Evidence of meeting #102 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was illness.
A video is available from Parliament.
7:45 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
I feel that my Conservative colleagues are simply trying to undermine the exchange I can have with the witnesses.
I am appealing to their better nature. If everyone rose on a point of order every time they heard something that was not to their liking, we would not be able to hold a meeting. I am making this appeal to ensure that we have a productive meeting without interruptions. It's a matter of showing respect to the witnesses who are here with us.
7:45 p.m.
Liberal
7:45 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Mr. Chair, I hope the Conservative point of order didn't eat into my time.
7:50 p.m.
Liberal
The Chair Liberal Sean Casey
Every time a point of order has been raised, the clock has been stopped.
7:50 p.m.
Liberal
7:50 p.m.
President, Association québécoise pour le droit de mourir dans la dignité
You have to understand that mental health is one issue and advance requests quite another. It's true there's no medical or societal consensus on mental health. We're told the psychiatrists are split 50-50.
That being said, there's a very broad consensus across Canada on advance requests associated with neurodegenerative diseases, the best known of which is Alzheimer's. Some 82% of Canadians are in favour of advance requests. As I mentioned, cognitive neurodegenerative diseases will put an enormous weight on the shoulders of patients, first, and their families, second. This is increasingly the case, and it's increasingly prevalent as people advance in age.
Advance requests enable individuals with an established diagnosis to say, while they're still capable of making a decision, that they want to receive medical assistance in dying once they've lost that capacity, in such and such a condition. It is the essence of the law in Quebec both to enable those individuals to retain their dignity and to help them live days, months or even a year or two longer surrounded by their families and loved ones, even if they've lost some of their capacity. That's the principle of advance requests: to honour people's dignity to the end of their lives.
7:50 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Thériault.
Next we have Mr. MacGregor, please, for six minutes.
February 14th, 2024 / 7:50 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much, Mr. Chair.
Thank you to all of our witnesses for helping to guide us through this part of the study of Bill C-62.
I've been a member of the Special Joint Committee on Medical Assistance in Dying from the beginning, and I'm very familiar with the subject matter that's before us.
Ms. Long, I'd like to start with you, if I could.
Thank you for your opening statement and for representing Dying with Dignity. Of course, ever since our special joint committee tabled the report in the House of Commons and in the Senate with our single recommendation, we are also in receipt of a letter that was signed by the health ministers from seven out of 10 provinces and all three territories.
If you look at that letter, you can quote from the middle of it, where it says, “The current March 17, 2024, deadline does not provide sufficient time to fully and appropriately prepare all provinces and territories across Canada”. Further down, they ask the Minister of Health and the Minister of Justice to “indefinitely pause the implementation of the expanded MAID eligibility criteria to enable further collaboration between provinces, territories and the federal government”.
Ms. Long, when I look at the signatories, I see that they include ministers of health and ministers responsible for mental health and addictions. You can see that they are widely across the political spectrum. They include the NDP government in British Columbia and several Conservative governments in other provinces.
I want to know from you how Dying with Dignity responds to this letter, given that these are all cabinet ministers, they have executive-level functions within their respective governments and they are responsible for the systems of health that are actually going to be overseeing this process. If they are publicly asserting that their systems are not ready, how do you respond to that with your opening statement where you said that we are ready?
7:50 p.m.
Chief Executive Officer, Dying with Dignity Canada
Thank you for the question.
I think that, when you listen to the testimony that was heard in front of the committee, there were certainly indications from the regulatory authorities, for example, that they are ready. There was an indication from individual clinicians, psychiatrists and nurse practitioners that they are ready. While every province may not feel fully ready, certainly some of the conversations we've had and the testimony that we heard, as did all the committee members, would indicate that there are people who are ready to move ahead.
In terms of system readiness from the provincial perspective, it's not clear what needs to be done, so I think the question I would have for the individuals writing that letter is this: What exactly are we looking for before the provinces determine they're ready?
7:50 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Okay, but with respect, I don't think these ministers—yes, they're all elected officials—would have attached their names and signatures to a letter if they had not conferred with their deputy ministers and assistant deputy ministers, who are essentially the heads of the civil service, who then would have gotten feedback from their respective ministries of health.
When you're talking about the regulatory environment, if I were a cabinet minister I wouldn't attach my name to this letter unless I had a nod of approval from my deputy minister. How do you respond to that fact?
7:55 p.m.
Chief Executive Officer, Dying with Dignity Canada
What we've heard is what we heard in testimony in terms of this issue. We're not clinicians, so we're not able to participate in all of those discussions, but it was certainly made very clear by the individuals representing the regulatory authorities in the provincial health authorities that they are ready and certainly that individual clinicians are ready.
