Evidence of meeting #3 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 maid.
A video is available from Parliament.
Nurse Practitioner, Primary Health Care, As an Individual
Just to clarify, I was already working within the field of MAID before my mother had her assisted death, but yes, I did support her through that.
I'm not quite sure what you mean by the “rigorous process”. I think you're asking what steps are involved in assessing someone for MAID.
Nurse Practitioner, Primary Health Care, As an Individual
Okay.
When someone makes a request for MAID, it can be done in an informal way or often through, as we have in Ontario, a central intake. That's how we get the referrals. I contact them directly by phone and set up an appointment to come to their home. At that point, I ask for consent to be able to check their medical records through the online hospital system so that I can get some background information, so by the time I come to their home, I already have some information about what their health experience is.
When I get to their home, I have three agenda items I usually try to follow. The first is that I explain the entire process of being approved for MAID as well as what the actual procedure involves. The second is that I explain what happens in the actual MAID procedure so that they have an understanding of what it looks like. The third is that I offer them the opportunity to begin the assessment process formally. In this process I complete my initial part of the assessment, understanding from them their personal experience of their journey, their symptoms, what's causing their suffering, what treatments they may have had, what they've been offered and what they have experienced as changes in their life as a result of their illness.
That visit is usually between about an hour and an hour and a half, so I get to know them fairly well, and they get to know me as well.
Depending on what the results of that are, we have a discussion about timing. Sometimes it's just information they want to have at that time. Sometimes they're ready to move forward. At that point, if they haven't already completed the written request, they would do that, and we would arrange for a second assessor to come in to do the confirmatory assessment.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you.
Senator Kutcher, you have the floor for three minutes.
Senator, Nova Scotia, ISG
Thank you, Mr. Chair.
I have three questions—and they should be short—for Ms. Gwartz. I'm hoping you can help us learn more about a MAID assessment through these questions and how data is collected.
Let's say that as a MAID provider. If you're seeing a cancer patient and you're not certain at any point in your assessment, would you seek assistance from a colleague, or would you just come to conclusions on your own about what you should do?
Nurse Practitioner, Primary Health Care, As an Individual
There are multiple ways of gathering information. As I said, I usually have access to health records through the hospital system. I would often contact the care providers they are already seeing—a family doctor or a specialist. If I continue to be uncertain about things, then I may speak to colleagues who perhaps have more experience with the health issues that person has or possibly the MAID eligibility criteria and how that would play out in that particular situation.
Through the Canadian Association of MAiD Assessors and Providers, we have a very robust forum that is a confidential opportunity for us to share, and I post on that quite frequently about situations to get feedback from others.
Senator, Nova Scotia, ISG
It's fair to say that your assessment is thorough. It's not just a fly-by-night thing. You take a lot of time and sort things out very carefully.
Nurse Practitioner, Primary Health Care, As an Individual
Most often it's hours. Sometimes it's months. I had one patient whose assessment I was spending a fair amount of time on, probably five to 10 hours a week, and supporting him through his journey for almost three months.
Nurse Practitioner, Primary Health Care, As an Individual
Absolutely not.
Senator, Nova Scotia, ISG
Earlier today we were told that MAID data from the ministry of health cannot be trusted because it's filled out by a MAID provider. Do you agree that you cannot be trusted to provide correct information about your MAID patients?
Nurse Practitioner, Primary Health Care, As an Individual
Of course I do not agree with that. We are health professionals. We take all our data collection very seriously and responsibly.
Liberal
Senator, Quebec (De Lormier), PSG
Thank you, Mr. Chair.
My question is for Professor Gaind.
If I understood correctly, he is opposed to offering medical assistance in dying to people whose only problem is a mental health problem, with no comorbidity. In his opinion, there is nothing to justify expanding that.
As a specialist in this subject, has he studied the situation in the Netherlands and Belgium, where medical assistance in dying is available for people suffering solely from mental health problems?
Do the studies done there, in particular the commissions' annual reports, indicate that there is a problem? In the Netherlands, fewer than 1 per cent of cases end in euthanasia; in Belgium, in 2020, it mentioned 21 cases out of 2,444.
Professor, As an Individual
Thank you for the question, Senator.
I should clarify that my concern is that offering MAID for sole mental illness cannot be done honestly under our current framework. The whole premise of what our MAID framework has been based on and what the Canadian public has been told is that MAID is being offered for a predictable, irremediable condition. That, fundamentally, cannot be met for mental illnesses. When that criterion can't be met, everything else falls apart.
In terms of the Benelux data, the European data you're speaking of, I will point out that year on year, the psychiatric euthanasia there is seeing regular increases quite significantly. I will also point out that—
Senator, Quebec (De Lormier), PSG
That's not exact. In Belgium it went down in 2019.
Professor, As an Individual
Yes, you're right. I'm looking at the Netherlands data, but what I will point out as well is the risk to the marginalized that this data clearly shows. When you have a fifty-fifty gender balance here for MAID when it's for reasonably foreseeable death up until now, and you expand it to psychiatric euthanasia and you find a two-to-one gender imbalance, that imbalance parallels the number of suicide attempts by women with mental illness. Most do not try again. Most do not end their lives by suicide.
The concern, obviously, is converting a transient suicidality into a permanent death. In that sense, I think the expansion ends up feeding into sexism, ageism, ableism and even racism of marginalized populations, because they are shown to have greater unresolved psychosocial suffering. We have to think about how these policies affect all of our Canadian citizens, not just the ones who will get increased autonomy.
Senator, Saskatchewan, CSG
Thank you.
My question goes to Audrey Baylis, if we could start there.
You talk about being denied your right to choose this in advance. We've talked about this, the catch-22 that goes along with dementia or Alzheimer's. You can't ask in advance, but then once you're diagnosed, it's hard to ask after the fact.
How are you dealing with this? Have you talked to other medical professionals? Are you making a list of things that you think would constitute, for you, intolerable suffering and a situation in which you would like to access MAID? How are you preparing for this, even though you don't yet have the right to do this?
Retired Registered Nurse, As an Individual
Well, I'm 84 years of age and I feel that I've had a very good life.
I have very clearly stated in my document for them to take me somewhere where I could qualify—I know that people went to Switzerland—when they can make a decision, if I can't make it. I have no intention of going into a nursing home. I will do whatever is necessary.
I think about it an awful lot. My friends are in the same situation as I am. We're all getting up there in years. What's our option if we don't want to go to a nursing home? There's only one way out.
I can't understand why people can't talk about death these days. It seems to be a taboo subject. We're all going to die. To me, it's very personal. I have the steps in place for me when I can't look after myself.
Senator, Saskatchewan, CSG
Your friends and your family are very aware of this, and if you have to go to another country, you will.
Retired Registered Nurse, As an Individual
Definitely. My passport is always valid, and there's money in the bank to take my whole family over there. They can party and do what they want. They have to wait to bring my ashes back. If they don't want to bring them back, throw them out to the fish.
Senator, Saskatchewan, CSG
Ms. Gwartz, I'll go to you on this topic.
We've heard the frustration, not just in this session but in other sessions, about people who have taken the ultimate step because they're afraid they won't be cognizant and won't be allowed to make the decision. They actually take their lives much earlier than is necessary because they have the same fears as Audrey has just expressed.
Nurse Practitioner, Primary Health Care, As an Individual
Are you asking me if I'm familiar with this?