Medical Assistance in Dying committee  That number comes from the psychological literature on youth and medical decision-making. It's the youngest age that has been identified where it's considered to be plausible that a youth would have decisional capacity.

Medical Assistance in Dying committee  If the youth is in distress or in foster care, these are all things that I would think would result in a physician concluding that they weren't making a free decision, if they came to them seeking medical assistance in dying. I don't know if you're hearing from the voices of families with youth who are living with complex and painful illnesses.

Medical Assistance in Dying committee  I don't think I have much to add there. For me, the heart of the suggestion about safeguards is about public transparency and public confidence, that they understand the process that's being undertaken to ensure that vulnerabilities are identified and addressed when it comes to youth.

Medical Assistance in Dying committee  I don't suggest review boards as being in an intermediary position necessarily, because I don't think they can move quickly enough. I don't think they can get in there in that 10-day period and determine if they think the request has been properly considered. I would personally want to see some sort of a collective body receiving information about every instance where MAID has been given to a minor so that we understand what is happening in that practice, and that there is that other level of scrutiny.

Medical Assistance in Dying committee  That's right.

Medical Assistance in Dying committee  Do you mean in Canada, or in jurisdictions where youth are able to access MAID?

Medical Assistance in Dying committee  It's not yet allowed. There was a recent publication by the Canadian Paediatric Society, which was a survey of pediatricians with regard to whether or not people had been approached for requests or queries about MAID in the last few years. There were a number of requests or queries that had been made here in Canada.

Medical Assistance in Dying committee  A young person in crisis would not be eligible for MAID anymore than they would be eligible for any other decision, for example, to deny life-sustaining treatment. The individual's emotional state is taken into account when assessing whether, in that instance with that decision, the minor is able to fully appreciate the decision they've been asked to make and its consequences.

Medical Assistance in Dying committee  I would certainly hope that if a physician or a care team was approached by an individual who was living with a disability in the sort of situation of poverty and exclusion that you've been describing, the physician would realize that situational aspect and hopefully support getting them to a better place and getting those supports in place that should be there.

Medical Assistance in Dying committee  Consultation with parents I think is a very important one, and just in general I would like to see a regularization of how we approach the decisions of mature minors across the country and get some consistency across the provinces. The only thing that I would be really pushing on in terms of the code itself is bringing in parental consultation.

Medical Assistance in Dying committee  The younger a person is, the less likely it is that they will have decisional capacity. When I suggested 12 as a potential threshold, I raised that because that is where the psychological evidence rests as being really the minimum possible for a person to have the level of discernment necessary.

Medical Assistance in Dying committee  Thank you. In my view, if the health care treatment team has determined that the youth has decisional capacity, is psychologically, emotionally and psychiatrically stable, understands the decision at hand and understands the consequences and the irreversibility, then I think that it is an affront to their dignity, to their basic charter rights, for their parents to be able to overrule that decision and so to make the outcome turn on the consent of the parents.

Medical Assistance in Dying committee  I'm open to additional criteria among the safeguards, so that would be part of the code, potentially, if we were to add factors—

Medical Assistance in Dying committee  The Supreme Court of Canada rejected the distinction of not giving treatment versus giving a medical service in Carter. They found that was a false dichotomy in Carter, which I think is a complete answer to the question. I would note that the reasoning in Carter turned very much on the reasoning in the A.C. decision.

Medical Assistance in Dying committee  Let me start by saying that I think the approach developed by clinicians working with minors seeking to make decisions about medical treatment—things like withdrawing or not undergoing life-sustaining treatment—is a pretty robust system in each province in their assessment of the capacity of a minor in this situation.