Evidence of meeting #7 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 carter.
A video is available from Parliament.
Co-Chair, Ending of Life Ethics Committee, Council of Canadians with Disabilities
This is a poll that was done prior to the decision that came out of Carter, correct? This poll was done in the fall of 2014.
Co-Chair, Ending of Life Ethics Committee, Council of Canadians with Disabilities
Right.
This poll was commissioned by Dying With Dignity, I think through Ipsos Reid. I don't have it in front of me, so I can't speak directly to it. I know we have some paperwork on the reasons why we have disagreed with those findings.
If you want that, and if it would be helpful, we can supply that to the committee if you don't have it in front of you.
Co-Chair, Ending of Life Ethics Committee, Council of Canadians with Disabilities
I can't speak to it now, just because I don't have that paperwork in front of me.
The Joint Chair Hon. Kelvin Kenneth Ogilvie
You can follow up with the clerk. Thank you.
Ms. Harder.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Dean and Rhonda, I have another question for you. It's been stated on a number of different fronts from your organization that you disagreed with the provincial-territorial expert advisory group. I'm just wondering if you can share with me your experience there.
I have a two-part question. First, I'd like you to talk a little bit about how you thought you were treated or corresponded with by this group, and then I would like you to answer for me what safeguards you feel are necessary for persons with disabilities going forward.
Co-Chair, Ending of Life Ethics Committee, Council of Canadians with Disabilities
Neither Rhonda nor I were there to speak to the panel, but certainly we can get you information on that.
I think either John Hicks or Amy Hasbrouck spoke to the panel on that issue.
The Joint Chair Hon. Kelvin Kenneth Ogilvie
Perhaps you could get that information to the clerk.
Could you answer the second part of the question?
Co-Chair, Ending of Life Ethics Committee, Council of Canadians with Disabilities
Could we have that question repeated, please?
Conservative
Rachael Thomas Conservative Lethbridge, AB
I'm just wondering if you can outline for us the safeguards that you believe the people within your organization are asking parliamentarians for.
Co-Chair, Ending of Life Ethics Committee, Council of Canadians with Disabilities
On the types of safeguards we're asking for, we would look for definitions of the criteria. We would be asking for the definitions of the criteria in the legislation, the criteria outlined by Carter in particular, and of what is a “grievous and irremediable” condition that causes enduring suffering. We would be indicating that it should be only for competent adults with a grievous and irremediable condition.
We also agree that palliative care, or at least support systems, and physician-assisted suicide is one of the safeguards, so we would ask, realizing that perhaps it isn't the committee's area to be dealing with funding for palliative care, that it be part of this. If you are bringing recommendations, that would be a recommendation.
We would ask that requests for physician-assisted suicide be reviewed and authorized by an independent review panel with sufficient information to determine if the necessary criteria are met, and that in making that decision the review panel would be looking at a person's request and the reasons for the request.
As we know, the Carter case dealt specifically with the issues around vulnerability and indicated that quite clearly, in I think paragraph 76 of the decision, when it agreed with Justice Sopinka in his saying in Rodriguez that he notes sections 14 and 241 of the Criminal Code are “grounded in the state interest in protecting life and [reflect] the policy of the state that human life should not be depreciated by allowing life to be taken”.
These are the reasons why we think we'd look at the reasons for requests: what are the reasons for the request?
Thank you.
Murray Rankin NDP Victoria, BC
I would very much like to say to you, Mr. Fletcher, how much I appreciate your very candid and moving presentation. I look forward to getting your book.
We have a conflict, I think, between what your vision is of the safeguards we need and what we heard from the Council of Canadians with Disabilities. I want to put that on the table. You're asking for it to be very simple and to simply track the language of the Supreme Court of Canada in Carter. You say “don't make it complicated”, whereas the CCD has talked about the need for a review board process, a federally appointed judge, 45 days, and the like.
First, I'd like to hear your response to that proposal, and then I'd like to hear from the CCD on this prior review notion.
As an Individual
Access delayed is access denied. There are many caveats and many obstacles that were described by the CCD, which, by the way, is a great organization. They have done great work, but on this.... I'm not in Parliament now, but I've been in Parliament long enough to know that Ottawa could really screw this up by putting in too much red tape and by making assumptions about what people feel about life and what quality of life is.
You cannot have a cookie-cutter solution when you are dealing with individuals. Doctors deal with individual cases all the time. I believe the chair of the committee is an oncologist. Are there two cases that are identical? Of course not.
The further you move away from the Carter decision, the more likely it is that you're going to step into provincial jurisdiction. When you make that step, I predict you'll go into constitutional darkness, never to be found again. That is just the reality.
For health, for palliative care, of course we should put in as many resources...but that is a provincial area of responsibility and provinces need to decide how they're going to use the monies they receive from the taxpayers and make decisions accordingly.
NDP
Murray Rankin NDP Victoria, BC
You would reject the notion of a review board as described by the CCD.
As an Individual
I would, though in my bill.... Of course, you could always take the wording in my bill and just insert it. It's very well worded.
As an Individual
There is a review in it that would take away anyone who has a vested interest in having someone pass on. That includes family or the institution a person may be in. You don't want the institution saying, “Well, we need to clear out bed 15.” There has to be an arm's-length process, I believe, but I don't think it's up to Ottawa to decide. It should be the provinces that form that.
Yes, it will be a patchwork and it won't be unified, but that's our health care system.
NDP
Murray Rankin NDP Victoria, BC
Thank you.
In the time available, I wonder if I could ask the CCD if they wish to respond to what Mr. Fletcher said, specifically about the need for a review board.
Co-Chair, Ending of Life Ethics Committee, Council of Canadians with Disabilities
A review board process will honour the differences and won't be cookie-cutter. The access can be quite quick. As we know with the care and consent board in Ontario, you can have access within 24 hours. We're saying that it doesn't have to be by way of oral evidence, so it can be very quick. It's not cookie-cutter at all.
We agree that if you meet the criteria like a Dr. Low, this isn't a situation where you're waiting 45 days. This is a situation where you're in and out, where a doctor will say, yes, not vulnerable. He's requested it and two physicians have said yes. They've done a capacity assessment. They've done a consent assessment: done. Send it to the board: done. The doctor, if they have a conscientious objection, now cannot object to that. They send it to a review board process.
I can imagine it taking very little time to do that, very little time.
The Joint Chair Hon. Kelvin Kenneth Ogilvie
Thank you very much.
Colleagues, do I have agreement from you to allow two more questions? I can tell you that our next panel has agreed to a slight extension in their time. Are you prepared to allow two more questions?
Nancy Ruth Senator, Ontario (Cluny), C
To the council on disabilities, you've said that a vulnerability assessment should be mandated.
I wonder if you could tell us, of the countries that allow some sort of physician-assisted dying, whether it's in Europe or the United States, whether any of them require either a mandatory vulnerability assessment or advance authorization by an independent party. Are there any models for this anywhere else in the world?