Medical Assistance in Dying Committee on April 13th, 2022

[The Joint Chair, Conservative, Michael Barrett]

You have 30 seconds.

[Abby Hoffman]

Senator, the implication of your question is correct. We have information about whether the individual has had palliative care, but the extent of that care is not well documented. It is the case in many parts of the country—in most parts of the country, in fact—that there are time limits on palliative care in terms of the amount of care one can get and the proximity to death one anticipates, and so on.

Insofar as this committee is looking at the state of palliative care in Canada in general, lots of positive developments have happened, but what remains is that 1% of specialists are palliative care specialists. That's a very small number. Resources are growing at this point, but not sufficiently to meet what should be a legitimate demand. I think those are fair conclusions.

[The Joint Chair, Conservative, Michael Barrett]

Thank you, Ms. Hoffman.

Next, for four minutes, we have Senator Kutcher, please.

[Stanley Kutcher]

Thank you very much, Mr. Chair.

I have a clarification for Ms. Hoffman and then a question for Ms. Banerjee.

To date there has not been a nationally accredited program for MAID providers. I just want to make sure I understand this.

[Abby Hoffman]

That's correct.

[Stanley Kutcher]

Since the development of Bill C-7, there is currently an accredited training program under development. The purpose of it is to enhance the quality and standardization of MAID assessment and delivery. My understanding is that the accreditation will be by the most responsible national medical organization, such as the Royal College of Physicians and Surgeons. Thus, it will become a national standard, which is similar to how all medical practitioners are currently accredited. If you're a psychiatrist, a gastroenterologist or a palliative care specialist, it's the same kind of level of accreditation.

It is not the purview of provinces and territories to accredit; it's the purview of the national medical organizations to accredit, as they do for all specialists. Regulatory bodies such as colleges of physicians and surgeons in provinces and territories can, at their discretion, should they choose to do so, require that MAID practitioners be accredited. Is that correct?

[Abby Hoffman]

That is very well expressed, Senator Kutcher, yes.

[Stanley Kutcher]

All right, thank you. Maybe the record can show that.

This question is for Ms. Banerjee.

What proportion of individuals who have received MAID to date in Canada have had MAID provided solely on the basis of a disability? If you don't have that data at your fingertips, could you find that out for us, please?

Could you also find out, for other jurisdictions such as the Benelux countries, Switzerland and Washington and Oregon states, what those proportions would be—the number or proportion of people who had solely a disability and received MAID?

[Mausumi Banerjee]

I will definitely follow up on that question as well to see what numbers we have available.

[Stanley Kutcher]

Great. Thank you very much for that. It would be very appreciated.

I will cede the rest of my time to my colleague Pierre Dalphond, who is much more erudite and astute than I am.

[The Joint Chair, Conservative, Michael Barrett]

Thank you, Senator Kutcher.

We'll move to Senator Dalphond for four minutes, please.

[Pierre Dalphond]

Thank you. Thank you, Stan.

My question is for Ms. Hoffman.

You referred to the fact that the health department report of the year 2020-21 will be released only after we have our report in, because we have a deadline coming this June. Is it possible for the department to send out a kind of draft or outline of what the report will be, or some rough data that has not been processed, in order for the committee to get access to this kind of critical information?

[Abby Hoffman]

Senator, we'll see what we can do. Just as I spoke last year about the 2020 data before it was published, we'll see what we can provide you with. We just want to be sure that we are not providing you with data that has not been properly and fully verified and then you ultimately include some data that's not correct. We will be happy to work with the committee to respond to your very reasonable request.

[Pierre Dalphond]

I assume that 95% of the report will be accurate, so you can have a big caveat on the first page, and we'll rely on the 95%.

I'd like to ask you another question.

The Quebec National Assembly is likely to pass an amendment to its law on the provision of health services to ban MAID for people suffering solely from mental illness. This is a decision that was made following a report produced by a Quebec group.

If a province ever decides to go in this direction, does the government have a strategy to see—

[The Joint Chair, Conservative, Michael Barrett]

Excuse me, Senator Dalphond, and I've stopped the time there. Could you lower the boom on your microphone, please, for the interpreters?

[Pierre Dalphond]

Thank you.

In December 2021, a special committee of the Quebec National Assembly recommended that MAID not be made accessible to people for mental illness alone. I know that's something the committee will have to decide on. We look forward to the report of the ad hoc committee of experts that was formed last year.

Should access to MAID be extended to mental illness, how do you see working with the provinces? Without the co‑operation of the provinces, services cannot be provided.

[Abby Hoffman]

That's absolutely right. A province could decide that it wishes to proceed with a regime that is more restrictive than that of the federal government. Depending on the nature of that more restrictive regime, that jurisdiction could be subject to legal challenge. I don't want to say that this is akin to the case of Truchon and Gladu, because that challenged the regime in both Quebec and Canada, but that risk certainly is there.

I think on the more positive side, shall we say, we have been and we will continue to be discussing this, and when the report of the expert panel is out, there will be extensive discussions with provinces and territories, as well as conversations going on among the clinician organizations, about how best to implement the recommendations that we expect the panel will make and that you will see as the next part of your work.

[The Joint Chair, Conservative, Michael Barrett]

You have 30 seconds.

[Pierre Dalphond]

Thank you. I'm done.

[The Joint Chair, Conservative, Michael Barrett]

Thank you, Senator.

We'll go to Senator Martin for three minutes, please.

[The Joint Chair, Hon. Yonah Martin]

Thank you, Mr. Co-Chair.

My question is also again for Ms. Hoffman. It's regarding the indigenous communities in Canada. One of the most compelling witnesses we had at the Senate was a leader of the Dene Nation who spoke about the word “suicide” not even being in their language, he said, for a very long time, 300 years, which gives us the perspective from which he comes.

Are any consultations with the indigenous communities being done ahead of MAID being open to those who suffer from mental disorder as a sole underlying medical condition?

[Abby Hoffman]

Perhaps I can respond to that.

I think it probably makes sense to start by acknowledging that there have not been the consultations that are required with indigenous communities. I am not referring to indigenous people as one single population bloc; obviously the distinctions-based approach that's now conventional needs to be pursued in this particular case.

At Health Canada we are now in the process of working with representatives and stakeholders in indigenous communities to try to figure out what sorts of consultation activities would make sense. This may pertain to the recommendations that come from the panel on MAID and mental illness, but they also apply much more generally to MAID in Canada.

Just as an example, there's the training and accreditation program for MAID providers that I've mentioned a couple of times and that is being managed and supported by us. It will be very important that there will be dialogue with representatives of indigenous communities about how any of those modules that are being developed need to incorporate a cultural safety and awareness dimension so that any practitioners, whether they are indigenous practitioners or non-indigenous practitioners, can proceed with the appropriate sensitivity and awareness of concerns from the indigenous community.

I will also say that we need to bear in mind, as we've heard many times, that even in groups in which there is significant indigenous representation—

[The Joint Chair, Conservative, Michael Barrett]

You have 30 seconds.

[Abby Hoffman]

—no single indigenous person can speak for the entirety of their community, and certainly not for all indigenous people. The question is this: How can people be sensitized so that they are aware of the kinds of considerations that should be introduced into a conversation about MAID or the practice of MAID when indigenous people are involved?

That is a process that we're engaged in right now. We will support whatever process the indigenous spokespersons say they want to pursue. If they want to have us involved, we will be. If they don't, we will not.

[The Joint Chair, Conservative, Michael Barrett]

Thank you, Madam. That's your time, Senator.