There is no issue before this committee that is more important than that of advance consent.
In their decision, the Supreme Court justices wrote that to force someone to choose between undergoing a premature, perhaps violent, death and enduring prolonged suffering is a cruel choice. We submit that unless the committee recommends that informed consent be allowed by advance consent, the injustice will continue.
Nowhere does this play out more than around the issue of dementia. In the years that I have been speaking about this subject, it's hard to overestimate the number of people who have expressed their fears, their dread, of living for years with dementia. In my home province of British Columbia, we have seen this play out in two cases, that of Margot Bentley and Gillian Bennett.
Margot Bentley was a dementia nurse. She knew that she never wanted to live in a demented state, and yet she has ended up, despite previous written wishes, in a care facility. Against her family's objections, she continues to be spoon-fed, even though she has stage seven dementia, the final stage. She is unable to communicate, is unaware of her surroundings, and has no control of her bodily functions. Perhaps in response to this, we have the situation of Gillian Bennett, a psychotherapist in British Columbia who wrote in her blog, deadatnoon.com, about her decision to end her life before her dementia left her incapable of doing so.
There is another clear case where individuals must have the right to provide advance consent to assisted dying. That is when assisted death is imminently scheduled, but after clearing all the safeguards and protocols, an individual becomes incompetent. Perhaps it's a patient who agrees with her doctor to have an assisted death on Monday but lapses into a coma on Sunday afternoon.
I now turn to the questions of safeguards and access. I remind the committee that you need to bear in mind that we must support two vulnerable populations here. There are those individuals who are socially vulnerable and may be at risk of being coerced into a death that they would not choose, and there are also those who are sick and dying, who are suffering grievously and want to ensure that they have access to this court-promised right. While doctors deal with life-and-death medical decisions every day, we accept that Canadians want to see additional safeguards in the area of assisted dying, and we believe there are two that are important. The first is that a second doctor be involved in this unique case to ensure that a patient is giving voluntary, free, and informed consent. The second is that at least initially, we believe that every single case of assisted dying should be reviewed after the fact and that there should be an aggregate review to identify any systemic issues.
We categorically reject the idea that there should be some kind of panel reviewing requests for assisted death in advance. This is not a safeguard, but a barrier. It is an obstruction to access. It would take assisted dying out of the medical realm, where it belongs, and put it in the justice system. Furthermore, in no regime where assisted dying is legalized—in Quebec, in North America, or in Europe—is this provided for. There is no regulatory support for this from the colleges, and there is no credible evidence of public support for this measure.
We do accept the premise that there are individuals who are vulnerable and that there should be protections, but why would we restrict that just to people who are seeking an assisted death? Why would we not want to also ensure that someone who is asking to be removed from life support or to stop chemotherapy or dialysis would also have a vulnerability assessment? We believe the responsibility for that should fall squarely on the shoulders of the physicians, the ones who are making decisions about capacity every day. If, as others have said, physicians are not trained to do this, we can think of no group better able to learn and to carry out this critical task.
I now want to turn to the issue of access.
My colleague has talked about the need of the Supreme Court to reconcile the rights of doctors and patients. Although the Supreme Court didn't compel doctors to provide an assisted death, that is not something we argue for. We believe every physician should have the right to refuse to either prescribe or administer medication, but we think it's critical that patients' rights be acknowledged too. Simply allowing doctors to turn their backs on patients and walk away does not serve patients or the health care system well.
Patients must not just be left with the Yellow Pages and information to find their own doctor. They need support and access, and we think there's a very expeditious way for the committee to recommend that this happen. It's through transfer of care. Quebec's legislation talks about a doctor notifying their institution. That would be an acceptable solution to us.
What we do not believe is that patients should be left to fend for themselves. In the event that there is not a system in place to expedite care, then the responsibility must fall on doctors to provide effective solutions and effective referral. Ultimately, the health care system must be here to support patients, not to answer to the wishes of doctors.
Finally, I'd like to talk about the roles of institutions. In the final bill in Quebec, there were some concessions made whereby stand-alone hospice palliative care facilities were allowed to choose not to provide an assisted death. We have also heard from many religiously affiliated institutions that they do not believe that assisted death should be provided on their premises.
We do not accept that bricks and mortar have a right of conscience. If a taxpayer-funded institution has patients who are eligible for assisted dying, they must provide it. It is not up to them to deny patients their charter right, nor can they discipline doctors who are acting on their conscience to provide a qualified patient within the framework of the law with the right to the assisted death they seek.
We remind the committee that your decisions and recommendations will affect how Canadians die for decades to come. We urge you to consider two core Canadian values: that of compassion, and that of patient autonomy, or what we call choice.
Thank you.