ADVOCACY ACT, 1991, AND COMPANION LEGISLATION / LOI DE 1991 SUR L'INTERVENTION ET LES PROJETS DE LOI QUI L'ACCOMPAGNENT

NORMAN W. STERLING

CONTENTS

Tuesday 17 December 1991

Advocacy Act, 1991, Bill 74, and companion legislation / Loi de 1991 sur l'intervention, projet de loi 74, et les projets de loi qui l'accompagnent

Sterling, Norman W.

STANDING COMMITTEE ON ADMINISTRATION OF JUSTICE

Chair: Cooper, Mike (Kitchener-Wilmot NDP)

Vice-Chair: Morrow, Mark (Wentworth East NDP)

Carr, Gary (Oakville South PC)

Carter, Jenny (Peterborough NDP)

Chiarelli, Robert (Ottawa West L)

Fletcher, Derek (Guelph NDP)

Harnick, Charles (Willowdale PC)

Mathyssen, Irene (Middlesex NDP)

Mills, Gordon (Durham East NDP)

Poirier, Jean (Prescott and Russell L)

Sorbara, Gregory S. (York Centre L)

Winninger, David (London South NDP)

Substitutions:

Malkowski, Gary (York East NDP) for Mrs Mathyssen

Sullivan, Barbara (Halton Centre L) for Mr Sorbara

Wessenger, Paul (Simcoe Centre NDP) for Mr Mills

Clerk pro tem: Brown, Harold

Staff: Swift, Susan, Research Officer, Legislative Research Service

The committee met at 1547 in room 151.

ADVOCACY ACT, 1991, AND COMPANION LEGISLATION / LOI DE 1991 SUR L'INTERVENTION ET LES PROJETS DE LOI QUI L'ACCOMPAGNENT

Consideration of Bill 7, An Act to amend the Powers of Attorney Act; Bill 8, An Act respecting Natural Death; Bill 74, An Act respecting the Provision of Advocacy Services to Vulnerable Persons / Projet de loi 74, Loi concernant la prestation de services d'intervenants en faveur des personnes vulnérables; Bill 108, An Act to provide for the making of Decisions on behalf of Adults concerning the Management of their Property and concerning their Personal Care / Projet de loi 108, Loi prévoyant la prise de décisions au nom d'adultes en ce qui concerne la gestion de leurs biens et le soin de leur personne; Bill 109, An Act respecting Consent to Treatment / Projet de loi 109, Loi concernant le consentement au traitement; and Bill 110, An Act to amend certain Statutes of Ontario consequent upon the enactment of the Consent to Treatment Act, 1991 and the Substitute Decisions Act, 1991 / Projet de loi 110, Loi modifiant certaines lois de l'Ontario par suite de l'adoption de la Loi de 1991 sur le consentement au traitement et de la Loi de 1991 sur la prise de décisions au nom d'autrui.

NORMAN W. STERLING

The Chair: I call this meeting to order. I would like to say I am pleased to have Norm Sterling, the member for Carleton, here. We will be proceeding with Bills 7 and 8. Please proceed and we will follow with questions and comments afterwards.

Mr Sterling: In anticipation of my meeting this afternoon, I passed over a very important document to you in the House today and I hope you have had a chance to read that.

In December of 1989 I first introduced the concept of the living will and the durable power of attorney to deal with advance directives. Of course, the former government called an election in July 1990. One of my bills had received second reading in April 1990. The bill died when the election was called.

We introduced Bills 7 and 8 again on November 29, 1990, and they both received second reading by the Legislature and were referred to this committee in April 1991. I was very pleased to see the co-operation of all members of the Legislature in advancing these ideas.

On May 28 of this year I appeared before this committee and went over the concepts involved in my two bills, Bills 7 and 8. Just one day prior to Tuesday, May 28, the government had introduced Bills 108, 109 and 110. Bill 74, the advocacy bill, which we are all familiar with, had been introduced I think two or three weeks prior to May 28.

At that time I said to the committee that I thought we had two options with Bills 7 and 8. One was to embody the concepts of Bills 7 and 8 in the government legislation that had come forward, or the second option was to use those parts of the government legislation which embodied the principles in 7 and 8 and transfer them into Bills 7 and 8; in other words, improve 7 and 8.

