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.
April 25th, 2022 / 9:25 p.m.
Dr. K. Sonu Gaind Professor, As an Individual
Thank you, Madam Chair, for the chance to speak.
My name is Sonu Gaind. I'm a professor at the University of Toronto and chief of psychiatry at Humber River Hospital, where I serve a diverse population, including marginalized communities. I'm a former president of both the Canadian Psychiatric Association and the Ontario Psychiatric Association and I sat on the Council of Canadian Academies panel on mental illness. I've worked in psycho-oncology with dying patients and their families throughout my career.
I'm speaking as an individual; I'm not representing any group I work with.
I'm also physician chair of my hospital's MAID team and not a conscientious objector. I don't bring any particular ideology to the issue other than advocating for evidence. I believe sensitive public policies like this demand a non-ideological, evidence-based approach. I've seen the benefits of MAID in appropriate situations like Mr. Baylis'. I have also been sensitized to the dangers of MAID in inappropriate points. I've come to realize that our MAID expansion to non-dying disabled and those suffering from solely mental illness is a tale of two cities—of two worlds, actually.
Evidence shows that when death is foreseeable, people seek MAID to preserve dignity and autonomy to avoid a painful death. Those seeking MAID in these situations tend to be, in researchers' words, white, more educated and more privileged. That's been used to suggest that MAID is safe to expand to other situations.
However, when expanded to the non-dying disabled for mental illness, that association completely flips. A different group gets MAID. These are the group of non-dying marginalized, who have never had autonomy to live a life with dignity. Rather that death with dignity, they are seeking an escape from life's suffering. They do overlap with those who are suicidal in the traditional sense.
Evidence shows that this group is more marginalized and has unresolved psychosocial suffering, such as loneliness and isolation. A terrifying gender gap emerges of twice as many women as men receiving death to avoid life suffering.
Introduced to help avoid painful deaths, MAID expansion provides these marginalized, non-dying people with death to escape painful lives. Worse, many of these people could have gotten better. CAMH, the Canadian Association for Suicide Prevention and others have concluded that evidence shows we cannot predict irremediability of mental illness in any individual.
I can't comment on the federal mental illness panel's specific recommendations, since their report is delayed. Still, the panel cannot manufacture non-existent evidence. That panel was charged with recommending protocols, guidance and safeguards on how to implement MAID for mental illness, not with reviewing whether that can safely be done.
That and the sunset clause is not how science works. No drug company is told their sleeping pill will be approved in two years without evidence of effectiveness or safety while being asked to develop instructions in the meantime on how to use the pill. The sunset clause and the federal panel's mandate are based on less evidence than is required for introducing any sleeping pill.
In bypassing the primary safeguard against premature death, which is getting MAID only when we can predict irremediability, any other so-called safeguards can be no more than false reassurances and lip service. Marginalized people in despair who could get better will get MAID. I think it bodes ill that a member of the 12-person panel resigned months ago, though her name remains on the public website.
While over 85% of Ontario psychiatrists who responded in a recent survey supported MAID in general, less than 30% agree with MAID for solely mental illness. They opposed the sunset clause by a 3:1 margin. The Quebec commission has now recommended against providing MAID for sole mental illness.
Last March in the House, Monsieur Thériault said, “If the expert panel and special committee arrive at the conclusion that mental health should be excluded, it will be excluded.” The panel's narrow charge would have prevented them even considering excluding mental health. I call on you now to listen to the evidence and honour that commitment through this special committee.
I grew up hearing the story of the Komagata Maru and about those who were refused entry to Canada and sent back to India, some to their deaths. As a child, it showed me that the policy, the continuous passage act, could ostensibly be the same for everyone, yet in actuality be racist towards some. I view our current MAID expansion the same way. That's the tale of two worlds. It's the same law, but with different impacts on different groups.
It's a myth that expanded MAID is just about autonomy. The planned expansion and sunset clause may increase privileged autonomy for some to die with dignity, but it will do so by sacrificing other marginalized Canadians to premature deaths for escaping painful lives that society failed to allow them to live with dignity. That's not my Canada, and it should not be yours.
Thank you for listening. I'd be happy to answer any questions.
9:30 p.m.
The Joint Chair Hon. Yonah Martin
Thank you so much.
Thank you to all of our witnesses for their compelling testimonies.
We'll begin our first round with Madame Vien for five minutes.
9:30 p.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Thank you, Madam Chair.
My first question is for Ms. Gwartz. Ms. Baylis can also give us her view.
Ms. Gwartz, did you hear the testimony of Dr. Félix Pageau earlier?
9:30 p.m.
Nurse Practitioner, Primary Health Care, As an Individual
I apologize. I was not aware that I was allowed to be in.
9:30 p.m.
Conservative
9:30 p.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Dr. Pageau maintained that a person with dementia should not have access to medical assistance in dying, even if they had made an advance request for it. He said that such access would be unethical, because, in another context, that person would not necessarily make the same decision. In his opinion, this was therefore a contradiction. The two don't go together, they don't go hand in hand.
