Mr. Speaker, I will be sharing my time with the member for St. Paul's.
This motion is fairly simple. It is asking for a special committee to be set up to seek input from experts and to have a broad consultation with the public and with physicians because we are talking about physician-assisted death. The Supreme Court has actually talked about the very complex and controversial nature of the whole issue of the idea of assisted death. We know that some people are anxious and concerned that vulnerable people would be coerced. The Supreme Court spoke clearly to the idea that people could be coerced and abused and pushed into making decisions to end their life when it is not necessary. The court has balanced that with the idea that some people do feel they need to end their life for various reasons. Because of the very complex nature of this ruling and because of the very controversial nature of how Canadians see this, many groups should be consulted. It is important for us to deal with this controversy within the public realm, and also to speak to physicians who would be the people dealing with the issue of physician-assisted death.
The Supreme Court was very clear that this legislation has to be balanced. It must balance protection of the vulnerable from coercion, et cetera, and allow for that right to life, liberty, and security of the person, for people who are:
...a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.
That is particularly clear. What the Supreme Court said is that any law must have “...properly designed and administered safeguards...capable of protecting vulnerable people from abuse and error”. The Court was very clear that we need to balance this. It is something about which we need to talk to the public. We need to hear from all the various groups and experts and from physicians.
The courts also said something very important. In the context of medical decision making and informed consent, physicians are fully competent and capable of assessing all of the criteria that the court spoke about earlier, which is about the adult person who is competent, et cetera. Physicians are the ones who diagnose a patient's condition, who know the prognosis of a patient, who understand all of the available choices that a patient has in order to relieve suffering and in order to look at the choices in terms of his or her life. Ending his or her life has to be one of those choices. Assessing competency is core when a physician is dealing with a patient.
Every day as a physician, I spent a lot of time with my patients, giving them the options for treatments and interventions, telling them exactly what their illness is about, what the prognosis is, and what the treatments may or may not be; and giving them every single option, so that at the end of the time patients are the ones who actually choose. It is called informed consent. They are given the information about what to do, where to go, and what decisions to make. This is just one more part of that informed consent, and physicians are the only persons capable of doing that, because they know how to assess competency. Physicians know when a patient is being coerced or abused. They know when a patient is able to understand the nature of his or her illness. Physicians are able to diagnose whether a situation is irremediable. They are able to assess whether the patient is in intolerable pain and whether there is no hope for the patient. In fact, in the context of life and death decisions, physicians are very capable of assessing these criteria.
In some jurisdictions, such as Oregon and Belgium, in Europe, we see that, in the decisions where there is physician-assisted death, there is always a second opinion. Many physicians, in the course of their discussions with their patient, will suggest getting a second opinion, so that patient hears from another qualified physician whether those options are indeed the only ones, and the patient is able to make the choices.
I think it is really important that physicians be able to do this, and I think the courts have said that they believe that physicians are capable of doing it.
One of the things we would have to look at, which is not widely accessible to anyone across the country right now, is an option for many patients who are finding themselves in intolerable pain or who are totally unable to have their condition remedied. That is the idea of palliative care. There is no palliative care accessible. I know that a physician would like to be able to tell a patient that there is a choice, that there is a place to go to for good palliative care, to relieve the pain a person may be experiencing and to do the kinds of things to help them die with dignity. Patients could then have a choice, but this is not a choice that is currently available across the country.
I want to stress that the Canadian Medical Association and I as a physician believe that palliative care is a key component to create as some kind of parallel program that would assist us when the legislation is being written, thereby offering these kinds of informed consent and real options to patients.
Suicide prevention programs need to be maintained, because we know that many patients who face a chronic, debilitating disease or an intractable illness become extremely depressed. It is one of the first things that happens to a patient when they are diagnosed with something that is intractable or life threatening. Therefore, they are not really making competent decisions because of depression. Good mental health care for patients who have been diagnosed with these illnesses is another option that is not currently available to patients. If we look at dealing with this issue, we have to give patients real options, so we need to expand these programs where necessary.
The second piece we need to discuss is to talk with physicians about legislation. The CMA has said clearly that it believes that the medical profession should be given adequate opportunity to comment or to have input into any kind of legislation, because we see clearly that physicians will be playing a great role.
We also know that physicians themselves are quite split down the middle on this issue. We know that physicians are torn between the two primary ethics. One is to consider first the well-being of the patient, which may very well be to assist that patient in dying with dignity. Second is to do no harm, which many physicians feel is an ethic that conflicts with that.
Therefore, there need to be clear protections, as currently exist in all jurisdictions globally that have legal physician-assisted suicide. They say that physicians who do not wish to assist a patient dying, for moral, religious, or other reasons, have an ethical and moral duty to refer that patient to a physician who will assist that patient.
These are some of the reasons that physicians have to be protected if they make a decision, as is currently the case in regard to abortion. If a physician for moral or other reasons will not perform an abortion, that physician has an ethical duty to refer the patient, if the patient wishes that to be done, to a physician who will do so.
These are very important issues on which we need to hear from physicians as we are crafting legislation. We need to look at best practices in other jurisdictions. That is an important piece.
However, the procedural component of this is very clear. The House will only sit for another 12 weeks. If we in fact get a committee to go now, to travel, to listen to Canadians and meet with experts and listen to physicians, we would be able, after an election with a new government of whatever political stripe, to meet the Supreme Court's deadline with a committee report.
Using a special committee is not without precedent. In fact, other special committees, such as the committee on solicitation, the special committee on the non-medical use of drugs, and the special committee on missing and murdered aboriginal women, have been precedents for this. It is because parliamentary committees have other roles to play in the course of their duties in looking at legislation and would not be able to carry out this job as completely and fully as a special committee could, whose only job would be to do that.