Medical Assistance in Dying committee  Thank you. Thank you for the clarification as well.

Medical Assistance in Dying committee  Thank you very much. I have a question for Dr. Downie, but first I'm going to ask her to clarify something I read in the record of our meetings. I think it was a question to a witness. Here it is. the Supreme Court of Canada stated unequivocally three times in Carter that medical assistance in dying may be performed only when a patient clearly consents. [...]

Medical Assistance in Dying committee  Thank you for that clarification. I think it's extremely important. I know you have concerns about pre-diagnosis advance requests. I have two quick points. One, once you're diagnosed, I guess people could challenge your competence. More importantly, wouldn't a history detailing an advance request and concerns about a prolonged life under intolerable suffering, by that person's definition, be helpful in assessing whether the post-diagnosis request was valid?

Medical Assistance in Dying committee  For anybody who has had any experience with this—a loved one or family member who has gone through this and has suffered through something like dementia or Alzheimer's—it is reasonably foreseeable what the outcome will be. Therefore, it seems we could make that advance request.

Medical Assistance in Dying committee  Thank you very much. I would like to make a comment, if I could, Chairs, that over the last few sessions we have heard witnesses so many times using pejorative words and making claims about surreptitious medicating and other things. I think we need to make sure in advance that our witnesses are reminded that their statements should be supported with evidence and documentation if they are going to be meaningful for us here, and they should be qualified to comment on this, because it is our mandate to look at advance requests.

Medical Assistance in Dying committee  Thank you very much. I'd like to hear from Dr. L'Espérance and Dr. Andrew. I want to have comments from both of you. I'll make my point and have you respond to it and agree or disagree. I want to follow up on the comments made by Madame Vien, another of our colleagues, on the catch-22 that we find ourselves in when it comes to dementia or Alzheimer's.

Medical Assistance in Dying committee  I agree with that totally. It was represented by others in a different way. Thank you. Go ahead, Dr. Andrew.

Medical Assistance in Dying committee  It's as if informed consent is becoming a question of timing, depending on where you live and the nature of the progression of your individual disease.

Medical Assistance in Dying committee  Go ahead, Dr. L'Espérance.

Medical Assistance in Dying committee  Thank you very much. I will address my questions to Senator Cowan and Ms. Long. As you know, Senator Cowan, the Senate dealt with this issue and proposed an amendment, which was accepted overwhelmingly by the Senate, to deal with the very conundrum that you have to make an advance request if you know your disease or illness will render you incompetent.

Medical Assistance in Dying committee  Ms. Long, on the question of advance directives and advance requests, we do allow that anybody who goes in for surgery can sign a DNR, a “do not resuscitate”, and specify the circumstances. It seems to me that we're just trying to extend that very right that we give to a patient.

Medical Assistance in Dying committee  Thanks very much.

Medical Assistance in Dying committee  Thank you very much. I have two questions to Dr. Buchman. We have heard other testimony from professionals in the field of palliative care that somehow, when we get to the end of palliative care, it is not their responsibility to really offer the MAID option or to even have that discussion at the front end of opting for palliative care.

Medical Assistance in Dying committee  I went through this process with a friend recently. It was almost the opposite way. She said to her doctors, when the diagnosis was terminal, that she wanted the MAID option, and then they had the discussion with her about using palliative treatment in the interim to maximize her quality of life until her chosen date.

Medical Assistance in Dying committee  I understand.