective versus subjective assessment.
In the case of a mental disorder, a medical determination has to be made as to whether or not the disorder satisfies the criteria. Similarly, in the case of mature minors, somebody is going to have to make a subjective assessment—I'm calling it subjective, but maybe you'll disagree with me—as to whether or not that person is mature enough to make that decision.
First of all, would you both agree that's a fair characterization?
Acting Senior Counsel, Department of Justice
I guess one point on which I might be able to assist is that if the committee were to look at expanding availability of MAID to mature minors, it would be open to the committee to also specify safeguards or conditions under which that would occur. Safeguards could address issues pertaining to capacity assessment, for instance. Just as the eligibility criteria, as they exist now, for adults provide, for example, that a person is eligible only if they've made a voluntary request and an informed request for MAID. Then there are safeguards that are practical things a practitioner needs to do in advance to satisfy themselves that the criteria are met. It would be open to the committee, when looking at mature minors, given their unique situation as being underage, to determine if there are measures that might be appropriate for those cases to help give confidence that, for example, the person is capable of making that kind of very significant decision.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you.
Let's deal with mature minors, then.
With an adult, you're dealing with informed consent, but with a minor, you have the added layer of complication of determining whether they're able to make a decision and whether they even know what informed consent is. That's the challenge. I know there are other countries in which minors have access to medical assistance in dying. I've looked at some of the statistics, the numbers, and from what I can tell, they are very low. Is there data available on the criteria that are used in those countries in making a determination of whether or not somebody is mature enough?
The second part of my question is this: Is there data available about the number of minors who have sought this right to medical assistance in dying and have been refused, so we can get an idea of how well the criteria, to the extent they exist, are actually being applied?
Acting Senior Counsel, Department of Justice
I'm not aware of specific figures from the other jurisdictions you've referenced. It would most likely be places like Belgium, for instance, that would provide that. There is certainly information that's more easily available regarding, for example, what the criteria are, such as, for example, what the ages are, what the requirements are, such as whether or not parental consent is required, or if it is simply consultation with parents.
To go back to the first part of your question, there's the issue of whether capacity assessment is subjective or objective. Maybe a way of looking at it is that capacity assessment, as I understand it, in Canada doesn't mean that a person decides for themselves whether they are capable. It's an assessment made by the practitioners, an objective determination. Generally, for adults, there's a presumption that people are capable of making medical decisions for themselves, but if the practitioner has reason to doubt that, then they're able to engage in an assessment using various instruments to help validate whether the person has capacity to make a particular type of decision.
For mature minors, for example, if that is something the committee is interested in exploring—
Acting Senior Counsel, Department of Justice
As I said earlier, you could look at whether or not there ought to be required elements in that kind of assessment.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
I'll pursue this further again, but somebody's going to have to convince me that deciding whether somebody's mature enough is an objective assessment and not a subjective assessment.
Thank you, Madam Chair.
The Joint Chair Hon. Yonah Martin
Thank you, Mr. Maloney.
Our next questioner will be Monsieur Thériault.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
Thank you to the witnesses for being here today.
To start, I have a very straightforward question for Mr. Potter, since he brought up the expert panel and its forthcoming report.
Do you happen to know when the report might be released? That may help the committee with its work plan.
Acting Senior Counsel, Department of Justice
Madam Chair, if it's all right, I'll allow my colleague Ms. Hoffman at Health Canada to answer this one.