Proceedings of the Standing Senate Committee on
Human Rights
Issue 11 - Evidence - September 29, 2014
OTTAWA, Monday, September 29, 2014
The Standing Senate Committee on Human Rights, to which was referred Bill S-201, An Act to prohibit and prevent genetic discrimination, met this day at 4:05 p.m. to give consideration to the bill.
Senator Salma Ataullahjan (Deputy Chair) in the chair.
[English]
The Deputy Chair: Honourable senators, welcome to the eighteenth meeting of the Second Session of the Forty-first Parliament of the Standing Senate Committee on Human Rights.
We have a mandate from the Senate to examine issues related to human rights in Canada and abroad. Unfortunately, the chair of the committee, Senator Mobina Jaffer, could not be here tonight, so it falls upon me, Salma Ataullahjan. As deputy chair of the committee, I have the honour to welcome you to our meeting today. Before continuing, I would like my colleagues to introduce themselves.
Senator Eggleton: Art Eggleton, senator from Toronto.
Senator Munson: Jim Munson. I live in Ontario but my heart is in New Brunswick.
Senator Nancy Ruth: Nancy Ruth from Toronto the great.
Senator Tannas: Scott Tannas from Alberta.
The Deputy Chair: We are here to begin our hearings on Bill S-201, the genetic non-discrimination act, a private member's bill introduced by Senator James Cowan, the Leader of the Opposition in the Senate.
To begin our hearings today, I would like to welcome the sponsor of the bill, the Honourable Senator James Cowan, and his policy adviser, Barbara Kagedan. I understand you have opening remarks to present to us and then you will be available to answer the committee's questions.
Hon. James Cowan, sponsor of the bill: As the chair mentioned, Barbara Kagedan, who is a senior policy adviser in my office, is here today, so I'll take the easy questions and she can handle all the tough ones. She's been heavily involved in this project and has a lot of background, which I hope will be helpful to us in our discussion. Thank you.
Colleagues, I'm pleased to be here today to launch your study of my private member's bill, Bill S-201, An Act to prohibit and prevent genetic discrimination. The reason I introduced my bill is simple: It is to bring our law up to date, as has already been done in many other Western nations, so that Canadians can take advantage of the extraordinary advances in genetic testing without fear that by doing so they are opening themselves up to discrimination; and right now, that is not the case. Let me explain.
Scientists have and are continuing to identify genes associated with particular diseases, and each discovery brings new possibilities of treatments and, in some cases, even being able to prevent the disease from happening in the first place.
When I wrote these notes the other day, there were 20,000 tests for genes associated with almost 4,600 conditions. Barbara checked the website before coming here today, and in that short interval of time, the number of tests available has gone up to 23,185 for 4,975 conditions.
In only 17 months, the number of genetic tests has expanded over tenfold. For Canadians, the benefits can be very tangible and critically important. Increasingly, armed with the information that one has a genetic predisposition to something, there may be steps that a person can take to actually reduce the chance that the disease will develop in the first place.
Angelina Jolie brought international attention to this story when she went public with her story. She found that she carried the BRCA1 genetic mutation known to increase a woman's chances of developing breast cancer by as much as 87 per cent. Armed with that knowledge, Ms. Jolie had preventative surgery. She reduced her 87 per cent chance of developing breast cancer to under 5 per cent. She had watched her mother suffer and die from breast cancer. After her surgery, she wrote in The New York Times: ``I can tell my children that they don't need to fear they will lose me to breast cancer.''
Ms. Jolie's story prompted women around the world, including here in Canada, to ask about genetic testing. Researchers at the Odette Cancer Centre at Sunnybrook Hospital in Toronto decided to put numbers to the ``Angelina effect,'' as it was called. They found that the number of women referred for genetic counselling increased by 90 per cent after Ms. Jolie's story was published, and the number of women who were then identified as carrying one of the BRCA genes increased by 110 per cent, from 29 patients to 61. That's just a brief snapshot at one clinic.
There are other genetic tests for other diseases with similarly dramatic stories and extraordinary health benefits.
But right now, Canadians need to stop before they have a genetic test and consider the possibility that if they discover that they carry a genetic mutation associated with a disease or condition, they may find themselves vulnerable to genetic discrimination. In Canada, unlike most other Western countries, there is no protection at either the federal level or the provincial level. That is the problem that Bill S-201 is designed to address.
Right now, there is nothing to prevent an insurance company or a potential or current employer from demanding the results of any genetic testing one may have had, and then using that information to one's detriment.
CBC Radio 2's call-in show ``Ontario Today'' devoted a show last month to genetic testing, asking Canadians if they would choose to be tested and, if not, why not. I had the pleasure of participating in the show.