I wrote to the committee two or three days after I appeared before the committee on May 28, and indicated to the Chairman at that time that I thought the legislation surrounding the areas of policy I was discussing in my bills was superior to the legislation I had put forward in my private member's bill. I believe that has resulted from a wider consultation that has taken place by policymakers in the Ministry of the Attorney General and the Ministry of Health over a long period of time, because the gestation period for this legislation has been extremely long; in fact, it has spanned three governments at this time, going back into the early 1980s.

I still maintain that position, but when asked by members of this committee whether I would like to see Bills 7 and 8 live on, I thought it might be useful to keep Bills 7 and 8 there for the options the committee might want to consider after it has heard the various witnesses come before it, who will primarily be targeting the government legislation.

I say that only from the point of view that if it should be the determination of the committee, after it has heard many witnesses, that it would be better to sever out from Bills 108 and 109, in particular, those sections dealing with advance directives and embody those in a different act or piece of legislation, then Bills 7 and 8 would be a handy tool to have in our arsenal if that is in fact what the committee decides to do. I do not think that is going to happen, but I think it is probably useful to do that.

Second, because of the timing of the process, because Bills 7 and 8 had a lead time of two to three months in advance of the government legislation, there were several people and citizens and groups who responded to Bills 7 and 8, or prepared their response in the belief that this committee was going to be hearing briefs about 7 and 8. I do not think it is fair to those people who put in that time to deny them the opportunity to comment on Bills 7 and 8 during the hearings which this committee will be having in the next three or four months.

I would also draw to the attention of the committee that since Bills 108, 109 and 110, Manitoba has developed a piece of legislation that is much simpler than ours. I am going to give a copy of that to our researcher, Ms Swift, and ask her to give that to you.

I would say that at the end of these hearings if there was some concern by the members of this committee that by putting so much into Bills 108 and 109 we lose the effect of saying to people in Ontario, "You should seriously consider making a living will; you should seriously consider making a durable power of attorney to deal with your personal care," then we have that option.

There is one matter raised in Bill 8 which has drawn some attention, which is not covered in Bills 108 or 109. Bill 8 is my act dealing with the concept of a living will or an advance directive. Under subsection 3(3) of the bill -- I put in this section because I had seen it in several pieces of legislation in the United States -- "The living will of a person is not valid while the person is pregnant."

That has drawn some responses back from various groups who have a different view of things than I do, but it has drawn a fairly significant response to Bills 7 and 8.

I have discussed this particular scenario with Mr Sharpe of the Ministry of Health, and he points out to me that this kind of situation is not covered in Bill 108, that is, the concept or the situation where a woman making a living will perhaps two or three years in advance of her pregnancy, not contemplating pregnancy but still having a living will which would be valid, is struck by a disease or an illness or an accident which falls in the bounds of the living will; in other words, that her life should not longer be prolonged by artificial means.

According to Bills 108 and 109, there would be an obligation upon the physician to terminate that life, even if by extending that life the child could be born as a result of extending that lifetime.

I throw that out to the committee, that if you choose to take Bills 108 and 109 to their finality, you might want to include a section which would basically invalidate a living will during a period of pregnancy, particularly if the woman had not anticipated the pregnancy when she made the living will. It is a minor point in terms of the overall concept, but it is one which has sparked some debate.

That is it. I am pleased to answer any questions. My bills are rather insignificant in terms of 108 and 109, but the primary purpose of my bringing them before the Legislature was to push the concept along, and I hope I have been able to achieve that in some way.

The Chair: Thank you, Mr Sterling. I would like to remind all members that legislative research has put out a summary of recommendations. I believe it is at each of your desks.

Mrs Sullivan: I am very pleased that Mr Sterling has once again come forward with these bills. I think it is a tribute to him and in fact to the process when a member takes a responsible and new position in private members' hour and brings forward substantial views and ideas that can be interpreted and massaged so they can be put forward for legitimate debate of interested parties. Mr Sterling should be congratulated for not only having done this in the past but having been persistent in continuing to bring the issues forward.

I am interested in some of the questions relating to the issue of pregnancy he has raised. I would like to know from Mr Sterling if he has had opinions relating to the effect of the inclusion of the pregnancy provisions he has raised with respect to the effect of the Charter of Rights in that situation.

The other question I would like to ask him, because I did not sit on the committee when his private member's bills came forward in the past, relates to whether there was also a consideration of a living will that would authorize or make provision for tissue and organ gifts, which I think are a matter of substantial concern to the provision of life in many circumstances to other people and which may well be part of what is a living will.

