Evidence of meeting #22 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 request.
A video is available from Parliament.
8:20 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
We'll start with Dr. Bigham.
You'll each have about 25 seconds.
8:20 p.m.
Doctor, Emergency and Critical Care Medicine, McMaster University, As an Individual
Specifically to the point on dementia, my current understanding is that it would be unacceptable to provide MAID without a clear duration of life expected. For that reason, advance requests would be required.
Advance requests may not be perfect, but we frequently see patients.... Ms. Demontigny said that she would rather die too early than too late. We see this in our technology-enabled world, where people forgo medical technology that could save their lives. They are afraid of rolling the dice and ending up in a worse situation where they are dependent on others to survive and where they're unable to communicate or contribute to society. For that reason, advance directives are useful far beyond dementia, cognitive decline, and other areas of chronic illness and perhaps acute illness as well.
8:20 p.m.
Pamela Wallin
Let's have a quick word from Dr. Pringle.
8:20 p.m.
Liberal
8:20 p.m.
Professor Emeritus, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, As an Individual
At this point in time, from what Ms. Demontigny has told us, she would not be able to get MAID.
I think the only issue that we haven't talked about is that, when you are cognitively impaired and you have this list of indications of when you want MAID, somebody else has to initiate it. It has to be a family member, but if a family member isn't available, then it's probably going to go to the medical team. The difficulty that's been experienced is with somebody who doesn't know that patient well initiating MAID. It's a problem if there's resistance on the part of the patient because they're cognitively impaired and do not understand what's going on.
I think in the case of Ms. Demontigny, it's a perfect situation and a terrible circumstance in the sense of having family who are on board and who would be prepared to follow her directions. When that occurs, I think that's the intention of advance directives.
8:20 p.m.
Liberal
8:20 p.m.
The Joint Vice-Chair Hon. Marie-Françoise Mégie
Thank you, Mr. Chair.
My question is for Dr. Bigham.
I know that you work a lot in intensive care. That's not the kind of place where you would find numerous people with dementia making advance requests for medical assistance in dying. But among your intensive care patients, there are many for whom you will be disconnecting technological devices. Some will die, but others will live longer.
Based on your experience with these people, have there been any who have told you that they would have wanted to die when the tracheotomy tube was removed, or who asked whether they might one day be able to request medical assistance in dying?
Have you ever had this kind of discussion with a patient for whom you withdrew technological devices?
8:20 p.m.
Doctor, Emergency and Critical Care Medicine, McMaster University, As an Individual
First of all, it's very unlikely that at that stage in someone's illness they're able to communicate with me, but I very often hear from family members along the lines of “Can we speed this up? It's torture for us watching this go on and drag out.”
For many patients, when we withdraw technology, they die quite quickly. For others, they can linger for hours, for days, sometimes for weeks, but the outcome is certain. This can be very distressing for families, and occasionally it can be uncomfortable for patients.
For patients who require technology to have a shot at life, but for whom that technology then fails, there is certainly a role for assisted dying.
8:20 p.m.
The Joint Vice-Chair Hon. Marie-Françoise Mégie
Thank you.
Ms. Demontigny, before asking my question, I'd like to thank you sincerely for having testified and spoken about your personal experience.
At some of the many lectures that you give, you must have encountered some families with approximately the same experience as you. What kinds of things do they say to you? For example, do they say that they would have wanted their mother to have requested medical assistance in dying? Or is it the other way around, and that they would not have wanted that so they could have more time to spend with them?
I've heard comments like that. But what have you heard when you meet people?
8:25 p.m.
As an Individual
Thank you for your question.
Of course, given my approach to end-of-life care, including care during the final phase of Alzheimer's disease, and as the spokesperson for the Association québécoise pour le droit de mourir dans la dignité, the people I meet are often those who have already given the matter some thought, who want to die in dignity and who hope that their expectations will be met.
I can talk to you about them.
As it happens, we had our annual meeting today. Quite a few people came to see me; they touched my arm and tears were flowing. They thanked me and said that's what their mother had wanted, but it had not been possible. Others thanked me by saying that they found it reassuring and they were encouraged, because they had been diagnosed as having Alzheimer's disease.
Of course those who were against the idea were not there, because it's an association for people who want to die with dignity. The comments I received were positive. People see it as the beginning of some form of relief and they were hoping for legislation that would help them achieve that. It gives them hope that they will end their life with dignity, which is not what their loved ones had experienced.
8:25 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you very much.
This brings our panel to a close. I'd like to thank Dr. Blair Bigham and Dr. Dorothy Pringle for being with us this evening, providing their opening statements and also sharing their expertise with us.
Ms. Demontigny, we give you our sincere thanks.
As many of my colleagues have mentioned, your testimony was very powerful and moving. It was also extremely eloquent. You have obviously given a great deal of thought to the questions we asked you this evening, and your replies will be extremely useful to us in our deliberations.
Thank you again to our three witnesses.
This will bring our panel to a close.
The meeting is adjourned.