One caller described how he was diagnosed around 1999 with a heart condition, hypertrophic cardiomyopathy. He agreed to genetic testing and learned that he indeed carries a gene associated with this condition. His family was tested as well. His mother, then in her late seventies, was tested and found to have the gene but has never had any problems with her heart. His brother, in his late forties, did the same thing. His two daughters were tested, and one was found the carry the gene. It may never cause her problems, like her grandmother and her uncle, but as a result of the genetic testing she finds herself, at 19 years of age, uninsurable. The caller said she would never be able to open her own business; in our society that is one of the many things that require life insurance. Her life choices are now being dictated by genetic discrimination.
The caller, meanwhile, had open-heart surgery and is now apparently cured. His problem has been fixed and, according to his doctors, is extremely unlikely to recur. But he, too, is and remains uninsurable.
Colleagues, that's wrong. This gentleman's daughter may never develop the disease or, if she does, she may, too, be able to have it corrected surgically. But today she regrets having taken the test because of the impact it's having on how she lives her life. This is not the impact of a disease. She is feeling the impact of discrimination because of her genes.
This is not an isolated case. A genetic counsellor was an invited guest on the program. She told the host, Rita Celli, that this is a pretty common scenario and something she and her colleagues regularly discuss with patients. She described that some patients will decide to put off having the testing as a result — a decision that has medical implications.
Colleagues, there are many personal reasons why someone may choose not to have genetic testing, including exercising the simple right of ``I don't want to know.'' But concern about genetic discrimination should not be a factor in that decision. No Canadian should have to make the choice between a medical test that could point the way to a healthier life, and being able to get insurance or finding and keeping a job. Countries around the world have passed laws against this and, in my view, it's time that Canada did as well.
Indeed, some countries are now debating whether to make certain genetic tests universally available to their citizens. That is how powerfully some view the potential health benefits. There is now a vigorous debate in the U.S. on the merits and perils of such universal genetic testing. There is a similar debate going on in Israel. They can have the debate there because Israel has a strong law prohibiting genetic discrimination, with penalties for contravention including fines and imprisonment.
Should there be universal testing? I don't know. But here in Canada even such a debate is very problematic because without clear, strong protection against genetic discrimination, any universal program would be more than irresponsible.
Bill S-201 is my proposal to fix this gap. The bill is in three parts: First, it would introduce a new genetic non- discrimination act; second, it would amend the Canada Labour Code; and, finally, it would amend the Canadian Human Rights Act. I would like to briefly take you through each of those parts.
The new genetic non-discrimination act is, in my view, the heart of the bill. It prohibits anyone from requiring someone to take a genetic test or to disclose the results of a previous genetic test as a condition of providing goods or services to that person, entering into or continuing a contract or agreement with that person or offering or continuing specific terms or conditions in a contract or agreement with that person. It would similarly prohibit anyone from refusing to engage in any of these activities on the grounds that the person has refused to undergo a genetic test or refused to disclose the results of a previous test.
There are exceptions provided in the bill for a physician or other medical professional in respect of an individual to whom they are providing medical care, and there is an exception to enable someone to participate in medical or scientific research.
Everyone who contravenes the prohibitions would be guilty of an offence and liable on summary conviction to a fine not exceeding $300,000 or imprisonment up to 12 months or both, and on indictment to a fine of up to $1 million or imprisonment of up to five years or both.
In her speech in the chamber on the bill, our colleague Senator Frum questioned whether these penalties are excessive. I know they sound high, but I point out that they are maximum penalties only to be available to a court for cases that warrant their application. There are no mandatory minimum penalties in this bill.
I also note that the government's anti-spam law, which we passed in the Senate in December of 2010 and which came into force this summer, contains penalties of $1 million for an individual and $10 million for a corporation sending unwanted email. I think if it's proportionate to provide those penalties for a case where someone sends someone an unwanted email, it cannot be disproportionate to provide for significantly lower maximum penalties when we are talking about gaining unwanted access to someone's DNA or forcing someone to take an unwanted genetic test.
The second part of the bill contains amendments to the Canada Labour Code to protect employees from being required by an employer or potential employer to take a genetic test, or to disclose the results of a previous genetic test. In the interests of time I won't go into the details of those provisions, but we can discuss them after my remarks during the question and answer period.
The third and final part of the bill amends the Canadian Human Rights Act to add ``genetic characteristics'' as a prohibited ground of discrimination. This amendment was proposed in a number of private members' bills that have been introduced over the years in the House of Commons. The need to ensure that genetic discrimination is prohibited under the Canadian Human Rights Act goes back a long way. Indeed, our former colleague Senator Sheila Finestone raised the issue as far back as 1999 when she told the La Forest panel, which was doing a comprehensive review of the act, that genetic discrimination could become the human rights issue of the new millennium.
