Evidence of meeting #20 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 research.
A video is available from Parliament.
6:55 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
No, there is actually an increasing number of studies on access to palliative care. As some of my colleagues have said in this hour, it depends on your postal code. It depends on your own knowledge—
6:55 p.m.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
I think my time is just about to expire, so Dr. Gallagher, could you provide the committee with any additional data that could shed light on the issue of access?
7 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
Yes, I certainly could. There are a number of studies I can send.
7 p.m.
The Joint Chair Hon. Yonah Martin
Thank you very much.
Next we'll have Mr. Maloney.
You have five minutes.
October 18th, 2022 / 7 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you, Madam Chair.
Thank you to all of the witnesses for being here today. Your presentations have been very helpful.
I'm going to start by addressing my questions to The Dorothy Ley Hospice. For full disclosure to fellow committee members, The Dorothy Ley Hospice is located in Toronto, in Etobicoke, in my community, so I'm very familiar with the good work they do and I want thank them for that. Because of that, I had occasion to participate in a Zoom call hosted by Dorothy Ley a few months ago—I believe it was in July—during which they invited people to come out and outlined the process involved in MAID with some statistics.
Many things struck me that evening, but one landed the most. The doctor who was doing the presentation suggested that when MAID was first legalized, none of the doctors—I believe it was 12—at Dorothy Ley wanted to be involved in the MAID process. Now that number has changed and the number is, I think, six or more. If I am correct on that, I would like to hear your explanation of why that is.
7 p.m.
Executive Director, The Dorothy Ley Hospice
Thank you so much, Mr. Maloney, for highlighting that.
Since 2016, we've seen a substantial change. We've just completed a review of not only our palliative care physicians but all of our staff in terms of their perceptions and thoughts about MAID. About 70% of our physicians have changed their perspective, and the reason for that, as they've stated, is that MAID has become more commonplace and people are more accepting of it.
They've seen that MAID can be one of the options in their tool kit as it relates to palliative care. When all other options for comfort, symptom management and relieving distress and suffering fail and the individual is still suffering and still asking for other solutions, they would never offer MAID, but if the individual brings up MAID, they have those conversations with them and exhaust that option for them. I think they have changed and evolved to consider MAID as one option in the tool box of options that exist for palliative care versus seeing MAID as something separate and distinct from palliative care.
7 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
There's been some evidence before this committee that it's an either/or situation—it's MAID or palliative care. If I understand you correctly, the doctors at your facility have come to the conclusion that it's part of the process; it's not an alternative.
7 p.m.
Executive Director, The Dorothy Ley Hospice
Absolutely. It's just one option; it's not a substitute for all the other palliative care options that exist.
In our experience working with individuals who are thinking about or requesting MAID, it is an informed choice and informed decision they're making. What our palliative care team does is talk to the individuals and families about what their choices are, why they are making this choice, what's driving it, what their fear is and what their concern is. They talk to them about all the options that might exist to address them. Then at the end of the day, if MAID is still something they wish to choose, they will support them in that.
In the process, MAID is one aspect of palliative care, but it has to be an informed choice and individuals need to understand that there are other options available to them. If after all that they still wish to proceed with MAID, then I think that's something we would support.
7 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay.
Palliative care is funded through the province. All of us here agree that there's a severe lack of palliative care. Because MAID is available, should it be restricted in some way or limited because of the lack of provincial funding?
I'll put that out to all the witnesses.
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
I'll take it on.
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
I'd like to make the point—and I think my colleague from Dorothy Ley also made it—that a person who has to choose between MAID and no funding doesn't have a choice. We've had several episodes like that in B.C. People could not get access to round-the-clock care, so they could not stay in their community and were offered either a transfer out of their community or MAID.
7:05 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
I'm sorry, but my question really was this: Should MAID not be available because of lack of provincial funding—
7:05 p.m.
The Joint Chair Hon. Yonah Martin
I'm sorry, but we're out of time. Thank you.
Next we'll go to Monsieur Thériault for five minutes.
7:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you very much, Madam Chair.
Dr. Gallagher, do you provide palliative sedation?
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
Do I use palliative sedation?
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
Yes, I do.
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
No, I do not. I should tell you that I've been retired clinically since 2019, but when I was practising I did not provide MAID.
7:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you.
In your opinion, how is it morally more acceptable to provide palliative sedation than medical assistance in dying?
7:05 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, Canadian Society of Palliative Care Physicians
I'm not making a statement about morality. I provided palliative sedation very rarely, mostly for people with delirium at the end of life, because it is very difficult to keep a person comfortable and in their bed and calm if they do not have some degree of sedation. The use of sedation is not to end the life of the person; it is to make them more calm and make their symptoms more controllable. They are not the same.
7:05 p.m.
Bloc