Physician-Assisted Dying Committee on Feb. 3rd, 2016

[A voice]

Yes, we can.

[The Joint Chair (Hon. Kelvin Kenneth Ogilvie]

While you were offline in inner space we had two questions that were directed to you. The clerks will be in touch with you with the written questions, and we would appreciate your getting back to us with the briefest possible delay. Is that fine with you?

[Dr. Tarek Rajji]

That's very fine, thank you.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Thank you very much.

The last question will go to Mr. Albrecht.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Thank you again, Mr. Chair.

I just have another question for the Canadian Paediatric Society.

You pointed out that quality palliative care must be accessible for children and youth, and you extrapolate from some British Columbia data that indicated 10 out of every 10,000 children are in need of palliative care services, and yet with that very low number, 10 out of 10,000, you indicate that only 5% to 12% would have benefited from palliative care services in terms of what was available to them. I think you're pointing out to this committee again the extremely low level of palliative care options that are available, especially in terms of palliative care for children. We know in a general sense from the expert advisory panel that only 55 out of 77,000 Canadian physicians are specialists in palliative care. These two very concerning issues point out that we need to do better.

My question would be this. Are you saying in your submission that for physician-assisted death to be offered, before that happens we at least have to be able to offer extensive palliative care options to children who may, in the future, be requesting this procedure?

[Dr. Dawn Davies]

That's a personal opinion, but I think I can also speak on behalf of the CPS. That is exactly what we're saying. It's absolutely premature that we would expect that children should be able to ask to end their lives when we have completely inadequate national palliative care services available for children. Just for the record, there are fewer than 20 full-time physicians in Canada who are providing specialized palliative care services to children, and very many front-line community health professionals, be it family doctors or home care nurses, are completely devoid of any training or experience in caring for children with life-limiting illnesses.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Thank you.

I may have missed it in your earlier presentation or your response to a question, but what is your current definition of an adult? Is it 18, or something other than that?

[Dr. Dawn Davies]

I think for the purposes of your legislation, I would say 18 is an adult. I would be as conservative as you can possibly be.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

I like your being conservative.

I'm going to share the rest of my time with Mr. Warawa.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Thank you.

I want to thank Imam Hashmi for being with us.

Do you have a handout?

Apparently, it's not in both official languages, but we could come back and meet with you after the meeting. Would you have a handout that is your testimony?

[Imam Sikander Hashmi]

We can absolutely make that available.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Thank you.

Just for clarification, on the conscience issue, you said that physicians of faith and institutions of faith should not have to be involved. Are you saying in participating and not having to refer?

[Imam Sikander Hashmi]

No, they would refer, but we're talking about participation in the practice.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Thank you very much.

[John Aldag, Liberal, Cloverdale—Langley City, BC]

Mr. Chair, I don't know if this is a point of order or not, but we were able to overcome the technical difficulty. Although I agree with sharing and we moved to share, I just wonder, since we have the others back online, if we could get the two questions that were asked to be answered really quickly. I think it would help all of us to hear the answers, instead of waiting for a written deliberation.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

I'll put it to the committee.

Is it agreed?

[Some hon. members]

Agreed.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Thank you, committee.

Dr. Rajji, you're going to be back on. Let's see, the first one was from Ms. Dabrusin, and the second one was from the co-chair.

Ms. Dabrusin.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

Let me see if I can do this.

[The Joint Chair (Mr. Robert Oliphant), Liberal, Rob Oliphant]

Do you want time to think? I can ask my question.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

No, it will just be a slight variation on how it was said.

When you were talking about “irremediable” earlier, Dr. Rajji, you were talking about the availability of treatments and about not being able to assess how treatments are going to succeed or not, but the Carter decision doesn't actually require a patient to accept treatment. A patient can decide that they do not want to pursue further treatment. Taking that into account, I was wondering how you would see that affecting eligibility for a person with mental health issues.

[Dr. Tarek Rajji]

When I was talking about the irremediable nature of the illness, I was thinking of three concepts. The first is the natural history of the illness itself. There is no proximity of death or inevitable death associated with mental illness the way there is with some other medical disorders. By natural history, for example, 25% or more of individuals with schizophrenia may recover if they wait long enough, and they may recover completely from schizophrenia.

The second point is that—

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

To clarify, is that spontaneously or with treatment?

[Dr. Tarek Rajji]

We don't know. We don't have enough knowledge about this. Most people would have had some form of treatment. Whether it's because of the treatment or natural history, it's hard to tell what is causing that. These are longitudinal studies that would take 10 years, 20 years, 40 years sometimes to get that knowledge.

The other issue is the issue of suicide. It does happen, but again, we don't know when it's going to happen or if it's going to happen. We have good knowledge about the factors that increase the risk.

The third point is related to medication and whether someone would respond or not and even without responding to a treatment, whether they would recover naturally. We know, for example, with depression that people who do not have any treatment for depression or depressive episodes will eventually recover from it. We don't know exactly when.

The other part of the issue, the second big concept related to the irremediable nature of the illness, is that even for individuals who have the symptoms and still experience the episodic nature of the illness, there is a recovery approach that we take on to help individuals live with the illness. Because of that lack of inevitable and progressive course towards death, in some sense, we have the luxury and the hope of working with someone, even if they are refusing treatment. I can think of specific examples of individuals and patients I have seen in the last week or so who are refusing treatment but are still coming to see me, because my point to them is that I will be there if they come back to see me. We will keep working on talking about the issues related to treatment or recovery, and about how to live with the illness, so that the illness doesn't become—

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

I think we understand the overall answer to your question. This could go on for some time, so I'm going to ask Mr. Oliphant.