Evidence of meeting #28 for Medical Assistance in Dying in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was disability.
A video is available from Parliament.
8:10 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
I'm sorry, Dr. Ethans, but I have very little time.
My question is about the example you gave us.
Had MAiD been requested?
8:10 p.m.
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
No.
8:10 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
The question that comes to mind is, did you or your colleagues, who knew the physician who made this incredible suggestion, file any complaints under your code of ethics?
8:10 p.m.
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
No. It wasn't a code-of-conduct issue. The ICU doctors have to make counselling decisions with patients every day. They have to help patients and family members realize what is going to be worth keeping—
8:10 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
All right. Thank you, Dr. Ethans.
I don't have much time. I'd like to ask Ms. Brittain a question.
Ms. Brittain…
8:10 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Madam Brittain, is there any safeguard when we put the patient in the centre of asking for MAID? Is there any safeguard that we should put in place for people who are heavily handicapped?
8:10 p.m.
As an Individual
I think the only safeguard necessary is to inform them of all the options so they can make informed decisions. Without knowledge, without understanding and education, they don't know all the facts. They need them in order to make an informed choice that is best for them.
8:10 p.m.
Liberal
8:10 p.m.
The Joint Chair Hon. Yonah Martin
Next, we have Monsieur Thériault.
Mr. Thériault, you have the floor for five minutes.
8:10 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you very much, Madam Chair.
I'd like to thank all the witnesses for being here. I don't know if I'll be able to ask everyone questions, but I really appreciated your testimony.
I will address Dr. Ethans first.
If I were 25 years old and had a spinal cord injury, I would be reassured to have you as my doctor. For example, you say that it's up to the patient alone to decide on their quality of life. You also talk about the whole adjustment period.
Don't you think that all of this is part of what might be called good medical practices in managing spinal cord injury cases? Would you agree that a practice that would go against what you have described to us would be ethically questionable?
8:10 p.m.
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
Thank you.
As a physiatrist or a physical medicine and rehabilitation specialist, there are lots of people like me who deal with spinal cord injury in a rehab centre who would have the perspective I have. However, it's the acute care health care professionals who have their preconceived notions. I believe it's because they haven't had the opportunity to look after people with chronic, severe disabilities who live in the community.
There are studies that show that if physicians are asked what people's quality of life would be like, they rate the people with disabilities' quality of life quite low. That's a general physician. When I'm talking about my colleagues, that's their job: They deal with people with disabilities. But when you ask the patients or the people with disabilities, what their quality of life is, especially with spinal cord injury, it's rated quite high.
8:10 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
There's no doubt that people from all walks of life need to be educated. You're saying that yes, it should be part of good medical practices. Some people in your field are not experts and they might have certain biases. However, they won't have to one day assess your patient requesting MAiD who has been through all the procedures and is not in a suicidal state. Everyone who has appeared before us has clearly indicated that, in all cases, a suicidal state completely disqualified all patients requesting MAiD. It's important that it be said again.
Mr. Shannon, do you consider yourself a vulnerable person?
8:15 p.m.
Barrister and Solicitor, As an Individual
I'm now 41 years post-injury. I can speak to the first two years. I was highly vulnerable. I was only 18 years old, starting university, and then I wasn't there anymore. I'd lost my place and my identity.
I returned to university later. I have friends, I have a career. I have things that would have been lost to me, although MAID wasn't an option then. If in those acute stages I had opted for MAID, it would have been a life extinguished. I was so thankful that option wasn't there.
I think of the learned colleague just a few minutes ago who quoted a poet. I think also of Dylan Thomas. That is:
Do not go gentle into that good night,
....
Rage, rage against the dying of the light.
I think that's a personal motto now for me.
8:15 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you.
If good medical practices were used, do you really believe that those working with you would have proposed MAiD to you had it been an option? You were 18 years old. Do you think they would have proposed that to you rather than give you all kinds of examples of people who had lived a very full life after age 18? I don't know how long ago you were 18.