Mr Sterling: Thank you very much, Mrs Sullivan. We do not often get to appear in these various roles, so it feels a little uncomfortable answering questions rather than asking them.

At any rate, in terms of the responses I am getting personally the same responses which have been submitted to the committee and are summarized within the documentation. Unfortunately, the responses do not lead to the practicalities of the problem. The people who are interested in these issues are those people who are concerned about, for instance, whether a foetus is a living human being or not a living human being and the extension of those arguments rather than the practical situation.

Quite frankly, I am not interested in debating whether or not a foetus is a living human being. I am interested in providing practical direction to a health care giver who is faced with the question. I received criticism from both sides of the fence, both those who are known as pro-choice people and pro-life people, both making arguments going back to the charter.

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I have always maintained -- not being a great fan of the Charter of Rights in some instances -- that I believe legislators should make laws which are practical and worry about the effects of the charter secondarily. I cannot imagine a case, dealing with this particular issue, where litigation would arise and the question of the charter would come to the fore. I cannot really envisage anybody suing anybody and therefore one party using it either as a sword or a shield in terms of a civil suit or a criminal suit where the charter argument would come up.

I am more interested in not putting a health care provider in a box and providing him or her with directions as clear as possible, that is, what to do with an advance directive should he or she be put in this kind of situation.

I do not really view the charter argument on this, what I consider a very minor issue in terms of the whole legislation, as really worth the effort of going into the charter issue, because I think the people who are interested in the charter issue basically are people who are trying to prove other points; they are not really concerned about dealing with this specific problem.

As to the second one with regard to human tissue, I think it is an omission on my part for not including it or a provision for it in the legislation. I would hope that within living wills they would develop over a period of time a form which would include the provision for people to be reminded that it is a way they can assist other people who follow them, by donating their human organs which can be of use after they have died. I had turned my mind to only the issue of terminal illness and therefore did not turn my mind to the issue you raised.

But I think it is a valid point, and as we go through our deliberations -- and I hope we are going to ask the Ministry of the Attorney General for what a standard living will should look like -- I think we should include those kinds of suggestions to the Ministry of the Attorney General so it would include in its standard living will a provision for donation of human organs and tissues.

Mrs Sullivan: I want to move more to the technicalities of, I suppose, what is called "the right to pull the plug." Your legislation speaks more to the refusal of treatment. Do you have a view of a living will being used as a vehicle for the request for a particular procedure?

Mr Sterling: I do not know if you are talking about an act of euthanasia or if you are getting that far. I have steadfastly refused to cross that line in terms of this legislation. I have had I do not know how many requests from various television and media people to be drawn into that debate, but I wanted to limit this legislation to not taking any active steps towards the ending of a life.

I think that is another debate for another day after we deal with this legislation. I do not believe this is suggesting euthanasia in any way, shape or form. I view this as a respect for the individual's right to maintain control over his or her body until the end. I still have trouble with the concept of euthanasia at this time. I would want to hear a lot of debate before I would ever consider such a proposal.

Mrs Sullivan: For the last question I wanted to pursue, I am going to move back to the case of the young woman, whose name I cannot remember, who was seriously head-injured in an accident in America and whose parents worked very hard on a DNR, do not resuscitate, situation at the hospital she was located at. Indeed, what we were seeing there was a substitute decision-maker, at that time being the parents, pursuing court procedures to ensure that life-sustaining procedures were not invoked in that circumstance. Karen Quinlan, is that who that was? I wonder why you have stayed away from the substitute decision-maker.

Mr Sterling: I was aiming at a more simplified case and not trying to cover the waterfront. As a private member, my resources are limited in terms of the amount of consultation I can undertake, so I was trying to put a fairly easy concept into Bill 7 and Bill 8 and not deal with the harder ones you are talking about.

I have received some negative comments, for instance, from the Catholic Women's League on my legislation. In the Quinlan case some of the very strong witnesses were members of the priesthood in the Roman Catholic Church; they were a very strong Catholic family. It is interesting to see when they get into the depths of the issue that there is a lot more support for letting nature take its course in all institutions. A lot of people are just not aware of those. That was an interesting sidelight in terms of reading about that case.

Mr Fletcher: This is a comment more than anything else. I want to say thank you for bringing these bills forward, especially Bill 8. I say that because of a personal experience. My sister was on life support for a number of days before we were asked whether to have her taken off. The decision was to take her off and she died. The decision to take her off was because we had spoken many times with our family members; she was one of them, and that was her wish. She had not written it down but it did make it a lot easier for our family. A living will and some previous discussion are, I think, going to help a lot of people who have to face that situation.

