Professor Jocelyn Downie:

I thank the committee for the opportunity to speak with it on the topic of assisted dying in Canada. By way of background, I am a professor emeritus in the faculties of law and medicine at Dalhousie University in Canada. I am a member of the Order of Canada and a fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences. I have been researching and writing in the area of assisted dying since the 1990s. Further biographical information is contained in my written submission.

MAID came to Canada through the 2015 Supreme Court of Canada decision known as Carter in which that court unanimously struck down our federal criminal code prohibition on assisted dying, finding it breached our charter of rights and freedoms. The Supreme Court established parameters within which MAID must be permitted. The federal Parliament then established a detailed legal framework for MAID within an amended criminal code. MAID can be either provider-administered or self-administered. It can be delivered by either a physician or a nurse practitioner. It can only be provided if the person receiving MAID has been found to meet the eligibility criteria by two independent practitioners. One must have decision-making capacity and be an adult. One need not be terminally ill and one can be eligible for MAID if one has a serious and incurable illness, disease or disability; is an advanced state of irreversible decline in capability; and the illness, disease or disability and-or the state of decline in capability is causing an enduring and intolerable suffering that cannot be relieved under conditions acceptable to the person. There are numerous procedural safeguards that must be followed. All requests for MAID must be reported to the federal Government. The federal Minister of Health is required to publish a report annually. Oversight and monitoring of MAID also takes place in the context of provincial and territorial law and policy, as well as the regulatory practice standards set by the colleges of physicians and nurses.

I turn to the questions I am asked frequently by people in other countries trying to learn from Canada’s experience to inform their own. Have the eligibility criteria expanded over time? Has there been a descent down a slippery slope? No. The Supreme Court of Canada established parameters in Carter. MAID is not now, nor was it ever, limited to the terminally ill. Patients with mental disorders could be eligible for MAID under the Carter parameters. This description of Carter has been affirmed by the Court of Appeal of Alberta and the Superior Court of Quebec and acknowledged by the federal Government. Can people get MAID for poverty, loneliness, or other forms of socioeconomic vulnerability? No. It is a breach of the criminal code to provide MAID for this as the law requires that the person's enduring an intolerable suffering be caused by their serious and incurable illness, disease or disability, or their advanced state of irreversible decline in capability.

Furthermore, as demonstrated in the peer-reviewed literature, evidence shows that in Canada, as in all other permissive jurisdictions, recipients of MAID are, on average, socioeconomically advantaged and that, at a population level, socioeconomic vulnerability appears statistically to be inversely correlated with MAID. Do people choose MAID because they cannot get access to palliative care? No. Over 95% of those who received MAID received or had access to palliative care. Has the legalisation of MAID had a negative impact on palliative care? No. Funding and support for palliative care have increased dramatically since MAID became legal and more people are receiving palliative care today than five years ago. Are people getting MAID when ineligible or incapable, or for trivial medical conditions? Are patients being pressured by hospital staff to request MAID? These questions arise from widely disseminated media reports that, when you dig into the cases behind them, are based upon incomplete information, misinformation and disinformation. Contexts within which allegations can be properly investigated and tested reveal none of this. There are no reported cases of clinicians being charged or disciplined by their regulatory bodies for breaches of the law or practice standards, despite allegations, reports and exhaustive reviews.

In conclusion, I offer my opinion that the matter of whether and how best to design a MAID system has been thoroughly examined in Canada by parliamentary committees and expert panels with massive amounts of public consultation and engagement. Furthermore, it has undergone rigorous testing in the courts. It can be confidently stated that the Canadian system is effectively achieving its goals of upholding the autonomy and dignity of individuals, mitigating unwanted suffering and safeguarding the vulnerable.