Evidence of meeting #12 for Physician-Assisted Dying in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patient.
A video is available from Parliament.
Liberal
The Joint Chair (Mr. Robert Oliphant) Liberal Rob Oliphant
No, that's fine.
We need to go on now to Senator Seidman. Thank you.
Senator, Quebec (De la Durantaye), C
Thank you, Chair.
Thank you all very much for being with us tonight.
I'd like to go back to an issue that we've all been struggling with. Dr. Stern, you really did say that to us. We have been struggling with rights of conscience.
We understand we have the imperative to balance the charter rights of physicians to their conscientious objection with the charter of rights of patients to access. In your response to Senator Joyal, you spoke about patients' rights to access to care, and how Quebec has done this.
I was looking at page 7 of your submission to us, at the end of the first paragraph. I'd like to try to understand how this is connected. You wrote, “we urge Parliament to ensure that physicians' freedom of conscience is protected when considering the legislation in response to Carter.”
I understand the “ensuring the patient access to care” component as it plays out in Quebec. Is that the answer to ensuring that physicians' freedom of conscience is protected, with which you charged Parliament? I'd like to ask you about that as well, if I may.
Executive Director and Chief Executive Officer, The Canadian Medical Protective Association
There really are two levels of freedom of conscience here. The first is those physicians who are uncomfortable for reasons of conscience to participate in responding to the request of the patient but who feel comfortable with referring the patient to a different physician who would be willing to perform that assistance. I believe that would be the majority of the physicians who express difficulties of conscience.
The last part, the Quebec part, which we're referring to, would involve a very small number of physicians who may feel uncomfortable referring a patient to another physician for reasons of conscience. This is our attempt to say we believe that Quebec has done an extensive review of the issues of conscience. They have been very thoughtful about this, and the solution they've come up with is, in our view, the best way of balancing the two rights, the rights of the patient and the rights of the physician. It will apply to a very small number of physicians, but that's what we think is important. We want to preserve the physician being able to participate in this in that empathetic and thoughtful way, and knowing that some of their colleagues may have difficulty with this is quite helpful in this process.
Senator, Quebec (De la Durantaye), C
Telling us there are two different aspects to dealing with this really helps me understand, but I'd also like to go back to where you urge Parliament to ensure this. Do you think this should be addressed in federal legislation, or is it a provincial jurisdiction, or is it a regulatory body jurisdiction? How do you see this?
Executive Director and Chief Executive Officer, The Canadian Medical Protective Association
I think this is an absolute necessity. Our concerns are that some provinces may not entertain legislation. In the absence of legislation on this very important social policy, both physicians and patients will be left in limbo with a significant amount of uncertainty. That will be filled in a way that is insufficient and provide unequal access. It's inappropriate for a patient in one jurisdiction to have access that is different from the access available to a patient in another part of this country. Therefore, the federal legislation will guarantee that the legislative requirements are fulfilled and that patients will have a consistent approach across the country to access physician-assisted dying. We hope that the provinces' legislation, where they entertain to do it, will be sufficiently similar, so that the federal legislation will not supplant the provincial legislation in those provinces that actually do the legislation.
Senator, Quebec (De la Durantaye), C
With respect to freedom of conscience of physicians, is it the responsibility of the federal Parliament to build that into the legislation, or is that something that you see the provinces or the regulatory body doing?
Executive Director and Chief Executive Officer, The Canadian Medical Protective Association
I absolutely believe that it is a federal legislative requirement, for the reasons I entertain. It is for consistency of access for those patients.
If we go back to my original point, the physician who feels insecure because of uncertainty is not going to be able to enter into that relationship with that patient without fear that something bad is going to happen to them. They need to be in that relationship so they can provide the empathy and trust that allows the patient to move forward with that doctor to a successful implementation of the physician-assisted death.
Senator, Nova Scotia, Lib.
Thank you to all the presenters. We've had very interesting and very important evidence.
