Medical Assistance in Dying Committee on April 13th, 2022

[The Joint Chair, Conservative, Michael Barrett]

You have one minute and 30 seconds remaining, Senator. Are you going to yield the time or continue?

[Marie-Françoise Mégie]

I'll give the floor to one of my colleagues.

[The Joint Chair, Conservative, Michael Barrett]

Thank you, Senator.

We'll move to Senator Kutcher for three minutes, please.

[Stanley Kutcher]

Thank you very much, Chair.

Ms. Hoffman, you mentioned earlier in the discussion that consensus around MAID has not been a phenomenon all the way through this process. Is there any way you could give us some idea of the numbers or the proportion of medical practitioners, let's say when Bill C-14 came into place, who were comfortable with and supported MAID, and then the percentage of those who didn't? In the palliative care community, what was that proportion when MAID was first introduced? Has that changed? Has there been a change in the consensus over time?

[Abby Hoffman]

First of all, I think when MAID first came in there was a small critical mass of providers who were ready to proceed. There were individuals who had done everything but assisted dying with their patients at the end of life and they were ready to proceed, but fairly quickly we got to the point where there are close to 1,500 providers now and assessors. Not all of them are doing numerous cases. Some are doing relatively few cases.

I can tell you that going back to the outset surveys that were done by the Canadian Medical Association, for example, their own community indicated not unanimity in favour of MAID, but relatively high support for MAID and the willingness to be a MAID assessor or provider. Those are not exactly the same things.

What I think we've seen is an increase in receptivity to MAID, generally, and an increase in the number of individuals who are prepared to take on MAID assessment and provision functions. We know that there is going to be I think a pause, shall we call it, as providers start to receive these so-called track-two cases, which some may give serious consideration. It could be partly because they have some reservations about providing an assisted death to someone who's not dying. It may equally be because they know a particular specialized skill set is required and unless they want to become a kind of specialist MAID practitioner this may be a route they don't want to go.

That's why I mentioned earlier that we've already seen a trend of some practitioners doing more cases and we expect that it is going to be a significant place for growth into the future. I can't tell you exactly how many were agreed and how many were opposed. I think people's views change over time, and that has happened in the medical community. We have seen that.

[Stanley Kutcher]

Thank you very much.

[The Joint Chair, Conservative, Michael Barrett]

Thank you, Senator.

Thank you, Ms. Hoffman.

We'll hear from Senator Dalphond. You have three minutes, please.

[Pierre Dalphond]

Thank you, Mr. Chair.

Ms. Hoffman, I understand the right to self‑determination. I also understand that there are situations where people with mental illness can be assessed on a case‑by‑case basis.

However, in terms of general policy, don't you think it would be more acceptable to Canadians if this change were accompanied by an additional infusion of public funds into mental health treatment? During the pandemic, we saw that resources were woefully inadequate in this area.

[Abby Hoffman]

I think as a general matter, clearly when it's widely recognized that there is an area where that the services are not sufficient, it would make sense to have more services available and for those services to be better resourced.

Let me just note, though, that when we're talking about MAID in cases in which the sole underlying medical condition is a mental illness, these are likely going to be cases that have not responded to treatment. If you look even at the regime that is in place now for cases in which the person's death is not reasonably foreseeable, and then you think about what you will hear, inevitably, from the expert panel about additional safeguards, I think what you'll start to see is a picture of access to MAID for people who have a significant mental illness and there's been an extensive review of all of the treatments and supports and interventions over a long period of time.

These are more likely going to be individuals who might be considered for MAID who have had the benefit of an extensive interaction with psychiatric care modalities. These are not the people for whom all of a sudden some newly diagnosed bipolar disorder or something like that appears, and a month later they show up on the doorstep of a MAID practitioner with a request for MAID.

Anyway, the expert panel will talk in their expert fashion—not my vernacular version—and will describe all of this. I think these are related issues, but they are somewhat different issues: the general availability of mental health and wellness services and the situation and the access to treatment for someone with mental illness who gets to the point where they're seeking MAID.

[Pierre Dalphond]

Thank you.

[The Joint Chair, Conservative, Michael Barrett]

Thank you, Senator.

Senator Martin, you have three minutes. Please go ahead.

