Professor Harvey Chochinov:

I might respond to the question on burden. Suffering is very much like cancer. If left unattended, it will grow, spread and can kill in the absence of good palliative care. Unfortunately, we know all too little about the quality of palliative care being provided to patients who receive MAID in Canada. The most recent Health Canada report stated that in about 40% of instances, patients have under a month of palliative care, and all we know about that is that it is the period in which they had some exposure to palliative care, but we really do not know what took place. If we think about someone who has a terminal illness or who, for months or years, has symptoms that are mounting without adequate supports or family, things like respite or the availability of good symptom management, patients begin to feel as though they are a burden. Family members buckle under the strain of looking after that individual. Good palliative care, and the early introduction thereof, can mitigate all that, including patients feeling like a burden to others, given they will have the kinds of supports they need. Feeling like a burden to others has been front and centre in almost every study on desire for death or the wish to have a hastened death. It is less important, in my mind, in the context of considerations regarding legislative criteria, but it is really important when it comes to making recommendations about the availability of the early introduction of palliative care.