Thank you very much.
I'll try to keep my comments as brief as I can. I've already sent in some notes for people to follow.
I'm the head of the division of palliative care at the University of Ottawa. I have a clinical research chair in palliative and end-of-life care and a master's degree in ethics.
I've taken an interest in this issue for some time, have served as an expert witness in different cases involving medical assistance in dying and have developed educational materials for medical assistance in dying for different jurisdictions, including Canada and Australia. I've also led a few studies looking at MAID and people who receive medical assistance in dying to understand a bit about their experience and about who these individuals are, but I'm not here representing any organization or agency.
I've previously spoken in favour of legalization of medical assistance in dying, but I'm not here to promote MAID and certainly not to advocate for any position on any of the remaining issues before Parliament about mature minors, advance directives, etc.
The main points I would like to make today really are that I'm very grateful to say that funding for palliative care and support for palliative care research is improving and that there have been some notable successes in that regard. I really want to thank Parliament and Health Canada for that, but I really emphasize the need to continue doing this and to reduce barriers so that we can improve the way we treat suffering among the dying.
I've heard a lot of comments in the previous sessions about the social determinants of health and the vulnerable. I think it's very important to say that we really do need to address social determinants of health, including housing, food security, pharmacare and dental care, because these are important to the health of all Canadians. I think it's important to recognize that these measures are really not about medical assistance in dying at all, because structurally vulnerable individuals are already far less likely to use medical assistance in dying than anybody else. We should do these things simply because they're a good idea and the right thing to do.
There are a lot of narratives about medical assistance in dying in Canada. These are generally driven by ideological or political aims that really have nothing to do with saving lives or protecting the vulnerable. I think we've learned an awful lot over the past 20 years about how medical assistance in dying is provided in different countries, including Canada, and who is requesting it and who is receiving it.
What we know very much is that it is not what has previously been thought. It is heavily driven by something known as existential distress. This is a type of suffering for which we have very little or nothing to offer. We really should be attempting to understand this type of suffering better, to identify new forms of treatment and to support research into identifying new forms of treatment for it, so that we can address this suffering as really the root cause of MAID requests. I think that's something on which everybody—as controversial as this issue might be—can agree.
Finally, I'd like to also mention that our experience through Bill C-14 and Bill C-7has been that Parliament, in the past, has really been unwilling to address medical assistance in dying and key issues in a proactive way, preferring to let the courts strike down laws and leave the government to replace them. This unfortunately happens usually in a very partisan process—a bit of a circus, almost—in an accelerated time frame and with predictable results.
I really love that there's now a committee like this that's going to be studying some of the important issues and reviewing things. I would really encourage a committee like this to continue operating to try to make sure that the remaining questions about medical assistance in dying are handled in a way similar to what Quebec's parliament does: proactively addressing questions, studying them thoroughly, forming committees to really review evidence and then developing nuanced answers. I'm not suggesting that we should go the same way Quebec has on any issue. I'm simply admiring its process and encouraging us to follow it.
I think we can get into some further discussions around some of the drivers, but I really want to emphasize that there is absolutely no data suggesting that the practice of MAID at this point is driven to any degree by poor access to palliative care, socio-economic deprivation or any isolation. Quite the contrary: The people who receive MAID almost invariably have excellent access and are receiving palliative care far more than the average population. They tend to be very wealthy, privileged, non-institutionalized and married, not widowed or single.
The national reviews on this have shown that the number of people who received MAID and who had trouble accessing disability services and palliative care services is tiny—absolutely minuscule. That's very reassuring. Obviously, it could be even lower than 1% or 3%, but that's pretty good. Certainly, it would not be accurate to say that it's being driven by a lack of access to services.
I really want to emphasize a bit of information about the research and the successes that have been found in research—