Evidence of meeting #6 for Medical Assistance in Dying in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was request.
A video is available from Parliament.
Professor, Faculty of Law, Université de Sherbrooke, As an Individual
Absolutely. There has to be follow-up. There has to be a way to transmit information. I also think it should be done continuously, as the condition evolves, not just one final time.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
When you refer to something resembling a standard, that would be at the national level, wouldn't it?
Professor, Faculty of Law, Université de Sherbrooke, As an Individual
I think it could be determined by the professional associations. Certain aspects would also have to be determined: if this becomes a protected act, is it a paid act, and how does that have to be organized? This is a bit beyond my field of expertise, but I think this is a really good opportunity to establish standards.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
A professional who came to talk to us about this issue last week told us he thought advance requests should be reviewed every five years.
What you think about that?
Professor, Faculty of Law, Université de Sherbrooke, As an Individual
I think that could be done depending on how the condition progresses. It could be every five years or a little less than that if the condition evolves very quickly. There may not be any absolute rule, but, yes, it could definitely be done at least every five years.
I think it would be wise to provide for requests to be reviewed because circumstances change. We have a lot of data on experiential knowledge and on the way people's perceptions can change following an announcement because they ultimately grow accustomed to certain things. People may not change their minds in the end, but they must have an opportunity to review certain choices.
Liberal
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Mr. Lemmens, I'm not sure I understood your remarks so I'd like a few points clarified. You aren't in favour of advance requests, and you say we must be cautious.
How cautious do we need to be? In other words, do you mean we have to be cautious to the point of preventing advance requests? Is that in fact what you're saying?
Professor, Scholl Chair, Health Law and Policy, Faculty of Law, University of Toronto, As an Individual
Yes. I'd say the experience of the Netherlands and Belgium shows that advance requests for medical assistance in dying create insurmountable ethical and legal concerns. Furthermore, the practice in the Netherlands sometimes involves the involuntary administration of medication to anaesthetize patients in order to complete the euthanasia procedure or…
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
I apologize for interrupting, Mr. Lemmens, but I have only 20 seconds left.
Regardless of what's done elsewhere—we are, of course, in Canada, and we're going to develop our own bill—we believe it's impossible to introduce safeguards that will protect someone deemed to be of sound mind who makes an advance request for medical assistance in dying.
Is that correct?
Professor, Scholl Chair, Health Law and Policy, Faculty of Law, University of Toronto, As an Individual
Yes. It creates more problems. There are other approaches to providing assistance to those persons.
Liberal
Professor, Scholl Chair, Health Law and Policy, Faculty of Law, University of Toronto, As an Individual
For…
Liberal
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Ms. Chalifoux and Ms. Bernier, in Quebec, we have what are called advance medical directives. They aren't yet widely known, and they very often apply to specific situations. For example, one can consider the desired level of care when a relative enters a CHSLD, which is a long-term care facility. Advance medical directives cover discontinuation of treatment, refusal of treatment, level of care, reanimation and so on, and that's not well known.
Shouldn't we develop an entirely separate process for advance requests for medical assistance in dying, as some witnesses have proposed? That would apply to neurodegenerative disease cases, where the stages of development are predictable and there's an established process and an entire team following the patient right up to the medical-assistance-in-dying stage.
Shouldn't the cases you refer to, strokes, aneurysms and so on, be covered by advance medical directives?
Conceptually speaking, wouldn't it be better to distinguish between the two mechanisms so we can move forward cautiously, as circumstances dictate?
Professor, Faculty of Law, Université de Sherbrooke, As an Individual
Who's that question for?
Liberal
Bloc
Luc Thériault Bloc Montcalm, QC
First, I'd like to hear x Ms. Chalifoux' comments because I wanted to make a connection with Quebec.
Lawyer and Chair, Institut de planification des soins du Québec
I see two aspects to your remarks. I find your questions very interesting.
First, the advance medical directives that we have in Quebec wouldn't be applicable to medical assistance in dying. They're binding, by which I mean they are mandatory, and they apply to situations that don't call for extremely long and extensive reflection. Consequently, they're easier to apply.
Lawyer and Chair, Institut de planification des soins du Québec
That's why they've been well received.
For example, consider a man who becomes incapable following a stroke and is in the same situation as a person suffering from a neurocognitive disorder, by which I mean that his condition is grievous and incurable, that he is experiencing what he deems intolerable suffering and so on. That case must definitely be distinguished from those that are the subject of the advance medical directives provided for under Quebec's Act respecting end-of-life care. I think those are two completely different things.
Bloc
Bloc
Luc Thériault Bloc Montcalm, QC
However, you don't agree that the medical situation you referred to falls under advance medical directives, even if…
