Thank you, honourable Chairs.

By way of background, I am a distinguished professor of psychiatry at the University of Manitoba and former chair of the External Panel on Options for a Legislative Response for Carter v. Canada. I'm also a long-time researcher and clinician, who has published extensively on psychosocial matters pertaining to palliative care.

I'd like to use the brief time I have to make five specific points.

Number one, some studies, both in Canada and the United States, imply that medical aid in dying is for the so-called white, wealthy and worried. In other words, these studies suggest that we don't need to be concerned that people seeking to hasten death are vulnerable or disenfranchised, but rather are well positioned to make autonomous choices. This is a very narrow and, I would say, problematic interpretation of the data. If we look at MAID deaths reported by Health Canada, most are elderly and fraught with various disabilities and comorbid medical conditions.

However, the most significant concern about this data is that it pertains to patients with less than six months to live or those whose death was reasonably foreseeable.

If you want to look at how vulnerability and hastened death will play out in Canada, we need to look at the Benelux countries or Switzerland, where, like now in Canada, dying or approaching death is not a requirement. In Switzerland, assisted suicide is more common in women—who suffer higher rates of clinical depression—and those who are living alone, divorced or without children. Loneliness and a lack of social support are key vulnerabilities that we can expect to play out in Canadian MAID. Sixty per cent of patients who have received euthanasia for mental illness in the Netherlands were described as socially isolated and lonely.

Like persons with disabilities, we also know that mental illness is associated with a higher rate of poverty and lack of access to critical support services, food and housing security, things that can wear down the human spirit and undermine the desire and wherewithal to go on living.

Number two, it's also claimed that whether you are dying, disabled, mentally ill or chronically suffering, you are free to exercise your autonomy and choose whether you want to live or die.

If someone is standing on an open balcony in a high-rise apartment rapidly being engulfed in hot flames, is it reasonable to say that they have a choice of whether or not to jump? Exercising autonomy means having real and viable options. If you're dying in the absence of quality and available palliative care; if you're disabled but don't have access to supports and services, or social, housing, and employment opportunities; if you have chronic pain or uncontrolled symptoms and don't have timely access to a specialist; if you're struggling with a mental illness and can't find a therapist who is prepared to help you grapple your way towards recovery, can we really say you're exercising an autonomous choice?

Did the 51-year-old Ontario woman with severe sensitivities to chemicals, who chose MAID two weeks ago after failing to find affordable housing free of contaminants, really make an autonomous choice? Or, did she just get tired of being seen as “expendable trash, a complainer, [and] useless”, and out of desperation, jumped.

With regard to number three, individual or person autonomy is like helium: its nature is to expand and occupy whatever space it is given. Look at what's happening in Canada. We've removed “reasonably foreseeable death” and soon will include mental illness. We're now contemplating children and advance directives. If individual autonomy is the driver and we observe what is happening with our European brethren, we will see MAID expand to include life completion and tiredness of life.

Number four, various palliative care researchers, myself included, are advancing the art and science of addressing suffering for patients with life-threatening and life-limiting conditions. While dignity therapy, developed by my group in Winnipeg, or others, such as meaning-centred psychotherapy or calm therapy, are not a panacea for suffering, they are proving to be effective in mitigating distress while enhancing end-of-life experience.

Number five, whatever direction Canada takes on MAID, it must first and foremost support the continued study and ongoing provision of palliative care. Fewer than 2% to 3% of Canadians will ever avail themselves of MAID, yet nearly all Canadians living with a life-threatening or a life-limiting illness could benefit from palliative care even though only a minority will receive it. In instances when there aren't real choices, we must tread carefully into conversations about the right to jump and do all we can to douse the flames of human suffering across Canada.

Thank you.

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