I am glad they are here and I can only support what you are doing and your bills, especially Bill 8 because of the experience I have had. That is my comment. I have no questions.

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Mr Winninger: I too would like to commend the member for Carleton for his undying commitment to this issue and also for acting as a catalyst in bringing this legislation forward.

I am a little concerned, however, were a subsection like 3(3) of Bill 8 to go into our legislation because of the charter implications Mrs Sullivan alluded to. I could think of an example where a court action would invoke the charter.

You are probably familiar with the Court of Appeal decision last year which ruled that a doctor who had given a blood transfusion to a Jehovah's Witness victim infringed her rights and constituted, technically, a battery on her person.

If we had a situation where we had a living will drawn by a Jehovah's Witness who specified that she would not, under any circumstances, allow a blood transfusion in the future to save her life and this Jehovah's Witness happened to be pregnant at the time of an accident, the doctor could then say, "There is a section that makes it okay to give you a blood transfusion." I cannot think of a more clear case where her rights would be violated.

I wonder if you would agree with my scenario.

Mr Sterling: I think that is a real scenario. If I were a doctor, whether I was going to face a $20,000 suit or not, I would do it anyway. That is my own feeling, so I do not have trouble leaving the section in regardless.

Mrs Sullivan: I thought you were a lawyer.

Mr Sterling: I guess you have to sort of go with your gut. I understand what you are saying and it is a real case, but notwithstanding that I would leave this kind of section in the legislation, because whether the foetus is alive is not relevant; that the foetus could be alive three or four months down the road, if you want to view it that way, is important enough.

Mr Winninger: I raised this point when you presented your bill in the Legislature during private members' hour: It does not say in subsection 3(3) what "pregnancy" is defined as and whether there is a certain cutoff point. I think that would be very problematic. If it were technically feasible to measure one day's pregnancy, then a woman's wishes would be denied on that basis because she would be one day pregnant. It does not make a lot of sense to me.

Mr Sterling: You could define that if you wanted to define that within the bill. That is not a big problem. Once you accept the concept or disregard the concept then you can go on to that. I find that a minor problem, and you are sounding like a lawyer, David.

Mr Winninger: Would you pick the first trimester for your definition?

Mr Sterling: I have not even considered which trimester I would consider.

Mr Carr: I hope the question has not been asked. I want to thank the member for attempting to push this through. I know you have touched on a couple of the areas of recommendations for the government's bill. I was wondering if you could expand a little. What else would you like to see in the government's legislation, if anything, to improve it? Are there any comments you had in some of the other areas?

Mr Sterling: One of the problems I have with the government legislation, and I think we will see this as we go through it -- I was not able to be here for Mr Hampton's presentation yesterday -- is the very difficult way it is set up. It appears to discourage people rather than encourage people to, for instance, make a durable power of attorney, which I consider the more powerful of the two instruments you could draw. It provides for registration procedures, which I do not think is necessary. You register these with the guardian. I do not want the situation to come to the fore where people are guessing what a registration means or does not mean. If it is not registered, does the doctor or does he not follow the wishes of the attorney?

I would really like to see some of the provisions of Bill 108 and Bill 109 simplified as much as possible.

The second problem I see is that it is buried in the middle of a very large piece of legislation. I do not know how many sections there are in Bills 108 and 109, but both of the concepts are buried in two or three sections in bills which deal with a whole number of other matters. I do not know whether that serves the public well in terms of trying to encourage them to make living wills and durable powers of attorney, which is the goal I would like to achieve. They are not difficult instruments to draft. I think they can be done by the layman; I do not think lawyers have to do them. I thought there would be some benefit in keeping it fairly simple and within perhaps a bill which would contain maybe 10 or 15 sections in total.

I have some concern about enmeshing it in dealing with people who are confined for life in mental institutions and that kind of thing. I guess it is more the form I have some difficulty with; the government legislative thrust in combining it with what I consider the average person will not normally run across in his or her lifetime.

I would like to deal with powers of attorney dealing with property and powers of attorney dealing with personal care. Perhaps that would be one piece of legislation. The other piece of legislation I would like to have is one dealing with advance directives, ie, living wills. All that other legislation dealing with the advocates, advocacy and that kind of thing for ongoing care I would like to see separated from the other. That is my personal opinion about the government legislation at this time. But as I said, the people who have drafted the government legislation have consulted widely. I am quite anxious to hear what other groups have to say about it. I am quite open on it, as far as that goes. That is where I am now.

