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.
Senator, Nova Scotia, ISG
So there was no consensus that ending someone's life was part of what you were doing.
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
No, there was consensus that ending life is not part of palliative care and not part of the skill set of a palliative care clinician.
Senator, Nova Scotia, ISG
I hear you. I was just saying it the other way around.
Is there consensus now among palliative care physicians that track two MAID, as described in Bill C-7, should be provided by palliative care physicians?
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
We have not surveyed our clinicians. Those aren't typically the patients we're involved in caring for. We usually provide care for patients who meet the reasonably foreseeable death criterion.
Senator, Nova Scotia, ISG
So you would not have information on whether or not palliative care physicians, as a group, are in favour or not in favour.
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
We would not have that information.
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
I think the point is that this is not about whether or not people are in favour of MAID; this is about how people can access the care they need to live. Currently in Canada, we don't have the infrastructure for people to have palliative care.
Senator, Nova Scotia, ISG
I don't think people are debating that. We all agree on that. The issue I'm trying to understand is whether there is consensus within the community of palliative care physicians that track two MAID should be provided.
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
Certainly the Canadian Society of Palliative Care Physicians and the Canadian Hospice Palliative Care Association spoke out against Bill C-7 and thought it was putting too many vulnerable lives at risk, so I would say that the consensus of the two national organizations is that it was wrong to extend MAID to track two.
Liberal
Senator, Quebec (De Lormier), PSG
Thank you, Mr. Chair.
My question is for Dr. Naud.
You may have heard the testimony of Dr. Pageau, in the previous group of witnesses, who seems to make a distinction between not preventing death from happening—which is how he sees advance medical directives—and causing death—which is how he sees advance requests for access to medical assistance in dying.
I understand the distinction from a legal standpoint, but from the standpoint of medical ethics, does that really present a problem, Dr. Naud?
Family and Palliative Care Physician, As an Individual
Thank you, senator.
There is no problem in that regard. The only problem lies with the caregiver themself. You know that opponents of medical assistance in dying use the term "euthanasia" a lot, with contempt, saying that this is euthanasia. We have to go back to the Greek root of the word "euthanasia" to understand that the word means "a beautiful death". In Belgium, there is no hesitation about using this word, which in fact is part of the name of the federal commission to oversee and evaluate the law on euthanasia.
Medical assistance in dying is an act of euthanasia. It is medical care that consists of relieving suffering. What is the best way of relieving suffering? As a caregiver, it is not up to us to determine it. When it is a matter of end of life dignity and the best way to die, I don't have the answer. It is not for me to choose or decide for a patient. Again, my role as caregiver is to explain to the patient the options available to them and completely respect their choice.
Surveys show that 85 to 90 per cent of the general public support medical assistance in dying. The proportion is even slightly higher among physicians in Quebec, according to a survey done by the Collège des médecins du Québec on the question. So that means that 10 to 15 per cent of the public oppose medical assistance in dying. Certainly, if you ask the people who have opposed medical assistance in dying since the start whether they support expanding access, their answer will be no. That proportion of the public will always oppose expanding access to medical assistance in dying.
Personally, I think we have to respect the wishes of the majority of the population of Canada and Quebec and know exactly what an expansion of access to medical assistance in dying will look like. We can debate death, end of life dignity and the best way to die at length. In my opinion, it is up to each individual to determine what the best way to die is.
Some people will say that God is the one who gave them life and it is up to him to take it back. As a palliative care physician, I completely respect that position. Those people want to experience a terminal coma or terminal agony phase. I think we have all seen this kind of situation in our families, where the person is going to die gasping for breath, mouth open, for 10 days. On the other hand, some people absolutely do not envision their end of life like that, because they have seen their parent die that way and they say to themselves that their own life is not going to end like that.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you.
We'll now proceed with Senator Wallin for three minutes.
Senator, Saskatchewan, CSG
Thank you very much.
I have a question for Leonie Herx.
MAID is the law of the land. You understand that, correct?
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
This is not about MAID being right or wrong. This is about access to care that relieves suffering before it becomes irremediable.
Senator, Saskatchewan, CSG
You have said, in answer to one of my colleague's questions, that you've not really surveyed your clinicians on the question of MAID specifically, and whether they would offer it. You said no palliative care clinician would want to do that. Are you saying that palliative care clinicians, if asked by a patient to discuss MAID or to have someone come in and hear their request for it or to explain the options, would refuse to do so?
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
My goodness, absolutely not. I'm not sure where that idea came from. We provide our patients with all of the information so that they can make a choice that's best for them.
We have a special expertise that comes through our certified training program. Palliative care has come so far in the past 10 to 15 years in terms of its advances to understand symptoms, especially spiritual and psychological distress. We accompany people. We have a specific expertise to support people in focusing on living and reframing hope. We're not there to hasten someone's death. That doesn't mean that a person can't access MAID.
Senator, Saskatchewan, CSG
No, I'm not talking about hastening their death. If they say, “I've been through the palliative process. I personally see this as a continuum. I would like to go to the next step now and choose MAID”, what do you do? Do you bring in someone who will discuss this? Do you give them access?
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
Us? No. We discuss all options with our patients.
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
I can't go into specific examples, but we make sure patients have all the understanding they need, which includes understanding palliative care. One of the biggest—
Chair and Associate Professor, Palliative Medicine, Queen’s University and Chair, Royal College Specialty Committee in Palliative Medicine, As an Individual
It's actually part of—