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.
9:25 p.m.
Senator, Saskatchewan (Saskatchewan), CSG
Thank you very much.
I have two questions for Dr. Thorpe.
We come from the same part of the world, which is Saskatchewan. I want to ask about the rural-urban issue and access.
Presuming that the pandemic has given everybody some experience with this, are you now comfortable doing assessments on Zoom or some other kind of technology? Does that actually create more access because people don't have to travel and you can do it more often?
9:25 p.m.
Professor, University of Saskatchewan, As an Individual
Thanks. That's a good question.
Saskatchewan actually has a centralized MAID program. We have really good access throughout the province. We have people in most areas of the province. There is now funding for the assessors and providers to go out, and their time is reimbursed.
Some of the assessments are done virtually. We're all better at that now, but we like to have at least one of the assessments in person. We have generally been able to have a really quick response. We probably have one of the quickest responses across the country. It's usually within a week, and often much quicker.
Certainly we've learned assessment by virtual means. The second assessment is sometimes easier to do in a virtual format. I have done quite a few of those, as I'd see most of the more complex cases. There's been some improvement with this, but I prefer to see them myself.
9:30 p.m.
Senator, Saskatchewan (Saskatchewan), CSG
Thank you.
On my second question, we've heard statements about this over the course of our hearings. As a long-time MAID assessor, do you know of any cases of forced MAID—of a practitioner or a family member compelling someone, clearly against their will, to subject themselves to MAID?
9:30 p.m.
Professor, University of Saskatchewan, As an Individual
Absolutely not. What I see much more often is that family members dissuade their families from having MAID. That is much more common.
I've never seen a case of anybody pushing someone into MAID. You need two assessors, and with two separate assessments, you would absolutely be aware of that pressure.
9:30 p.m.
Professor, University of Saskatchewan, As an Individual
I think so, yes.
9:30 p.m.
Senator, Quebec (De Lorimier), PSG
Thank you, Mr. Chair.
Dr. Boisvert, my question is for you.
Based on your experience and your area of specialization, can you tell me whether, since the act was amended, you have encountered any situations in which patients, out of fear of losing capacity and being unable to consent later, decided to advance the date on which they would receive medical assistance in dying, and perhaps miss out on six months or a year of happy living, simply because they wanted to make sure they could decide when their life would end?
9:30 p.m.
Physician, As an Individual
I have in fact given medical assistance in dying to several patients with dementia who clearly retained their capacity until the last minute, but who would definitely have liked to spend a little more time with their family. If they had been able to make an advance request, the criteria they would have chosen would have been not being able to care for themselves or recognize their family members, which would have left them quite a lot of additional time. It can indeed take months and sometimes even years in some instances before reaching that state.
I think people have heard about the case involving Ms. Demontigny, who is fighting for advance requests. She is fighting for the additional years she might have.
I have indeed had patients who received medical assistance in dying too soon, as it were, because they did not have the opportunity to complete an advance request.
9:30 p.m.
Senator, Quebec (De Lorimier), PSG
, People are being deprived of their decision to live for additional months or years, because they are forced to choose to die now in order to be able to exercise their decision.
9:30 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you.
Now we'll go to Senator Martin.
Senator Martin, you have three minutes.
9:30 p.m.
The Joint Chair Hon. Yonah Martin
Thank you, Chair. My question is to Dr. Gallagher.
Based on your experience and knowledge, what do you see are the major risks of advance care planning that includes MAID? What should we be aware of?
9:30 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, As an Individual
Well, I think you should be aware of the extreme difficulties in actually deciding when and how to do this. I think there's little evidence that shows that doing it this way or that way, or defining some kind of arrangement between two people, will sort out the problems.
Life is difficult, and things don't always work out the way that one plans. I think it's knowing, as Dr. Thorpe very ably pointed out, that life is complicated and things are challenging, and it's not easy to do this.
There are a lot of risks, and the benefits are hard to measure, so I do not believe it's in the best interest to enact this kind of legislation. I think it's very problematic.
9:30 p.m.
The Joint Chair Hon. Yonah Martin
In the time that I have remaining, would you like to talk a little bit more about what the federal government should do regarding palliative care?
9:30 p.m.
Clinical Professor, Palliative Medicine, University of British Columbia, As an Individual
Oh, thank you.
What we want to do is to have a system where you....
We know that all provinces have to rely on accreditation of their organizations. Therefore, you can put in place standards and measures of the quality of palliative care. You can also enact symptom screening and distress screening in all chronic disease clinics.
I believe that doctors have great intentions, but they often aren't focused on symptoms; they're focused on disease indices and testing and so on. We need to hear from people. People will often rate very differently on a survey than what they will admit to their family doctors. We need to pick up suffering early. We need to have a system in place that ensures we are detecting it and addressing it early, before people are suffering to the point where they say, “My life is intolerable the way it is right now.”
It's my hope, knowing that this is within the control of the federal government, that in your role in reviewing the state of palliative care, you will take this incredible step to enforce a change in our system that will benefit everybody, no matter whether they have MAID or they have a natural death. I think it's very important.
I thank you.
9:35 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you very much.
I'd like to thank Dr. Gallagher and Dr. Thorpe.
And I'd also like to thank Dr. Laurent Boisvert.
Thank you for having testified this evening and answering our questions on an important, but very complex subject. We are truly very grateful. I'd like to thank everyone for having remained available at such a late hour, especially for those of you who live in the eastern part of the country.
Thank you very much. We very much appreciate your being with us this evening.
With that, I will remind the committee members that our next meeting is one week from today. It will be a three-hour meeting. As agreed upon at the beginning, we will reserve the third hour for in camera committee business.
Before we adjourn, there has been a suggestion that we extend the period for people to provide briefs, given the fact that our final report has been extended to October. I'd like to see a show of hands from people supporting allowing briefs to be presented up until May 30.
Does anyone have a problem with that?
I can't see everybody in the room, but I'm looking at—
9:35 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Yes. There are lots of thumbs up.
That sounds very good. We will notify people that they can provide briefs—the length is still 1,000 words—up until May 30.
Thank you very much.
This meeting is now adjourned.