Evidence of meeting #9 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 treatment.
A video is available from Parliament.
2:35 p.m.
NDP
Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC
Good afternoon, Madam Chair.
Mr. MacGregor’s name is Mr. Boulerice today!
2:35 p.m.
The Joint Chair Hon. Yonah Martin
Yes, go ahead, Mr. Boulerice.
You have the floor for five minutes.
2:35 p.m.
NDP
Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC
Thank you very much, Madam Chair.
I thank all three witnesses for being here.
Professor Vrakas, thank you very much for your honesty, sincerity and candour. It’s very moving.
I will ask a question, which I invite all three witnesses to answer in the five or six minutes that I have. I have a question that is troubling me. I came here with no preconceptions. I’m listening and trying to learn.
Ms. Vrakas, you said in your testimony that you did not want to die, but to stop suffering. I am under the impression that this is the case for many people who have physical illnesses and are suffering. They don’t necessarily want to die, they want to stop suffering. How can I, as a legislator, differentiate between the right of someone who is suffering physically and the right of someone who is suffering from a mental health problem? I want them both to have equal rights.
Mr. Maher, you said there was no discriminating between the two, but why would I give a right to someone who has irremediable physical suffering and not give the same right to someone who has mental suffering? I know that the issue of irremediability is very sensitive.
Ms. Vrakas, you could go first, and Mr. Maher and Ms. Wiebe can respond afterwards.
2:35 p.m.
Psychologist and Professor, Department of Psychoeducation, Université du Québec à Trois-Rivières, As an Individual
First of all, the aspect of irremediability is essential. It can’t be ignored. When I say I wanted to stop suffering, that was exactly what I wanted. So I went to the emergency room to get help. I called the Suicide Prevention Centre. Do you know what? My suffering decreased. I’m here today in front of you, alive, and I’m fine. You could have said: it’s fixable, but while we’re at it, let’s go for it. That is not reality. It’s not the same for someone with cancer whose death is predictable.
2:35 p.m.
President, Ontario Association for ACT and FACT
A very short answer to the question is that the main difference is that we're talking about treatable brain diseases, so if it's treatable, why are you offering death?
To the second point about suffering, when Dr. Fry asked the question, she was setting me up to sound like I'm paternalistic or that my wishes would supersede the patient's. In fact, the patient comes to me because of suffering. They come to me because they believe I have expertise and knowledge and the ability, with my team, to relieve that suffering. Why would I offer death instead of doing exactly what they're asking from me in the first place? They have crossed my doorstep seeking help, seeking relief from suffering, and I'm telling you I can offer it. I'm telling you that teams can offer it. I'm telling you that we only have one in three Canadians who have accessed mental health care in Canada and you're offering death instead of treatment.
Treat everybody and then let's have this discussion, but to offer them death and say, “Oh, these people have had all kinds of treatments”, I have patients referred to me all the time from psychiatrists who have said that they're never going to get better, and they get better because of subspecialist care. It's subspecialist care. If you have a particular type of tumour, you're not having your family doctor treating it. You're going to a specialist in that type of cancer. It's true in psychiatry as well. You have this false narrative going on here about how it's all equal and all psychiatrists are equal and all diseases are equal.
Talk about the treatment of resistant diseases. Talk about the people whose suffering has lasted for a long time and answer this question: What do they want? They want relief from suffering. I would tell you honestly—
2:40 p.m.
NDP
Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC
I would like Ms. Wiebe to have a chance to speak.
2:40 p.m.
As an Individual
I see physical and mental illness and suffering very similarly. People come to me sometimes and say exactly what you said, Dr. Vrakas, that they don't want to die but they want to stop suffering.
The question is this: Have they been offered the treatments that might relieve their suffering, and did it work enough for them? For example, if I had a subspecialist like you, Dr. Maher, and I told my patient there was a five-year waiting list for the specialist in their area and asked them whether they were willing to continue suffering for the five years, and they said they weren't, then I would say that was irremediable.
The issue with relieving suffering is so similar in many kinds of situations. Most of the suffering that people talk about is not pain but lack of ability to have a normal life. That's true of people with mental illness as well as those with physical illness, so I don't see a big difference. Have they been offered the right treatment? Can they be offered it? We talked about—
2:40 p.m.
