Thank you.
I'm a retired registered nurse with a background in psychiatric and gerontological nursing. I've practised and have taught nursing students in both acute care and long-term care facilities.
I had the pleasure and the opportunity to be a member of the Council of Canadian Academies expert panel on medical assistance in dying and on MAID and advance requests.
I'm strongly supportive of MAID and advance requests for MAID. I think that patients with devastating terminal illnesses that do not affect their cognition—for example, most types of cancer, cardiac conditions and amyotrophic lateral sclerosis—gain a sense of control and comfort by determining when and under what conditions they will be relieved of pain and suffering.
More challenging are diseases that result in dementia and the loss of cognition, which require someone other than the patient to take responsibility for initiating MAID based on conditions specified by the patients. The Netherlands experience indicates that MAID following a patient's loss of competence is rare but difficult. Most patients with dementia exercise the MAID option while they are still competent.
Now, practices to enhance the effectiveness of advance requests have been identified, but we have little understanding of how effective they are. I think a critical issue is the management of advance requests when the patient is cognitively impaired. We have some advantages to bring to this. We have lessons from the Netherlands, which has excellent oversight and very good data, and we have experience with MAID across Canada on which we can draw.
Thank you.