Medical Assistance in Dying Committee on Oct. 18th, 2022

[Dr. David Henderson]

Thank you very much.

In my experience, the majority of people we see requesting MAID are often well educated. I haven't seen very many people who have a lot of physical symptoms, so existential distress certainly is something, but more and more I'm seeing people who want that personal autonomy to choose their time. They want to have a time when families can come and be present, and they look at it almost like planning a vacation versus planning their death. It sounds strange but it is strange when you experience some of that.

My concern is that there's a proportion of health care professionals in this country and a proportion of the population who are really looking at having autonomy in the sense that this needs to be available for absolutely everybody. I'm not saying it shouldn't be, but before we push it that far, we have to remember that there are people who don't live a life of autonomy. They've been struggling with financial difficulties; they're responsible to other people, or other people are caring for them, so already they don't get to make a lot of their own life choices. That doesn't mean they shouldn't have this choice, but do they perceive it as truly a choice? That's the challenge and the struggle there.

That's why I'm so concerned that we need to be extremely careful with this. I don't think we've had the proper checks and balances in place. I know we've heard various concerns across the country, and I never hear of any follow-up on those cases.

A colleague of mine gave an example. For any of us to prescribe an opioid, there are provincial bodies that now monitor our prescriptions, and if a patient of mine gets a prescription for an opioid from two other physicians, I get a letter saying that this patient has done this. We're trying to make sure that the person's not using opioids inappropriately. Does anybody get a letter about a patient who has had MAID or a physician who's done a large number of cases?

[Luc Thériault, Bloc, Montcalm, QC]

I'm sorry to interrupt you, Dr. Henderson, but I don't have much time left.

[The Joint Chair, Hon. Yonah Martin]

Yes, you have 30 seconds.

[Luc Thériault, Bloc, Montcalm, QC]

You'll agree with me that personal autonomy can't be reduced to economic or social autonomy.

When we talk about a person's dignity, we're referring to their ability to make a choice. Therefore, we must not take away their ability to choose between continuing with palliative care and getting support until death. People don't suddenly decide to request medical assistance in dying.

[The Joint Chair, Hon. Yonah Martin]

Thank you very much.

Next we'll have Mr. MacGregor for four minutes.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you, Madam Co-Chair.

Dr. Henderson, I'd like to start with you. I had the opportunity to visit your beautiful province in September, and while I was there I had the opportunity to meet with some members of the legislative assembly of Nova Scotia to talk about the intersection between the federal government and the provincial government specifically on health care.

One of the things they mentioned to me was that the current funding formula is not working very well for Nova Scotia because your demographics tend to lean heavily towards the elderly end of the spectrum. Of course, the complex care needs and the palliative care needs are, per capita, a bit more of a burden for the Province of Nova Scotia to bear.

You have identified how health care in Canada is in crisis. In my province of British Columbia, particularly on Vancouver Island, we do have a fairly high population of retirees as well. With what I've heard from the MLAs, do you have anything to add, from your perspective of having practised, on how that federal-provincial partnership is going?

[Dr. David Henderson]

It certainly comes down to the dollars and cents of it. I've been involved in this at the national level enough to know—and we've tried as a group to bring together the provincial governments and the federal government because politics often gets in the way of doing the right thing. I'm not the right guy to say how money should be divvied up and such, but I think we need to have a really serious look at how we're delivering health care.

The issue of caregivers was brought up earlier. I think that for our health care system to survive the next few years, we're going to have to look at how we can compensate our caregivers, because we're not producing enough professionals and allied health people to be able to carry the load.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

I appreciate it. Thank you.

I'm just going to take note of the time here.

In my final couple of minutes, Dr. Li, I would like to turn my next question to you.

In your opening remarks, you really made it a point of underlining the psychological suffering part of it. Certainly we've heard a number of other witnesses talk about the same.

We have also had witnesses here, and I've had a doctor from my own riding. We've had a representative from a company that is involved in psilocybin and psilocybin-assisted therapy because that is involved in trying to help patients in end-of-life care come to terms with that existential crisis, that psychological suffering.

Are you aware of some of the research that's been going on? Do you have any comments on that? Would you like to see the federal government invest in more research in this area as a possibility that it might assist patients with the quality of their care?

[Dr. Madeline Li]

Thank you for that question. I have lots of opinions around this.

Absolutely, I would like to see more funding for psychedelic research, for psychosocial research in general—and psychedelics are a part of that. I would be wrong to turn that down, because I am running a.... I've just submitted to CIHR for funding for a study on psilocybin in cancer and palliative care, so I certainly think that research needs to be done.

