I'm happy to. Thank you.
A second point to consider is that persons with dementia can be supported to live with dignity. There is much work to be done to strengthen and create conditions for this. However, for some persons, regardless of these conditions, advanced dementia may nevertheless be experienced as a source of intolerable suffering.
As you have heard from other witnesses, recent public opinion surveys in Canada show strong support for advance requests for MAID. Some witnesses have attributed this to a general fear of dementia and institutionalized care, to limited accessibility of palliative care services or to embedded ageism and ableism within society. The worry is that advance requests for MAID may tend to exacerbate and reinforce systemic barriers and societal attitudes that render persons with dementia, particularly seniors, vulnerable as a group, and to displace needed efforts to provide dignity-enabling care for all persons living with dementia.
However, a focus on vulnerable groups as such tends to occlude the experience of individuals in the unique circumstances of their lives, including the impact that illness may have on their personal identity, their fundamental values and their ability to engage in the world and the projects that matter to them and with the people they care about. A study of advance requests must consider both the vulnerability of groups and of individuals without collapsing one into the other.
A final point to consider is that, as several witnesses before me have underlined, advance requests for MAID are complex undertakings with known uncertainties; however, there may be ways, as Dr. Reiner has pointed out, to reduce the complexity and narrow the uncertainty gaps.
Advance requests for MAID raise important challenges about, first, the clarity with which a person has described their circumstances under which their advance request should be enacted; second, the concordance of a person's current situation with the circumstances outlined in that advance request; and third, the extent to which the patient's wishes are known and understood by the care team, the substitute decision-maker and family members. No piece of legislation alone can do this, and indeed, our previous experience with MAID in Canada underlines that multiple actors have a role to play.
As this special joint committee study proceeds, one offering you might serve all of us with is not only to be able to provide recommendations regarding what legislation may look like, but a broad canvas of what you've heard through each of these meetings that may be able to foster directions for the fuller range of actors who may have a role to play in its implementation and continuing evolution.
I look forward to exploring these points further with you and with my panel colleagues.
Thank you.