That's an outline of the bill, but before I conclude I want to speak about the insurance industry, which I know is concerned about the potential impact of this bill and will be appearing before this committee immediately after me. They sit behind me this afternoon.
I met with representatives of the insurance industry at my request some time ago as we were beginning our work on this bill, and we had a very good discussion. I am sure they will present to you their views again this afternoon.
The industry adopted a policy in 2010 that insurers would not require an applicant for insurance to undergo genetic testing; however, if genetic testing has been done and the information is available to the applicant for insurance, or the applicant's physician, then the insurer would request access to that information.
The insurance industry takes the position that genetic test information is no different from a person's health history. I disagree. The Office of the Privacy Commissioner — and you will be hearing from that office later this week — expressed it very well in a report in 2013 when they said, ``When it comes to personal information, it doesn't get more personal than your DNA.''
Canadians feel the same way. Ten years ago, the federal government commissioned Pollara and Earnscliffe to do in- depth public opinion research about genetic information and genetic testing. In focus groups, the researchers found — and this is a quote from the report — it became ``clear that for many, genetic information is more personal and more fundamental to identity'' than any other health information. The overwhelming majority of Canadians surveyed in that research said that they did not believe that insurance companies or employers should have the right to access existing personal genetic information. This concern over insurance companies and employers having access to genetic information has been confirmed in subsequent surveys, as well.
That is the distinction that Bill S-201 draws. It prohibits the use of genetic test results and requiring someone to take a genetic test, but nothing in the bill would prevent an insurer requesting information about a person's present or previous state of health, including if they are being or have been treated for a particular condition or disease.
As I am sure you will hear over the course of these hearings, a number of studies have tried to gauge what impact the kind of ban set out in my bill would have on the insurance industry. The Privacy Commissioner commissioned several papers several years ago — one by an actuarial expert and another by two economists. Those papers both found that there would not be a significant impact on the insurance industry or the efficient operation of insurance markets. However, this summer, the Canadian Institute of Actuaries commissioned its own study, which reached a very different conclusion. You will hear more about that later. Meanwhile, we have the experience in a large number of countries in Europe and elsewhere where such a ban has been in effect for years and the insurance industry seems to have survived.
We will, I am sure, have an opportunity to discuss this with the insurance industry and the Canadian Institute of Actuaries — as well as, I hope, with one or two independent experts who I know would like to present their thoughts to this committee.
For my part, this bill, like any piece of legislation, is an attempt to strike a balance. Every law impacts one or another person or group — and meanwhile, not having any law is impacting many Canadians. The issue for us as legislators is to assess whether Bill S-201 is a reasonable proposal to address the very real and very serious problem of genetic discrimination — whether it gets the balance right or whether there are adjustments that could improve it.
For example, you will see that the bill, as drafted, proposes an exception for certain high-value insurance contracts. This was included to address what I understand to be the main concern of the insurance industry, namely, that someone will take a genetic test, find out they are at risk of developing a particular disease, and go out and buy a large insurance policy, knowing that the insurer cannot find out about the genetic test result.
The bill seeks to address this by providing an exception from the prohibition requiring disclosure of previous genetic test results for insurance policies that exceed $1 million, or $75,000 per year, in benefits. Respecting our constitutional division of powers, this would apply in those provinces that pass legislation allowing it.
Let me be clear. Nothing in the bill provides any exception to the prohibition against requiring someone to take a genetic test. Someone who buys a high-value insurance policy but has never had any genetic testing could not be asked or compelled to undergo testing. The clause would apply only to allow insurers to demand disclosure of prior tests.
I believe the insurance industry feels the bill sets the exception too high at $1 million, but I have also spoken with Canadians who said that it is too low, given the amount of insurance a business owner or a professional buys these days. I have heard suggestions that no exception is needed by the insurance industry at all, that many countries prohibit the use of genetic test results, with no exceptions, and the insurance industry there survives and does just fine. I am sure we can discuss this, and I look forward to engaging in that discussion.
In conclusion, let me say how much I look forward to participating in your consideration of Bill S-201 and the issue of genetic discrimination. This is obviously not a partisan issue. In fact, in recent years each of the three main political parties has highlighted the need to address genetic discrimination. You will recall that the government, in the most recent Throne Speech, promised to address this issue.
So we're all agreed on the importance of the objective. Our job now as legislators is to find the best way to achieve that goal.
None of us has perfect genes. This is an issue that could affect every single one of us and every single Canadian. I look forward to listening to what Canadians have to say about the issue and about this bill, and to working together to achieve our common goal.