I want to give a caveat, which is that it's not going to be the panacea or antidote to MAID in any way. I finished a clinical trial looking at ketamine, another type of psychedelic, in palliative care, and I published a paper of a case series of three patients, and what—

[The Joint Chair, Hon. Yonah Martin]

Thank you, Dr. Li.

[Dr. Madeline Li]

It doesn't necessarily change a patient's mind.

[The Joint Chair, Hon. Yonah Martin]

Thank you. Sorry, but I think we need to just quickly receive—

I see Gary's hand. It's probably related to the same matter.

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

Yes. We see that the bells are ringing, Madam Chair. I'm wondering if we could all agree to continue the meeting for another 15 minutes to conclude with the senator's interventions.

[The Joint Chair, Hon. Yonah Martin]

Is there unanimous consent?

[Some hon. members]

Agreed.

[The Joint Chair, Hon. Yonah Martin]

Thank you, Mr. Anandasangaree.

I will now turn this over to my co-chair for questions from the senators.

[The Joint Chair, Hon. Yonah Martin]

Thank you very much.

We'll begin with Senator Mégie for three minutes.

[Marie-Françoise Mégie]

Thank you, Mr. Chair.

My question is for Dr. Henderson.

Dr. Henderson, in an interview you gave, you said that many people fear palliative care. They believe that if they're admitted to palliative care, they will die faster.

What do you say to those individuals?

I'm going to quickly ask the next question so that you can answer me within two minutes.

In your opinion, what role can the federal government play in addressing the general public's lack of knowledge about palliative care?

[Dr. David Henderson]

That's a great point.

We actually said, when MAID was initially coming along, that there needed to be a national education campaign on palliative care, helping people understand what palliative care is, but then also what MAID is too, so that the public would be aware that this was actually available, which could help us reduce the risk of coercion. If the public knows that it's available, then they ask us. Right now we rely on them making a suggestion that there's something...or that life is intolerable, and then we will say, “You know that this is legal,” and we discuss it further.

With palliative care, patients are still afraid to this day that we're going to get involved and that they're going to die sooner. We try to reassure people that we actually discharge people from our program all the time. People will come on our program. We'll help them address their physical symptoms, help them start working through some of their psychosocial issues, and help make sure they have addressed things such as advance care directives and things like that.

If they're doing really well, then we step back and they continue on with their primary care people, plus their oncologist or whomever. Then we're able to get involved again when necessary. Reaffirming that with patients and families helps to reassure them that we're not there for just the last days and hours of life.

[Marie-Françoise Mégie]

Thank you, Dr. Henderson.

[The Joint Chair, Hon. Yonah Martin]

Thank you.

We will now go to Senator Kutcher for three minutes.

[Stanley Kutcher]

Thank you very much, Mr. Chair.

Thank you to the witnesses.

I have two questions.

The first one is to both Dr. Henderson and Dr. Li. The second one is to Baroness Finlay. I'll ask them together, and then ask you to respond.

Dr. Henderson and Dr. Li, in your opinion, how could the federal government nudge provinces and territories to provide better quality palliative care to those who require it? That's the first question.

Baroness Finlay, has the National Health Service substantially improved palliative care in the U.K. over the last few years? Compared to Canada, what percentage of people in the U.K. have rapid access to quality palliative care?

Dr. Li and Dr. Henderson can go first, if you don't mind, please.

[Dr. Madeline Li]

I'm happy to answer that.

As I said in my statement, I think what has been missing in better quality palliative care is a focus on psychosocial care, because that's what underlies existential distress, which is what psychosocial care addresses. It's what underlies the request for MAID. I think there has not been enough attention, so there needs to be more investment in research and the delivery of end-of-life psychotherapies, such as CALM or dignity therapy or meaning-centred psychotherapy. They exist, but they're not disseminated, and additional research needs to be done on the dissemination.

[Dr. David Henderson]

I agree 100%. I think the federal government could pass down some words of recommendation to our professional colleges. I'll pick on the colleges for social work nationally as they tend not to do any specialized training at all. There's a great place and such a great need, and the social workers, in their training, could be learning more about things like dignity therapy. We tend to have to teach all the social workers a lot of this stuff when they come out before they start working in palliative care, because they don't get their core competencies in palliative care during their training programs.

Canada has done a really good job of looking at core competencies for social work, for primary-care physicians, for nurses, for almost everybody in the country. There's a national document that talks about that. Nova Scotia and British Columbia have produced their own provincial documents on competencies in palliative care for virtually all health care professionals. Those competencies need to be integrated within the professional schools so people have the skill sets to be able to deal with this.

[The Joint Chair, Hon. Yonah Martin]

Thank you.

Baroness, you have about 20 seconds for your comment.