Dr. Stern, I wanted to go to the issue of the decision-making process. You described it as the CMPA supporting a decision-making process that will be easily accessible to patients, respect patients' privacy, and not impose undue administrative challenges for patients or their physicians. You heard Mr. Chipeur talk about a rather more elaborate decision-making process with a prior review, including court hearings and serving of affidavits on next of kin. Can you comment on the suggestion that he's made to us this evening as it fits with the CMPA position, as I've read to you from your statement?
Executive Director and Chief Executive Officer, The Canadian Medical Protective Association
To be clear, we have no formal objection to a judicial review, with a couple of caveats. Our concerns are those of limiting access through a complex process that may make it more difficult for the patient to actually achieve access to physician-assisted dying.
That is provided that, one, it is not overly bureaucratic and complex and does not make it difficult for the patient to access it, and, two, that there is clarity and understanding of what this process is so that patients can understand it fully.
Patients dealing with physicians in a trusting environment get their information about the process clearly and unequivocally through a physician with whom that trust and empathy exists. The court is a remote, legal, and much more fearful environment in which to try to make these decisions. Again, we have no objection to it, but we have concerns that, one, the patients will not understand it, and, two, that it will delay the access.
Senator, Nova Scotia, Lib.
That quality of access and availability of access are critical, as far as you're concerned.
Executive Director and Chief Executive Officer, The Canadian Medical Protective Association
We believe that they are. Again, we have no objection to the judicial process, but those two caveats—that it is simple and clearly understood by patients, and does not limit, slow down, or retard the access of the patients—are the critical factors in your decision-making, in our view.
Senator, Nova Scotia, Lib.
The co-chair mentioned to you, Mr. Chipeur, the practice advisory that came. It's my understanding, and I just want to make sure that I understand this clearly, that you're not suggesting that the regime which Chief Justice Smith has proposed is required by the Carter decision itself; it's to comply with the interim requirements established by the Supreme Court of Canada in granting the four-month extension.
Lawyer, As an Individual
I think that what the Chief Justice has done is comply with the January 15 decision. There's no doubt about that.
My recommendation to this committee is that it's a great model. It's working. It was created organically by people who know about these issues and deal with them every day, so I'm suggesting that if you go to those who are already doing it today and you follow their model, I think you will not go wrong.
Senator, Nova Scotia, Lib.
I'm not suggesting that we couldn't go there, but I'm also taking you as not suggesting that we would be required to go there in order to meet the Carter decision.
Senator, Nova Scotia, Lib.
I think that those are all the questions that I had. I did have one statement that I wanted to get on the record. It tends not to do with this, but as long as I could have a minute at the end—
Senator, Nova Scotia, Lib.
If colleagues wanted to ask questions of these witnesses, I—
February 4th, 2016 / 8:30 p.m.
Liberal
The Joint Chair (Mr. Robert Oliphant) Liberal Rob Oliphant
No, you're the last witness, so if you would like to make a statement—
Senator, Nova Scotia, Lib.
It was just a point of clarification, perhaps.
Colleagues will recall that yesterday we had pediatric specialists here, and the suggestion was made that the provincial-territorial panel did not have access to pediatric expertise, that no witnesses were called, or that the aspect of the pediatric lens, if I can put it that way, was not available to the provincial-territorial panel.
It struck me as a little odd, and I should have twigged to it at the time, but I didn't, and I went back and looked at the makeup of the provincial-territorial panel. A person whom I know very well, and I should have twigged to that last night, is Dr. Nuala Kenny, who is a pediatrician. She is a fellow of the Royal College of Physicians and Surgeons of Canada in pediatrics. She was in pediatrics at Sick Kids Hospital in Toronto, at Queen's, and then came to Dalhousie, where I knew her and where she was the head of the department of pediatrics and chief of pediatrics at the children's hospital in Halifax. She's also a past president of the Canadian Pediatric Society.
She was not a witness before the panel, but a member of the panel. I would take it that the members of the panel felt that they had that pediatric lens in their membership, so I just wanted to make that clarification.
Conservative
Harold Albrecht Conservative Kitchener—Conestoga, ON
Mr. Chair, in response to that, I just want to clarify that I was not implying that there were no pediatricians involved.
The question last night was specifically whether the Canadian Pediatric Society had been consulted. On two occasions, it was made very clear that they were not.
That's the only point that I was making.