Evidence of meeting #21 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 disease.
A video is available from Parliament.
10:10 a.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Right. Thank you.
Ms. Guillemette, do you have anything to add in relation to those comments on advance requests?
10:10 a.m.
Member for Roberval, Government of Quebec
What is important is individual self-determination.
We spent a lot of time discussing individual self-determination and, as Dr. Gauthier was saying, it is possible at present to give advance directives. However, an advance directive for medical assistance in dying is another thing.
I think that falls on a continuum of palliative care. A person can be receiving palliative care and request medical assistance in dying. Here in Quebec, we have...
10:10 a.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
I'm sorry, but my speaking time is up.
Thank you both very much.
10:10 a.m.
The Joint Chair Hon. Yonah Martin
Thank you very much.
Next we will go to Monsieur Thériault. You have five minutes.
10:10 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Madam Chair, before the countdown on my speaking time starts, I have a point of order.
I would like Ms. Guillemette to clarify something for me.
In the notice of meeting, it says that she represents the Government of Quebec. I would simply like to know whether she is here as the chair of the Select Committee on the Evolution of the Act respecting end-of-life care or, in fact, as a representative of the Government of Quebec, because that changes everything.
If we want to hear a representative of the Government of Quebec who is authorized for that purpose, we will do that later. If I understand correctly, she is here today as a representative of the Government of Quebec.
Can we clarify that now? We should perhaps have done that before the meeting. I just want to know whether that is indeed the case.
10:15 a.m.
Member for Roberval, Government of Quebec
I was mandated to appear here as a representative of the Government of Quebec. However, I was also the chair of the Select Committee on the Evolution of the Act respecting end-of-life care.
10:15 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Right. Thank you very much.
You understand, Ms. Guillemette, that I make a distinction between a government and the legislative process, which you participated in and which you also chaired.
Dr. Gauthier, with respect to Bill C-7, I had asked you earlier at what point, and up to what point, a patient could be considered to be capable of making an advance request. My colleague also asked you the question. At that time, you told me about stages 3 and 4.
Is your answer the same now?
10:15 a.m.
Emeritus Professor, As an Individual
Thank you for the question.
Actually, we avoid using numbers, because the nomenclature relating to the stages of Alzheimer disease is in the process of being changed. There are now six, three of which precede the stage of dementia. For that reason, I suggest that you not use numbers at this time.
The most important thing is to use the tools already in place. A person is capable up to the time when they are declared incapable by the court, based on a medical assessment report and a psychosocial assessment report, and...
10:15 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Right.
I followed the work done on the subject in Quebec City, and a lot of questions turned on what was called "contemporary suffering", "happy dementia".
What do you think about that?
With respect to the condition of the brain, I imagine that when a person has reached those stages, it can't be very easy to deal with it. It is referred to as an irreversible condition.
10:15 a.m.
Emeritus Professor, As an Individual
Thank you for the question.
That is correct. In order for committee members to clearly understand what we are talking about, I would point out that this is a stage of dementia where people are generally already incapable. They are then living in a protected environment which is ordinarily an institution, in our culture. In addition, their interaction with their environment seems to be happy.
The purpose of my comments is this. If the person had chosen prior to that precise stage to receive medical assistance in dying, there would be no hesitation on the part of the trusted person who had been designated to represent them, that is, the third person, or on the part of the clinical team.
10:15 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
So there would be no questions. On the other hand, for people who are wondering, could we say that essentially, everything depends on the third person? At some point, that person has to ask the care team to start the assessment process. That does not mean that the care team is necessarily going to agree and proceed with the assessment, but it all depends on the examination process being initiated at the request of the third person.
However, if the third person, as third person, is not concerned about the patient's condition because they personally believe that the patient may still be experiencing happy interaction, at that time, that is not a problem.
10:15 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
It is really quite important to emphasize the third person. In this process, which seems to me to be fundamental, it will be the solemn occasion when all these arrangements will be made.
Do you agree with me on that?
10:15 a.m.
Emeritus Professor, As an Individual
I agree on that.
As a recommendation to the committee and to the provincial committees that will have to make it all operational later, I would say that the importance of informing the third person or the caregiver of the stages of the disease must be stressed.
The third person or caregiver, together with the person who has the disease, if possible, has to decide the stage of the disease at which they both agree that when the time comes, the third person will be comfortable saying that it is the appropriate time, that it is the time the person who has the disease would have chosen for receiving medical assistance in dying.
10:20 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
A person could say that they would like medical assistance in dying to be given when they have reached the severe stage. That can also be possible.
Is that correct?
10:20 a.m.
Emeritus Professor, As an Individual
That is correct.
I think it is even easier, for the reasons I have mentioned, when death is foreseeable within the next year, for example.
10:20 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
As a final point, I imagine that your patients want to live as long as possible. The reason we are asking about advance requests is that those people want to enjoy life as long as possible up to the time they cross the threshold of the intolerable. It therefore varies based on the individual's request.
Am I correct?
10:20 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
At the severe stage of the disease, you told us, most of the time the person can survive for a year, two years, a few months.
10:20 a.m.
Emeritus Professor, As an Individual
That is correct.
When aspiration pneumonia occurs, ordinarily death occurs within the next six or 12 months.
10:20 a.m.
The Joint Chair Hon. Yonah Martin
Monsieur Thériault, there is no more time. Thank you very much.