What do you think about that position, Ms. Gwartz?
9:30 p.m.
Nurse Practitioner, Primary Health Care, As an Individual
It's a difficult question. I don't know all of the safeguards that would be put into place in order for advance requests to be incorporated into the legislation for MAID.
I believe, in terms of respecting autonomy and trying to minimize suffering, this is an area that needs to be explored as an option. I have several patients whom I have assessed with dementia who are very determined to have medical assistance in dying as their end-of-life option.
As I said in my presentation, sometimes people have to choose timing in order to balance fear for loss of capacity, and opportunity for advance requests would, I believe, help to minimize that struggle.
9:30 p.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Thank you.
We can see that you are very open and very calm when it comes to medical assistance in dying. You said it was important to expand resources and funding.
Do you make that a prerequisite to amending the law?
More precisely, do you want additional funding to be allocated before we make changes?
9:30 p.m.
Nurse Practitioner, Primary Health Care, As an Individual
I would suggest that it's a recommendation and not a requirement. MAID practitioners have been doing the work that needs to be done, but it's difficult with the increasing demands, and in order to be able to service Canadians who are making these requests, we will need more resources.
9:35 p.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
What do you think about the question of minors who demonstrate maturity?
How do you see that?
9:35 p.m.
Nurse Practitioner, Primary Health Care, As an Individual
Quite honestly, it's not one that I have had to deal with or have given a lot of thought to. I do believe that age as a cut-off is a number and can be arbitrary. There is concern, for sure, in terms of people having to achieve a certain criteria that may be arbitrary in order to have equitable access to care options.
I believe that it's something that should be explored, but again, would need considerable safeguards to ensure that individual safety is still maintained.
9:35 p.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Thank you.
I'm sure my speaking time is running out.
Ms. Baylis, you have apparently experienced...
9:35 p.m.
The Joint Chair Hon. Yonah Martin
I'm sorry, Madame Vien, your time is up. I apologize for interrupting.
We'll go next to Monsieur Arseneault.
9:35 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Thank you, Madam Chair.
Ms. Baylis, I want to congratulate you on your nursing career, even though you are now retired. You have seen it all over the course of your career. You have now reached what is called the age of wisdom.
As you know, Canada has offered palliative care for quite some time now; only very recently has it started offering medical assistance in dying. The statistics show that almost 80 per cent of people who request medical assistance in dying have already received palliative care and do not want to end their lives that way. Instead, they want to receive medical assistance in dying. As well, after thinking about it, 20 per cent of people who request medical assistance in dying do not want to receive palliative care.
As a nurse, what are your comments on that subject?
9:35 p.m.
Retired Registered Nurse, As an Individual
I haven't nursed for a number of years, because I had three careers, but I am a registered nurse. Most of the people whom I have been knowledgeable with are 100% behind MAID, because none of us are going to go into a nursing home, one way or another. Right now I still do not qualify to have MAID in Canada because I don't have anything really medically serious at the moment. I don't qualify.
People who want to qualify for MAID don't have that opportunity. That's why I believe so strongly in preplanning while you're still competent, because if I got in an accident tonight, I don't qualify.
9:35 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Thank you, Mrs. Baylis.
Ms. Gwartz, I come from an extremely rural area. In face, I think I am one of the rare members of the committee, if not the only one, who comes from an area that is extremely remove from major centres.
When you began your presentation, you alluded to the fact that in Niagara, which is a large populous area, compared to mine, there are not enough resources to offer medical assistance in dying.
Could you tell me more about that, please?
9:35 p.m.
Nurse Practitioner, Primary Health Care, As an Individual
Much of the limitations here in Niagara actually have to do with health human resources and providers who are willing to do the work. It's not currently a funding problem. It was when I first started working. As I said, I provided MAID services for three years without any financial compensation. That was because I believe very strongly that MAID should be an option for people in my community, and it wasn't, because we had no providers who could actually get compensation who were willing to do the work.
The current model in Ontario provides funding for physicians to be able to bill through OHIP, but there is no model for nurse practitioners in the community who are competent to be able to provide this care to be able to get compensated. That was a major issue—
9:40 p.m.
Liberal
9:40 p.m.
Nurse Practitioner, Primary Health Care, As an Individual
A year ago, I and a colleague led a very strong advocacy program in order to be able to have funding allocated specifically for us here in Niagara, so we do now have funding, but it's just us. It's not throughout the province.
9:40 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
In northern Ontario, for example, they do not have that access or that resource.
9:40 p.m.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Wow.
As a nurse practitioner, do you have to get training, in Niagara or the Niagara region, in order to offer medical assistance in dying?
9:40 p.m.
Nurse Practitioner, Primary Health Care, As an Individual
I am a nurse practitioner, and nurse practitioners are qualified to be able to provide MAID. Any MAID practitioner wants to do training for sure, and there are programs that are actually in process now and being developed, as I understand. When I trained four years ago, it was a self-directed training program. I had a mentor whom I worked with, and I did a lot of self-study, so yes, there was training.