Evidence of meeting #9 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 indigenous.
A video is available from Parliament.
February 1st, 2016 / 5 p.m.
Judith G. Seidman Senator, Quebec (De la Durantaye), C
Thank you, Chair.
Thank you very much for your testimony.
If I might, I will say to Mr. Miller and Ms. Masotti that likely every single one of us around this table would agree with you that palliative care is a pretty important aspect of health care in this country, and that there is a continuum in end-of-life care that includes palliative care as well as physician-assisted dying now that the Supreme Court has made this ruling.
There are those who would suggest that parliamentarians—and I have heard this—should consider a separate piece of legislation around a national palliative care strategy and program, but I would like to ask you about and push you into physician-assisted dying, if I might.
We know that Bill 52 in Quebec has already begun. There was much conversation about it. It's been in effect since December. I'd like to know if the cancer society in Quebec has had any kind of feedback or if your national organization has something to say about how things are proceeding in Quebec.
5 p.m.
Director, Public Issues, Canadian Cancer Society
I have an answer to your question. I'm not sure it's going to satisfy you, but we'll find out.
The cancer society in Quebec has had quite a bit to say about the process there. The organization has been very involved in these discussions right along and has expressed strong support for where that process came out, most importantly because part of what the province did was enact end-of-life legislation that included a right to palliative care.
That was always the number one priority for our organization on the issue. Certainly, I think they felt that they were actively engaged and that a broader view of the needs of Canadians as they approach their end of life was seen by the government. Not only has that right been recognized in legislation, but the Province of Quebec has now started identifying some investments to help make the transition to a more home-based and community-based approach to palliative care.
5:05 p.m.
Senator, Quebec (De la Durantaye), C
You talked about the conflicts in terminology and the misunderstandings about the terminology, about definitions and things like that. I know that I've often heard the confusion about what palliative care does, compared to physician-assisted dying. From the point of view of Canadians, there is a good deal of confusion. I wonder how you would respond to that and what you would recommend in terms of education.
5:05 p.m.
Director, Public Issues, Canadian Cancer Society
Thanks for that question.
I hadn't even considered the confusion between palliative care and assisted dying. We have confusion within the country just on competing definitions of palliative care.
This is tremendously important, because of course if we're talking about rights and we're in the process of defining what all Canadians have a right to in terms of assistance in hastening death and we also decide to say that palliative care needs to be in place, then we need to have a common definition of what palliative care is across this country.
Education is a big part of this. In our report, I think we identified it in a few places. I would defer to any medical professionals in the room who could correct me, but certainly the latest information is that these issues are still simply not a big enough part of the education and training of our medical professionals. For physicians, taking into account and learning how to meet people's palliative care needs is a very small part of their overall medical training.
There are some astounding figures in this report by the federal panel about the number of palliative care specialists in Canada. According to this, the situation is even more challenging than we have found. We need to train more people. We need to have more specialists in palliative care, but we also need to train people as members of teams to be more familiar with how to deal with palliative care needs as part of their specialty, whether they're a nurse, a psychotherapist, an oncologist, or whoever. That's part one.
Then, obviously, Canadians need to be better educated. There's a variety of ways in which we can do that, but one thing we need to do is get advance care planning dramatically increased in this country. In Canada, less than half of the people who die from cancer have an advance care plan.
Having an advance care plan is not just about under what circumstances you should be revived or resuscitated; it's about really looking forward at the potential progression of your disease and the types of choices that you and your family may face. I think it's our best insurance for people making clear and informed decisions and also then maximizing the quality of life they have for however much longer they're going to live.
5:05 p.m.
Serge Joyal Senator, Quebec (Kennebec), Lib.
Thank you, Mr. Chair. I will start with Professor Bourassa and then Mr. Miller.
Professor Bourassa, in the section on health in the Truth and Reconciliation Commission report, there are specific recommendations that address the responsibility to train doctors and nurses who provide services to aboriginal people regarding the special realities of aboriginal life conditions and the particular description that you have outlined in your presentation.
What would be your recommendation, in relation to physician-assisted death, in the context of those two sections of the report? I'm thinking of sections 23 and 24 of the report. I bet you know the report. I should have asked you, not put you in an uncomfortable position.
5:05 p.m.
Professor, Indigenous Health Studies, First Nations University of Canada
No, it's good. I'm glad you're familiar with it.
