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. As well, as mentioned by Mr. Garneau, I have a national perspective both as a past history of being president of the Canadian Medical Association and as president of The College of Family Physicians Canada.

I am also a MAID assessor and provider, in addition to my palliative care work. Currently I am building a hospice in Toronto. We only have one general hospice for adults in all of Toronto—we can talk about access to palliative care—and I am also a supporter and founder of a facility to provide medical assistance in dying in Toronto called MAiDHouse.

What I am saying I guess is that I walk two roads, in support of vastly improved access—a strong advocate for palliative care—but support the right of Canadians to assess the eligibility for medical assistance in dying. I went into this profession to alleviate suffering, and after years of reflection came to the feeling that I could do the best in addressing suffering when I encounter the limitations of modern medicine, including the limitations of palliative care, and am able to address my patients' suffering through the provision of MAID. I consider myself a conscientious provider.

I would like to state at the outset that I think there needs to be improved education and training, and perhaps certification both in the fields of palliative care and in the provision of medical assistance in dying. I strongly believe that the most important thing to do—any clinician can do as part of an assessment—when people express the wish to hasten death is to address and explore their suffering in all of its domains.

In palliative care, we follow the teachings of Dame Cicely Saunders, who was one of the original palliative care physicians with a background as a social worker nurse and physician, who started St. Christopher’s Hospice in the U.K. in the sixties. She talked about four domains of suffering: the physical, the psychosocial, emotional and the spiritual existential. I believe that too many clinicians in this world of MAID will just prefer when a patient asks for a hastened death...as opposed to exploring their suffering. I believe that's an important competency, and I'm happy to speak to that more.

Ultimately, we need to maintain the rights of Canadians to access medical assistance in dying when their suffering is deemed intolerable and other forms of treatment aren't acceptable.

Thank you, and I look forward to your further questions.

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