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.
Liberal
Senator, Ontario, ISG
Thank you, Mr. Chair.
I'm sorry. I can't get my camera on, but I will ask my questions.
I would just point out to Mr. Fergus that a 2023 Ipsos survey showed that support for MI-SUMC was 80%.
My question is for Ms. Prokopy.
Conservative
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
I don't believe it's permitted for members to intervene with their cameras off.
Liberal
The Joint Chair Liberal Marcus Powlowski
I'm sorry, Senator Moodie, but you're required to have your camera on.
Liberal
The Joint Chair Liberal Marcus Powlowski
Could we maybe go on to the next senator? We'll try to get IT to sort that out in the meantime.
Liberal
The Joint Chair Liberal Marcus Powlowski
Oh, there you are.
Go ahead. You have until three minutes from now.
Senator, Ontario, ISG
Thank you.
My question for Ms. Prokopy is this. Are all the services deemed to be necessary or even essential for Canadians and for Ontarians available at all hospitals across Ontario? Is it not a fact that we have gone through, in the past 20 years, a process of regionalizing care so that certain hubs across the city have certain levels of care that are not available at every hospital, and selected services are not available at every hospital because of resource problems, because of critical-mass issues, because of available expertise and for other reasons?
Can you explain how this reality is not a problem for some of these essential services for Ontarians, but for mental health you would not see care become available, particularly care around MAID, because you perceive that all hospitals should have it equally?
Vice-President, Policy and Advocacy, Ontario Hospital Association
I'll start by reiterating what I said earlier, which is a point you alluded to. Our concerns are around broader access to mental health care across the province. We have seen the emergency department visits for mental health increase by 11% in the last five to six years. We track something in Ontario called “alternate level of care” patients. These are patients who are waiting to be discharged from hospital to go somewhere else—to go home, to go to long-term care—
Senator, Ontario, ISG
I'm sorry, but the question is about whether you see some sort of comparison between the fact that many services that we still offer in Ontario are not available across every hospital. We actually rationalize that care in certain places and don't offer it in every hospital. Is that a problem? Why is it such a big problem for us to not have MAID in every hospital to the same degree, to the same level? Why is that going to stand in the way of making this service available to Ontarians and to Canadians?
Vice-President, Policy and Advocacy, Ontario Hospital Association
If I understand your question, I would say that not every service is available in every hospital. We have regional programs in Ontario—
Vice-President, Policy and Advocacy, Ontario Hospital Association
—for cancer. We have localized programs—
Vice-President, Policy and Advocacy, Ontario Hospital Association
Again, it depends on where you live in the province, it depends on geography, it depends on rurality and it depends on the complement or composition of the physician and nurse practitioner groups. That will determine the services you receive. That is the case across any service, not just in the context of MAID.
Senator, Ontario, ISG
In the context of MAID, why is it necessary, before we proceed, to have equal levels of service and access across the system for your group to feel comfortable that this is something we can only then proceed with?
Vice-President, Policy and Advocacy, Ontario Hospital Association
I would just say, to the comments the panel has made, that if there is no access to mental health services, housing, other community-based services and the treatments that the doctors on the panel today have described, how do we know that a person's underlying mental illness is irremediable? We need access to mental health services to be in place, and consensus among clinicians, before we get to a point where medical assistance in dying for mental illness will be collectively accepted, but that's a lot of conditions.
Liberal
Senator, Manitoba, CSG
Thank you, Chair.
My question is for the Ontario Hospital Association. It's a bit of a follow-up to the last question, on access to care.
As you note, access to care and health care administration and delivery are primarily a provincial responsibility. What actions have the OHA taken with the Ontario government to resolve these issues in order to be ready for the lifting of the mental illness exclusion?
Vice-President, Policy and Advocacy, Ontario Hospital Association
Maybe I can speak quickly at a high level and then ask Dr. Young to speak to some specific examples.
Part of the OHA's role as an association is to represent the voice of the hospitals of Ontario. We do that by working closely with the provincial government to not just expand access to hospital-based mental health services but also ensure that hospitals are working closely with primary care, community mental health, long-term care and home care so that people can have access to the services they need in the location they need it.
There are certainly significant gaps, as Dr. Young and I have both alluded to. We don't have access to care that's equitable across communities. We also know that there are certain populations that face inequities in a much greater way than others.