Physician-Assisted Dying Committee on Jan. 28th, 2016

[Dean Richert]

David Baker can possibly speak to that. I think Colombia's supreme court has just recently indicated.... They used to have physician-assisted dying without a prior review process. But David Baker, who's speaking later on, can speak to that issue.

In terms of a vulnerability assessment, doctors do that right now. Doctors do a vulnerability assessment right now, or that's my understanding. If you have a case where you have a person who wants to withhold or withdraw life-sustaining treatment, a doctor will do a vulnerability assessment on that person, dealing with capacity issues. Capacity and consent—that's for vulnerability. We're not saying that an independent, qualified expert needs to come in every time and deal with a vulnerability assessment. We're saying that if there's smoke, there should be some deeper reasons for it. If a doctor says there's no smoke here, there's no smoke. They've done the vulnerability assessment.

[Nancy Ruth]

What you have said, though, is that apart from some legislation that may be coming forward in Colombia, there are no existing models of this. My comment is, why put it on Canadians?

In terms of informed consent, you did say that it may require someone else to do this other than the physician, although you've just said that physicians go ahead and do this now. Why would there need to be another—

[Dean Richert]

If I can, Mr. Chair, I'd like to answer that question.

The reason there would be is so the instance of suicidal ideation doesn't come out of the disability. For instance, if I have type 1 diabetes and I now have to take insulin five times a day, my end organs are involved, I am legally blind, and that's the reason I want to die, what supports are there? What family doctor may be able to tell me what all of the supports are? If I'm looking at informed consent, which is what is necessary in this particular situation, I think informed consent should involve these other support issues.

At the end of the day, I may still decide, as a type 1 diabetic who's aged 55, that I want to die and that I still want physician-assisted dying. That's something where I may have a grievous and irremediable condition, enduring suffering, and I don't want to live this way anymore. I may actually deal with that issue in that way. A doctor may say, “I think there's smoke here. I think you should look at other options.” Or a doctor may say, “Yes. Okay.”

That's what we're asking for. A doctor may not have all of the understanding around him or her to deal with those issues.

[Nancy Ruth]

I'm sure that is always so. I'm someone with type 2 diabetes who is going blind and I can assure you my doctors of various kinds tell me where to go for low-vision clinics and all kinds of other things, and what foods to eat and not eat. There are supports out there. With regard to the example you used, these people who get insulin have medical consultants.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Thank you.

The final question goes to Mr. Arseneault.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Thank you, Mr. Chair.

My question is for the Honourable Steven Fletcher.

I can ask the question in English if you prefer.

[Steven Fletcher]

You'll get a better answer.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

As I read your proposed Bill C-581, could you comment on the fact that there would be 14 days, if I read well, between the demand for the physician-assisted death and the act itself?

[Steven Fletcher]

What the member is referring to is that between the request and the action, I put in a 14-day span, so if the individual in any way said that they wanted to live, that would nullify the physician-assisted death request. Some people wanted it to be seven days or 24 hours, and some people wanted it to be years, but this is one of the key issues. How far in advance can a request be made, and what will be tolerable in the Criminal Code as far as living wills go?

That is a Criminal Code issue. If this committee could come up with a consensus, and I think it would be in such form that in a decade or whatever you would have to renew it, most Canadians would be in favour of that and would find peace of mind, especially with all the terrible things we hear about dementia, brain injuries, stroke, and so on.

That would be a helpful suggestion from the committee, but telling provinces what they can and cannot do is a slippery slope.

I will say just one more thing. To emphasize the importance of the framework of the Supreme Court decision, the committee can suggest raising the penalty. If you go outside of the 18-year-old competent adult, you're going to go to jail for a long time. That would be a very good countermeasure to make sure people follow the intent of what the Supreme Court has suggested.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

I don't want to go back to exactly what my colleague Mr. Rankin asked you before, but I am going to ask you this. You recommended that the federal government take a minimal role and leave details to the province. The foremost authority on constitutional law in Canada, Professor Hogg, who we heard here, warned us against assuming that all provinces would act, and he recommended that the federal government set forth a detailed regime that would apply only if any given province did not legislate.

Do you agree that this would be preferable to having patients or doctors shop for the province that has the rules they would prefer?

