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.
4:50 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you, Ms. Hoffman. I would appreciate your sending that graph to us, please. Send it to the clerk.
4:50 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
With regard to mental health as the only medical issue raised, I'd like to provide an example to demonstrate the difficulty we'll have in ruling on this issue. You can tell me what you think afterwards. In fact, I'm trying to find out if this is the main challenge.
I'll quote again from the Council of Canadian Academies report:
A particular challenge for some people who request [medical assistance in dying where a mental disorder is the sole underlying medical condition] is that their desire to die could be a symptom of their mental disorder. Suicidal ideation is a common symptom of some mental disorders, and some mental disorders can distort a person's thoughts and emotions, leading to a desire to die, hopelessness, and a negative view of the future. It may be difficult for a clinician to distinguish between a capable person who is making an autonomous decision for MAID MD‑SUMC and a person whose pathological desire to die is a symptom of their mental disorder that impairs their decision‑making.
When I read that, I say to myself that I'm looking forward to reading the report of the expert panel on this issue. We won't be able to spare them from appearing before our committee so that they can explain to us, among other things, how we can get out of this kind of difficulty.
What do you think?
4:55 p.m.
Senior Executive Advisor to the Deputy Minister, Department of Health
I agree absolutely. That is precisely what the panel has set out to do. These are undoubtedly complex and difficult decisions, but I think it is important not to enter into the discussion with, if I may use this word, “biases”. The fact of the matter is that an impulse to commit suicide manifests as a symptom of some mental illnesses, but the overwhelming majority of mental illnesses do not have suicidality as a symptom or a characteristic.
We need to be sure. Look, I shouldn't speak further about this. The experts on the panel, I'm sure, will be happy to meet fully with this committee. They can tell you more about the professional practice that lies behind the kind of point I have just made and other means to clinically assess a person relative to the MAID criteria, the eligibility criteria, and the safeguards that are in place today.
4:55 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
The suicidal state is known to be reversible, but according to the literature, the irremediable nature of the illness seems quite difficult to pin down, given the evolution of a mental illness or disorder in a particular individual and the different states they may present.
In short, there is a lot of work ahead of us, and I'm a bit anxious about the time we have to make decisions on this.
On another note, we were talking earlier about mature minors. There is very little data on MAID, which is now also available to mature minors in the Netherlands and Belgium. What protections are in place in these countries around requests for MAID for mature minors?
4:55 p.m.
Acting Senior Counsel, Department of Justice
I might be able to begin. Very quickly, I'd refer you again to the Council of Canadian Academies' report because it overviews those jurisdictions.
In the Netherlands, for instance—to your earlier question, Monsieur Thériault—if you're between 12 and 16, parental consent is required. If you're between 16 and 18, the parents must be consulted but they don't have a veto. I hope that answers your earlier question, but generally I'd refer you back to that report as a starting point.
4:55 p.m.
Senior Executive Advisor to the Deputy Minister, Department of Health
I'll add if I may, Madam Chair, that in some countries the person—
4:55 p.m.
Senior Executive Advisor to the Deputy Minister, Department of Health
I'm sorry. I was just going to note very quickly that in some of the Benelux countries the only minors who are eligible for an assisted death are those whose condition is terminal, so there would be no equivalent to our situation of people whose death is not reasonably foreseeable.
4:55 p.m.
The Joint Chair Hon. Yonah Martin
That is five minutes. Thank you.
The next five minutes will be Mr. MacGregor.
4:55 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much, Madam Joint Chair.
Maybe I'll turn to Ms. Banerjee and ESDC. What I would like to know, for persons who live with disabilities in Canada, from your viewpoint and the feedback that you receive serving this population, what's the main feedback you get in terms of the obstacles that are in their way for achieving real quality of life in Canada? Is there anything about which you can help inform the committee in our work on this very sensitive subject?
5 p.m.
