Medical Assistance in Dying committee  I may have expressed myself poorly, and if so I'm sorry. Cognitive neurodegenerative diseases like Alzheimer's fall into a class of diseases. It excludes people who are brain-damaged, whether as a result of cranial trauma, strokes, or brain hemorrhages. That's an entirely different category.

Medical Assistance in Dying committee  I don't have numbers for you, but based on 35 to 40 years of my own experience, I think it would be very difficult. When people begin to have memory, judgment or other problems, they consult someone. Most of the time, it's their GP who broadly diagnoses neurodegenerative diseases.

Medical Assistance in Dying committee  To begin with, you are attributing something to me that I am not. I'm a neurosurgeon, not a neurologist. We can tell that the brain is functioning properly when patients have all their capacities. We have mechanisms to check on a patient's capacities. That, moreover, is what we do every day, whether by operating on patients, or responding to their requests for medical assistance in dying.

Medical Assistance in Dying committee  Well, they are no longer the same person they were throughout their life, whether at 60 years, 70 years, or 80 years. Why, all of a sudden, with dementia, are they no longer the same person? It's true that it's no longer the same person because they no longer have the brain they used to have when they lived and related with other people.

Medical Assistance in Dying committee  Yes, you're right. The answer is in your question. What we have learned in Canada over a period of six years now, and slightly longer in Quebec, is that we never encountered the slippery slope against which everyone was warning us. A doctor assesses a patient and a second doctor or a clinical nurse does an assessment to determine whether the patient's circumstances meet the criteria.

Medical Assistance in Dying committee  I don't think one can say that a patient had lost their autonomy. I'm not sure what basis one could use to say that. On the other hand, I'd like to repeat the words used by Dr. Marcel Boisvert, a geriatrician and a compassionate doctor, who said that even if someone very old tells us that they no longer want to be a burden to their family, what's pathological about saying that?

Medical Assistance in Dying committee  There are no statistics to my knowledge. Let's say that it's our joint experience, meaning the experience of virtually every doctor who provides medical assistance in dying. The experience acquired is from being with patients who have received a diagnosis of a cognitive neurodegenerative disease, and with whom we proceed to medical assistance in dying after three months, six months or a year.

Medical Assistance in Dying committee  That's what the whole debate is about. These people can lose weeks, months and even a year or two of a very pleasant and very interesting life with their families. When people lose their decision-making capacity, they can no longer receive medical assistance in dying, and that's the reason for the study in progress.

Medical Assistance in Dying committee  I'll take a few seconds to answer before giving the floor to Dr. Andrew. These days, patients who receive a diagnosis of a neurodegenerative disease or dementia can get it as long as they still have decision-making capacity. Why? Because they are asking why they are experiencing judgment, memory, and other problems.

Medical Assistance in Dying committee  For the various forms of dementia, what's involved is a relatively slow process for the vast majority of patients. It's spread over several years. There may be locations, in the far north for example, where it may be more difficult to obtain a diagnosis, but that has not been our experience, even though the health system may not always be adequate.

Justice committee  In the case of Alzheimer's, we know that, once a patient receives their initial diagnosis—say, at stage two—they die within eight to 10 years. Patients who do not die from the disease directly tend to die from complications such as pneumonia, sores and undernutrition. Once a patient reaches stage four, statistics show that their life expectancy is usually three to five years.

Justice committee  Precisely. A whole mechanism is in place to ensure the process is followed rigorously. That is what the majority of those in the very elderly population want, however, because they do not want to see themselves go downhill cognitively. I think that is entirely reasonable and valid.

Justice committee  I will answer very quickly. In the past year in Quebec, 76% of patients who received medical assistance in dying had cancer. Cognitive and neurodegenerative diseases such as Alzheimer's are now the second leading reason why people seek medically assisted deaths. Why should the bill include the diseases?

Justice committee  You touched on a big part of the answer in your question. Both of them testified before Justice Baudouin. I was there for all the testimony, and what emerged was how carefully they had considered the issue for so many years. Like other people with disabilities, the two of them had access to all the necessary supports.

Justice committee  Good afternoon, ladies and gentlemen. Thank you for this invitation. My name is Georges L'Espérance, and I am president of the Quebec Association for the Right to Die with Dignity. As a retired neurosurgeon, I provide medical assistance in dying and am part of a private discussion group in Quebec.