Evidence of meeting #8 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 patient.
A video is available from Parliament.
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
I personally would not feel that it necessarily needs to be a specialist. Perhaps only in instances where there may be questions with regard to the competence or capacity of the individual would there be a need for more specific, specialized expertise.
NDP
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
I want to thank the witnesses.
My question is for Dr. Lemire.
Some witnesses have said that only physicians could provide assistance to die to patients who request that assistance, as the Supreme Court of Canada decision in Carter talked about a physician's assistance to that end. That is even more true in the English version.
However, the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying says that members of regulated health professions—including registered nurses and physician assistants—should be able to provide assistance to die under the guidance of a physician or a nurse practitioner.
According to your organization, which health care professionals should be allowed to provide assistance to die to patients who make the request, especially those who live in remote areas or in the north and have more restrictive access to a physician?
February 1st, 2016 / 12:50 p.m.
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
We really believe that physician-assisted dying is the responsibility of family physicians. That said, I would not say that it is exclusively their responsibility. For instance, nurse practitioners who are working in more rural or remote regions should also be authorized to provide that assistance, especially if their professional body is prepared to include the process in their scope of practice.
For an informed decision to be made, I think that a consultation with a family physician, based on a consensus process the patient is involved in, is completely appropriate.
NDP
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
We have also been told about telehealth practices that could foster collaboration between physicians who are not on site and nurses, for instance.
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
We support that tool as a consultation vehicle that is part of this important decision.
Liberal
The Joint Chair (Mr. Robert Oliphant) Liberal Rob Oliphant
Merci.
I've asked if Senator Seidman would share six minutes with Senator Joyal so that they can each have three minutes and we can get both of them in and still end at 1 p.m.
Thank you very much.
Serge Joyal Senator, Quebec (Kennebec), Lib.
To show you how amenable we are, I will say yes.
Senator, Quebec (De la Durantaye), C
Thank you.
Dr. Lemire, you stated that physician-assisted dying is not just about process and procedures but very much about the relationship between the physician and the patient. Clearly we need to deal with clarity for professionals, as you yourself put forward as well.
My question to you is this: should the process involved in making a request for physician-assisted dying and the process involved in providing physician-assisted dying be established through federal legislation?
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
We are on the record as saying yes, and I still believe this is important. That really is around equity. I believe that a federal process would strengthen equity for Canadians around this issue.
Senator, Quebec (De la Durantaye), C
It's true that the provincial regulatory medical authorities have established guidelines for their members in relation to physician-assisted dying. Do those guidelines provide somewhat of a satisfactory framework?
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
The guidelines that are probably best known, as we referred to earlier, are the ones that exist in Quebec. I would say, based on everything that I've heard from my colleagues in Quebec, there is a sense that they are appropriately framed.
Guidelines are emerging as they are issued by the licensing authorities in other provinces. I must admit that I've not had the opportunity to study those in as much detail as I have in looking at the Quebec situation.
Senator, Quebec (De la Durantaye), C
Shall I defer the rest of my time now?
Liberal
The Joint Chair (Mr. Robert Oliphant) Liberal Rob Oliphant
It would be good if you wanted to. You have 45 seconds, or you can pass.
Liberal
Senator, Quebec (Kennebec), Lib.
Thank you, Senator.
Madame Lowi-Young, I would like to come back to your statement or answer to our colleague Mr. Rankin.
If I understand the position of the Alzheimer Society, you're not opposed in principle to advance consent, but you advise us that there are three points we should keep in mind, especially the timing of when the consent is being given and appraised during the life of a patient. Am I right in understanding your position the way I have stated?
Chief Executive Officer, Alzheimer Society of Canada
Yes, that is correct. If you look at Alzheimer's disease and dementia, the progress of the disease can happen over a long period of time. It can be 10 years or more. It's that there is usually a substitute decision-maker who has to understand the values and the beliefs and the philosophy of the individual or family member they are caring for.
We are saying that advance planning, once somebody is diagnosed, needs to be considered in the knowledge that the whole issue of physician-assisted dying is a complex one, because he context in which the decision gets made changes over time, from the initial diagnosis until when the person is near the end of life.
We're saying that fundamentally their access to care should be to high-quality palliative and hospice care. That's very important, because the issue of how to determine what the person's wishes are at the end of life is very difficult, since they cannot state clearly what their wishes are.
Chief Executive Officer, Alzheimer Society of Canada
We're just saying that because of the needs this group of individuals has and because of the nature of dementia and Alzheimer's, all these issues need to be considered in the work you're doing in creating the framework for the legislation.
Senator, Quebec (Kennebec), Lib.
Thank you.
Dr. Lemire, if I may, I will come back to page 4 of the brief your association sent us on January 18. I received a letter, and I assume my colleagues received one, as well. The brief was produced by the College of Family Physicians of Canada. On page 4, the document talks about a physician's right to freedom of conscience. Here is what is stated in the second paragraph. Do you have the document with you?
Executive Director and Chief Executive Officer, College of Family Physicians of Canada
I don't, but go ahead.
Senator, Quebec (Kennebec), Lib.
If it's okay with you, I will read the following in English, since the document I received was in English.
It concludes:
...physicians must be cognizant of the scope of their responsibility in providing care to a patient. The CFPC opposes in principle any action that would abandon a patient, without any options or direction.
That's under the heading “What is the meaning of a physician’s right to freedom of conscience?”
Could you expand on that sentence, where you say that your association “opposes in principle any action that would abandon a patient without any options or direction”, in view of a physician refusing to assist a person in dying?
Liberal