[Steven Fletcher]

Legislation is not necessary. The Supreme Court ruling stands on its own: you have to be 18 and a cognitive adult. There are all sorts of other issues that the Supreme Court took into consideration when making these decisions. I suggest that everyone on the committee read the Supreme Court decision and the references. You will see what the big issue is: what is a competent adult?

What's intolerable suffering to me may not be acceptable to you, and my religious views may not be compatible with yours, but we're all individuals, and with this, we will be able to empower people to live full and meaningful lives right to the last moment, and the state will provide the resources to that last moment. That is the goal, so please don't try to tell people what they can or cannot do with their lives or tell them what quality of life they have or don't. Just let the people.... Trust the individual, the competent Canadian.

By the way, everything you decide here will affect every Canadian who is alive and every Canadian there will be in the future, and it will probably set the framework for the western world, so think about it.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Thank you very much.

I want to express my gratitude to the remarkable Canadians who have appeared before the committee this evening. On behalf of all my colleagues, I thank you for your appearance here and for your dialogue with us.

With that, I am going to suspend the meeting for two minutes. We need to have a quick turnaround for the next session.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

We are back in session. Please assume your positions. We are going to begin.

Mr. Lemmens was here a minute ago. I know Mr. Lemmens is in the building, so we will not start with that pair, and I will begin the presentations with Ms. Downie.

I want to remind both groups that you have a total of 10 minutes. Mr. Baker and Mr. Lemmens will have 10 minutes in total. Ms. Downie, you have 10 minutes.

We will begin. This session is scheduled to end at quarter to eight. Thank you.

[Prof. Jocelyn Downie, Professor, Faculties of Law and Medicine, Dalhousie University, As an Individual]

Good evening. Thank you for inviting me to speak with you today. I'm grateful for the opportunity to be a part of this critical conversation.

I should note here that I've played a variety of roles in various initiatives to advance end-of-life law reform in Canada. Today, however, I speak only on my own behalf as a legal academic who has been researching and writing about assisted death in Canada and abroad for more than 20 years.

Given the time constraints, I'll jump right to the heart of the matter.

I would argue that in order to have the properly administered regulatory regime for medically assisted death called for by the Supreme Court of Canada in Carter, the following need to be established through federal, provincial, and territorial legislation and health professional self-regulation: definitions of some key incontestable terms; criteria for access to medically assisted death; processes for ensuring criteria have been met; access for rural and remote contexts, and in the face of conscientious objections by institutions and providers; and oversight.

Other issues that need to be addressed also include liability insurance; life insurance; medical certificates of death; good faith immunity; and, perhaps most importantly of all, access to palliative care.

Of course, the federal Parliament cannot do all of these things, so you need to focus on what you can do. Again, given time constraints, I'm going to focus my remarks on what you can and, I would argue, should do under the federal criminal law power. You can—and I would argue should—exercise the federal criminal law power to design and implement a robust regulatory framework that, first, respects the autonomy of capable individuals making free and informed decisions with respect to medically assisted death; second, protects vulnerable persons from being induced to end their lives at a time of weakness; third, enhances access to medically assisted death; and fourth, ensures that the system of medically assisted death in Canada is well monitored.

Allow me to propose some key elements of such a framework. The first is definitions of terms.

Medically assisted death: I would define this as medically assisted suicide and voluntary euthanasia that is performed by a physician, by another health care provider acting under the direction of a physician, or by a nurse practitioner. This clarifies that the Criminal Code exception covers both assisted suicide and voluntary euthanasia, as is required by Carter, and it resolves the issue of who is protected under the Criminal Code exception in a manner that retains an appropriate level of professional competency and accountability while also ensuring access, especially in rural and remote communities where there may be no physicians.

Assistance: I would define this explicitly as the provision of a prescription for a lethal dose of medication or a lethal injection for the purpose of medically assisted death. This clarifies that providing supporting services—for example, a pharmacist filling a prescription—during the delivery of medically assisted death does not constitute providing medically assisted death and therefore does not violate the Criminal Code. This will prevent exposing people who provide such services to liability and will prevent people from declining to provide such services because of fear of liability.

Grievous: I would recommend that you use its established definition in law and common usage, which is “very severe or serious”. Do define it so as to make the meaning clear and to prevent it from being narrowed inconsistently or inappropriately by provincial-territorial legislative assemblies or by regulatory colleges. Do not define it through a list of conditions, because you cannot possibly anticipate every condition, and many conditions are only sometimes grievous.

