Thank you for inviting me.
As legislators—and I'm a legislator—we must ensure that legislation's protective role for the vulnerable is reinforced, not weakened, and that the state's duty of care is fulfilled equitably, as exercised via its clinical workforce.
Canada's physician-assisted suicide and euthanasia deaths show a disproportionately rapid increase, even compared to Benelux countries. Removing the foreseeable death requirement in effect creates death on demand. Evaluation of patients is purely subjective, and consultations have never been qualitatively evaluated. Doctors have an inherent power differential in a consultation. Offering lethal drugs as a therapeutic option gives the subliminal message that what lies ahead is so awful that you would be better off dead. Subconsciously, this may reflect unconscious bias or ignorance, shortcuts in care or cost-saving motives.
The so-called safeguards are only broad, qualifying criteria, rather than verifiable safeguards. For example, foreseeable death was incredibly loose, as prognostication is notoriously inaccurate. According to the Royal College of General Practitioners, prognosticating beyond a few days has a scope of error that can extend into years.
Doctors, by their very compassion, often fail to detect coercion. U.K. data reveals that one in five elderly people is affected by abuse, particularly financial abuse, and neglect in their own home. Similar situations seem to exist in other countries in the developed world. Mental capacity impairments and distorted thinking are features of mental illness, with or without concomitant physical disease. Most clinicians are inadequately trained or experienced in assessing capacity.
Hence, including mental illness undermines suicide prevention policies and discriminates against those with mental distress by signalling they don't warrant ongoing psychiatric care or are of less value in society. The emerging accounts of those in poverty who are opting for MAID suggest an abandonment of society's duty to care for this group of citizens, yet many who strongly wish for death at one time later enjoy life and contribute to society in many unpredicted ways.
The drug mixtures used to end life have never been scientifically evaluated. Propofol's duration of action is short, at five to 10 minutes, as it's rapidly distributed in the body, yet rocuronium has a very long duration of total paralysis, making it likely that some patients will have regained consciousness as they die of asphyxia but appear to the observer to be tranquil, as they cannot move a muscle to signal distress.
Good palliative care does not include MAID. In my written submission, I gave three definitions of palliative care. All emphasize improvement in the quality of life for patients, their families and carers, aiming to help people live well until they die.
Distress and suffering require meticulous diagnosis through working with the patient, particularly where distress is amplified by financial worries, loneliness, fear and hopelessness. Any improvement can often be obtained very rapidly. I can give you an example of a man who referred to overwhelming distress, with his wife and daughter both in tears. His pain and nausea were controlled within an hour. All three commented they never believed things could be so greatly improved.
Medical assistance in dying is a euphemism for physician-assisted suicide and euthanasia of those thought to be terminally ill. It cannot be applied when the previous requirement of foreseeable death has been abandoned, because those being given lethal drugs are not dying.
In summary, Canada would do well to abandon the current expansion of its MAID law, which is an existential threat to those with disability or mental illness. Canada should invest in adequate specialist palliative care and move the provision of lethal drugs outside of health care, with prospective evaluation of the application consultations, research into the cocktail of drugs used and research into the short- and long-term effects on the bereaved.