Director, Office for Disability Issues, Employment and Social Development Canada
Like I said, we've been doing more engagement more generally on disability inclusion rather than MAID specifically, and we also have relationships with a number of stakeholders. Certainly financial security is a concern and the impacts that the pandemic has had on persons with disabilities is a concern, and all of this is serving to inform the work that we're doing on a disability inclusion action plan.
They also talk about barriers and obstacles, whether they're attitudinal or physical, so we're taking all of these into account in going forward with the disability inclusion action plan and in terms of developing the Canada disability benefit that was announced in the 2020 Speech from the Throne.
5 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
In trying to achieve inclusion, do you think the responses lean more heavily towards financial security, or is it in general supports that are available, whether that be access to services, mobility access and so on? Can you illuminate that a little bit more?
5 p.m.
Director, Office for Disability Issues, Employment and Social Development Canada
I think the overwhelming concerns that have been raised have been with respect to financial security and employment, so very heavily weighted on that. Certainly, in more general terms, access to programs has been raised and just ensuring that anything that we do federally, whether it's a disability benefit or other, has an overall beneficial impact on persons with disabilities so that they don't lose other supports that they may be eligible for.
5 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much.
Ms. Hoffman, on the subject of palliative care, in Health Canada's 2019 action plan on that subject, one of the goals is to foster improved access for underserved populations. Do we have an idea of what that gap is currently? How much more is required so that Canadians, no matter what part of the country they reside in, have fair and equitable access to palliative care? Do you have an idea of the timeline that will be needed to achieve those goals and of how much more funding we need to earmark to ensure that it's a reality?
5 p.m.
Senior Executive Advisor to the Deputy Minister, Department of Health
I don't think I could respond, Mr. MacGregor, with real data that says here's the actual gap. We know that there are gaps very significantly when it comes to the provision of palliative care in people's own homes, when people are needing palliative care but their situation is not such that they need to be hospitalized. We are also taking a bit of a sectoral approach through various initiatives and projects and money that we received in budget 2021 that are all designed to deal with some of those gaps that were identified in the action plan.
With respect to underserved populations, not surprisingly, indigenous communities are significantly underserved. There was a special allotment of money near the beginning of the initiative aimed at this specifically. We work with Indigenous Services Canada and indigenous groups to find the best ways to allocate that money, but those are not decisions taken so much by us. They are more done in conjunction with the communities and ISC.
On the data that you're looking for, I can ask my colleagues if we can speak to that, but I think the gap is not documented in the detail that would be great to have and that you're requesting. I don't think we have it.
I'm looking to my colleagues to see if anyone wants to answer that or to add anything.
5 p.m.
Venetia Lawless Manager, End-of-Life Care Unit, Strategic Policy Branch, Department of Health
I would agree with that. We don't have the data on the size of the gap. We do know that it is large. We're working with provinces and territories and partners to see how we can fill those gaps together.
5 p.m.
Conservative
The Joint Chair Conservative Michael Barrett
Folks, we have 11 minutes remaining and we have 12 minutes of question time left for our senators, so we'll be strict with our time.
We'll begin a three-minute round with Senator Mégie.
5:05 p.m.
Senator, Quebec (Rougemont), ISG
Thank you, Mr. Chair.
I'd like to address the issue of mental illness.
There's often a link between mental illness and social inequality. What safeguards have other countries put in place for people with mental illness?
Can the federal government invest in improving access to support services for people with mental health issues? This could help these individuals make their way through the process before they apply for medical assistance in dying.
I don't know which of the witnesses can answer these questions.
5:05 p.m.
Senior Executive Advisor to the Deputy Minister, Department of Health
Senator, maybe I can start by saying that we know that the panel has looked very closely at measures taken in other jurisdictions when it comes to safeguards for dealing with cases involving mental illness. Rather than my trying to speculate on what the panel will say in their report, I would ask that you wait for the report and the opportunity to question the leaders of the panel.