Thank you very much.
Thank you, Dr. Janz.
My expertise is not in disability, so I am honoured to share this space with my esteemed colleagues. I suspect that I was invited to participate in this panel—and I thank the committee for the invitation—because I have done quite a lot of work with people experiencing homelessness, with substance users and with prisoners, who also face incredibly limited medical and social supports. Because I know that I'm the only researcher in Canada who's done MAID research with prisoners, my statement is going to focus on them tonight. I'll end with a comment about vulnerability as it relates to people with disabilities and also prisoners and many others.
To align with international human rights norms, all prisoners ought to have access to the same standards of health care that are available in the community. This is referred to in the United Nations as the principle of equivalence of care. In Canada, between the legalization of MAID and August 2020, there were 11 requests for MAID by federally incarcerated people. Three were granted, and three deaths were completed. I have had a request in to Correctional Service Canada, CSC, for quite some time, but I don't yet have the new numbers to date.
I want to draw on the research that I've done with prisoners in Canada, as well as on reports from the Office of the Correctional Investigator, to focus on three main points this evening.
The first is that parole by exception for end-of-life care needs to be expanded and more readily approved.
You might be asking, “How does this relate to MAID?” Well, what we informally call compassionate release is actually called parole by exception, and being granted parole by exception in Canada is exceedingly rare. In two of the three known MAID cases for patients in CSC custody, the prisoners had applied for and been denied parole. The third prisoner didn't apply. Apparently he knew that his prospects for release were minimal, even considering his advanced stages of illness.
Especially given that palliative patients pose very little risk to the public due to their bodies and minds being incapacitated by illness, the rationale for denying parole by exception is not clear to me. I would just offer a quote from one of the prisoners I interviewed. He shared, “We had one guy in here... he had dementia and I don't even think he knew he was sick. We have another guy...that's got Parkinson's, and there's no reason...he should be in here. He can barely walk. He's not going to go out and rob a bank or anything. Put him in an institution... even if you have to start a prison old-age-home. One where there is a little [bit] more dignity.” He said, “It's really sad to die in a cage.”
The second point I'd like to make is about the Correctional Service Canada guidelines. They need to align with federal policy, but there are actually several key areas where they don't. In 2017, Correctional Service Canada released "Guideline 800-9, Medical Assistance in Dying”, which provides operational direction for MAID with regard to federally incarcerated people. Canada is the only jurisdiction in the world where assisted dying is legal who does have specific guidelines about how it ought to be implemented for prisoners. I appreciate guidelines for the clarity and consistency they can provide, but in this case, there are a few key areas where the guidelines don't align with federal policy. I'd be happy to elaborate on those more during question period, or I would direct the committee to the extensive report titled “Philosophical and Practical Considerations of MAID for Canadian Prisoners”, which I was commissioned to write for Public Safety Canada last year.
Third, as we move towards allowing MAID for people where mental disorder is the sole underlying medical condition, I think particular attention is going to need to be given to how prison weariness and the psychological suffering caused by imprisonment are addressed. This is because incarcerated people have described their living conditions in prison, the monotony of prison life and the fear of not knowing when or if they'll be released as reasons that might drive them to seek death, whether through suicide or MAID. We know that seeking MAID as an alternative to a prison sentence is not something that's legal in Canada, nor do we see its being legal anytime soon. I think the fact that prisoners are talking about it and potentially seeking it demands our attention.
When MAID eligibility expands to include assisted dying for reasons of mental illness, consideration is going to have to be given to differentiate between MAID requests due to an incurable and ongoing mental disorder and MAID requests due to psychological suffering that could be relieved if the person's circumstances were different. I think that ties into Dr. Janz's opening statement as well.
It's true for both prisoners and the general public that in a country as wealthy and as resourceful as ours, there is no reason someone should feel that the only option they have is death because their medical and social supports are so limited.
That is where I'd shift to a brief statement on vulnerability. My time is probably almost up.
I am going to frame the statement in relation to disability. I think it's perhaps a bit of a different perspective from my colleagues tonight, but it is applicable to anyone who suffers from limited medical or social supports.
I would begin by saying that it's not my place to speak on behalf of people with disabilities, and I would offer that it's not the place of this committee to speak on behalf of people with disabilities either. However, we need to trust people to make decisions about their own lives and deaths, recognizing that if someone is incapable of making decisions, they're already not eligible for MAID in the first place.
In terms of vulnerability, I am also concerned about people being vulnerable to having their health care rights denied because of who they are, and about people being vulnerable to discriminatory policies and procedures that would deny them access to MAID under the guise of protection. Excluding in order to protect is both patronizing and discriminatory.
I'll leave my thoughts there for tonight, with thanks for—