Medical Assistance in Dying committee  I would just say, “ditto”. I echo Ms. Guillemette's comments. I think it was said very well. Most of the time as we approach decisions about the end of life, we do it in a collaborative fashion. I don't think an advance request is really any different. It's ultimately going to be one of our end-of-life options.

Medical Assistance in Dying committee  Thank you for the question. The long-term care strategy should include, at a bare minimum, obviously, national standards for care right across the country so that you won't get a deficiency of care in one region versus another. At this point in time, there is. For example, we did see in the pandemic that for-profit long-term care facilities did much worse than not-for-profit long-term care facilities in terms of the number of deaths that occurred within the facilities.

Medical Assistance in Dying committee  I'll give you some examples. The latest that I have is old data, but I think it can be scaled up in terms of the number of dollars. It is from the Ontario Auditor General's report of December 2014. One day in hospital for an end-of-life patient would cost $1,100 scaled up to 2022 dollars.

Medical Assistance in Dying committee  My apologies. There were serious technical problems, but I was on the whole time. Good morning and thank you for asking me to appear before you today. My name is Sandy Buchman. I'm a palliative care physician and the chair and medical director of the Freeman Centre for the Advancement of Palliative Care at North York General Hospital in Toronto.

Medical Assistance in Dying committee  For that patient, it sounds like that was the best course for them. It sounds very reasonable.

Medical Assistance in Dying committee  No. That has not been my experience at all. In fact, it's very interesting. When I work with the more vulnerable patients, they very much want aggressive medical care. Often we talk about goals of care, or have end-of-life discussions with our patients, and whether they want to go through resuscitation, more comfort measures.

Medical Assistance in Dying committee  A very interesting and challenging question is when to introduce the option or bring up the idea of MAID. In some jurisdictions such as in Australia, where I've spoken with regard to this, they prohibit physicians from bringing up the option of medical assistance in dying. There's a power differential between physicians and our patients.

Medical Assistance in Dying committee  I'm going to start with the second question first, if I may. I spend most of my time providing home-based palliative care or, as earlier mentioned, on the streets. I'm a very strong believer that the palliative care approach can be provided by primary care physicians, family physicians, nurse practitioners, etc.

Medical Assistance in Dying committee  It's hard to generalize, but as a rule, no. Most Canadians aren't really aware of palliative care, for example, until they happen to encounter it themselves or with a family member. The same is true for medical assistance in dying. A lot of the more vulnerable people haven't had the opportunities to have the same kind of education in health literacy as many other more fortunate Canadians.

Medical Assistance in Dying committee  I'm going to go right there with the question, and the answer is likely yes. When an individual's suffering is a conglomeration of their past—they may have had severe trauma earlier in their life—we learn very much about performing trauma-informed histories. There's been a sequence of events, given the social and structural determinants of their life, everything from systemic racism perhaps, to mental health issues and addiction issues, that render them in the situation they are in.

Medical Assistance in Dying committee  I don't think that it's a failure of palliative care. It's unlikely a person will just wake up one morning.... But the wish to hasten death is very common in our field. At times, despite our best efforts...like anything in medicine, there are limitations to what we can do. It may be that we are just unable to address the suffering in ways that are acceptable to the patient.

Medical Assistance in Dying committee  We see these patients virtually every day. What happens is that you do everything possible to address their suffering in those domains I referred to before, including existential and spiritual suffering. Part of the frustrations that many of us have with the system is that, if I want to refer for spiritual care or anticipatory grief or even family members for grief and bereavement, the access to those services is very poor.

Medical Assistance in Dying committee  I agree one hundred per cent. It's a shame that the funding did not follow the framework. That's been the consistent place in Canada. We have wonderful plans, but they end up sitting on a shelf because the funding never comes. When Australia created its assisted dying legislation a couple of years back, they pledged a very significant amount for palliative care at the same time.

Medical Assistance in Dying committee  Good evening, everyone. Thank you for the invitation to participate in this important panel on MAID and palliative care. First and foremost, with regard to a little on my background, I was trained as a family physician, for 22 years, and I've spent the last 16 years or so as a full-time palliative care physician, working both in hospital ambulatory clinics and home-based palliative care, including palliative care for those living on the homeless continuum.