Dr. Konia Trouton:

Good evening, and go raibh maith agat. I thank the committee for the opportunity to address it. My name is Konia Trouton. I am a clinical professor in the department of family practice at the University of British Columbia, UBC, and have been in practice for over 30 years. I speak to the committee today as co-founder and president of the Canadian Association of MAID Assessors and Providers, CAMAP. We are a charitable voluntary organisation that supports the people who do this work. I hope to convey to the committee that assessing and providing a death is a humbling and intimate experience that requires compassion, caution and diligence. I have shortened my stories from my written submission so I can respect the committee's time.

One of my more memorable patients was an avid outdoorsman who died of motor neurone disease. He put in a request when he was diagnosed and was struggling at home despite daily nursing support. By completing the Government-approved form, he attested that he was informed of his incurable illness, that he was suffering intolerably and that he was in an advanced state of irreversible decline in capability. I saw him alone in order to be sure he was not coerced. His respirologist had told him he was likely to need breathing support and a feeding tube in the months to come, yet he wanted none of that. He was connected with the palliative care team. I believed that he met the criteria for MAID and awaited the other assessment. I let him know how to reach me. I did not hear from him for over a year. At that point, I received a call from the palliative care unit at the local hospital. He was able to formulate only a few words at a time, but those words asked for MAID because he still wanted to be in charge after having no say in the disease that took his life and his independence. His wife and his daughter were taking turns with him at all times. He wanted assistance within a few days and, in fact, wanted to die on his birthday and with a blessing. The palliative care physician recorded that he maintained capacity and was focused on MAID. At his chosen time, I started the IV. With his wife and his daughter present, he had his final blessing and was able to say goodbye to both of them, knowing he had explored life to the full and lived as long as he could with a grave disability. He tolerated more interventions because of the good care and because he knew he could access MAID when he was ready.

What does this tell us about applying the law in Canada? An assisted death is requested by the patient and it is formal. It is not requested by a clinician. It is not requested by the family. It is required that the assessment confirms there is no coercion to make the request, so part of each assessment has to be done with the patient alone. The patient directs everything. They can change their mind, they can opt out, they can cancel and they are in charge until the last minute.

Next, the law requires two separate independent clinician assessments. Many of the clinicians who provide assistance in dying are not the treating clinician but are clinicians like me who care about choice, support autonomy and have added this to our other practice. The second assessment is done by the person who knows the patient best, namely, a family physician or a specialist. Between the assessments, however, the patient is generally looked after by others, whichever type of clinician is best suited to manage the patient's needs and reduce his or her suffering.

Third, the law requires very careful documentation. Those of us who do assessments and provide assisted deaths must report them to our local health authority and to our federal government within 72 hours of the event. There is no exception. We must liaise with the pharmacy team that dispenses the medication and review our documentation with it before it releases the medication. It is a carefully regulated process. If it is wrong, we risk discipline, court and jail time. If we get it wrong, we can lose our licence, our career and our livelihood. We must prepare each case and each document as if we were on trial.

The final point is that we recognise that death is both a physiological and a spiritual event. If a person believes in an afterlife, then meeting that next life with the relevant blessing is still possible, even when there is assistance involved in the transition. We cannot presume to know the mind, wishes or dreams of another.

I am not alone in experiencing this work to be professionally satisfying. Qualitative research studies and surveys have very similar findings. We are able to have intimate contact with patients and families and bring an end to suffering while supporting their autonomy and their choice.

What we are now working on in our organisation, CAMAP, is to ensure a standardised approach to assessments and provisions across Canada. No clinician is required to do assessments or to provide assistance to die. If they choose to do this work, however, it is important to be rigorous and consistent from one end of the country to the other. We have worked within the legislative framework of C-14 since 2016 and under C-7 since 2021. Throughout this journey, CAMAP has brought opportunities for networking with the professionals in our country who do our work. We have established position papers and guidance documents and, in the past two years, have developed a comprehensive multi-module MAID curriculum. To do that, we have engaged the input of all the national healthcare professional organisations and representatives from each province and each territory because it is they who implement the services. The curriculum is completely accredited and requires 80 hours to complete all the modules.

I will leave the committee with the thought that there is a lot of distracting noise in some of the sensational headlines about MAID in Canada. I believe it is done well and done according to the law by hundreds of compassionate, careful and thorough clinicians.