Irremediable: I would codify the subjective aspect that the Supreme Court established. As the Supreme Court said, it means that the condition cannot be alleviated by a means acceptable to the person.

Mature minor: this is a person under the age of majority who has the capacity to make an informed decision about medically assisted death and sufficient independence to make a voluntary decision. This is a well-established and well-understood concept in health law and policy across Canada.

Moving from definitions of terms, we come to the second key element: criteria for access. Access should be limited to those who have “a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual”, based on their assessment of their personal circumstances. This is Carter.

Terminal illness should not be an inclusion criterion. It was not included by the Supreme Court in Carter. It is too vague and indeterminate. It is arbitrary and it has no moral justification as a barrier to access.

A specific age should not be an inclusion criterion. Although the Supreme Court used the word “adult”, it did not define it—intentionally—and in law the word “adult” has been defined in various statutes and the common law as a variety of ages not limited to 18 or 19.

It is also important to note that across Canada, it is well established that individuals under the age of majority have the authority to make health care decisions, even if the consequence will be death. It's also important to note that the Supreme Court, in A.C., held that an “irrebuttable presumption of incapacity” for medical decision-making based on age violates the charter. First, then, it doesn't violate Carter to include mature minors. Second, even if Carter only held the Criminal Code prohibitions to be invalid for individuals over the age of majority, Carter sets a floor and not a ceiling, and the issue of minors was not before the court. The third and most important point is that to exclude individuals on the basis of a specific age flies in the face of established health law, policy, practice, and the charter.

Next, mental illness should not be an exclusion criterion. It was not excluded by the Supreme Court, and not all individuals with mental illness are incompetent. Physicians already routinely determine whether someone is competent, even when they have a mental illness. Furthermore, the suffering that can accompany mental illness can be as excruciating as any suffering that can accompany physical illness. Finally, I would argue that excluding individuals on the basis of mental illness would violate the charter.

Before moving on to procedural safeguards, I should say a few words about when the individual must meet the criteria for access. This is what you've been discussing as the “advance directives” issue. The questions are these: what criteria do you need to meet to make a valid request for an assisted death, and what criteria do you need to still have at the time of the provision of assistance?

I would suggest that the best position to take at this time is to require the following: at the time of the request, the patient must have a grievous and irremediable condition and be competent, and at the time of the provision of assistance, the patient must still have a grievous and irremediable condition and be experiencing intolerable suffering by the standards set by the patient at the time or prior to losing capacity.

This approach prevents the tragic case of someone having met all of the criteria but being denied medically assisted death because they became incompetent just before it could be provided. This approach also prevents someone killing themselves earlier than they otherwise would for fear of becoming incompetent before reaching the point of intolerable suffering. One example is a person with progressive dementia.

Finally, this approach allows for the consent process to happen before someone is actually experiencing intolerable suffering. It seems cruel to require the person to be actively experiencing intolerable suffering throughout the process of assessing the criteria, including, perhaps, a waiting period.

Moving from criteria for access to the third key element, procedural safeguards, here we turn to rules with respect to consent, capacity assessments, documentation, reporting, and other procedural safeguards. This is, of course, the area with the greatest overlap in jurisdiction with the provinces and territories. However, for a number of reasons, I would argue for federal action here, tied closely to the criminal prohibitions and exceptions.

The first reason is to ensure consistency in approach across Canada. The recent federal-provincial-territorial ministers of health meeting does not instill confidence that they will come out with a harmonized approach. The second is to prevent gaps in coverage if some provinces and territories do not legislate. There is a real risk that some provinces and territories will not legislate but will just leave this matter to the colleges, which have already shown themselves to not be willing to adopt a harmonized approach. Their newly developed standards are an absolute patchwork.

The fourth key element is oversight.

We need two levels of oversight. The first is retrospective case review. For this I would recommend a regional review committee system to retrospectively review all cases of medically assisted death to determine compliance with the new rules. The second is oversight of the regulatory framework itself. For example, it would ensure data collection, analysis, and reporting. It would commission research to ensure ongoing, evidence-based policy-making, and it would make recommendations to the minister about potential law and policy reform with respect to medically assisted death in Canada. For this I would recommend the creation of a national oversight commission for medically assisted death.