Thank you very much.
The Deputy Chair: Thank you, Senator Cowan. We have a list of senators wanting to ask questions.
Senator Eggleton: Thank you very much, Senator Cowan, for your presentation and for this initiative. It very much is timely and it's obviously something that a lot of other countries have considered, because a number of them have put similar measures into effect.
I would like to ask you three questions. First of all, with respect to the penalty, you responded to a concern that was raised by another senator that maybe the penalty was too much, but I would be interested to know what the penalty is actually based on and how it was arrived at.
Senator Cowan: There is no scientific basis to the number. It was simply a large number to demonstrate the seriousness with which I, and I think all of us, take this issue. It has to be a meaningful deterrent. That's the reason for the number.
Senator Eggleton: Secondly, the provinces also have jurisdiction in this area. How is this going to dovetail? If you had done an amendment to the Criminal Code, perhaps that would override anything that the provinces would do and would be paramount, but I'm not quite clear where this lands in that case. The Canada Labour Code amendment would be in regard to federally regulated institutions — transportation, communications, et cetera — but it would not be related to provincially regulated institutions. In terms of the Human Rights Act, again, there are human rights acts within the provinces.
I'm trying to get an understanding of how this will affect the largest number of Canadians. Will it affect only those who are regulated through federally regulated industries, or will it go beyond that? How far is its reach? How much does there have to be cooperation with the provinces in order to make this a comprehensive law?
Senator Cowan: You're right, senator. The insurance industry is provincially regulated under the property and civil rights provisions in the Constitution, but there are many instances where federal authority would step into an area like that because it's important to make a national statement. We're a very mobile population, and I think that if we're going to get involved in this area, or many other similar areas, it's important that people have assurance that, as they move from one part of the country to another, they're not going to have to deal with different situations.
As an example, I come from Nova Scotia. If Nova Scotia were to pass a law that was the provincial equivalent of this, I could say, ``All right, I can safely take genetic tests in my home province.'' However, then I move to Ontario. But Ontario has not done the same thing — and, no federal law has come into effect — so, while I thought I was doing something safely in my own province, by changing provinces and by coming to work and live in another part of the country where there's not a similar protection, I could be at risk of this type of discrimination.
It seemed to me that it was sensible to try to send a national, uniform message. It may well be that provinces will try to enact complementary legislation at the provincial level. I know that a member of the Ontario legislature has, on several occasions, introduced a bill to do the same type of thing as I've done here. That bill has not gotten anywhere for a variety of prorogation and election events in Ontario, but it seems to me that it is appropriate to send a national message. I know the provinces are aware of this initiative. I have not gone and canvassed their opinions, but I have not heard from any provincial officials or legislators saying that I shouldn't get involved in their field. Those I've spoken to think that this is a good initiative that we need to protect here, but it may well be that we need to get some complementary legislation at the provincial level because, as you quite correctly point out, insurance is provincially regulated in this country.
Senator Eggleton: I think you make a good point about its being on a national level in terms of setting a standard, but, when you get down to the nitty-gritty, could the insurance industry, for example, ignore this amendment if it says it's not a change in the regulations or the law regarding the insurance industry in the different provinces? Can they get around it in that way if they wanted to challenge it in the courts?
Senator Cowan: The offences and punishment section does talk about summary convictions and indictable offence convictions, so we are using the criminal power. I think there are occasions. I know that Professor Hogg, a noted expert in constitutional law, has said that in certain circumstances it's appropriate for the federal authority to intervene in provincial jurisdiction through the use of the criminal power. He uses discrimination as one of those instances.
Senator Eggleton: Okay. My third and final question deals with the two definitions of genetic tests: predictive and diagnostic. ``Predictive'' means trying to find out whether, somewhere in your life, you may be faced with a certain problem and you want to know what might come down the pipe that you might be able to avoid in terms of your genetics. The other one is genetic testing done at the time of a diagnosis for a particular problem that has already manifested itself.
Are both of those to be included in your proposal? I note that in some countries, like Austria, Belgium, France, Israel, Norway and Portugal, both predictive and diagnostic testing is included in their non-discrimination provisions. Are you talking about doing the same thing here, or are you making a distinction here?
Senator Cowan: No; my bill includes both. However, as I said before, if you've had a diagnostic test that discloses you have a disease and you are being treated for that, then, as is the current situation when you apply for insurance or for a job, your employer or your proposed insurer is entitled to ask you about your medical condition, your medical history. My bill would simply say they could not access either the fact of or the results of genetic testing that led to that. But if you're being treated for a condition, then that can be disclosed and it is taken into account by the insurer or by the employer, as it is now.
