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

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

Thank you very much.

My next question is for the Canadian Paediatric Society. I want to be sure that I heard you correctly. I thought I heard you say that the provincial-territorial expert advisory group did not consult with the Canadian Paediatric Society before it made its recommendations. Did I hear you correctly?

[Dr. Dawn Davies]

Yes, that's my understanding.

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

Are you aware of any other stakeholder groups, and I believe that the Canadian Paediatric Society is certainly an important stakeholder group, that may have been excluded from consultation in the formulation of the recommendations by the provincial-territorial expert advisory panel?

[Dr. Dawn Davies]

As far as it concerns children, I'm not aware of any consultation with any child advocacy group, any child protective service, or the Canadian Paediatric Society.

Mary, is there anything that you can add?

[Dr. Mary Shariff]

I'm not aware.

[Dr. Dawn Davies]

No.

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

Thank you.

I guess it's concerning for me as a committee member to realize that, especially when many times during these consultations we have heard the phrase, “Carter is a floor, not a ceiling”, you as a pediatric society are recommending that we not go beyond Carter. I think that's very informative.

My last question is for the Centre for Addiction and Mental Health.

You indicated that you provide care for up to 30,000 patients who are dealing with various mental health challenges. You also indicated that it's difficult to say conclusively whether or not these conditions may or may not be irremediable. You commented on chronic and episodic features of mental illness, and even talked about how schizophrenia could in some cases be overcome to the extent that it may not be cured but that there are strong coping mechanisms.

I was so encouraged to hear you say in your testimony that you focus on hope, because I think that one of the conditions of what this committee is charged with is providing that hope. Part of providing that hope, in my opinion, is being sure that we are not opening the door for those who may be vulnerable, especially those with mental health challenges.

Because of the episodic nature and the potential for changing minds, and so on, can you assure us that we can put adequate safeguards in place to be sure that even 1% of that 30,000 is not allowed to end their life prematurely, unintentionally, because of an episodic issue with depression?

We were informed earlier by some of our witnesses that the concept of safeguards might actually be an illusion. I just wonder if you could comment as to whether or not we can be sure, as committee members, that we can, in fact, put adequate safeguards in place.

[Kristin Taylor]

That is a big ask.

This is one of the areas that we talked about in our working group, the concept of vulnerability for our patient population, and as we talked about earlier, the social determinants being part of that sense of hopelessness in patients suffering from mental illness, particularly depression.

The safeguards that I think you're being asked to craft need to take into account that there will be people who are seeking this type of assistance as part of their illness to end their lives prematurely. I think one of the safeguards that we are considering is that clinicians here have the ability to conscientiously object, based solely on our focus on hope and recovery. As we've gone through our discussions, the clinicians are struggling with when our conversations with our patients in our treatment take a 180-degree turn and start to talk about how they could end their lives today—

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

I'm going to have to ask you to wrap it up.

Could you sum up your answer quickly, please.

[Kristin Taylor]

Yes, sorry.

To sum it up, you have a very large task ahead of you, and anything we can do to assist, we are happy to do.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Thank you.

Thank you, Mr. Albrecht.

Senator Nancy Ruth.

[Nancy Ruth]

Senator Seidman, do you have a question?

[Judith G. Seidman]

Yes.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Are you deferring your time to her?

[Nancy Ruth]

Yes.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Senator Seidman.

[Judith G. Seidman]

Thank you.

I believe it was the Canadian Paediatric Society, so perhaps it was Mary Shariff who spoke about the first iteration of Canadian physician-assisted death legislation.

In light of our discussion here about data, oversight, monitoring, and input to a legislative process, I was interested that you used the concept of the first iteration, because I had a feeling that you were thinking about a second iteration or a third iteration.

Might you please explain why you used that language, and what it implies?

[Dr. Mary Shariff]

I used that language because Carter can be construed very narrowly. It seems to me there is a pre-emptive discussion for including other individuals, such as children and minors, and other types of conditions, for example, through the advance directive, all at this time pre-emptively, in anticipation that there might be a charter challenge.

We know there could be a charter challenge simply because of the nature of the arguments that were made in Carter. Many arguments can be made on the section 7 right-to-life argument that unless they have this down the road, they will take their lives sooner. Many things can fall into that.

Because there wasn't any data in the Carter case with respect to minors, for example, and there was no discussion on advance directives.... I know there's this idea floating around about the floor and ceiling. I'm not particularly fond of that analogy, metaphor, or whatever you would call it. I think that we need data. We need to understand.

Even with Belgium there's controversy, but we're looking at something similar to a Belgian scheme. I think right from the beginning of the trial decision we were looking at a Dutch-Belgian scheme in Canada. There's no secret to that.

In Belgium when they looked, for example, at children, they put their law in place in 2002 and didn't start thinking about minors, other than emancipated minors, until 12 years later, so they had time to actually gather data and look at the evidence. That data around minors is simply not before the Supreme Court.

The decisions and the arguments around sections 7 and 15 are based on experiences with respect to adults who are requesting a particular service, a termination-of-life service, and we don't know how the essence of those arguments is transferrable to minor children. It's as simple as that.

When I say “first iteration”, I'm not sure.... If the argument is that we can move forward with this because there's only a handful of people that it involves, let's be prudent and not rush to put it all in. Let's gather some information. We're Canada. We're not the Netherlands. We're not Belgium.

[Judith G. Seidman]

So you're saying the strictest interpretation of Carter to begin with perhaps.... In the first round of legislation: data, monitoring, and input into maybe an update to the legislation. Is that what you're suggesting?

[Dr. Mary Shariff]

Something to that effect.

[Judith G. Seidman]

Thank you. I appreciate that.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Senator Cowan.

[James S. Cowan]

My questions are for the Canadian Paediatric Society as well.

In your presentation, you talked about the first iteration and the need to be very careful if we are to go beyond the adult capacity to younger persons. I was reading the bioethics committee's practice point document, which was originally posted in April 2011 and was reaffirmed on February 1 of this year. It deals with withholding and withdrawing artificial nutrition and hydration. I look at point 7, which says, “Medically provided fluids and nutrition can be withdrawn from children when such measures only prolong and add morbidity to the process of dying.”

[Technical difficulty—Editor]

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Keep talking.

[James S. Cowan]

Okay.

How do you square that circle? How do you reconcile the presentation that you're making here tonight, urging us to be very careful and not to go beyond...above the floor, if you like, with the document that was originally posted in 2011 and then reaffirmed just the other day?