Evidence of meeting #5 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 access.
A recording is available from Parliament.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
You have confidence, then, in the medical professional's ability to help the patient make the free and informed decision that is right for them.
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia
Very much so. To me, informed consent is the cornerstone of the Canadian medical system. Physicians are robustly trained to identify the decisional capacity of patients. We do it in many complicated scenarios, and this is one of them.
Physicians are also challenged in many disciplines to determine whether patients can provide informed consent. There is the mature 14-year-old who seeks or denies transfusion, the mature 13-year-old who seeks contraception, and the suffering patient who chooses not to pursue the potential life-saving treatment of chemotherapy. It's a regular feature of medicine—and of all health professions, by the way—to identify whether a patient has decisional capacity and can provide informed consent. I believe this should remain in the hands of medical professionals.
The Joint Vice-Chair Hon. Pierre Dalphond
Thank you, Dr. Grant.
Is there consent to go until 8:20 and then suspend for the vote?
Liberal
Senator, Ontario, ISG
My first question is for Dr. Grant.
We have heard testimony from John Maher, who mentioned a case that he claimed he was aware of in which MAID was offered to a 30-year-old. He claimed that he called the college of Ontario on this, and they said something about the patient not being dead yet, so they couldn't do anything.
What would a physician do if they believed that another clinician was not complying with the Criminal Code provisions on MAID? What would your college, and I presume other colleges like yours, do if presented with an allegation that a clinician is operating in a way that has already breached the Criminal Code or is going to?
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia
We'd investigate, and we'd investigate quickly.
At the risk of repeating what I said to the previous question, physicians have a duty to report. That's a professional standard all colleges have.
Physicians have a professional and ethical duty to report, which is embedded in the CMA code of ethics. Physicians working in health authorities have safe disclosure or whistle-blower responsibilities throughout, as do all other health professionals. I have a hard time envisaging a situation as described in the previous question where the regulator, the health authority and the other professionals involved are blinded to this unprofessional conduct.
The short answer to your question is that if we receive that phone call, we investigate immediately.
Senator, Ontario, ISG
Thank you.
Dr. Close, this is a question for you. You've talked a lot about the importance of coal face regulation. Does that mean you expect there would be variability across the country? Does it strike you as a problem that coal face is an integral part of the complete package of oversight and regulation that you referred to?
Senior Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology, As an Individual
There is variation across the country. We are a federation. Ultimately, provinces and territories have made different decisions about how to invest in their MAID programs and how some of the coal face regulation operates.
I don't think variability is necessarily a problem, because ultimately it's up to the provinces to decide how to deliver MAID. Depending on the local context, different mechanisms of regulation can be more appropriate. Some provinces have very few cases of MAID. The very fact that there's variability should not be cause for concern on its own.
Senator, Ontario, ISG
Dr. Grant, are you aware of any cases in your college or in colleges across the country where MAID physicians have committed the crime that was described by John Maher in his past testimony?
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia
I am aware of none, though I take note of the case in British Columbia referred to in the previous question.
Liberal
The Joint Co-Chair Liberal Marcus Powlowski
Thank you.
Senator Osler, you have three minutes, please.
Senator, Manitoba, CSG
Thank you, Chair, and thank you to all the witnesses.
My question is for Dr. Close.
Five minutes is a very short period of time, and you've tried to cover as much of your research and analysis as you could. Can you share with the committee if there are other key aspects of monitoring, oversight and regulation that you think are important for this committee to understand, particularly as they apply to MAID with mental illness as the sole underlying medical condition?
Senior Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology, As an Individual
Can I just clarify what you mean by other aspects?
Senator, Manitoba, CSG
Can you share with us anything else in terms of monitoring, oversight and regulation that you want us to know?
Senior Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology, As an Individual
Thank you.
One thing that I think gets underappreciated is that the existence of no escalation or no disciplinary consequences from the colleges gets used to suggest that they are looking the other way and that problems are not being detected. What is often happening, and what we know from the Ontario MAID review team data, is that tiered responses happen when matters go to regulators. Often, it's administrative errors that are occurring, and these are easily and quickly addressed by things like an educational email or a phone call. This type of tiered response is normal in regulation.
The Ontario review team data, which I can provide to the committee, also says that no MAID cases have been escalated to the police. Again, that gives me confidence that these mechanisms are working. It's not that things are being covered up. It's just that they're not occurring.
The tiered response mechanism is really important to know. When we're looking at the data, we need to look at those reports and see what is actually going on in practice.
Senator, Manitoba, CSG
Thank you.
Dr. Grant, can you respond to any of the implications that colleges are looking the other way or that cases are not being taken seriously?
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia
All I can speak to is my own college.
We take them very seriously. I've had the benefit of working closely with Nova Scotia's MAID team in the development of their clinical standards. We have this device in Nova Scotia called “the phone”, and when there are difficult cases, I'm often phoned by clinicians who say, “Hey, Gus, how do you think we should proceed?”
I think Nova Scotia enjoys a very close relationship between the regulatory body, the health authority and the clinicians delivering the care, so I'd say just the opposite. We're not turning away. We're leaning into these cases, and I'm grateful to have the opportunity to do that.
Liberal
Senator, Alberta, PSG
Thank you.
Dr. Close, this committee has heard from multiple witnesses that the current safeguards to protect against illegal MAID assessments have fallen short. Based on your research and the empirical evidence you referenced in this meeting, what recommendations do you have for any additional safeguards or other forms of regulation we should be considering for MI-SUMC?
Senior Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology, As an Individual
I don't think additional safeguards are warranted in the law. I think the system has enough safeguards.
What is needed is more transparency in provincial oversight. We have good data from, say, Ontario, which the coroner, I understand, will make publicly available from the MAID death review team. There need to be networks of accountability mechanisms, which exist already but can be reinforced. That requires investment from the provinces. Ultimately, that's a provincial decision.
These mechanisms are more flexible and appropriate for dealing with complex cases. They're not additional legislative safeguards.