Physician-Assisted Dying Committee on Jan. 26th, 2016

[Dr. Jennifer Gibson]

This became clear to us through the consultation. We heard from many physicians who initially felt as though this was a burden and it was falling only on physicians' shoulders.

However, on the issue of access, very clearly, there are multiple actors who need to be operating together in order to ensure access. In here, we've defined roles for different levels and institutions, including regional health authorities, to facilitate access.

Quite apart from the issue of conscientious objection, access itself is going be a challenge for many in Canada. There will need to be system coordination, which will be at the provincial and regional level within provinces—

[James S. Cowan]

That's the role of the regulatory authorities, the colleges of physicians and such?

[Dr. Jennifer Gibson]

It is of regulatory authorities, indeed. I think this is where the Supreme Court of Canada invited us to balance rights.

We do acknowledge in clinical practice—not just physicians but other health professionals as well—that they have a right of conscience. In fact, one of our members on the expert advisory group, Dr. Sister Nuala Kenny, reminded us that conscience also applies to those who are proponents and are willing to practise physician-assisted death. Their conscience tells them that this is the right thing to do.

We need to be able to ensure that we have a regime that calls on physicians and clinicians to stay closely anchored to what they're called to do in terms of public service. Colleges do have a key role in making very clear the expectations of their members in terms of facilitating access.

It's been very clear in our recommendations, and we're hearing this especially from physicians in palliative care, that an effective transfer of care would be important, but that all physicians and clinicians ought to be able to provide information about all of the options. That doesn't mean that the physician needs to participate in the act of physician-assisted death, but they must be able to provide information on the options and, if necessary, on the basis of conscience, they must facilitate an effective transfer. To do that well, they're going to need others in the system facilitating it.

[James S. Cowan]

Exactly. Can I just make sure that your comments would also apply to institutions?

[Dr. Jennifer Gibson]

Yes.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Mr. Aldag.

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

Thank you. Before I get started, I do want to take a moment and share something very personal. I'll be very quick.

When I shared with my wife, who's a physician, that I was being put on this committee, she immediately sent me a YouTube link to the story of Dr. Donald Low. I simply wanted to thank you, Maureen, for being here, and to share, acknowledge, and honour the impact of your husband's life and death.

[Maureen Taylor]

Thank you.

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

Thank you.

I'm going to share my time really quickly with my colleague Brenda. I have two really quick questions.

In the report, you talk about physicians refraining from participating in physician-assisted dying. That was in recommendation 36. I'm just really curious about your discussions on how big an issue that is. Do you see that it's a large issue we need to pay a lot of attention to with regard to conscientious objection?

Do you have any quick thoughts on that?

[Maureen Taylor]

I'm not a legal expert, but I have a feeling that this is going to be seen as something that the provinces will say they have jurisdiction over. That's what we were told by the Attorney General.

I will say that I love that you're thinking along those lines, because, again, we don't want a patchwork approach to this. As we know, right now in Prince Edward Island, women cannot get an abortion. We do not want that to happen with physician-assisted dying. Anything your group can do to ensure.... One worry—I'll be blunt—is that some provinces will do nothing after next June and they won't bring in legislation. I think you were talking about that yesterday.

If you can have something in place so that those Canadians who live in a province that wants to bury its head in the sand won't be left without this option.... I don't know what those things are, I'm not the expert, but I love that you're thinking about it.

This is an issue that seems uniquely Canadian. Of course, there are physicians who conscientiously object in the other jurisdictions, but as far as we know from our research, it has never been such a mountain to climb as it seems to be in Canada, and I have no insight as to why that is.

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

Thank you.

I have a very quick one and then I'll pass it to Brenda.

There's a struggle I've had, and I don't know if you've come up with it in dealing with provinces and territories, and that is simply the terminology. As I go back and talk to constituents about physician-assisted dying, “physician” doesn't capture it and “dying” doesn't, nor does “death”. I wonder if that came up and if you have tight terminology that we could be considering.

Then I'll pass this on to Brenda.

[Dr. Jennifer Gibson]

We eventually just went with the language that was in the Supreme Court of Canada's ruling, of course, but we did hear some.... Each of these terms could be unpacked and has its own associated controversies.

Consistency would be great. I don't know how to land on that to provide any strong recommendation one way or the other, except to say that we like the language we've been using.

