Hon. Pierre J. Dalphond: I heard the speech given by my colleague, Senator Boisvenu, the substance of which was very interesting. We share the same opinion on the issue at hand, that is, advance directives in the context of diseases that cause gradual degeneration of the brain and the loss of the capacity to consent. Quebec is way ahead on this issue, and I think there is a growing consensus that we should adopt a regime of advance directives.
However, I still have some questions about the solution that is being proposed.
What is being proposed is that we set up a committee — this house, the House of Commons or a joint committee — and this committee will report within a year, which I suppose means 15 months from now. I suspect we may have an election within 15 months from now. It is likely, and we’ll have to adjust. That concerns me.
My second concern is that the current law, Bill C-14, provides, as the currently proposed Bill C-7 in its preamble states:
. . .whereas the law provides that a committee of Parliament will begin a review of the legislative provisions relating to medical assistance in dying and the state of palliative care in Canada in June 2020 —
— we know we missed that —
— which review may include issues of advance requests and requests where mental illness is the sole underlying medical condition . . . .
Because of the way Bill C-7 was drafted, all of the witnesses we heard from did not address the issue of an advance directive. It was not part of the bill. We had a few witnesses who referred to it. Certainly, it’s a complex issue.
In Belgium, for example, where there are advance directives, there is a commission that must supervise and review on a five-year basis. They ask, “You signed that five years ago. Do you still agree?”
It is complex machinery that has to be developed. I think the parliamentary committee could look at that. But I have a concern of having this on one side and, as Senator Gold and the Minister of Justice invited us to do before, setting up a committee as soon as possible to do an overall review of Bill C-14 and the regimes. If there were two tracks going more or less in parallel, one committee more specialized on the issue of advance directives and another committee doing everything else, how could this recoup the work of the other committee? So I think we should work on pressures to have a committee looking at all these issues together in the context of the review of the bill.
I understand the purpose of what Senator Boisvenu wants to achieve and I share that. But I think I’m confident that the undertakings that Senator Gold, in this house, and the Minister of Justice made are real commitments and in the coming months we will look at the whole review. Thank you.
Hon. Stan Kutcher: Senator Dalphond, would you take a question?
Senator Dalphond: Yes, please.
Senator Kutcher: You spent some time discussing with various psychiatrists language for your amendment and you chose “neurocognitive disorders.” Here the language is “neurodegenerative disorders.” I would like to know what you think about that. Neurodegenerative disorders include Alzheimer’s, ALS, Friedreich’s ataxia, Huntington’s disease, Lewy body dementia, et cetera. There is a whole host of them that are traditionally called neurodegenerative. However, I want to raise the issue that more recently schizophrenia and even depression — there has been a lot of work suggesting that they too may be considered to be neurodegenerative diseases; for example, multiple studies in depression have found atrophy or neural loss in various parts of the brain, including the cortex and the hippocampus, and there is increasing scientific thought that these diseases are also neurodegenerative. Do you think the language could be tightened up if it’s looking primarily at neurocognitive disorders?
Senator Dalphond: It is kind of tough answering questions from an expert who is asking what you think about his expertise.
I would be inclined to defer to his expertise. But I must say that through the consultations I made, psychiatrists told us we should use “neurocognitive” rather than “neurodegenerative” concepts because it’s not exactly the same thing, as our expert just pointed out. That is why in my motion I was referring specifically to neurocognitive disorders.
Senator Kutcher: Thank you very much, Dr. Dalphond — or, rather, Senator Dalphond.