Thread by @InclusionCA

We're tweeting from the Special Joint Committee on Medical Assistance in Dying (MAiD) #AMAD this evening. It isn't yet clear what the theme will be - but the witnesses are all medical doctors and professors.

Here's the link: parlvu.parl.gc.ca/Harmony/en/Pow…

The first presenter is Chantal Perrot, a MAiD provider and director of Dying with Dignity.

Dr. Perrot is making a case for more widespread use of advanced requests (aha! the theme must be advanced requests). "Audrey's amendment did not go far enough for most people."

"I am frequently contacted by people who want to be assessed for MAiD because they think that they can then have it at a later time of their choosing." - Dr. Perrot.

Professor Peter Reiner is up next. He's pushing really hard - saying that the implementation of advanced requests "represents an uphill battle." He and some expansionist colleagues did a study that indicated doctors would be hesitant to provide MAiD when consent was ambiguous.

His recommendations : "specific circumstances," "periodic reaffirmation," "why each circumstance constitutes intolerable suffering," "discussion with family," "a question asking the person what happens if things don't go as expected"... they're all designed to "sway" providers.

Dr. Jennifer Gibson says advanced requests aren't just for people with dementia.

Dr. Gibson also rejects systemic concerns about ageism and ableism "a focus of vulnerable groups as such, tends to occlude the experience of individuals."

She also cites the paid Ipsos poll.

This is a particularly one sided panel.

In the Q+A Professor Reiner says "It's entirely possible that if you're demented...you might resist" and then goes on to talk about "happy dementia".

He specifies that if a person can anticipate those circumstances, they can tell you what they would want.

It's too bad that Jonas Beaudry (from Friday!) isn't on this panel.

Dr. Beaudry outlined the problems with holding a person accountable to the decisions of their past self - which are often rooted in discrimination.

Rainer is looking to make the past self more convincing.

Oh MP MacGregor asks Rainer about this, basically citing Dr. Beaudry directly. "If somebody is to decide for me, when I am in this debilitated condition, who is best in a position to make that decision? I think that as a scholar of the neurobiology of autonomy, clearly it is me."

Dr. Gibson hints at "standards of practice" in the Q+A (as opposed to using the law to regulate advanced requests) and Senator Kutcher is quick to pick up on this.

All panel members suggest standards of practice and not legal change. So sneaky.

Canada's MAiD law basically lays out the conditions under which doctors can NOT be changed with serious crimes for killing a patient. Regulating MAiD is absolutely a legal consideration. Putting regulations in "standards of practice" gives more power to the medical system.

Dr. Kathryn Morrison is a philosopher. She's talking about MAiD for mature minors. She believes mature minors should be eligible under track one (for people who are terminally ill), but not under track two (for people with disabilities)

We wonder: how long would that last?

Dr. Gordon Gubitz was prepared to speak about advanced requests, but when he hears mature minors mentioned pivots to speaking about a 19 y/o's MAiD request. "She is the closest experience to a mature minor I have experience with...I can't remember how many pots of tea we drank."

Professor Kimberley Widger is the first presenter of the night to express any sort of resistance: "My research continues to show that many children do not have access to specialized pediatric palliative care. And there are some concerning inequities in who accesses this care."

"The children who got some kind of palliative care outside of a specialist team were no different in terms of hospital visits or dying in the hospital than those who got no palliative care Specialist teams make a difference." - Professor Widger

"My greatest fear would be that a 16 or 17 year old who did not actually have access to this type of care would be left feeling that meat is their only option." - Professor Widger

"I do want to emphasize that when we think about decision making, the alternatives to a decision are a central part of informed consent. And that's also true of mature minors." - Dr. Morrison.

The presenters are all struggling to outline what a capacity assessment looks like for children / mature minors. There's a lot of "I'm not a pediatrician" talk going on.

In the Q+A, reflecting on her time as a nurse, Professor Widger says "I can remember many children who could have made this decision in my assessment, and many of the same age who could who could not have made this kind of a decision"

Witnesses are asked if MAiD for mature minors should be restricted to track one. They all agree: yes.

Dr. Gubitz's response is telling: "Let's start with the low hanging fruit ...to go immediately to track one & track two for mature minors might be more than the Canadian public is willing to handle."

So, are we just waiting for enough appetite for MAiD for disabled teens?

"The youth voice is still missing from the work that's been done to date." - Widger

Q: Are there services and supports that are needed for certain groups such as indigenous, racialized, were disabled youth?

A: "Those are the groups that we really still have not heard from."

And that's it for tonight. Thank you all for being in this with us.