Thank you.
I'm the registrar of the College of Physicians of Nova Scotia. I have been since 2011. Before that, I practised law and family medicine for many years. It's a privilege to make these submissions.
The committee has had read into its record a letter from the Federation of Medical Regulatory Authorities of Canada. I was one of the signatories to that letter. To summarize its essence, wherever the law lands on medical assistance in dying, the regulatory colleges will be ready.
My submission—and I'm here on behalf of my own college—is that the college in Nova Scotia will be ready because it's our legal duty to be ready.
As a medical regulator, our college must keep pace with change in medicine. Otherwise put, medical regulators can't be the rate-limiting step for medical progress. We haven't been for MAID, and we won't be if MAID changes. Recent history supports that.
When the world changed with the pandemic, the regulators were the enablers of medical change. I think of the hours spent on vaccine mandates, on public health orders, on virtual medicine and on remote prescribing. On all of the things that were required in the moment to make medicine work, the regulators were at the front.
For MAID, additional time won't help us. Additional time in and of itself will not materially advance the regulation of MAID in Nova Scotia. If the law changes, we'll make the necessary regulatory changes, which will involve changing professional standards, communicating with the public and communicating with the profession. We'll respond to questions from the public. We'll investigate complaints to hold physicians accountable. We'll do what's necessary.
On the surface, Nova Scotia's regulatory experience with MAID has been smooth, as has been the country's as a whole. At each punctuation mark, we've made the necessary changes in standards and communicated with the profession. We've kept step with the law. We've kept step with practice.
Since it was introduced, since MAID became part of clinical medicine in Nova Scotia, our college has investigated around 4,000 complaints. Three of them have involved MAID, and all three involved cases where family members were unable to access an assessment for MAID by a conscientiously objecting physician. These complaints were resolved through advice and education, not through discipline.
Most regulation takes place behind the scenes. I appreciate Dr. Close's comment about regulation at the coal face. For me and for MAID, there have been lots of meetings to provide advice, there's been engagement with advocacy and faith-based groups with conscientious objections and there have been discussions with institutions seeking to assert policies inconsistent with the law. Some of these meetings have been difficult, but overall, the regulatory burden associated with MAID has been less than this chamber might anticipate.
When I spoke to this committee—and I think I've given evidence two or three times to this committee or predecessor committees—the questions of regulatory readiness were raised at each significant juncture, each significant punctuation mark with MAID. They were raised following the Carter decision. They were raised in the debates about Bill C-14 and Bill C-7. They were raised in contemplation of Audrey’s amendment.
At least in my experience, each time I was asked questions about regulatory readiness, they came from voices known to be opposed to MAID for other reasons. I urge this committee to examine the question of readiness as readiness per se and not as a proxy for other reasons.
I see four domains of readiness. The first is legal, and the Carter decision is your foundation.
The second is political. By the way, I'm grateful for the service of the people sitting in these chairs who work on questions of political and legal readiness.
The third is regulatory readiness. I really appreciate Dr. Close's analysis of the matrix, the filters and the various levels of regulation, but from the purely medical regulatory authorities' perspective, I'd submit that that shouldn't be a determinant of your deliberations.
The fourth, of course, is clinical readiness. You're clearly hearing significant evidence about that. I would submit that Nova Scotia's clinical approach is extraordinarily robust, and I have tremendous confidence in it, but that's your decision to make.