Good evening.
Thank you for welcoming me to this committee.
I have been practising medicine in the field of palliative care for 30 years, and I have administered medical assistance in dying 180 times in the last six years, mostly at home.
I was asked to speak a little about palliative care. At the end of my presentation, I will share with you my views on advance medical directives.
Five percent of patients at the end of life who receive excellent palliative care are still seeking medical assistance in dying. Why? Because existential suffering at the end of life cannot be relieved to the patient's satisfaction by any current conventional palliative approach.
First, we must not forget that any curative or palliative care can be legally refused. Nor should we forget the ethical principle of respect for individual autonomy. The individual is the only one entitled to make decisions about their own end of life and to judge the results of the care given to them.
When palliative care physicians claim that medical assistance in dying would not be necessary if good palliative care were available everywhere, one should first define what is meant by "good" palliative care.
When I assess a request for medical assistance in dying to see if it meets the eligibility criteria, the law recommends that I ensure that the person is aware of the alternative options to medical assistance in dying that are available, including palliative care. When the palliative care physician is about to put the patient under continuous sedation until death, why does the law not require that the patient be made aware of the existence of medical assistance in dying, to allow them a choice, as I am required to do?
I have helped thousands of people to die. I can testify that medical assistance in dying is probably the most compassionate life care, the most respectful of the person and their values, and the most comfortable for them and their family. Medical assistance in dying should be considered appropriate care in a logical continuum of palliative end-of-life care, which can be requested when, in the patient's opinion, all reasonable efforts have been made. It should be made clear in law that medically assisted dying is part of a continuum of palliative care.
The conscientious objection of caregivers to the administration of medical assistance in dying must be maintained, but conscientious objection applies only to the caregiver as an individual. It cannot apply to an institution, a health care facility or a social professional group.
In 2015, the law passed in Quebec allowed hospices not to offer medical assistance in dying. Since then, 50% of them have changed their minds under social pressure from the community. All health care facilities in Canada, public or private, especially if they are partially publicly funded, should be required to offer this care, even if it means bringing in external physicians to implement it.
Finally, it would be necessary for what is meant by "palliative care" to be defined in a way that is more consistent with reality. To think, or even wish, that the intense level of care found in most hospices should be set as the norm is unrealistic and, ultimately, undesirable. Basic palliative care is comfort care. The family doctor who relieves the pain of his elderly patient suffering from generalized cancer at the end of life is providing palliative care. When I report to Health Canada about a medically assisted death that I have performed, I am asked on the reporting form if that person received palliative care and for how long. Let me tell you that the thousands of responses to this question received to date are probably meaningless, because the term "palliative care" has never been defined at the operational level.
I had a few more ideas to share with you about advance medical directives, but since I don't have much time left, I'll try to do it very briefly, if I may.
First, when a person has just been diagnosed with Alzheimer's, the doctor should adequately inform them of the nature of the disease, its course and prognosis, and the possible treatment options. That person could then define in their own words...