5:05 p.m.
Professor, Indigenous Health Studies, First Nations University of Canada
It's refreshing.
I was just looking at it the other day. I actually have a grant related to aging and dementia, and in the areas of aging, dementia, and end-of-life care, we are sorely lacking in training, especially with regard to indigenous people. I sit on the Royal College of Physicians and Surgeons of Canada, and end-of-life care and palliative care are, in general, areas where we're lacking in training.
I think these have to be priorities, particularly around indigenous people. Cultural safety in general is such an area. There is a high need for all of these things, so for the TRC to make the recommendations and to have those recommendations in hand, we not only need to train more indigenous people but we also need to have more indigenous physicians. We also really have to train the physicians we have so they will understand the reality in indigenous communities.
It's really twofold. We have a lot of work ahead of us on both sides, if that makes sense.
5:10 p.m.
Senator, Quebec (Kennebec), Lib.
Thank you.
Mr. Miller, do I understand that since you have no position on physician-assisted dying, you did not intervene in any of the cases that went to the Canadian court and raised the issue of physician-assisted death?
5:10 p.m.
Senator, Quebec (Kennebec), Lib.
That's correct.
Can I give you my candid appreciation of that?
5:10 p.m.
Senator, Quebec (Kennebec), Lib.
I'm surprised that a society as important as the Canadian Cancer Society—which I would think all of us around the table have supported at some point in time through a fundraising drive or a benefit auction or whatnot, as well as through the sale of all kinds of goodies that you put forward on the market—has no position on that, since cancer is the first cause of death in Canada and one can presume that those who will have recourse to physician-assisted death will be Canadians suffering from cancer. I find it strange.
Could you explain to me the rationale behind that? Is it the fact that you don't want to scare Canadians—or donors—with physician-assisted death?
5:10 p.m.
Director, Public Issues, Canadian Cancer Society
I can only make some observations based on.... I've been there only a little while, so I'll play that card to protect myself a little bit on this question.
5:10 p.m.
Director, Public Issues, Canadian Cancer Society
I'll wait until I'm a senator.
5:10 p.m.
Voices
Oh, oh!
5:10 p.m.
Director, Public Issues, Canadian Cancer Society
I have to be honest with you. My best guess, from what I've seen, is that there was a lot of concern about the potential for the issue to divide people. Obviously, when you count on donations, you worry about how your supporters will feel. However, I think there's also genuine ambivalence within the organization.
I have to say that as someone who's fairly new to being immersed in this issue, I've been struck by how it feels as though the country's opinions on it have come around pretty quickly. The conversations I'm hearing in the city now about this are very much focused on “how”. I think five or six years ago, they were more about “if”.
To be honest, the Canadian Cancer Society has been going through what a lot of Canadians have been going through, which is to make its peace and to address the questions and misgivings that it had about this.
I should also say that one thing I've told people is that defeating cancer is enough of a day job. We don't have to solve all of the mortal questions of the universe, and we have to leave some stuff for other people to figure out.
5:10 p.m.
Senator, Quebec (Kennebec), Lib.
Thank you very much for the frankness of your answers.
5:10 p.m.
Liberal
Julie Dabrusin Liberal Toronto—Danforth, ON
Thank you.
I would like to direct my question to Professor Bourassa, if I may.
One of the discussion topics that we've heard a lot about is the question of what is an adult and what is a mature minor. There are differences across our provinces and different frameworks for that. From your research with indigenous health issues, what do you know about how “adult” might be interpreted in different indigenous groups across Canada? Are different ages used?
5:10 p.m.
Professor, Indigenous Health Studies, First Nations University of Canada
Oh, yes. Sometimes an adult is 18, sometimes an adult is 21, and sometimes it's 26. It really depends on the region. Sometimes we say you're still a youth when you're 26. That seems crazy to some people. How could you still be a youth when you're 26? But I was a youth for a long time, and I was sad when I wasn't a youth anymore. Clearly I haven't been a youth for a long time.
It really depends. It's different in different regions, different territories. It really varies.
5:15 p.m.
Liberal
Julie Dabrusin Liberal Toronto—Danforth, ON
Is there a concept beyond numerical age? Is there a concept of when a person reaches...? We've been using the term “mature minor”, but it's the age when a person is assumed to have reached a certain maturity in being able to make decisions. Is there that kind of concept in the different cultures you've investigated?