Evidence of meeting #6 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 nurses.
A video is available from Parliament.
Senior Nurse Advisor, Canadian Nurses Association
We know of a few examples and models. I'm thinking about a Newfoundland model that uses telemedicine sometimes to access specialized services. It's been very successful at reaching out to specialists who are not able to physically go into those communities. A lot of consultations are done through that service.
There are a few models and innovations across Canada that have been successful.
Liberal
Julie Dabrusin Liberal Toronto—Danforth, ON
For those of us who aren't actually working in this sphere, can you perhaps describe to me how telemedicine works? Let's say you have a nurse who has a patient in a remote area and they do not have a doctor present there.
Senior Nurse Advisor, Canadian Nurses Association
They will have access to a visual aid, such as a TV, and a communication tool. The patient would be there, and they would be able to communicate with the specialist. Sometimes it's very sophisticated, so that through the technology you're able to do a fairly comprehensive....
I'm looking at my physician colleagues here. My experience as a nurse has been around advanced specialized wound care. I've used telehealth, and it was very successful in terms of getting a fairly good quality of image and communication and getting access to a specialist.
I hope I've answered your question.
Liberal
Julie Dabrusin Liberal Toronto—Danforth, ON
You have, but perhaps I can continue on with that. Once the nurse gets that information, they proceed to actually administer the care under the doctor's direction?
Liberal
Julie Dabrusin Liberal Toronto—Danforth, ON
Thank you.
What role do nurses play in examining capacity? When nurse practitioners, for example, do training, do they do any training on how to assess capacity?
Senior Nurse Advisor, Canadian Nurses Association
We have RNs and nurse practitioners who are able to do the initial assessment. Capacity assessment requires special training, and we need specialized individuals to help us. The nurses are able to do some initial evaluation, but those next steps around capacity are usually done by specialized trained professionals. The laws and legislation are different in all jurisdictions.
Liberal
Julie Dabrusin Liberal Toronto—Danforth, ON
I just wanted you to define the term “professionals” for our purposes. When you're referring to specialized trained professionals, are you referring to doctors?
Senior Nurse Advisor, Canadian Nurses Association
Usually it's a legal professional. Nurses do not usually sign for those capacity tools and assessments. We can contribute to that assessment throughout our initial interactions with the patients, but the legal and formal part is not done by the nurses.
January 27th, 2016 / 6:05 p.m.
Liberal
Julie Dabrusin Liberal Toronto—Danforth, ON
For the CMA witnesses, are there any medical interventions that are currently excluded from advance directives?
President, Canadian Medical Association
I'm not sure of the answer to your question. I know there is quite a process for a procedure to be considered as an advance directive. It has to be approved through the regulatory bodies of physicians working in conjunction with the nurse regulatory body. There have to be guidelines around it, and there are very specific ones. Not all procedures are advance directives. Certainly something like physician-assisted dying would have to go through a regulatory process.
Liberal
The Joint Chair (Mr. Robert Oliphant) Liberal Rob Oliphant
Thank you.
We may ask you for help with that question later in a written question.
Mr. Warawa.
Conservative
Mark Warawa Conservative Langley—Aldergrove, BC
Thank you, Mr. Chair.
Thank you to the witnesses.
Doctors Blackmer and Forbes, what you've shared with us today at the committee is a compilation of consultation, and you're representing the CMA and not your personal views. Is that correct?
Conservative
Mark Warawa Conservative Langley—Aldergrove, BC
Thank you for the work, the paperwork, and the reports you've provided.
Under your recommendation 5.2, regarding conscientious objection by a physician, it says:
Physicians are not obligated to fulfill requests for assisted dying. This means that physicians who choose not to provide or participate in assisted dying are not required to provide it or to participate in it or to refer the patient to a physician or a medical administrator who will provide assisted dying to the patient. There should be no discrimination against the physician who chooses not to provide or participate in assisted dying.
Would this apply to physicians and facilities and organizations, or just to physicians?
Vice-President, Medical Professionalism, Canadian Medical Association
It applies only to physicians.
Conservative
Mark Warawa Conservative Langley—Aldergrove, BC
So your recommendation is based on consultation with physicians? Thank you.
Dr. Branigan, you touched on wait times, and I think you said that most people would like to die at home. I think you're quite right. Almost everyone around this table has enough years under their belt to have experienced the death of a loved one. I've watched both parents, my stepmom, and my in-laws die. It was not easy, but I was blessed in being able to say goodbye to each of them.
Regarding palliative care and its involvement, as a physician dealing with people who would like to consider premature death, as I think you called it, or physician-assisted suicide, euthanasia, or assisted dying, have you ever been with a patient who, after receiving palliative care, has changed their mind?
Conservative
Mark Warawa Conservative Langley—Aldergrove, BC
Could you elaborate on some examples of that and of how palliative care has changed somebody who might have chosen death but now wants to live?
Canadian Society of Palliative Care Physicians
I'm not sure I want palliative care to take all the credit. There's also personal growth and a chance of accommodation.
There are two that come to mind. One gentlemen showed up in emergency, saying he wanted his life shortened because he was too sick to get on the plane to Switzerland, where he'd already been accepted by Dignitas. He had prostate cancer. He had uncontrolled pain. He came into the hospital, and we got his pain under control. He ended up marrying his girlfriend and dying in a palliative care unit, and he was very happy. I remember walking into his room, and he said, “I don't have to do anything. I can just enjoy this time of my life.”
I also worked with a woman with ALS who, the first time I walked in to see her, gave me the papers for Dignitas. In the end, she changed her mind. She ended up getting a feeding tube, which prolonged her life. She could have chosen not to do that and could have ended her life earlier.
Just this week I met a woman who wanted assistance in shortening her life because she simply could not tolerate being helped to go to the toilet. We have not been able to relieve that kind of suffering. I'm not sure we would ever be able to do that.
Conservative
Mark Warawa Conservative Langley—Aldergrove, BC
Thank you. I have many more questions.
You shared that most physicians have not been trained in palliative care. Am I right in assuming that they do not have proper training and knowledge in what assistance palliative care could provide to somebody considering assisted death?
Canadian Society of Palliative Care Physicians
I think that might be generational. Medical students in residence now are getting more of it. There's a bigger cadre of people who do have palliative care skills, but I think a lot of people do not understand what palliative care is and are not referring appropriately because there's this thinking that it's going to upset the patient. That still happens.
Liberal
The Joint Chair (Mr. Robert Oliphant) Liberal Rob Oliphant
Thank you very much to our witnesses. We're going to stop there for today.
I suspect individuals may still be in touch with you for your further opinions as we continue over our very short course.
Committee, we are going to now clear the room and have an in camera meeting for a very short period of time, because there will be a vote in the House shortly.
I thank our guests. I'd ask that we turn it around in three minutes so that we can have a short in camera meeting. Thank you.
[Proceedings continue in camera]
[Public proceedings resume]
Liberal
The Joint Chair (Mr. Robert Oliphant) Liberal Rob Oliphant
Thank you, especially to the senators, for allowing us to go and do this part of our civic duty.
Welcome to some substitute members, Mr. Wrzesnewskyj and Mr. Maloney. Mr. Albrecht is still here.
Thank you also to our witnesses tonight. I would apologize if it was really our fault. Votes happen. We apologize that we've kind of danced around with you for the last two days on the time that you were going to come. Thank you for your patience with us, and we look forward to your testimony.
We have two presentations in this section. They are from the Canadian Pharmacists Association and from the Canadian Psychiatric Association. We ask for about 10 minutes from each of those groups and then we'll turn it over to members for questioning. Thank you.
We'll start with the pharmacists.