I want to reiterate a point made by the CCD to you, which is that while there is strong support in polls for physician-assisted dying—and that is not the issue, the Supreme Court having spoken—there are only two polls of which we are aware that address the issue of safeguards. They are the CARP poll, which has been mentioned in the papers recently, in which a majority of people said a panel, a prior review, rather than an ex post facto or after-death review, was appropriate, and that of the federal panel, which conducted its own review and found that more than 50% supported review by a panel before the death occurred, rather than after death, as occurs in Belgium, amongst others.
Senator Nancy Ruth wanted to put it in an international context. The American experience is not relevant to you, because in the American states this applies only to people in the last six months of their lives. It's a completely different issue.
There are examples, and Colombia is the best one. There the Constitutional Court of Colombia, in December of 2014, said they were wrong in 1997 to say that this should happen with physicians' involvement only, and they now have required that prior review be put in place. That was done in May of 2015. You heard this from your justice advisers. The U.K. model, as you also heard from the justice advisers, also involved a prior review.
I would like to highlight two things and then invite your questions. Could you turn to the first tab in that blue volume? This is a piece of legislation that was drafted by me and Gilbert Sharpe for your assistance. It has actually been available since June of last year. I would be happy to answer any comments or questions that may arise from it.
What I would like to highlight first of all are the definitions of “informed consent” and the definition of “quality of life”.
First of all, in regard to informed consent, as the CCD indicated, in situations where one is talking about the withdrawal of life-sustaining treatment, as Mr. Fletcher did in his personal situation, the process is not as simple as “two physicians”. In those situations, there are social workers and there are case managers. There are non-physicians involved in the process of informing people about the issues that are of uppermost concern to them, as they would have been for Mr. Fletcher.
If we can turn to “quality of life care” on the next page, page 3, at the bottom, this language in (a) through (g) comes from the trial decision of Justice Smith. This is the only place in the Carter decision where people who subsequently were assisted to die indicated why they wanted to die. These are the issues: loss of autonomy; ability to engage in activities to make life enjoyable; loss of dignity; loss of control of bodily functions; perceptions that care requirements represent a burden for family, friends, or caregivers; pain control, including access to proportionate palliative care and/or hospice care; and concerns about the financial implications of care that is not an insured service.
This is crucial language, because these are the issues that cause people to seek assistance. These are not treatment issues. These are not issues in which doctors are involved. These are the issues in which counsellors and case managers are involved in addressing such questions as, Where am I going to live? How am I going to be transported? How am I going to go to the bathroom?
These issues are the issues that we say should be incorporated into the idea of informed consent, because that is why people seek assisted dying. Physicians are not the ones—and they would be the first to acknowledge this—who are in a position to address these issues. We do not say this is an issue that should be imposed on persons in late stages of life, when the options or choices are very few.
One final point, which I would emphasize, is that the bill addresses the access question. The bill imposes the obligation on the attending physician or the family doctor who is approached to initiate the process and see that the process goes to review. It is not a process for screening out applications, and the applications can proceed, in a case such as Dr. Low's, on an expedited basis within a matter of days, as review boards can do. The requirement set out here is that there be a maximum of 45 days. This is not an issue. Access is not an issue under this proposal.