I want to say something general about advance directives for competent patients and for incompetent patients. I studied this in nine countries, including Canada, although I was last in Canada in the early 2000s, so I haven't been here in the past 10 years or so.
In my studies, you can see time and time again that doctors who deal with dementia patients tell you time and time again that it might be the case that when a person in a certain situation comes to their end of life, knowing that they're going to end up not recognizing their own life, their relatives and so on, they change their mind. They find it meaningful and esoteric. They've now found meaning in something that would have been utterly meaningless to them, say, a few years ago.
I think you have to differentiate between conditions. If it's physical deterioration—a physical condition in which the mental capacity remains—I totally agree with James Cowan and Helen Long in all they said. When it comes to dementia and issues of the brain, I cannot agree, because people change and people change their minds.
Look at marriage. Many people, when they get married, think that marriage is for life, yet we see that 50% of the population get divorced. They change their minds. If you ask a young person whether he or she can perceive life in a wheelchair, the common answer is, “I'd rather die.” God forbid they enter into that state after a car accident, but when they find themselves in a wheelchair, they don't want to die. The majority of them want to continue living. I've seen patients in horrendous conditions, but when you ask them, “Would you like to die?”, they are silent.
We have to be very cautious when it comes to incompetent patients. To me, the issue of autonomy is something that we are all concerned about. I think all Canadians are concerned about autonomy. That's what motivates MAID: the autonomy of the patient. I don't think we can encompass that to incompetent patients. This is where we have to set the boundary, and the boundary should be very strong and very firm.
If you're going to pass these measures, we are going to open the gate to abuse, and Canada does not want that.