Thank you, Madam Co-Chair, Mr. Co-Chair, and members of the committee.
We are pleased to be invited to share with you the perspective of nurses on this important study. I'm speaking to you today from Mi'kma'ki, the ancestral and unceded territory of the Mi'kmaq.
My name is Tim Guest, and I'm a registered nurse and the chief executive officer of the Canadian Nurses Association. I'm joined today by Dr. Barbara Pesut, a registered nurse and a principal research chair in palliative and end-of-life care at the University of British Columbia.
CNA is the national and global professional voice of Canadian nursing, and we represent nurses across all 13 provinces and territories. Canada's 440,000 nurses touch the lives of patients at every point of care, and no provider has as much direct interaction with the public where complex human issues arise, such as medical assistance in dying.
Nurses have acquired significant knowledge and experience from nearly six years of MAID in practice and have valuable knowledge to share. In fact, nurses are the most consulted health care professionals when MAID practitioners are seeking to inform their assessments. Today, I will share key findings from a study conducted from Dr. Pesut on nurses' experiences with MAID, as well as some preliminary highlights of consultations conducted by CNA with nurses.
In 2017, Dr. Pesut and her team began a three-year study of Canadian nurses' experiences with MAID. The 59 nurses who were interviewed had diverse opinions about MAID, informed by different levels of engagement with cases. The study highlights how there is great variability in how MAID has been enacted in nurses' workplaces. Nurses emphasized the importance of teamwork in providing high-quality MAID care, although many worked without the benefit of a team.
Nursing work related to MAID is highly complex because of the need for patient-centred care in systems that were not always designed to support such care. Without adequate supports, some nurses chose to limit their involvement in MAID. The study concludes that without accessible palliative care, sufficient providers, a supportive team, practice supports and a context that allowed nurses to have a range of responses to MAID, nurses felt they were legally and morally at risk.
For its part, CNA held consultations in 2020 and 2021, in partnership with the Canadian Nurses Protective Society, with nurses involved in MAID. They provided insightful learnings of their experience, their expert opinion on MAID overall and the three special populations of mental illness as a sole diagnosis, mature minors and advance requests.
Nurses highlighted the lack of access to palliative care in Canada and the importance of scaling it up, as well as other types of services, to ensure that patients are not opting for MAID because of lack of access to acceptable alternatives. For example, we heard that limited access to primary care in rural and remote settings has led to patients directly reaching out to urban centres for MAID services. Furthermore, nurses stress the need to put in place strong safeguards to ensure the appropriate use of MAID for the three special population groups if MAID is expanded. We also heard that practitioners with appropriate expertise within these three groups need to be involved in the MAID process, although we recognize that this also brings concerns of creating barriers and limiting access.
Finally, we urge that if changes to the Criminal Code are brought forward, they are made in a way that safeguards and provisions are clear and include objective criteria. We need to ensure the practitioners can confidently interpret and implement the Criminal Code provisions.
In conclusion, the practice of nursing has been profoundly affected by the availability of MAID in Canada and the moral ambiguities it creates within the world of clinical practice. CNA heard from nurses that MAID can have an emotional toll on the clinicians who are providing it, particularly in areas with scarce resources and a lack of important alternative treatments, such as palliative care.
Thank you. We'll be happy to answer any questions.