Professor Harvey Chochinov:

I will begin by responding on the Deputy's first question. I apologise that my name is so difficult for everyone to pronounce. Dr. Harvey is fine, but my name is Harvey Chochinov. The Deputy asked why I have talked about the importance of insulating medicine as much as possible. The reason is that, again, we must not lose sight of what we are discussing. We are talking about how we deal with severe suffering that can undermine the wish of a patient to go on living. I have been studying these issues for decades. Some 30 years before Carter v. Canada, I published an article in the journal of the American Psychiatric Association on whether it was ever normal for terminally ill patients to desire death. We showed that approximately half of people who are approaching death think, at least on occasion, about wanting life to be over.

We need to understand that this is a very normal experience.

Whatever else we want healthcare providers to be able to do, we want them to be able to enter that space and understand how to unpack what is going on with a person that is leading him or her to no longer want to go on living. What is increasingly happening is that because medical aid in dying is available, we oftentimes find that people are seeing that expression as an invitation to determine eligibility criteria and do a determination as to whether a person meets criteria for medical aid in dying. This is really missing the boat because if we are going to provide good-quality end-of-life care, we need to respond to a wish to die, to sit down, lean in and ask what that is about. One might ask whether doing so makes a difference. Are there not sources of suffering that are just so overwhelming that death is the only option? We know the importance of human connectedness. I have the data right here that says providing patients with respect and understanding is the most ardent predictor of whether dignity is upheld. That is an effective means of dealing with a wish to die. It is the reason I have said we need to insulate the medical profession. The thrust of what they need to learn is how to address human suffering.