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.
Senior Executive Advisor to the Deputy Minister, Department of Health
No, I'm not telling you that. I'm telling you the report—
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
Maybe I'll ask you a specific question. Are there any on-site reviews, for example, of randomly selected cases across the country? That might be a way—
Senior Executive Advisor to the Deputy Minister, Department of Health
Not conducted by us, but I mentioned earlier in response to another question that there are oversight mechanisms in provinces and there are quality review procedures, and the oversight of MAID is generally, in our opinion, quite good. We are not concerned at this point. We don't have reason or evidence to be concerned that there are MAID reports being filed by practitioners that have incomplete or inaccurate or fraudulent data. That is not our observation. In fact, as I say, because of these additional mechanisms that are in place in provinces, some of which are for quality reviews and some of which are for oversight and compliance, we think the system is working pretty well.
I would say also that it takes more than 10 minutes to respond and that the new datasets will be considerably more complex and require more time.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
Again, not all of the reporting is going through provincial bodies.
Senior Executive Advisor to the Deputy Minister, Department of Health
That's correct. A small proportion of the total number of MAID cases comes to us.
Senior Executive Advisor to the Deputy Minister, Department of Health
It would represent probably less than 10% of all MAID cases in Canada.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
With respect to those cases that are being submitted directly to Health Canada, is there any mechanism in place to ensure that federally collected monitoring data in respect of those cases is being shared with local enforcement agencies as the regulations permit?
Senior Executive Advisor to the Deputy Minister, Department of Health
Mr. Cooper, I think you asked me this question last year, and I think I indicated at that time that enforcement is not the job of the federal government, and it is not the role of the monitoring system.
In the rare occasion—or a hypothetical occasion—that there was some reason to believe the report was incomplete, we would interact with the person who provided the report, but we do not have the kind of data that would make it reasonable for us to advise law enforcement.
These are responsibilities of the provinces. That's very clear.
The Joint Chair Hon. Yonah Martin
Thank you, Ms. Hoffman.
I'm back to my original order for the Liberal MPs, but because there's an even number, it would be Mr. Maloney again, for five minutes.
Is that correct?
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
I believe that's right, Madam Chair.
I'll share my time with Dr. Fry.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you.
I'm going to ask a couple of questions quickly and then pass the time over.
Ms. Hoffman, thanks for mentioning Victoria. I watched that show you were referring to, and it was Dr. Stefanie Green who was the practitioner involved. I believe the number on Vancouver Island is 7%. Do you have an explanation for why it's so high? There could be a greater number of seniors, for example.
Senior Executive Advisor to the Deputy Minister, Department of Health
I think it's a little bit the demography: the nature of the population, the age, the education and so on. The other thing—I alluded to this earlier—is that there has been an incredible effort in the health authorities operating on Vancouver Island to make sure that MAID is accessible.
It clearly has made a difference when you combine these two factors: the demography, socio-economic status and so on, and the availability of a very open, receptive and responsive MAID system.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thanks. I was asking that in conjunction with the 4% figure. It's not cause for concern is really what I'm getting at.
Senior Executive Advisor to the Deputy Minister, Department of Health
It's not at this point.
Look, there is variability across the country. We know that. Everybody knows that the rate in Quebec in terms of the whole province is considerably higher than that of Ontario and B.C. I think that if we saw a rapid spike to 7% across the whole country, which I don't anticipate but if we saw that, then I think it might be wise and prudent to look into that. We're not seeing that as a trend.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Fair enough.
Senator Kutcher asked a question that I was going to ask. It was about the percentage of cases in which there's a mental disorder involved as an overlay to the other diagnosis. I'm not sure we had the answer to that, but is getting the answer to that possible?
Senior Executive Advisor to the Deputy Minister, Department of Health
We can try, but I think we don't have good data on that under the current data collection system. It's more focused on the main underlying conditions. I'll defer to my colleague Jacquie Lemaire, if I may, Madam Chair, to just quickly respond to Mr. Maloney's question.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
I'll leave it this way. If it is available and if you could get it to us, that would be great.
Jacquie Lemaire Senior Policy Advisor, End-of-Life Care Unit, Strategic Policy Branch, Department of Health
I have a quick answer. It isn't. We do indicate where there are multiple comorbidities, but we don't break that down.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you. I'll stop there and turn it over to Dr. Fry.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you very much, James. I appreciate your generosity in allowing me to share this time.
There are a couple of things here. When you look at the Carter decision and what subsequently became Canadian legislation, now we're looking to see whether in fact things worked or didn't work. Do you have any idea, Ms. Hoffman, of what percentage of people who requested MAID were denied or what percentage of people requested MAID and then changed their minds? Do you have any data on that?
Senior Executive Advisor to the Deputy Minister, Department of Health
We do have data, and it's in the annual reports, Dr. Fry, so rather than my expanding on that data, I'm happy to follow up with the actual chart that shows you that information and how it's evolved over the life of MAID so far.
What I will tell you is that the number of requests that are declined is a smaller proportion than one might think. I'm sorry. I'm going off the top of my head here, but I think it's in the 15% to 17% range.
I will tell you that part of the reason for that is not that MAID practitioners are saying yes to everything. Part of it is that often the interaction that a person seeking MAID will have with a provider leads to a conversation about whether or not they are likely to be deemed eligible, and if they are not, they do not proceed with a formal request. Therefore, the refusals that I'm talking about, those numbers, are with respect to the formal written requests, which is a little bit different.
We also have detailed information about withdrawal of requests or requests that are approved but that do not lead to a MAID death. In many cases, it is because the person died before the procedure could be undertaken. There is a very small number—though not insignificant—of people who actually withdraw very close to the day or even on the day of their MAID request. They simply say, “I no longer wish to proceed.” There are also some in the middle who have received palliative care or other support who simply say, “I can carry on. I do not see that I need to pursue MAID right now.”