Evidence of meeting #4 for Medical Assistance in Dying in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was equality.
A recording is available from Parliament.
Chief Executive Officer, Inclusion Canada
People who have terminal cancer, to your point, under track 1 have the right to access that.
We're talking about expanding this law, first of all, to people who already qualify under track 2 and expanding it even further to a whole other group of people who are even more vulnerable based on the fact that mental illness is predicated on a lot of suicidal ideation. What we are saying is no.
We talk about this—
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Ms. Carr.
Ms. Jansen, you have two minutes and 50 seconds.
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
Ms. Hewitt, I live about an hour outside of Vancouver, and every time I drive down East Hastings, I see hundreds of poor souls living in squalor, danger and deep pain. You said that UBC did a study of the population there and found that 75% are living with mental illness, and they want support, not death.
What are we doing if we expand MAID in that reality? Are we treating suffering, or are we giving up on the sufferer?
Board Chair, Disability Without Poverty
I think we're giving up on the sufferer. Previous witnesses talked about the social determinants of health. If we have not put in place everything that we can possibly do as a society to build people up to where they want to live so they can move beyond surviving to thriving, then we haven't done our job as a society. Offering them MAID is the easiest way out, because it doesn't cost us any money and we don't have to do anything extra.
I find that absolutely appalling. If Victor were here now, he would tell you that his assessment for MAID was the easiest medical assessment he'd been through in his life, and it should not be like that.
Does that answer your question?
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
Yes.
You said there was no real attempt to explore alternatives that might have helped Victor live. If those safeguards are already failing in today's system, why should anyone believe they're going to work in far more complex cases where mental illness alone is the reason for the MAID request?
Board Chair, Disability Without Poverty
As I said, many of us with disabilities don't exist in a single state of disability. My husband had chronic depression. In his twenties and thirties it was particularly unstable, but ultimately he got it under control. We didn't meet until after that. If MAID had been around then, I would never have met and married my husband.
I think the safeguards that are currently in place are insufficient. I went through a process where I thought I understood what a track 1 MAID patient looked like and what a track 2 MAID patient looked like. My husband has died, and I still don't know whether it was under track 1 or track 2.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Ms. Hewitt.
I have to apologize to Senator Wells. I forgot him.
You have two minutes and 50 seconds.
Senator, Alberta, PSG
Great. Thank you, Chair.
My question is for Ms. Carr.
Thank you for the concerns you've raised today about people feeling driven towards MAID because of poverty and inadequate supports.
Would you agree that the core issue is not MAID itself but the failure of social systems, and that the solution should be to strengthen those supports while still preserving MAID as an option for competent adults experiencing intolerable suffering?
Chief Executive Officer, Inclusion Canada
No, and that is not what we are doing. We are offering MAID to people with disabilities who are not at end of life. That is the only group that is being offered track 2 MAID, and now we're looking at expanding that to 297 more labels under the definition of mental disorder in the DSM-5.
Senator, Alberta, PSG
Would restricting MAID in these cases remove a legitimate choice from individuals who are not being driven by poverty but are making a considered and autonomous decision?
Chief Executive Officer, Inclusion Canada
I guess my question back to you, Senator, would be this: Why then are we not offering...?
If that is the premise, that we're taking this particular special right away from this particular group of people.... If we were worried about that, we would be offering MAID to people not at end of life across the board. It wouldn't be designated for a particular group of people and then further expanded to people with MAID for mental illness.
We would be saying anybody who suffers intolerably and is not at end of life has access to MAID and can go to their family doctor, an assessor or a medical practitioner and request it. That is not what we are saying.
Senator, Alberta, PSG
With respect, that's not what we're studying right now. I can appreciate the concerns.
Do I have any time left?
Liberal
Liberal
Kristina Tesser Derksen Liberal Milton East—Halton Hills South, ON
Thanks very much, Mr. Chair.
Thanks so much to our witnesses who are providing testimony tonight, particularly those who are bringing us their lived experiences. Those are really important. We appreciate your sharing those.
I'm going to ask what I hope is a practical question, because I think it's important that we get this on the record with respect to provincial health care system readiness.
I'll address Dr. Frazee first.
A decision to expand MAID to those with mental illness was delayed to give provinces and territories time to analyze their capacity to assess and administer MAID for mental illness safely and in accordance with the law. That's really the core scope of this sitting of our special committee.
I'd like you to comment on your understanding of the current state of readiness of the provinces and territories to do this work.
Professor Emerita, School of Disability Studies, Toronto Metropolitan University, As an Individual
Thank you for the question.
The best way for me to respond is from my direct experience and observations working on the curriculum through which MAID practitioners receive their instruction.
My work on that group, when you read my testimony and my article, is that the medical profession has not risen to the gravity of the decisions that we have entrusted them with. They are unable or unwilling to disentangle those structural forces—I believe you're referring to them as social determinants of health. They're unable to disentangle that kind of suffering in cases involving stable physical disability.
I therefore conclude that there is no basis on which to be confident that they will do so when mental illness is the sole underlying condition. In other words, if they cannot or will not apply the very highest level of scrutiny to these assessments and the moral seriousness that these decisions require, they can't be entrusted with greater power and greater authority over the lives of people who are very vulnerable to harm.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Dr. Frazee.
Mr. Thériault, you have the floor for one minute and 50 seconds.
Bloc
Luc Thériault Bloc Montcalm, QC
Ms. Frazee, the report by the Expert Panel on Medical Assistance in Dying and Mental Illness highlights concerns and outlines a number of principles related to safeguards, particularly regarding systemic inequality. It states: “In the course of assessing a request for MAID—regardless of the requester’s diagnoses—a clinician must carefully consider whether the person’s circumstances are a function of systemic inequality. ”
Recommendation 6 states that it is necessary to “ensure that all requesters have access to the fullest possible range of social supports which could potentially contribute to relieve suffering […].”
This refers to safeguard measure 241.2(3.1)(g), which requires ensuring that the person has been informed of the means available to alleviate their suffering, particularly when indicated.
We must therefore be able to address structural vulnerabilities.
Wouldn’t these guidelines be sufficient, in your view, if they were applied correctly?
Professor Emerita, School of Disability Studies, Toronto Metropolitan University, As an Individual
No, with respect, they are not. Thank you for the question.
Perhaps I can best answer with reference to just one case among the many that I speak of in my paper. That is a case of a young man in his twenties who wanted MAID because he was desperately lonely and felt that he would never find a loving relationship and have what he considered a normal family.
I would suggest to you that the roots of this problem, the roots of the suffering that MAID is being deployed to address, are very deep. How on earth can we safeguard against heartbreak, which was what motivated this man to request MAID? He did die, by track 2 MAID, of a broken heart, frankly, and desperate loneliness. We can't safeguard against that.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Professor Frazee.
Next is Senator Wallin for one minute and 50 seconds.
Senator, Saskatchewan, CSG
Thank you.
I guess I just feel that we should put on the record here tonight some balance. We are in the process of declaring an entire profession—doctors, MAID providers, mental health professionals—incapable of understanding matters of life and death and that this entire group of people is inclined to break the law and risk their licences from some desire to provide MAID to people who don't want it.
I guess I'll ask Dr. Frazee that question: Are there no other kinds of doctors in Canada?