Medical Assistance in Dying Committee on Nov. 18th, 2022

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Madam Joint Chair.

I am now giving the floor to Senator Mégie for three minutes.

[Marie-Françoise Mégie]

Thank you, Mr. Chair.

My question is for the representatives of the Collège des médecins.

Apart from anecdotal information in the media, have you heard, from among your members who provide medical assistance in dying, anything like the situation described earlier by Ms. Joffe? She spoke about a young man with a disability who wanted to live, but who, because he would have to be placed in a long-term care institution, is requesting medical assistance in dying.

If any of your members were to speak to you about that, what advice would you give them?

[Dr. Mauril Gaudreault]

I'll give you an example, and Dr. Luyet will give you one as well.

Everyone, under all circumstances, must have access to the entire range of medical care suited to their circumstances, from prevention to rehabilitation, including medical assistance in dying. In their relationship with patients, doctors have to ensure that the entire range of options is discussed.

[Dr. André Luyet]

Moreover, it's important to clarify the consent. Patients need to be told about the possibilities and consequences of the various options available, of the assistance that can be provided under the circumstances, and of access to this assistance. All of these things need to be addressed with the full transparency and honesty that is central to the relationship between the patient and the professional providing this care.

[Marie-Françoise Mégie]

Thank you.

My next question is for Ms. Joffe.

When a doctor assesses a patient for medical assistance in dying, certain criteria come into play. Could some people challenge the doctor's assessment by alleging that it is based on the level of stigmatization in which all disabled people find themselves? Everything that you are saying might generate a form of public mistrust of health professionals. Before the existence of medical assistance in dying, these same people had the same doctor or the same nurse.

Could having medical assistance in dying as a possibility perhaps create a feeling of patient mistrust of the health professional? That could be the case for the 31-year-old man you spoke about.

[The Joint Chair, Liberal, Marc Garneau]

Ms. Joffe, you have a short time to answer that question if you've heard it.

[Kerri Joffe]

Thank you for the question. I did hear it.

I think that without a doubt it does create a very difficult relationship between people with disabilities and their health care providers.

In the work I do, what I've heard expressed by clients in my communities of people with disabilities is a feeling of abandonment by the government and a sentiment of “Why are governments not providing us with the supports we need to address suffering rather than offering death as an end to suffering?”, so I would just say, as I said before, that I think it is putting some health care professionals in very difficult positions.

We've seen op-eds in the media, and I think the committee has heard testimony from physicians about some of those difficult positions they're put in because of the regime.

[The Joint Chair, Liberal, Marc Garneau]

Thank you.

Senator Kutcher, you have the floor.

[Stanley Kutcher]

Thank you very much, Chair.

I have two questions, first for the Collège des médecins du Québec and then for Ms. Joffe.

The previous panel talked about MAID safeguards for people with disabilities. They focused on legislative safeguards. The expert panel on MAID for mental disorder as a sole underlying condition came up with a very thorough report that included various safeguards.

Would you think that a similar kind of process, a similar kind of report, would be useful to address these really legitimate concerns of people with disabilities?

[Dr. André Luyet]

I mentioned these briefly earlier, and had just begun listing them. I could give you something in writing that identifies the five criteria that provide guidance in safely making a decision in such very specific situations.

[Stanley Kutcher]

I would imagine that's yes then, is it?

[Dr. André Luyet]

Yes.

[Stanley Kutcher]

Thank you so much.

Ms. Joffe, we've had very legitimate fears raised that large numbers of persons with disabilities would be forced to seek MAID because of intolerable components of their life conditions. You spoke about some people whom you have worked with who have shared that concern with you.

We suffer from a lack of good data on what these numbers would be. Europe has had MAID for a much longer time than Canada. Would you have any data that's available that will let us know how many people who have received MAID in Europe have been identified as having a disability or would have had MAID provided to them because they weren't able to access resources in those countries? I understand that some of those countries might have better resources than we have. Would you have any of that data available for us?

[Kerri Joffe]

I do not have that data available for you. I can provide information based on the experiences and the legal practice that I do and that ARCH does, based also on the information that we are receiving from some of our partners, disability advocacy groups, from across the country.

I also want to say a couple of more points.

Senator Kutcher, you referred to fears of the impact of the legislation on people with disabilities. I am here today to tell you that it's not just a fear; it's a reality. We have clients who are living in poverty, who are people with disabilities, who are either seriously contemplating MAID, have applied for MAID or who have gone through with MAID and have clearly expressed that it's not based on physical suffering because of their disability; it is entirely related to suffering because they cannot get their disability-related needs met, whether on a social basis or an economic basis.

I can't give you data, but I can speak from my experience.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Senator Kutcher.

Go ahead, Senator Dalphond.

[Pierre Dalphond]

My questions will be for Ms. Joffe to follow up on what Senator Kutcher was asking.

You gave the example of the 30-year-old person who unfortunately lost the family support needed, so the only option provided by the provincial health care was to go to a long-term health facility.

Are you saying that we should not extend track two access to MAID, which you argue is not acceptable?

The provincial health system not only provides long-term health care facilities. Are you saying that the person should go to the health care facilities and stay there without any option to ask for MAID? We are dealing here with the Criminal Code; we're not dealing with the provisions of health services.

[Kerri Joffe]

I am not suggesting that a person should accept going into an institution and living out their entire life in an institution in a setting that's entirely inappropriate for them. I am telling you that that is the exact kind of discrimination and the exact kind of deprivation of the ability to live your life in dignity that is driving the people who I work with to consider, apply for or go through with MAID. That is the—

[Pierre Dalphond]

I'm sorry to interrupt, but my time is limited.

In that case, I guess you went to the rental board or some other authority on behalf of your client to get more provincial support.

[Kerri Joffe]

Yes. My role is to advocate as hard as I possibly can on behalf of my client to get the supports and the funding in place so that person doesn't have to consider MAID.

[Pierre Dalphond]

I understand.

[Kerri Joffe]

The problem is that it's often unsuccessful.

[Pierre Dalphond]

For you, then, because it's unsuccessful, it's a reason to deny access to MAID. I understand your point.

My next question is for the other witnesses.

For the Duncan family, I understand that your mother had a common-law partner. Mr. Rick Hansum was reported in the press as talking about the unbearable suffering that your mother went through for months. Is he part of your criminal allegations? Does he think that she was the subject of a faulty system?

[Christie Duncan]

I'm sorry...? Is it that Rick doesn't believe that it was part of a faulty system?

[Pierre Dalphond]

No. You say that the system faulted your mother, and I was asking if her common-law partner, Mr. Hansum, was also sharing your views and was part of your attempts to have legal inquiries and to have police investigations or have the college of medicine to investigate.

[Christie Duncan]

No.