Finally, there's the substantial similarity provision. This would allow provinces and territories that wish to design and implement—or, in the case of Quebec, keep—their own regimes to do so as long as these regimes were substantially similar to the federal regime. This respects the fact of overlapping federal-provincial-territorial jurisdiction, assures a level of harmonization across the country in relation to the core elements of the exception to the Criminal Code prohibition, and prevents gaps if some provinces and territories fail to legislate. In Canadian law, this is an established way of responding to situations of overlapping jurisdiction, such as this one.

With that, my time is up. I thank you for your attention, and I welcome your questions after the next presentations.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Thank you very much.

I'm now going to turn to Mr. Baker and Mr. Lemmens.

I understand you'll present, Mr. Baker.

[David Baker, Lawyer, Bakerlaw, As an Individual]

I'm going to make a preliminary comment and then turn things over to Professor Lemmens for a brief comment concerning the situation in Belgium and the Netherlands, which represents the model that has just been recommended by Professor Downie. I will then speak to the draft legislation, which you have in the blue volume, which is tabbed. I hope you all have that available to you. I will very briefly highlight the differences between what Professor Downie has just indicated and what we would be recommending.

Let me say first of all that when we initially applied to appear before you, Mr. Gilbert Sharpe was one of the three who together made the application. He is not here. He is truly the father of law in medicine in this country. He has drafted most of the important health legislation in this country. He drafted the mental disorder sections in the Criminal Code, which in many ways are parallels to what we are talking about here, which is a carve-out from the Criminal Code. He has vast experience. He would have spoken to you about how the panel of review, the review board, would have meant that physicians, including family physicians, would not have disqualified themselves from the process for moral objections because they would not be making the decision. That is the objection that the physicians have taken not to filing reports, which is the function of physicians. There are at least 18 mandatory reporting functions from which there are no moral objections taken.

I'll turn it over to Professor Lemmens.

[Prof. Trudo Lemmens, Professor, Faculty of Law and Dalla Lana School of Public Health, University of Toronto, As an Individual]

In Carter, the court actually explicitly stated that Canada could avoid any of the problems Belgium is facing in the context of physician-assisted dying by adopting a strict regulatory regime that allows for less discretion. I noticed with some disappointment that the provincial–territorial advisory group now recommends a regime that is more flexible, less restrictive, and more open-ended than even the Belgian system. I invite you, therefore, to look in more detail at the documented cases and evidence about problems in the Belgian system, which I've documented in this memo, in order for you to fully understand the risk associated with a flexible and open-ended system. I have a more detailed chapter that I can share later with the committee as well.

I can only talk about the essence because I want to give more time for the proposal, but the essence is this: even if, in Belgium, physician-assisted dying requests are to be granted only when certain conditions are met, the vague and flexible criteria, coupled with the significant powers vested in physicians, have resulted in what I would call a quite open-ended access regime.

Individual physicians are the main gatekeepers, but their tools of competency assessment and informed consent assessment are questionable and difficult. There are documented cases of how it may not work in the Belgian system. More than 70% of the physician-assisted dying requests are now granted in Belgium, which is a significant increase over time.

In Belgium, physician-assisted dying has expanded beyond the original intentions of offering compassionate access and exceptional care. The numbers give you an indication. We have gone from 347 cases in 2004 to 2,021 cases in 2015, the latest number, but numbers tell us only so much. Obviously these could all be valuable cases, but they do suggest a normalization of the practice.

I want to emphasize, as I do in the memo, that it is actually more interesting to look at the areas in which physician-assisted suicide has expanded. I'm not saying that these are the majority of the cases, but these are cases that the committee should be aware of. It has expanded in areas that are more problematic and a bit more existential, such as suffering cases and also, increasingly, mental health. This expansion affects people who are experiencing life-changing disabilities; situations of loneliness, isolation, societal stigmatization, and rejection; difficulties with managing daily activities; and difficulties functioning independently. In those situations, good support measures and structures can prevent premature death, while all-too-easy access to physician-assisted dying can incite life-ending requests.

I won't discuss the many publicized cases in the memo that you have in front of you, which have been quite widely advertised, but I will say that these are not just anecdotal cases. They are actually real and lived physician-assisted dying experiences, which in some cases we have seen documented in detail. These are the publicly known cases.

