Thank you to the committee for the opportunity to speak with you today.
I'm here as the president of the Canadian Association of MAiD Assessors and Providers, the clinical subject matter experts on MAID in Canada, and as an experienced practitioner.
As my remarks must be limited, I will not dwell on the elements of implementation that have proven both important and well done. Rather, these are fleshed out in my written brief, but I will highlight the most important and I am willing to discuss further if you wish.
The fact that we allow clinician-administered MAID, that MAID is not restricted to terminal illness or imminent death, and that we simultaneously provide very good access to palliative care are all essential to high-quality care for Canadians.
I note that Bill C-7 fixed the unconstitutionality of requiring a reasonably foreseeable natural death, removed the problem-causing 10-day waiting period and added an important waiver of final consent. Data to date suggests that the expected number of Canadians are accessing and receiving MAID, and that those who proceed with MAID are disproportionately advantaged versus socio-economically vulnerable. Well done.
Through my work, I've seen evidence of the distinction between what others might hope to conflate: MAID and suicide. Suicide is almost always a dramatic event, often violent, frequently impulsive, and usually carried out alone or in secrecy. It leaves devastation in its wake for families, for first responders and often for entire communities. By contrast, medical assistance in dying involves a legal framework, a rigorous process, the involvement of multiple health care practitioners and the option to involve many loved ones. I've witnessed the therapeutic effects of merely telling people they're eligible for an assisted death and have seen people live longer than they thought they'd be able to because they had this option. As a colleague so eloquently once stated, suicide implies some form of self-destruction, while assisted dying is a form of self-preservation. They're simply not the same.
This work was especially challenging in the beginning—no training and no guidance documents or standards. CAMAP and early practitioners filled that void, and while we're tremendously proud of all we've accomplished, I quote a colleague from just a few days ago lamenting the lack of practitioners in her region. She said, “The feds need to work with medical and nursing training programs, as well as provincial ministries of health, to address the limited provider/assessor issue, or these changes will be meaningless.” We couldn't agree more. Please read my brief for a review of the factors at play.
The establishment of a two-track system of access to MAID has led some practitioners to withdraw their services due to both a perceived and a real complexity, in process as well as patient population. CAMAP's federally funded Canadian-made curriculum project is an important and positive step toward helping correct the significant lack of standardization of care across the country. It will help set a standard of practice, and should provide both clinicians and the public some measure of confidence. However, a lack of accessible expertise and/or resources for patients continues to hamper practical efforts. Clinicians have begun to experience distress when faced with people who are eligible for MAID but whose suffering is primarily due to a lack of appropriate resources. We are not in any way suggesting MAID be curtailed due to the failings of our society, but we are strenuously suggesting that MAID and community resources for mental health, palliative care, and disability supports be developed and supported in parallel.
With my background in family medicine, I have seen the torment of families who are faced with the unbearable, the birth of a non-viable child or one with terminal illness, and I have journeyed with them. Mature minors in Canada already make their own health care decisions in the denial or acceptance of blood products or with regard to reproductive health choices, as examples. We already have experience in assessing their capacity to make independent decisions. In the catastrophic circumstance of a mature minor with an illness that is causing unbearable suffering, who in very rare cases might ask for access to MAID, to discriminate on the arbitrary basis of age seems indefensible and in fact blatantly cruel. Despite an initial discomfort, you might find a safeguard allowance of MAID for mature minors the most clear-cut of all the issues that you are considering.
I will leave the discussion of advanced requests to others, except to note that lack of availability is the concern I hear about at every presentation I have ever given on the topic of MAID. We would urge this committee to undertake a comprehensive review of past and current reports and recommendations, seek input from frontline clinicians, and make a decision about a matter that the majority of Canadians wish to see resolved.
As my final message, it remains unclear who or what is responsible for access issues. Is it the federal law or the provincial taxpayer-funded yet objecting facilities? As clinicians charged with doing this work, we are still far too few. Help train us. Compensate us and adequately resource our communities, or we will be unable to help people in the way you have trusted us to do.