Ms Carter: I also want to commend you for what you have done. I think this is a decision we can all go along with.

I really want to get back to the same sort of point Mr Winninger was on. I think in a general way to say that you have to make an exception in the case of pregnancy is right, but I can see that if we state that absolutely and leave it like that, we are going to run into all kinds of difficulties. There are all kinds of other aspects of that which have to be looked at. Obviously there is a difference between an eighth-month baby to a mother who is prepared to have it and a very early pregnancy where there is no obvious solution as to who is going to look after the baby and this kind of thing.

I was wondering how that would affect it. Suppose a woman said in a living will that if she was in this kind of condition when pregnant she did not want this to be taken into account. Could that then be done?

Mr Sterling: You can do anything you want in legislation, as far as that goes. All my legislation said was that the living will would not be a document during that period; therefore, you would go back to whatever is done when you are faced with these situations without a living will. A whole bunch of people would be involved in the decision at that time, I am sure the family and the physician, etc. I am not saying that anything happens as a result of voiding or invalidating the living will. All I am saying is that you are thrown back to where you would be if you did not have a living will.

Ms Carter: You are not saying it would be mandatory for the pregnancy to go to term.

Mr Sterling: No, that is right. There is a difference in how you interpret what I am doing; I am taking away somebody's rights or I am not taking them away. All I am saying is that it is no longer valid. Maybe I am taking somebody's rights away in terms of dealing with the situation Mr Winninger brought up. I think it is something I can support and I feel that way about it. That is what we are elected for.

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Mrs Sullivan: I wonder if it might be possible, because I see them in the audience, to invite Mr Fram and perhaps somebody from the Ministry of Health to talk about how the Substitute Decisions Act would already integrate Mr Sterling's proposals and how it would not integrate. Can we do that?

The Chair: It would be their option whether they would choose to come forward at this time. They were not scheduled to be here.

Mrs Sullivan: They are open and consultative; we know that.

Mr Sterling: At one time I was the parliamentary assistant to the Attorney General for the province and I had to sit beside Mr Fram many times. We did not differ that often then, so I know we will not differ now.

The Chair: If our guests could introduce themselves for the record, then Mrs Sullivan could proceed.

Ms Bentivegna: Giuseppa Bentivegna, legal services branch, Ministry of Health.

Mr Fram: Steve Fram, Ministry of the Attorney General.

Ms Auksi: Juta Auksi, legislation policy unit, Ministry of Health.

Mrs Sullivan: We have two bills before us for consideration in relation to consent to treatment and substitute decision-making. As you know, because you have followed Mr Sterling's private member's legislation over a period of time, I am sure, his efforts in fact are very much a part of many of the debates surrounding some of the issues: the ethical issues and other issues relating to the legislation before us.

As for some of the things we have raised in the course of briefing so far, today I mentioned tissue and organ gifts, we have talked about research, we have talked about the mature minor -- Mr Sterling's bill makes a different provision relating to consent availability -- and we have talked about Criminal Code and charter issues, which would have to be discussed in relation to Mr Sterling's bill.

I wonder where you see some of those and other issues we might not have identified fitting in with Bill 108 and Bill 109 where there might be concerns or further consultation necessary. Mr Sterling, as a result of the consultation he has done, which has been quite extensive in terms of the drafting of his private member's bill, may also want to respond to what he has heard from the community he has consulted with.

Mr Fram: Wow. In terms of talking about Bill 108, the central notion is there. I think that is clearly set out. In many places where they have expanded enduring powers of attorney and in terms of living will legislation in the United States, the major dilemma is that the legislation has been passed and it does not work. It does not work not because it is a bad idea, but there has to be an integration between what is said and the legislation or the governance of physicians and care givers and so forth.

The courts changed the law on informed consent in a number of classic cases a decade ago, but according to the latest studies of the matter, nothing has changed in physicians' practices. The law can change, but unless you consider, in such a vast field as the health field, how physicians act and you design a process and involve the physicians and other practitioners in that process, you change nothing, because the forces of practice, unless you recognize them, do not let it happen.