Senator Eggleton: Thank you very much.
Senator Munson: You mentioned, senator, that Israel has a tough law. Did something happen in Israel that made the government sit back and say, ``We must do something about this because people have been abusing the system?''
Senator Cowan: I frankly don't know the origin of the Israeli legislative intervention. Ms. Kagedan, do you know?
Barbara Kagedan, Senior Policy Advisor, Office of the Leader of the Opposition in the Senate: I don't know the origin.
Senator Cowan: I know they have done it, but I don't know why they did it. I can certainly try to find that out for you and provide the committee with that information. I don't know the legislative background.
Senator Munson: I am curious about that because, in the background briefings, we see where France has gone and where the United States has not gone, and so on. Some countries seem tougher with their laws and others are halfway with this.
We have you and we have witnesses from the Canadian Life and Health Insurance Association and the Canadian Institute of Actuaries. You mentioned figures at the beginning of how people have now stepped forward because of Angelina Jolie. You also talked about this show on the CBC where people have come forward and spoken about this. Are we going to have witnesses who have actually had issues and who have dealt with this issue in coming forward? I'm replacing on this committee and, beyond us, I have not really heard of this in public discussion as being a major issue. It is obviously a serious issue, but, in your estimation, how do you look at this right now? Are you getting calls from across the country from people saying, ``You really have to bring this up; I really want to come to talk about what's happening to me,'' as we have had with other human rights issues?
Senator Cowan: Since I became engaged on this issue, the only party that has expressed anything other than wholehearted support for what I have attempted to capture in this legislation is the insurance industry, and you'll be hearing from them later this afternoon.
I've been amazed at the number of individuals who have called and who have written to me about this issue, and others that I have sought out, such people in the genetic testing business and individuals. I think I mentioned in my second speech in the Senate that when I was making my first speech in the Senate, somebody who works here in the Senate called and said ``That's exactly my situation. I should have been tested, but I'm afraid if I test positive for some condition that it could affect my employability or my insurability.''
Whether those fears are legitimate, Senator Munson, I don't know, but I know that they are heartfelt. I mentioned this CBC program and listening to people calling into that program with those concerns, fears and experiences. I can't quantify it. A number of witnesses will come here; for example, Dr. Cohn from SickKids will be appearing. He's an expert in this field and can give you some idea about the volume and the experience that he's heard about.
Senator Munson: I was just concerned about the statistical evidence that could be in front of us from people saying I've had genetic testing and then an insurance company or somebody else saying, ``Sorry, we're not going to hire you.'' I don't know if I've heard that anywhere in our country.
Senator Cowan: Well, we've made a number of suggestions for potential witnesses to the committee. I've only seen the schedule for the hearings today and Thursday. For the remaining hearings, I don't know who has been scheduled or when, but certainly we do know of such individuals. I've listened to them in my office, and if you'd like to hear them, I would be happy to contact them and ask them to make contact with the committee clerk and apply for an opportunity to appear. Some of their stories are remarkable.
Senator Munson: You're obviously very passionate about this bill, and you said so in your opening remarks, but bills are bills around here. It seems to take a long time for bills, even a private member's bill, to get passed, but they do. If this bill does not pass and the status quo is maintained, what would that mean for Canadians in terms of risks that they may face in relation to genetic discrimination?
Senator Cowan: Well, I think those are questions that you should ask the other witnesses who will appear. I don't profess to be an expert in this, but the more I hear about it, the more concerned I am and the more strongly I believe that this is an area that requires a legislative intervention. I think I understand the position of the insurance industry and why it is they feel the way they do, but I also understand the very real concerns that individual Canadians have. What I have attempted to do is try to strike what I think is a reasonable balance.
This is an issue we need to address as legislators. I think it's a good issue for us in the Senate to address, and if there are improvements that we can make in this bill that will make it better, that will improve it, then I'm wholeheartedly in support of that. As I said at the end, each of the main federal political parties has promised in one election platform or another that they would address this issue, and the government, in its most recent Throne Speech, said it would do the same. Several private members' bills have been introduced in the House of Commons, but because of the — I was going to say ``peculiarities,'' but I don't know whether that's the right word — rules in the House of Commons, those haven't gone anywhere.
One of the advantages we have in the Senate is that each of us can bring forward these kinds of bills. I think this is an important public policy debate. I seriously believe we need to do something about it, but I'm not married to every single word in this bill. If suggestions can be made by senators or witnesses who will appear that will improve it, I'm all for that.
Senator Andreychuk: Thank you, Senator Cowan, for bringing this issue forward. I think it's an important one that needs to be addressed, and the Senate is the place that it should be discussed.
