This is unexpected, but thank you, Mr. Chair and members of the committee, for the opportunity to speak today.
I'm grateful to join you from Mi'kma'ki, the unceded territory of the L'nu.
I'm going to start with what I'm not. I'm not a lawyer. I'm not a bioethicist. I'm not a MAID scholar. I'm a generalist family doctor, and I have more than a decade in practice. I've also been a MAID provider since about 2017 as part of a full scope of palliative care work.
I'm going to tell you today what it's like to provide MAID and what the considerations for a MAID provision might be with regard to minors were it to become legal.
My first experience with MAID was with a dynamic, incredibly funny woman who did not qualify under the legislation at the time. I represented her third opinion because she didn't have a foreseeable death and wasn't suffering sufficiently under the legislation. She lived with constant chronic pain that limited her life, and she told me she was profoundly alone despite being very close to her family. She had plenty of joy, but she suffered nonetheless.
I remember that she gave her glasses to her daughters and she told them to do something useful with them. She then closed her eyes and made some very morbid jokes. We all laughed. Then she went to sleep, and then she died. It was the most profoundly patient-centred moment of my career up to that point.
Why am I telling you that story? This woman was in her nineties. The committee has asked me to think about MAID for mature minors. The truth is that the considerations for her capacity to give informed consent to that procedure are actually no different than they would be for a mature minor. Does she understand what's being offered? Does she understand the risks and benefits? Does she understand the alternatives?
Picture a mature minor, someone who happens to be under the age of 18. That age is mostly arbitrary; 18 is not a magic number. Minors already exercise autonomy over their bodies in other instances, and we don't require them to explore every option to some external standard of satisfaction for every medical procedure. The capacity to consent is specific.
As we move to expand MAID generally, there are a number of other considerations, including how we understand the developing brain and how we understand issues of mental health, which is soon to become an eligibility criteria. How that is or is not appropriately applied to minors would be an important consideration, and I don't feel qualified to understand the developing brain well enough to say that. In jurisdictions where mature minors do access MAID, it's actually quite rare. They tend to have had very long histories with their health care decision-making and with the health care system generally. That's the nature of illness in kids.
In family practice, I have the distinct privilege to see kids grow over time, which is to say that I watch them cognitively develop. I'm pretty confident that I could figure out whether a patient of mine was able to consent, but even if I couldn't, MAID providers exist inside a community of practice, which gives us a network to lean on for resources and for second, third and fourth opinions if we need them.
I want to close by naming the elephant in the room. There's a certain visceral revulsion to the idea that a child could suffer so much that they'd request an assisted death. How is it possible that that does not represent a monumental failure of our medical system? Surely better palliative care services and better social services—all of those things—would mitigate the need to request MAID.
It's okay to feel pain when a child suffers. We should. We would be monsters if we didn't. However, the existence of better treatments and better services does not negate our obligation to have equitable and humane access to MAID if it is appropriate. Respectfully, I think we are obligated to see past our revulsion. The right thing to do doesn't always feel good. In fact, a friend of mine who is an ethicist said that ethics only really come into play when everything makes you really uncomfortable.
We need to approach MAID for mature minors the same way we do for every patient: Each is unique and must be treated with careful consideration of their personal circumstances in the context of their life.
Thank you again for the opportunity to speak before you today.