In doing Bills 108 and 109, that is why 109 was separated out, so in fact it could be a complete code for health practitioners, starting from the issue of informed consent by people who are capable and going down to the issue of, if someone is not capable who then makes a decision? It is that context that must be given to powers of attorney to make them an effective tool to actually achieve what people want.

The first dilemma with just doing powers of attorney is that, by and large, physicians will disregard it and health practitioners will pay no attention to it as they go on their way, unless it is built into a context in which the practice is changed, and the Consent to Treatment Act is aimed at changing the practice of health practitioners so that the law can work.

As the Minister of Health said, the issue there is to give people responsibility for their own health care, and the final aspect of that is addressing the issue of health care when you are not around to direct the practitioners, when you are not capable of doing that.

The Vice-Chair: Excuse me, Mr Fram. Could I ask that you please confine your comments to Bill 7 and 8?

Mr Fram: Bill 7 by itself cannot work without a health context legislation which will make it work. It will be ignored in practice.

Mrs Sullivan: Can I break the rule and ask if Bill 109 provides that context or could provide that context?

The Vice-Chair: No, sorry.

Mr Fram: Talk to you later.

The Vice-Chair: We are dealing with Bills 7 and 8.

Mrs Sullivan: We understand what we are dealing with, but the issue is the context of the legislation.

Mr Sterling: Mr Chairman, I have no objection to people talking about Bills 108 and 109. I think they buy the same ideas, and my object, quite frankly, is to find the best, even if it is not my own.

The Vice-Chair: The parliamentary assistant is here.

Mr Wessenger: If we are going to ask questions about the Consent to Treatment Act, I think they should be addressed perhaps through me to the staff of the Ministry of Health. It is appropriate that Mr Fram be asked questions relating to the Attorney General, but I think we should try to keep the appropriate staff answering appropriate questions.

The Vice-Chair: Mr Wessenger, we are here dealing with Bills 7 and 8. Can I ask that we remain on Bills 7 and 8, please?

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Mr Carr: I will have to change my question now. Mr Fram, I appreciate the fact that you are talking in the overall context, the interrelated aspects, but there is a lot of public participation in the other bills -- they are very complicated. Would it not have been easier from the public standpoint to have bills like 7 and 8? As I look at it, notwithstanding what you just said, from the public standpoint I think it is very difficult to understand. Could there not be some type of compromise between what you just said and trying to keep it as simple as possible?

For example, I appreciate what Mr Sterling said about the living wills, not wanting to get lawyers involved and keeping it simple enough that a lay person could do it. Is there not something that could be said for trying to make it as simple as possible and as easy to understand for the general public?

Mr Fram: There is a lot to be said for it. It is difficult to do. The most important thing, however, with legislation, as very few people read legislation -- when was the last time you cuddled up with your Income Tax Act? What people deal with, and that is hard enough, are the forms we get sent, to our regret, early in each new year with our name on it and a direction to return them filled out.

What people will see of the legislation are powers of attorney forms, and I think those have to be carefully drafted. I do not think it will make any difference whether it is Bill 108 or Bill 8; the form will still be a straightforward, clear document, with instructions on how to fill it out. That, I think, is a matter of real importance.

The Vice-Chair: Are there any further comments or questions?

Mrs Sullivan: Could I ask, Mr Chairman, through the parliamentary assistant to the legal advisers for the Ministry of Health, if they have comment?

Mr Wessenger: I have no problem with that, if I could just ask with respect to what question.

Mrs Sullivan: Basically following on the same question, whether Bills 7 and 8 could readily integrate into those bills, the names of which we are not supposed to mention, but Bill 109 in particular.

Ms Bentivegna: The principles are the same in that there are advance directives set out. What it does, though, that is not in Bill 8 is that it puts the obligation on the substitute decision-maker to follow those advance directives; that is the very first thing they have to look at in making a decision on behalf of an incapable person. It sets out the fact that it only comes into force when the person is determined incapable, so it has those additional rules, and then it tells the health practitioner he or she has to abide by that decision of the substitute decision-maker, who is following advance directives.

It adds in all the other pieces so that everybody knows what they are supposed to do in the situation where there is an advance directive, and it allows for whether the power of attorney has been validated or not. This idea, whether it has been registered or not, kicks in; even if the attorney who is named cannot act, the directives still have to be followed. That is very clearly set out in section 14 of Bill 109.

Mrs Sullivan: Thank you.

The Vice-Chair: Are there any further comments or questions? Seeing none, we now stand adjourned until the call of the Chair.

The committee adjourned at 1635.