In preparing for this hearing and the bill, it seemed to me that more questions came to mind than answers in your bill. It seemed to me that on one hand the whole area of DNA is a tool that we want and, on the other hand, we're afraid of that tool. I'm not sure I want to map my future. Perhaps I'd rather it unfold as it should.
Then the question of how to address all the particular problems that arise is very interesting, as I work my way through your bill. It almost seemed to me that we need to have a discussion before we have a bill. I wondered why you didn't contemplate asking this committee or another committee to study the issue of DNA, to study the legal consequences of it and the social impacts in a way that we did on euthanasia. There was some discussion in the community, but it wasn't a definitive discussion one way or the other. So the Senate's role was to really dig deep into the issue, to bring out the pros and the cons of legislating on it and to identify the areas. One of them, of course, was the weakness of palliative care. We're now facing that issue coming back to us, and I think the Senate is well armed because we had the exhaustive study.
I'm a little wary of the bill because I need to know more about DNA, its consequences, its use in Canada, its abuse in Canada if it exists, before we know just how to approach the legislative content.
Senator Cowan: I appreciate your comments, senator. I did think about launching an inquiry or having a study, but I felt that on this narrow field of discrimination it was better to at least propose a legislative intervention that we could discuss, improve, but that this would be a more focused. As you say, DNA has many implications and, as you say, I might and you might choose that we don't want to know. That's perfectly in order. That's your right, that's my right, that's my decision, but my point is that in making that decision, you shouldn't have to worry about what impact that might have on your insurability or your employability. It's in that narrow context that I felt we should intervene legislatively.
There are a whole range of issues with respect to DNA and its use or perhaps abuse that are way outside the scope of this piece of legislation. However, I felt that there is a real need and there is a real issue which, in my view, requires legislative intervention rather than some sort of voluntary statement of intent by the insurance industry or by some employers' organization or, as they have in some other places, some sort of moratorium. My thrust is much narrower than that. If this committee or some other committee were to look at broader issues or other issues, I think that would be entirely appropriate.
I think this is an issue that is ripe for legislative intervention. I felt that rather than just say ``we should do something about it,'' I would come with a specific proposal that could form the basis of discussion. That was my thought process.
Senator Andreychuk: There is just one area in the bill that I find a bit confusing. You're saying that should you get tested and receive the results and they may have a negative component to them, it would stop people going for the DNA testing because they would be afraid it would be used against them in an employment setting. I think that's your premise.
But right now, and I certainly know of cases where, for example, you feel like you're in that rheumatoid arthritis or arthritis field and you want to go and get a doctor's test or opinion and you do end up getting a doctor's opinion. You may not have it now, you have the symptoms and you're likely to get it but they can't say definitively. That can be used in insurance. It's used in insurance in this very building — the Senate.
How then is that different from the person who wants to do the DNA testing? How do you separate those two? In the same way, I may think I have some other condition or not and then I go through it and I'm afraid to take the DNA testing because it will be used against me. That kind of problem with medicine exists now in a non-DNA situation. I don't know how you separate them.
Senator Cowan: I'm just talking about genetic testing. There are all kinds of other tests that you or I might undertake because we want to know or we're feeling poorly and we'd like to get to the bottom of this. That kind of information is not covered by what I'm talking about here. I'm only talking about genetic testing.
Senator Andreychuk: I'm not sure why you would pull that one out as opposed to all the others, because that fear exists now. We can bring to Senator Munson cases of where people have been denied insurance because they actually did the test. If you look at the application forms, it says ``have you ever been or suspect of'' and they have these diseases. Why do we believe that only the DNA should be protected against the discrimination when all the others are not? I don't quite understand your reasoning.
Senator Cowan: I guess again my answer, Senator Andreychuk, would be that I'm not trying to cure all of the problems. I'm trying to cure one. I'm trying to deal with that. Other professionals would be much better able to explain the line between those two types of tests.
There may be others, but the example one uses is Huntington's. If you carry the gene for Huntington's disease, then it's my understanding that you will get Huntington's disease. But there are a whole raft of other genes that you may have that will not necessarily result in your developing that condition. The Jolie example is a good one. She was able, as a result of knowing that, to reduce her chances from 87 per cent to 5 per cent. That's pretty significant. I urge you to put these questions to people who are professionals.
