Medical Assistance in Dying Committee on Oct. 25th, 2022

[Dr. David Lussier]

No, I haven't seen it in my professional practice, and nothing in anything I have heard in the various forums suggests that medical assistance in dying has been requested for lack of proper treatment. Furthermore, palliative care statistics show that the vast majority of people who have requested medical assistance in dying have previously had access to palliative care. If we want to extend that option to others, we only need to ensure that remains the case.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Thank you, Dr. Lussier.

Dr. Pageau, I'll continue along the same lines.

In your experience as a physician, have you ever witnessed situations in which patients were informed that there were no doctors available to provide treatment appropriate to their condition and medical assistance in dying was offered to them if they wished to have it?

[Dr. Félix Pageau]

Yes. People will often say they don't want to be a burden. They aren't being given adequate psychosocial care…

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

I have to interrupt you because I don't have a lot of time. I'm not talking about the patient's point of view, but rather about yours has a health professional. Have you seen professionals administer medical assistance in dying in such cases?

[Dr. Félix Pageau]

Yes, a contentious case came up in the research I conducted for my master's degree.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

So it was a case that you studied as part of your master's program. Is that correct?

[Dr. Félix Pageau]

Yes, there was at least one case.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Do you have any statistics that might show us that this is a common practice or that it has occurred many times?

[Dr. Félix Pageau]

Yes. According to Quebec data, one of the primary reasons why people request medical assistance in dying is that they feel they aren't getting appropriate services or treatment.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

I understand that. You're talking about the patient's perception. I'd like to know the the health professional's point of view.

We've heard a lot of professionals talk about safeguards and all that. Correct me if I'm wrong, but I don't get the impression that health professionals, regardless of the province they live in, have told patients that there are no specialists to treat their condition and that, consequently, if they want medical assistance in dying, they could administer it to them.

I want to know the profession's stance on this. Have you seen your peers administer medical assistance in dying because there were no other available treatments?

[Dr. Félix Pageau]

Yes, and, as I told you, it's very insidious. Professionals agree to practise medical assistance in dying as a result of a lack of resources.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Is that a known fact within the profession?

[Dr. Félix Pageau]

We're seeing that social suffering is one of the more frequent reasons given for requesting medical assistance in dying. Physical pain is cited in less than 1% of cases. Psychological suffering represents a very small percentage as well. It's often social suffering and other factors that are mentioned. People won't say it the way you said it because there's a certain lack of sensitivity…

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

I apologize for interrupting, Dr. Pageau, but I only have five seconds left.

Would you please send your master's thesis to the committee clerks?

[Dr. Félix Pageau]

Yes.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Thank you very much.

Thanks to all the witnesses.

[The Joint Vice-Chair, Hon. Marie-Françoise Mégie]

Thank you very much.

Mr. Thériault, you have the floor for five minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Madam Chair.

Dr. Lussier, you mentioned the right to life in connection with the Carter judgment. One might even say that the Baudouin judgment also presents the argument that people are obliged to end their lives prematurely by suicide.

When you inform patients that they have a major neurocognitive problem, do you then ask them in the same breath, as Dr. Pageau said, if they want medical assistance in dying!

[Dr. David Lussier]

Obviously, no. It wouldn't be possible to do that in the present circumstances because a person's capacities must be in advanced decline for that person to be eligible for medical assistance in dying.

When you make a diagnosis, you usually ensure that the person has made a will and a mandate in case of incapacity. You ensure that the person has made all the necessary arrangements for the disposition of his or her person and property. However, you won't bring up medical assistance in dying in the same breath or during the same meeting.

There's a major debate within the medical profession on this particular point: should we propose medical assistance in dying, as one of a number of therapeutic options, to someone who's clearly eligible, or do we refrain from from doing so? There's no consensus. I think we should wait for the request for medical assistance in dying to come from the person rather than propose it as a therapeutic option. That position is can be criticized, but it's mine.

[Luc Thériault, Bloc, Montcalm, QC]

In your practice, do patients often start a discussion of medical assistance in dying? Everyone wants to live as long as possible, although without going beyond the threshold of what's personally considered tolerable.

[Dr. David Lussier]

In my case, it's always the patients who bring up medical assistance in dying. Many of my patients who have neurocognitive disorders or other pathologies tell me they want to die. Many will ultimately decide not to request medical assistance in dying. Some discuss medical assistance in dying merely to express the fact that they want specific treatment for a particular problem. Some will go so far as to request medical assistance in dying, but it always comes from them.

What I meant to say earlier is that people want to wait as long as possible, until the very last minute, before requesting medical assistance in dying. In some cases, they won't say it's time until they think they're completely losing their mind. They think that, if they wait another two or three months, they'll probably lose their capacity and will no longer be able to obtain medical assistance in dying. If they could make an advance request, that would relieve this distress and concern, and they'd be able to continue living longer.

[Luc Thériault, Bloc, Montcalm, QC]

Even if a person solemnly designated a third party at a meeting held for that purpose and specified when he or she wanted medical assistance in dying to be administered, the fact remains that the process is spread over time and must therefore include a reassessment measure, as you mentioned. Meetings must be planned throughout the patient's journey to reassess the situation until the designated third party ultimately asks the attending team to assess the loved one's condition. There have to be repeated assessments.

In your experience, how many of these kinds of stages must there be? Is this done on a case-by-case basis?

[Dr. David Lussier]

That's very hard to say because it depends on how the disease develops. We often cite the example of Alzheimer's disease, which is a gradual deterioration of capacity, but there are other neurocognitive disorders where the deterioration won't be as gradual. It's impossible to predict. It may last many years or only one or two years, as in the case of fast developing dementias.

[Luc Thériault, Bloc, Montcalm, QC]

In your experience, in the case of pleasant dementias, isn't the third party ultimately the key person in the situation? If the third party doesn't start the process or request that the attending team start assessing…

[The Joint Vice-Chair, Hon. Marie-Françoise Mégie]

I apologize for interrupting, Mr. Thériault, but your time is up.