[The Joint Chair, Hon. Yonah Martin]

Thank you, Mr. Vice-Chair.

I have one question for you, Ms. Hoffman. In regard to palliative care, we did hear witnesses—I'm a British Columbian—regarding not a competition for funds but that sometimes funds were being directed for MAID that perhaps should have also been made available to palliative care. There's a bit of a competition for funding.

My question goes back to what Mr. Barrett asked. Is it possible for the federal government to be in touch with the provinces to find out exactly what is being spent on palliative care versus MAID? Is that information something that we could ask you to come back to us with or to send to our committee?

[Abby Hoffman]

If I may, Senator Martin, I'll ask Venetia Lawless to respond to that question.

[Venetia Lawless]

Thank you.

If you're referring to the common statement of principles bilateral agreements funding, we do have a broad-strokes understanding of how much is being spent on palliative care through the action plans that they have agreed to. Those are all public documents. It's hard to pin down exact amounts of money. For example, in Ontario the money came in and ended up merged into a pot of their full home and community palliative care expenditures. It includes their own provincial funds. There's a lot of crossover.

We don't have exact numbers, but we can certainly get broad strokes of how much money is being spent on the palliative care envelope for that allocation. We would follow up and provide it to you.

[The Joint Chair, Hon. Yonah Martin]

That would be helpful. I guess it's about the accuracy and transparency as much as possible, so that we know that palliative care is not having to compete in any way or that funding is lost as a result of increased MAID.

Thank you very much, Mr. Vice-Chair.

At this time, as a committee we'd like to thank all of the officials who made presentations and answered our questions today. We wish we could have many more hours with you, but for today, thank you very much.

[Abby Hoffman]

Thank you, Madam Chair.

[Jay Potter]

Thank you very much, Madam Chair.

[Mausumi Banerjee]

Thank you very much.

[The Joint Chair, Hon. Yonah Martin]

Members, before we move to the request from Mr. Anandasangaree to have a discussion in the final 15 minutes of our committee meeting, I want to remind you to submit your list of suggested witnesses to the joint clerks by tomorrow at 4 p.m., Eastern Time. It doesn't give us much time, but I know that we've all been working on these lists already. The clerks and analysts will review and compile the list of witnesses for the committee's consideration. Again, tomorrow's deadline is 4 p.m., Eastern Time.

I will now invite Mr. Anandasangaree to bring to us the item that we had agreed to look at in these final 15 minutes.

[Gary Anandasangaree, Liberal, Scarborough—Rouge Park, ON]

Thank you, Madam Chair.

Thank you, colleagues, for the indulgence.

Given the short nature of the time we have in order to complete this study and table it by June 23, I think it would be important to have a subcommittee meeting where the witnesses could be both finalized and prioritized, and we could have some agreement on the number of meetings and the availability of House resources for those meetings.

I'm proposing, and I don't know if this needs to be a formal motion, that we have a subcommittee meeting next Wednesday, April 20, from 1:30 to 3:30 to discuss the matter. Then I believe the House availability for the meeting would be on Monday, April 25. At that meeting we could submit the report and have it approved by members and continue with our witnesses.

I just wanted to canvass people on how they felt about this. A deeper dive could take place on Wednesday so that we could actually hammer out the work plan for the next few weeks.

[The Joint Chair, Hon. Yonah Martin]

Thank you.

The motion is for the subcommittee to meet next Wednesday, April 20, at, did you say, 11:30 a.m.?

[Gary Anandasangaree, Liberal, Scarborough—Rouge Park, ON]

It's 1:30 to 3:30.

[The Joint Chair, Hon. Yonah Martin]

Are there any questions or comments before we ask for consent? Seeing none, I think that is approved.

We will have a subcommittee meeting next week on April 20.

For that subcommittee meeting, I'm just wondering. Did we get the nomination of the additional Liberal member to sit on the subcommittee? We can also confirm from the Senate that we have agreed on Senator Kutcher being a part of the subcommittee. Do we know which additional Liberal member will be part of the subcommittee?

[Gary Anandasangaree, Liberal, Scarborough—Rouge Park, ON]

I would be prepared to serve, Madam Chair, if the committee wishes.

[The Joint Chair, Hon. Yonah Martin]

Okay. Is there such a motion, or acceptance of the offer?