If you change your lifestyle or do this or that or stop doing this or that, it will lessen the chances of your developing this particular condition. There are real advantages not only to the individual but to us as a society, as taxpayers. If we can prevent people from developing conditions that will require enormous resources and result in their losing the lifestyle that they enjoy, then we should be doing that. We should be encouraging or at least removing a disincentive from people taking this. If you decide, ``Look, I don't want to know,'' that's a perfectly legitimate position for you or me to take. You may say, ``Look, I don't want to know because I don't want to bother myself. I don't want to worry my family. I just don't want to know.'' But if you said, ``Look, I'd like to know, but I'm not going to know because it's going to affect my insurability or employability,'' or, ``I'm not going to have my child tested because it might affect their future employability or insurability,'' then I think there are real questions. As I say, this is my attempt to strike what I think is a reasonable balance.
Senator Andreychuk: Just following up, I come back to this point. If DNA testing is a valuable tool, that should be a public policy debate. If it is good and the government is going to intervene, then shouldn't the debate be around accessibility for DNA testing for all? It should not be just those who can afford it but a good medical tool for all of us. Then approach the discrimination on the broad field rather than just the insurance for those who have insurance, because a whole host of others don't have insurance and are trying to get a job of a different nature. Shouldn't they have access to that kind of knowledge? As a public policy thing, before you get to the downsides, should we look at the upsides?
Senator Cowan: I'm sure there may be some negative aspects to some genetic tests. I'm not defending every single one of the 23,185 tests. I don't know about them. Others may be able to speak to that. I'm sure some are good and some are not so good. That's a choice that you or I would make if we were looking at a particular test. Obviously we wouldn't go and take the test unless we were confident that it was the right thing to do for us. All I'm saying is that in making that decision, you should not be burdened by these two considerations. There obviously should be a debate about this. This is an explosion. What was the number when I first spoke on —
Ms. Kagedan: When you first spoke, I think you said that a decade before that, 100 tests were available. In 10 or 12 years, it's now 23,000.
Senator Cowan: Yes. And when I first introduced this bill and spoke in April of 2013, the number was then 2,000, and now it's 23,000. You are perfectly correct. There are many issues, and I think a Senate committee would be a great place to discuss that. I'm saying that we have a problem here now that in my view requires a legislative intervention and doesn't need to have all of that work done before we decide that we're going to address this problem, which I think all of us acknowledge we have now.
The Deputy Chair: Senator Cowan, I have a small question, then. The third part of the bill adds genetic characteristics as a prohibited ground for discrimination under the Canadian Human Rights Act. However, the term ``genetic characteristics'' is not defined. What is covered under this term? Could it potentially be too broad in scope and overlap areas already covered by the Human Rights Act?
Senator Cowan: Perhaps I could ask Barbara to speak to that.
Ms. Kagedan: I could, but I would think the best witnesses to discuss that with would be the Canadian Human Rights Commission. I know they actually issued their statement just today on this. I don't know if you want to speak to it.
Senator Cowan: This is the Canadian Human Rights Commission. Are they appearing?
Ms. Kagedan: I hope so. I know they're on the list. I don't know if they've been scheduled yet.
Senator Cowan: They are appearing?
The Deputy Chair: They are, yes.
Senator Cowan: Not to put words in their mouth, but this is their statement that came out today. They said, in part, the commission welcomes any bill or initiative that addresses genetic discrimination. The commission supports the addition of ``genetic characteristics'' as a prohibited ground of discrimination in the Canadian Human Rights Act.
Perhaps it would be appropriate, Madam Chair, to put to them why they feel there ought to be an amendment to cover that. Obviously they feel that because the current legislation doesn't cover it.
The Deputy Chair: Thank you, Senator Cowan.
I would now like to introduce our next panel of witnesses.
From the Canadian Life and Health Insurance Association, I would like to welcome Frank Swedlove, President, who will be joining us in a couple of moments; and Frank Zinatelli, Vice President and General Counsel. I would also like to welcome, from the Canadian Institute of Actuaries, Bob Howard, Past President; Jacques Y. Boudreau, Chair, Committee on Genetic Testing; and Michel Simard, Executive Director. From the Canadian Association of Counsel to Employers, I would like to welcome Karen Jensen, Partner, Norton Rose Fulbright.
I understand that you have some opening remarks to present to us and then you will be available to answer the committee's questions. As Mr. Swedlove is not here, we will start with the Canadian Institute of Actuaries.
Michel Simard, Executive Director, Canadian Institute of Actuaries: Thank you, Madam Chair.
[Translation]
Honourable senators, my name is Michel Simard, and I am the Executive Director of the Canadian Institute of Actuaries, commonly referred to as the CIA. Our team this evening consists of Bob Howard, a past president and fellow of the CIA, and Jacques Boudreau, another fellow of the CIA. Thank you for the opportunity to meet with you this evening.
[English]
Actuaries are the experts in the quantification and management of risk and contingent events for insurers, governments, pension plans and social programs.