We have some glaring examples. Ms. Gladu was a severely disabled woman, but she lived a very full life. She had to go to the Supreme Court to demand what she wanted. As soon as the foreseeable death criterion is back in place, all these people will be excluded.
Is that not discrimination?
8:15 p.m.
Barrister and Solicitor, As an Individual
I am not speaking to putting foreseeable death back into the law. That is removed. That is the current law. What I am suggesting is that if it can be remediated, if the state has caused the suffering, then the state must remove the suffering.
8:15 p.m.
The Joint Chair Hon. Yonah Martin
Thank you.
Lastly, we have Mr. MacGregor for five minutes.
8:15 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much, Madam Co-Chair.
Thank you to our witnesses.
Dr. Ethans, I'd like to start with you. Your opening remarks reminded me of a high school friend who once was an amazing soccer athlete. I played on the same team as him. He was involved in an unfortunate car accident and went through some pretty dark days. Nowadays, he's a remarkably successful lawyer and has his own family. That's a personal observation of mine about someone who has come through a very dark place and has adjusted to very life-altering circumstances.
Maybe I'll give you some leeway in what you'd like to say here. In our committee, yes, we do have five broad themes that we're looking at, but I also think our committee has a bit of latitude in the types of recommendations we can make.
For your field of specialty, when we're looking at supports for people who are dealing with spinal cord injuries, are there any specific recommendations you'd like to see our committee focus on for some of the supports that are necessary to help people achieve that full potential later on?
8:15 p.m.
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
Thank you.
One thing that is lacking here in my program, and that I think is lacking in many places across Canada, is psychological support. You can imagine what that person you were talking about went through in his dark days. In our study we heard the same thing. The people I interviewed had very little in the way of psychological support as they went through those dark days.
I'm not just talking about in rehab or in acute care. We need to be providing psychological supports for people out in the community, and social supports. We need to be able to provide housing. We need to provide accessible housing. We need to provide accessible housing where people can be cared for, as we heard. We need more home care to keep people in the community. For some of my young patients, it's like what we just heard about with regard to personal care homes in the last session. Some of my young patients are living in personal care homes because there is not enough care support in the community for those people.
Then we need to do a better job at some pain management. Pain clinics have very long wait-lists. I mean, sometimes the pain just can't be managed well, but we need to really be managing pain aggressively.
8:20 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you for that.
Ms. Brittain, I'll turn to you. I appreciated the perspective you brought with your opening remarks. You really centred on a person's autonomy and their ability to make a choice that's their decision. Whether it's palliative sedation or do not resuscitate orders or declining further medical interventions, these are all, in a way, different forms of medically assisted death.
When we've been looking at the issue of protection for persons with disabilities, often we're struggling with that theme of a person's autonomy being constrained by the social conditions in which they find themselves—the dire poverty, the lack of economic supports, the lack of housing—and that theme of really focusing on a dignified life before someone can actually make a decision to get a dignified death.
I'll give you some leeway as well if you want to add anything that you want to see our committee report focus on when we table it in February of next year.
8:20 p.m.
As an Individual
I think the most critical thing here is the individual rights and focusing on those.
I recognize that there are people in difficult circumstances. However, over the past five and a half years, many people—dozens and dozens from all across Canada, New Zealand and Australia—have approached me and shared their personal stories with me. I've written about them in the Dying with Dignity Canada blog. It all comes back to the same thing: these people are not destitute. They have homes. They have the means to live a life with all of the necessities. However, it is an individual choice.
There comes a point when your quality of life is so poor that there is no desire to continue. That is critical. It's the individual making the choice. It's what's acceptable to them. There's no point in the doctor saying, “Well, I think you have another good three or four years ahead. If you just wait a few more years, you'll feel differently”. That's not the point. The point is, I feel that way right now, and it is my right.
When my condition, to me, is irremediable, I have the right to make the choice about what's right for me.