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.
The Joint Chair Hon. Yonah Martin
No. Please don't apologize. It's very tight with all of these time limits.
Mr. Co-Chair, I'll return it to you for the round of questions from the senators.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you.
First, Senator Mégie has the floor for three minutes.
Senator, Quebec (Rougemont), ISG
Thank you, Mr. Chair.
I'd like to thank all the witnesses. My question is for Dr. Ethans.
Dr. Ethans, I'm going to repeat what Mr. Thériault said to you. This is a classic example, all the expert witnesses in the field told us that if a patient is depressed, in an acute crisis or suicidal, MAiD is not an option. That's the case with your patients in the early stages of consultation at the rehabilitation centre.
On the other hand, I would see them after rehabilitation, to help them continue to live in their environment. Many of them wanted to live. However, after several years, some may find that life is hard, that it's hard to go on for all sorts of reasons. They may find their situation intolerable at some point.
Do you consider them to be in a position to request MAiD? Do you trust the professionals treating them and assessing them to decide if they truly meet all the criteria, including intolerable suffering, and so on?
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
There a couple of things there.
When someone has lived in the community and they've lived their life with a spinal cord injury.... I've talked to patients and some of my patients have applied for MAID. Some of them have qualified, but have put in on the back burner. They just want to leave it there, in case.
One fellow has lived with his spinal cord injury for over 50 years. He's quadriplegic. He wants it on the back burner, in case he decides at some point that this is too much. He's definitely able to make an autonomous and well-informed decision. He's lived with this for a lot of years. He knows it better than anybody.
Now, do I trust the people...? In my province, the lead physician in charge of MAID is excellent. I trust her to make.... I've talked to her about all of this and how people in the early days, before they've realized what it's like to live with their disability, can't make that informed choice, and she agrees with me. I'm glad that I have her in this province and that I can trust her to do that.
Does that answer your question?
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator Mégie.
Thank you, Dr. Ethans.
We will now go to Senator Kutcher for three minutes.
Senator, Nova Scotia, ISG
Thank you very much, Chair.
Thanks to the witnesses.
I have a couple of questions. The first is for Dr. Ethans, and then I have one for Ms. Brittain.
Dr. Ethans, you have highlighted the importance of highly trained MAID assessors. You just talked about someone in your province who is highly trained and understands the issues that you talked about.
I'm sure you're aware of the training program that is currently being developed and accredited by the Royal College of Physicians and the Canadian Nurses Association. Not everybody who requests MAID receives MAID, so the crux here is the assessment and the quality of the assessment.
Would you agree that if the MAID assessors are properly trained to assess an individual with a spinal cord injury, such as the person you talked about, they would be able to conduct a proper and thorough assessment of the issues?
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
It's just the control of it, and I can't say that everybody.... If somebody gets asked to see somebody who's asking to die in the first several months of their spinal cord injury, even if they've gone through this course, I don't know.... As David Shannon said—
Senator, Nova Scotia, ISG
I'm sorry. We only have three minutes.
How many cases do you know of persons with a spinal cord injury having actually received MAID within 90 days of their injury?
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
I don't know of anybody in my province, but I know of one in another province—
Senator, Nova Scotia, ISG
I'm sorry, but I have just so much time.
Ms. Brittain, not every person with a disability struggles to obtain needed services. Some do, but not everyone, and some are very financially well off.
Should people with a disability be denied access to MAID simply because they have a disability?
Senator, Nova Scotia, ISG
You would think there would be circumstances where individuals who have a disability should be able to access MAID.
As an Individual
I think anyone who has a physical disability has the right to access MAID. I'm sorry, but I'm not understanding the question.
Senator, Nova Scotia, ISG
We've heard concerns that people with disabilities who don't have housing and other support services may sometimes feel that they need to access MAID because they can't get those services, but there are some disabled people who are financially well off and don't have that problem.
Do you think that second group should be denied access to MAID?
As an Individual
No, not at all. I think it's important to understand you don't wake up one morning and say, “I'm going to have MAID.” This is something that is thought of, and it goes on for months and weeks and years. It is not a capricious decision, and if you are in a position and wish to make that choice for you personally, then I think everybody should have that right, whether they're physically disabled or not.
Liberal
Senator, Quebec (De Lorimier), PSG
Thank you, Mr. Chair.
Thank you to the witnesses.
My question is for Dr. Ethans. You were cited in a National Post article that was published earlier this year as saying that patients with spinal cord injuries are being counselled to die, but that they don't know what their quality of life will be like after six months.
I guess you made that statement based on the things you have encountered. How many patients were counselled to die? In that type of patient you have a relationship with, I suppose you will explain to them that there is a quality of life after six months or a year.
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
I can't tell you the number of patients. Again, that's talking more about those very early on, when the ICU doctors do have to make counselling—again not just to people with significant new disabilities, but all the time—about whether they should be carrying on with their aggressive treatment or whether they should be withdrawing.
When I said counselling about dying and that choice, that's what I was referring to. Like I said, I haven't personally had any patients being counselled about MAID within the first few months.
Senator, Quebec (De Lorimier), PSG
But you were referring to colleagues who will be referring to these people that they should consider dying, but these doctors are not assessors. They're not involved in the assessment if the person decides to apply for MAID, are they?
Associate Professor, Internal Medicine Section, Physical Medicine and Rehabilitation, University of Manitoba, As an Individual
No, these are the—