When we look to Bill C-14 and the beginning of MAID, there was no time like this given for the provinces to be prepared in the way they are today. We are probably readier now than we've ever been to move ahead with MAID.
7:55 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you for that.
Dr. Gaind, I'd like to turn to you if I can.
We've had previous interactions at the special joint committee, and I recall that in one of our previous interactions we were talking about the track two process that's present in the Criminal Code. A lot of people have pointed to that as saying that the necessary safeguards are already present. However, I believe that in your professional capacity you've poked a few holes in that process.
Would you mind informing the committee of some of the problems you've seen in the Criminal Code with the track two process?
7:55 p.m.
Professor of Psychiatry, Faculty of Medicine, University of Toronto, As an Individual
I'm happy to, and that actually links a bit back to Monsieur Thériault's question, which is trying to set a predetermined timeline by which we will have evidence, and we don't know if we will.
The holes are this. If we are saying to people that we are predicting their mental illness won't improve, we need to have evidence that we can do that honestly, and we don't have that. Whatever there is on track two or track one doesn't address that.
As well, the separation of suicidality from psychiatric euthanasia requests also is something that the evidence does not show, so you can have people saying that they think they can do something and it doesn't mean that they can. We have physicians saying that they think you should take Ivermectin for COVID. It doesn't mean that we should set a regulatory framework to do that; it's ridiculous.
What I am speaking to is the evidence, not what any particular individual is saying.
I will also say, by the way, that in terms of my own former professional association, the Canadian Psychiatric Association, of which I am a past president, I find that the input they have provided to this file has actually been shameful.
You were asking about track two. In the consultations leading up to Bill C-7, consultations on mental illness and death, they never once mentioned suicide prevention. They never once mentioned evidence related to suicide risks of mental illness or marginalized populations. That would be like a respirologist association never mentioning smoking as a risk factor for lung health.
You go think what that means. I don't know what it means, so—
7:55 p.m.
Professor of Psychiatry, Faculty of Medicine, University of Toronto, As an Individual
The last point I'll make is that, in fact, in CAMAP guidance they have a document that goes through how you can essentially convert people from track two to track one, literally saying that examples might include stated declarations to refuse antibiotic treatment of current or future serious infections.
I don't even know how many people on track one may actually be, by other people, considered track two.
7:55 p.m.
Liberal
7:55 p.m.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
Thank you, Mr. Chair.
Dr. Gaind, proponents of this expansion, including the government-appointed chair of the expert panel, Dr. Gupta, have claimed that only a small number of individuals would be eligible for MAID for mental illness. In fact, she said that, in her many years of practising as a psychiatrist, maybe only two or three, or a handful, would be eligible.
They cite the model practice standard to demonstrate, supposedly, that this would be the case. I would be interested in your thoughts.
7:55 p.m.
Professor of Psychiatry, Faculty of Medicine, University of Toronto, As an Individual
I actually find those kinds of statements, coming from some people who were in positions to actually suggest potential legislative safeguards, quite remarkable, because while Dr. Gupta said that, she also chaired the same expert panel that literally said they were not recommending a single legislated safeguard for MAID for mental illness.
In terms of predicting irremediability of mental illness, the same expert panel—or the 10 remaining members, because one-sixth of them resigned, including the health care representatives—said they would not or could not provide guidance on the lengths, numbers or types of treatments that somebody should have access to before getting MAID for mental illness. To me, this actually speaks a bit to some of the points Ms. Long and others have raised. They paint a picture of how these are people who have been suffering for decades and decades and who have had multiple treatments. There's nothing in our legislation that requires that. It's an artificial picture.
If you want a sense of actual evidence-based numbers with respect to what this might be like, Scott Kim, a researcher at NIH, has done an evidence-based analysis and he estimates there are several thousand people a year.
The things in the model practice standard and other things that are not legislated and are not actual safeguards are basically suggestions. Suggestions are not safeguards. Reassurances without evidence are dangerous, in my opinion. This is a serious business. We are providing death to people who are not otherwise dying, and there need to be serious safeguards.
If Kenneth Law were a doctor instead of a chef, how comfortable would you be with his being your mother's MAID assessor if there were just non-binding suggestions and empty reassurances rather than legislated safeguards?
8 p.m.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
Thank you for that.
You said that on the issue of irremediability and determining it accurately, clinicians will get it wrong more than 50% of the time in cases where mental illness is the sole underlying condition. Would it therefore be a fair characterization to say that you would be better off flipping a coin and more likely to get an accurate result, than otherwise?