Medical Assistance in Dying Committee on May 5th, 2022

[Dr. Georges L'Espérance]

That's what the whole debate is about. These people can lose weeks, months and even a year or two of a very pleasant and very interesting life with their families. When people lose their decision-making capacity, they can no longer receive medical assistance in dying, and that's the reason for the study in progress. It's why we are here this evening.

[Pierre Dalphond]

Thank you, Dr. L'Espérance.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Mr. Dalphond.

We'll go now to Senator Wallin.

[Pamela Wallin]

Thank you very much.

I'd like to hear from Dr. L'Espérance and Dr. Andrew. I want to have comments from both of you. I'll make my point and have you respond to it and agree or disagree.

I want to follow up on the comments made by Madame Vien, another of our colleagues, on the catch-22 that we find ourselves in when it comes to dementia or Alzheimer's. Some witnesses have argued that you need a diagnosis for an advance request, but once you are diagnosed, you are then, by definition, considered incompetent. That's the bind that people find themselves in.

I think we heard testimony here that an advance request does not equal informed consent, when in fact that's exactly what it is. You're making that request in advance when you are still competent.

Could I have both of you speak to that issue? You'll probably have about a minute each.

[Dr. Georges L'Espérance]

I'll take a few seconds to answer before giving the floor to Dr. Andrew.

These days, patients who receive a diagnosis of a neurodegenerative disease or dementia can get it as long as they still have decision-making capacity. Why? Because they are asking why they are experiencing judgment, memory, and other problems. So they consult their doctor, who makes a diagnosis.

Some patients are definitely capable of deciding, just like people who are perfectly capable of driving their car and going about their business.

I believe that a diagnosis is essential. There is no contraindication.

I will now give the floor to Dr. Andrew.

[Pamela Wallin]

I agree with that totally. It was represented by others in a different way. Thank you.

Go ahead, Dr. Andrew.

[Dr. Melissa Andrew]

I totally agree that the diagnosis does not necessarily mean incapacity. That's a separate question and would happen later.

I would add the important point that in some places, unfortunately, we lack access to diagnosis. Some people, unfortunately, get a diagnosis quite late in their journey, even if they were trying to get it earlier. That speaks to the need for our system of dementia care to be strengthened.

[Pamela Wallin]

It's as if informed consent is becoming a question of timing, depending on where you live and the nature of the progression of your individual disease.

[Dr. Melissa Andrew]

That's an interesting point. Yes, if you require a diagnosis, it relies on the diagnosis having been made early enough, and all of the education that would go along with making these decisions being done early enough, before the lack of capacity occurs.

[Pamela Wallin]

Go ahead, Dr. L'Espérance.

[Dr. Georges L'Espérance]

For the various forms of dementia, what's involved is a relatively slow process for the vast majority of patients. It's spread over several years. There may be locations, in the far north for example, where it may be more difficult to obtain a diagnosis, but that has not been our experience, even though the health system may not always be adequate. In fact, people get their diagnosis and in a year or two they can have a consultation. Family doctors today are generally very good at diagnosing neurodegenerative diseases.

[The Joint Chair, Liberal, Marc Garneau]

Thank you.

Thank you, Senator Wallin.

We'll now go to Senator Martin.

[The Joint Chair, Hon. Yonah Martin]

Thank you to all of the witnesses this evening.

I have one question for Mr. Bach.

What is the difference between an advance medical directive for medical assistance in dying and an AMD for withholding life-saving treatment? I know we've been hearing various responses. If we have one, why not the other?

[Michael Bach]

I think they're quite different.

Advance requests or directives for withholding treatment are about things that aren't going to be done to us. All of the examples listed earlier by Dr. Andrew were about things that you refuse to have happen to you. We've provided for that under provincial-territorial law on the basis that by refusing certain things, you do exercise control in the sense that you will allow your death to take its natural course.

In the case of providing advance requests, I would still submit that there is no consent to the termination of your life at a future point. There is a substitute decision-maker who has to decide that now is when we'll do the injection. You're not consenting; someone else is, and it is to have something done to you that is intended to cause your death. That is fundamentally different from advance directives for withholding or withdrawing life-sustaining treatment, at which time comfort care—palliative care—is provided to support you through the natural course of your death. Those who provide that comfort care and withhold those treatments do so guided by your advance directive and on the decision of a substitute decision-maker at the time—I'm sure many around the table here have been in these decisions—that now is the time to withhold that treatment so that their son, brother or father can pass.

They're fundamentally different. I think collapsing or blurring the line between them leads down a path that puts one of the most vulnerable minorities in this country at risk. What is a democracy, after it all? It protects the rights of minorities. The minority I'm talking about is people with dementia who cannot consent and do not have capacity to consent, or people with intellectual disabilities who do not have the capacity to consent to their death.

That's the group we're protecting here. It's not those who can make advance requests. The group that we're talking about here is the group who cannot consent. They don't have the capacity to consent to a proactive intervention on the part of a medical professional intended to cause their death.

In this democracy, are we protecting one of the most vulnerable minorities in our society? I think the proposals that are advocating adoption clearly do not meet the test of protecting the right to life of one of the most vulnerable minorities in our society.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Senator Martin. Thank you, Mr. Bach.

That will bring our panel to a close.

On behalf of the committee, I would like to thank Dr. Andrew and Mr. Bach.

I'd also like to thank Dr. L'Espérance.

Thank you all for your testimony. It's on a very complex, difficult and sometimes emotional subject, as you all know. We are very grateful to you for having given us the benefit of your expertise on this committee.

With that, fellow members and witnesses, this meeting is adjourned.