I'll answer your first question. Thank you very much, Senator Kutcher.
As you indicate, a large majority of end-of-life care, and palliative care as well, can be provided by non-specialists. I think that as the complexity of symptoms increases you should involve experts and specialists, as you do for any other problem such as complex diabetes or complex heart problems; you don't need a cardiologist or an endocrinologist unless they're complex. I think that's definitely the case. Certainly, for more complicated physical symptoms, I think you would definitely want to look at an expert and get an expert's involvement.
Unfortunately, when it comes to the main drivers of medical assistance in dying, it almost never relates to physical symptoms—or even less to psychological symptoms—but actually to this existential distress, which is something for which we have little or nothing to offer. That's why it's important to distinguish this, but really, to emphasize and bolster the palliative care sort of pyramid and make sure we have adequate specialist resources for those more complicated symptomatic cases is super important.
In terms of your second question, I'm very impressed that you read through the documents about where the funding is going. I'm glad somebody did. I think it's really important to emphasize that the money comes to the provinces and the provinces decide how it's spent, but there's never a sort of “earmarked” anything in the physicians' services budgets anywhere that “this goes to palliative care and MAID” and you have to fight over it. That's definitely not how it happens.
Some people use the same fee codes for the same activities, but as I said, it's not a zero-sum game. One does not come at the expense of the other. There is sometimes a global cap on physicians' services budgets, but it doesn't mean that MAID happens at the expense of palliative care, and certainly for people who are salaried and do both activities, they almost invariably do MAID in their sort of downtime or on weekends. There's really no suggestion, I think, or no reason to believe, that these resources are being repurposed.
That said, MAID is not the reason that palliative care is under-resourced in Canada. The reason that palliative care is under-resourced in Canada is that palliative care is under-resourced in Canada.