Bill C-7 - Medical Assistance in Dying - Senator Plett's Amendment
Honourable senators, I rise today to speak on Senator Plett’s amendment to Bill C-7. I, too, am concerned about where this debate is going. It is not going in the direction that First Nations and the disability community want it to go.
I’ve worked on reserve as a health professional for over 30 years. In January 2021, I went to my home reserve to provide service at a dental clinic. On my travel there, I spoke to many nurses and doctors regarding MAID. Many were unaware of this bill, just as they were unaware of Bill C-14.
How, then, can senators evaluate the level of capacity assessment work that will be required? How can they assess it on behalf of medical professionals? It’s not for senators to determine and decide this for themselves. This is a determination to be made by the medical professionals. Moreover, it’s not only the medical professionals from whom people seek advice. They access information from the internet and other questionable sources. We are placing health professionals in a very precarious position without their informed consent, and patients likewise.
It has been stated that there exists the issue of ensuring an appropriate number of health professionals who provide care, namely, the doctors and nurses. When you look at safeguards, there is difficulty with ensuring that First Nations in remote communities have a single medical doctor, let alone two. The medical doctors and nurse practitioners come into the communities for two days every other week and they rotate. The nurses are the main health professionals and they are rotated through the communities from different areas of Canada and through different contracts.
To be able to have a conversation with patients regarding MAID, you need to have trust in your health care provider who understands the historical context of oppression. This takes years to establish and is especially true in First Nations communities. The health professional has to understand the language of the patient, and many don’t. Under the current system, this is impossible. Many patients are unable to write, let alone fully understand the nuances on concepts of MAID.
Ethics is an area that cannot be regulated by law. You either have it or you don’t. It’s not something you bring to the table and say: We’re going to practice ethics now. In my previous management position, I saw health professionals flying under the radar with their codes of conduct. The problem of oversight by regulatory bodies on self-regulating groups is inadequate and there is research with this.
Professional obligation is not always practiced, especially when many doctors are told to give 10-minute appointments and only four appointments per year. This is the reality in First Nations communities today. I know because I have raised that with hospitals. Once again, we hit the gap that is created by the interjurisdictional problem that First Nations have experienced through other laws passed by the Senate. In this situation, it places patients and health professionals in a gap that sees no resolution.
We have heard from people whose voices need to be heard. As a medical doctor wrote to me this week:
We spend a lot of time and energy working toward suicide prevention. However, now it seems we are sending a message to disabled and dying Canadians that says we agree with you, your life isn’t worth living. So we won’t try to stop you from killing yourself. Instead, we will help you end your life. Why is access to MAID a right that every Canadian should have to the point that doctors are being threatened against their consciences to provide access to it? However, we don’t put that same energy into ensuring everyone has access to palliative care or mental health services. Most people don’t actually choose MAID because of inadequate pain control. Most choose MAID due to fear of losing autonomy and because they aren’t able to engage in activities they find enjoyable due to loss of dignity and feeling like a burden on family.
These are primarily mental health issues that shouldn’t be solved by helping someone commit suicide. These burdensome fears can be lightened by coming alongside patients to support them, advocate for them, encourage them and help them to shift their focus. I encourage you to look at the research on dignity therapy by Harvey Chochinov, which speaks to this.
Generally, a desire to die is a cry for help and is transient. If we loosen the safeguards on criteria, we will be losing too many people who, with a little support, could have gone on to enjoy fulfilling lives. MAID unfortunately does not just impact the person who chooses it but also has wide-reaching effects for the person’s family, friends and their community.
I know that this is not an easy issue but I implore you, please do not continue to expand criteria for MAID or loosen the safeguards already in place. I know I speak on behalf of many of my patients, family friends who feel the same way. Thank you.