Thank you so much, and thank you for the invitation to meet with you in this important study.
I am director of the University of Toronto's joint centre for bioethics and an associate professor in the Dalla Lana school of public health. However, this evening, I am speaking as an individual, drawing upon my disciplinary background in bioethics and health policy, and my experience as co-chair of the provincial-territorial expert advisory group on physician-assisted dying in 2015, and as chair of the advance request working group of the Council of Canadian Academies' expert panel on medical assistance in dying in 2018-19.
I've had the opportunity to listen to several testimonies by previous witnesses over the last week. In the next few minutes, I hope to build on this testimony and indeed that of my colleagues on the panel today, and offer the committee some points to consider in its deliberation about the potential role, application and conditions of advance requests for MAID.
A first point to consider is that, while advance requests for MAID may be relevant to persons with dementia, they're not relevant only to such persons. Discussions of advance requests for MAID often focus on dementia as the root cause and reason for a person's advance request. It is important, however, to distinguish between the grievous and irremediable medical condition that may lead someone to seek an advance request for MAID and the clinical circumstances that may result in the loss of their decision-making capacity. For some patients, dementia may be both a grievous and irremediable medical condition and the basis of their loss of capacity; however, this is not necessarily the case.
For example, consider an advance request for MAID from a person who is in active treatment for cancer or heart disease, with an uncertain prognosis, who is also at risk of a potentially life-limiting event, such as a stroke. Consider a person who has inherited the dominant gene for Huntington's disease or the gene for early Alzheimer's and will most certainly develop the disease in the future, but may be diagnosed with another grievous and irremediable condition in the meantime. Consider a person who has been living with Parkinson's disease for several years, knows that the end stage of the disease might be accompanied by dementia and wishes to plan for this possibility whilst they still have the capacity to do so.
It is important that a study of advance requests take this broader range of circumstances into account.