[Maureen Taylor]

My personal opinion is that I don't like “suicide” with this. Yesterday, I think, you were talking about how Health Canada has a campaign to prevent suicide. That is precisely why I don't think suicide belongs in this discussion. I think that's a different issue.

As for “euthanasia”, yes, this is technically euthanasia, but we know that has a pejorative connotation. I like to use “physician-assisted dying” or “medically assisted dying”.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Ms. Shanahan.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Since we need to act on the federal Criminal Code provision, our responsibility is to ensure that there is not a worse public evil. In your opinion, what is the worst public evil, having physician-assisted dying legislation or not having it?

[Maureen Taylor]

I think that public evil thing was in there. That was how it was being explained in regard to how a federal law could trump provincial health care law. Again, these are questions better put to someone like Jocelyn Downie, who will be here on Thursday.

The federal government can get involved in health care, which seems to be a provincial purview, when it's to correct a potential public evil. I would think vaccinations might be an example. If a province weren't going to make it mandatory for children to get certain vaccines, the federal government might be able to step in there and say that's bad for public health. If you're asking me—

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

I guess what I'm seeing is that this report came from something. Something is going on across the country, and it seems that this report is trying to address it.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Okay. We can't explore this if she doesn't have it figured out.

Monsieur Deltell.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Thank you, Mr. Chair.

Ladies, welcome to your Canadian Parliament.

I would like to discuss two issues with you, including terminology, but I would first like to discuss the distribution of power between the federal government and the provinces.

Earlier, Mr. Pelletier was asked a very specific question—whether he wanted the proposed legislation to be open for provincial authorities or more restrictive. In other words, we wanted to know whether to give more powers to the provinces so that they could decide what direction to take, or give them specific instructions instead.

Do you think that the legislation the Government of Canada intends to propose should be very specific so as to leave the provinces little leeway, or should it instead give the provinces the leeway they need in this area?

[Dr. Jennifer Gibson]

I think our recommendations were quite clear that it's really around definition and the scope, particularly as related to health professional roles. That will be an issue that cuts across all provinces.

In terms of more prescription than that, I think there will likely be some push-back from the provinces. The provinces do have jurisdiction over health. They actually have active legislation in place. I think it would make a bit of a legal quagmire for them, because each province is going to need to look at its own jurisdiction and figure out, given its current acts of legislation and current legal framework, what is the best way to introduce physician-assisted death in the province's particular setting.

Earlier somebody mentioned the idea of equivalency and said that this was something that was surfacing for us to ensure that Canadians have effective access wherever they happen to be. Ensuring that there is a legal framework to do that may mean that some provinces might have a single act of legislation that captures the whole, while others might actually have omnibus legislation that makes revisions to what they have. But the effective result would be that all Canadians in all provinces and territories would have access.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Do you think the provinces and territories will welcome that kind of attitude that lets them decide where they want to go, instead of the federal government telling them where they have to go, period?

Let me remind you that it took six full years in the legislature of Quebec, under six different governments, six different premiers, to achieve that goal. Do you think the provinces will welcome the fact that they will be able to decide for themselves?

[Maureen Taylor]

Yes.

One statement in our report says that we advocate for moving forward on this at whatever level will achieve consistency across the country and prevent a patchwork. We thought we were talking to the provinces. That was our mandate: provinces and territories. If you think that you can, without encroaching on something purely provincial, come up with something that will achieve that consistency—of course, it would depend on how much it mirrors what we've recommended, and I am speaking personally—then that would be great.

You'll have lots of constitutional lawyers to advise you on what you can get away with, as far as the provinces go, and what you can't. From our point of view, we want consistency across the country.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

I'll be quick, and this will not be a question but just a remark. It's quite important to define the wording. Let me tell you that in Quebec, we started the debate under the title l'aide médicale à mourir, and we finished with soins de fin de vie. This is the same situation but not exactly the same words. It's quite important to define exactly what the words mean in that situation.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Senator Nancy Ruth.

[Nancy Ruth]

Yes. Thank you for being here.

I want to take your minds to vulnerable persons. What does “vulnerability” mean? Who are vulnerable persons? How will we recognize them? What specific measures do you propose to protect vulnerable persons from being induced to commit suicide at a time of weakness?