The Joint Chair Hon. Yonah Martin
Thank you, Dr. Wiebe.
We've now completed round one, so I will turn the floor back to the joint chair, Monsieur Garneau.
2:40 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator.
We'll now have a round of questions from the senators, and we'll begin with Senator Mégie. These will be three-minute rounds.
Senator Mégie, you have the floor for three minutes.
May 26th, 2022 / 2:40 p.m.
Marie-Françoise Mégie Senator, Quebec (Rougement), ISG
Thank you, Mr. Chair.
My question is for Dr. Maher, but Ms. Vrakas could answer it as well.
Dr. Maher, I don’t know if you fully answered Dr. Fry’s question. I feel like there were bits and pieces missing.
In the case of a physical illness, if specialists are trying to come up with all sorts of drugs and treatments, complex or not, to bring a person relief, it’s called overtreatment. In the case of mental illness, does this concept also exist?
Do we sometimes not offer MAID, hoping that the individual will one day get better if we put them on several treatments, experimental or not?
2:40 p.m.
President, Ontario Association for ACT and FACT
If you're asking me whether we try things without purpose, or let's see if it works because we have nothing to lose, the answer is no. I never get to that point. I have standard treatments that work, and it takes a long time to get there. The process of healing is slow. If you are asking me whether I think people should try experimental treatments, to me that's a matter of subjective choice. I'm not pressuring anyone to do anything. I'm offering standard treatments, and the standard treatments work.
It's an astonishing thing to me that if the treatment isn't available, and Dr. Wiebe is saying you can't get to see someone.... I'm wondering whether any of you would say “I'm going to die because I can't get the right care”, or are we people in a position of privilege, where we say, “I'm going to go to the States, or I'm going to pay for it somewhere else”? It's actually been said out loud, we'll let people die. We've seen in the news: Let people die because they can't get an apartment. Irremediability, on my understanding of the Supreme Court ruling and subsequent legislation, had nothing to do with psychosocial resources. We were talking about diseases. These were medical diseases—brain diseases we're talking about now—where we couldn't medically treat them.
Boy, has the barn door been opened wide here if that counts as irremediable. I'm going to cite this as a specific example of my great fear of the abuses that are going to follow with this legislation, because there's no oversight. There's no requirement that there be prospective judgment of what the doctors and nurse practitioners are doing. If Dr. Wiebe is going to let someone die because they can't get a treatment that will help them, then I'm frankly just shocked. That is not what this law is about, nor should it be. If we as a Canadian society are willing to let people die over apartments, I'm frankly just disgusted. Forgive my passion here, but you're parliamentarians with a duty to preserve life.
2:45 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Dr. Maher.
We're now going to go to Senator Kutcher.
2:45 p.m.
Stan Kutcher Senator, Nova Scotia, ISG
Dr. Wiebe, I just want to let you know that I'm sure all committee members appreciate the humility of your testimony.
Dr. Smith said in previous testimony that he felt that the Government of Canada should accept all—
2:45 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
I’m having a hard time hearing the senator as well.
Senator Kutcher, we can't hear you very well. Do you have your microphone boom down at the right place?
2:45 p.m.
Senator, Nova Scotia, ISG
I've moved it. Thank you so much.
Dr. Smith in his previous testimony said that he felt that the Government of Canada should accept all of the recommendations of the expert panel report. Would you agree with that?
2:45 p.m.
As an Individual
No. I accept a lot of them, almost all of them. My concern was with the issues of the provinces and the colleges being responsible for the standards guidelines. There's a huge problem with that. There are 26 different colleges that are handling the professionals involved, the nurse practitioners and doctors, and their mandate is that we provide professional and competent care. That isn't interpreting criminal law.
These 26 colleges are not what we need to do this, and the idea that the provinces and territories, the 13 jurisdictions—
2:45 p.m.
Senator, Nova Scotia, ISG
Excuse me, Dr. Wiebe. Would you be able to write that concern down and send it to us so that we will have that concern?
2:45 p.m.
Senator, Nova Scotia, ISG
There are couple of things in that report that address some of the concerns that other witnesses have had, one being the idea of having a national framework up for case review for educational and quality assurance purposes, a national framework for protective oversight, and improving the federal MAID monitoring system.
Would you agree with those components of the report, and if you do, how quickly should those be put into place?