In my main memo, I pay more attention to a less publicly discussed aspect: euthanasia in the context of mental health. I invite the committee to read this discussion in detail. When physician-assisted dying is defended in the context of mental health, it's often presented that PAD is only necessary and will only happen in exceptional cases of untreatable chronic depression, where physician-assisted dying is the only compassionate option, but reports in Belgium may surprise you. Also, ongoing research about practices in the Netherlands show that it now involves people suffering from personality disorders, post-traumatic stress, anxiety, eating disorders, schizophrenia, addiction, autism, and even profound grief. In most instances, according to ongoing research, it involved socially isolated, lonely people. In some cases, depressed people were euthanized without close family members even being alerted about the euthanasia request.

Reports have also raised questions about the safeguards in place. Again, you have documentation about that. I indicate why competency assessment is a notoriously problematic tool in very complex areas of mental health in particular, but certainly also in the context of disability, because, for example, it is influenced by the values of the physicians.

In Belgium, you have a small group of very committed physicians who are committed to physician-assisted dying and who by nature may be tempted to much more easily conclude that patients who are requesting access to physician-assisted dying are competent, and thus we see their lives being terminated.

There are also questions in many of these cases about how treatment resistance has been determined. Physicians may easily presume that people are treatment resistant, but this is a notoriously difficult thing to assess in the context of mental health, and it actually has been widely questioned.

I also discuss the limits of the reporting system with respect to the fact that there is still under-reporting, and also with respect to the fact that the reporting can actually give us the wrong sense of security. People are not looking sufficiently at exactly what is happening in individual cases, as is described in my memo. I won't expand on that here.

I will now turn it over to my colleague.

[David Baker]

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.

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

Thank you very much.

Ms. Dabrusin.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

I have a question for Ms. Downie.

An area that has come up several times today as well is the issue of people in transition. When a person is rendered paraplegic or paralyzed, there's that period of trauma immediately after the injury when that person may be requesting physician-assisted dying. I was wondering if you could comment on how you see the Carter test applying to that scenario.

[Prof. Jocelyn Downie]

Sure. I think the concern people are expressing is understandable, but I think it absolutely can be dealt with by reflecting on the Carter test, and also in the context of the practice of medicine.

Think about what “informed choice” requires. The individual has to have capacity, under the Carter test, which means they have to understand the nature and the consequences of the decision to be made. In the immediate aftermath of a traumatic injury, physicians will say a person doesn't actually have that yet, so being responsive to that kind of situation is built into the test.

Similarly, you have to be informed. You could argue again that in the immediate aftermath of an injury, you don't yet have the full information about what it is going to be like to live in that way, so you would again maybe not be found to be fully informed.

Under the Carter test, the suffering also has to be enduring. In the immediate days after an accident, no physician is likely to say that the suffering is enduring and that someone therefore meets the test.

The final thing to say in response to this is that physicians already, every day, deal with exactly this kind of scenario in relation to refusals of treatment. You can have somebody who has a traumatic injury, and then they say the kinds of things that Steven Fletcher may have: “I don't want the treatment. I don't want a ventilator. I don't want artificial hydration or nutrition.” We work with the established principles of informed choice and insist that the person have capacity and be informed, and that can take time.

You don't have people losing their ventilator or having antibiotics withheld in the immediate aftermath of a traumatic injury. I'm saying it can absolutely be managed in the context of current practice. We rely on physicians to do that now, and Justice Smith acknowledged this in her trial decision.

[David Baker]

May I say—

[The Joint Chair, Hon. Kelvin Kenneth Ogilvie]

No.

Ms. Dabrusin, you direct the question. If you want Mr. Baker to answer, you direct it. The question is to you.

[Julie Dabrusin, Liberal, Toronto—Danforth, ON]

I actually just wanted to follow up. You mentioned that Justice Smith had dealt with this in her decision. Can you elaborate on that for me, please?

[Prof. Jocelyn Downie]

Yes, and it's important in relation to what Professor Lemmens said.

The evidence about the challenges in competency assessments was before Justice Smith and was tested in court. She concluded that we trust physicians now to make these complex decisions all the time in relation to refusals of treatment. She said there is no basis for deciding that they are capable of making those assessments in the context of withholding or withdrawing life-sustaining treatment but not in the context of assisted dying. She concluded that the system we have, in which we trust physicians to make these complex decisions in the context of withholding and withdrawing treatment, applies equally in assisted dying, and we should continue.

That is not to say we have perfection around competency assessments, but it is to say there's no morally sustainable difference between the withholding or withdrawal on the one side and assisted death on the other side with respect to capacity. We just have to do it better in relation to both, but we trust the physicians and we should stick with the same system that we have now.