The CIA is the self-regulating national organization of the actuarial profession. As its first guiding principle, it holds the duty of the profession to the public above the needs of the profession and its members. We're here today because of that duty. We're here tonight to represent Canadian actuaries and not to speak for insurance companies.
[Translation]
Jacques Y. Boudreau, Chair, Committee on Genetic Testing, Canadian Institute of Actuaries: In June, the CIA released a statement on sharing results of genetic testing between applicants and insurers. I chaired the task force that prepared it. Bob Howard was commissioned to quantify the impact of a ban on access to genetic test results by insurers. We have shared our work with the Privacy Commissioner and human rights commissioners.
We believe a ban is counter to the public interest. Privacy and human rights are not infringed by access to the tests. All insurance offers consumers protection from financial loss due to the occurrence of an uncertain event.
Those who are insured are divided into pools with insureds sharing similar risk. Each insured pays premiums to cover their share of the cost of claims in their pool. The fundamental challenges are to assign people fairly to a pool and determine a fair price for them. Genetic testing can be useful in assigning people more accurately to a pool when there is scientific evidence of the link between certain genes and mortality. However, a ban on access to test results will upset the industry's fundamentals. Applicants may know their likelihood of living a long life is decreased because of a genetic test, but the companies are not allowed to know. Those applicants will be assigned to the wrong pool, and the price they pay will be inappropriately low. But is it enough to cause a material problem? My colleague's model answers that question.
[English]
Bob Howard, Past President, Canadian Institute of Actuaries: My model simulated the purchasing behaviour of those who have tested positive for certain genes and those who are not tested. I found that overall mortality experience, as observed by actuaries, is likely to increase dramatically. Term insurance premium rates for those aged 20 to 60 would increase by 30 per cent for males and 50 per cent for females if a ban is imposed. Then some won't buy as much life insurance as they need; some won't buy any. There will be a negative impact on our social safety net. Helping a few will harm the vast majority.
The CIA believes a ban on sharing known results of genetic tests is against the public interest.
There are serious flaws in Bill S-201. Legislation might reasonably concern itself with access to insurance, to ensure none are denied coverage solely due to a genetic test. But requiring that those who test positive pay the same as those who test negative or are not tested gives a significant, unfair advantage to those who test positive.
Even if it were accepted that an advantage should be conferred, the threshold is far too high. If it were set at $100,000 instead of $1 million, the insurance system might be able to absorb the cost with no apparent impact on the public. But the threshold must be applied by the life insured and not simply by policy, as my modelling assumes.
The current bill would allow an individual to buy a policy of $1 million from each of 10 or 20 life insurance companies. The impact on the public would be far above the 30 per cent or 50 per cent that I mentioned.
It is in the public interest to allow insurance companies access to known results of genetic tests. The scientific evidence satisfies the requirement of a rational connection, and the impact on the public of a ban satisfies the requirement of undue hardship.
The Deputy Chair: Thank you very much for your presentation.
I would like to turn to Mr. Swedlove or Mr. Zinatelli. Do you have any opening remarks?
Frank Swedlove, President, Canadian Life and Health Insurance Association: I am Frank Swedlove, President, Canadian Life and Health Insurance Association. I am accompanied by Frank Zinatelli, Vice President and General Counsel of the CLHIA. We are also accompanied by Dr. Judy Beamish, Vice President and Chief Medical Director at Sun Life Financial; and Karen Cutler, Vice President and Chief Underwriter for Manulife Financial. Both are available to answer any direct questions you may have about the underwriting process.
[Translation]
The CLHIA represents life and health insurance companies accounting for 99 per cent of the life and health insurance in force across Canada. The Canadian life and health insurance industry provides products that include individual life and group life, disability insurance, supplementary health insurance, individual and group annuities, and pensions. The industry protects almost 28 million Canadians and over 45 million people internationally.
[English]
The industry also makes benefit payments to Canadians of $76 billion a year and has $647 billion invested in the Canadian economy and provides employment to nearly 150,000 Canadians.
We welcome this opportunity to appear before the committee as it reviews Bill S-201. While this bill is well intentioned, its negative implications far outweigh its benefits, and therefore we cannot support its passage.
Let me first talk about the fundamental basis of how insurance is underwritten. Insurance is a good-faith agreement in which parties disclose any information that may be material to the contract so that the contract can be entered into on an ``equal information'' basis.
This ensures that the insured knows what benefits are being promised and that the insurer can properly assess the risk so that the premium reflects the degree of risk assumed. This is fair to the entire pool of insured persons. The principle of ``equal information'' is set out in the insurance legislation of each province and territory and is the foundation on which all insurance underwriting is based.
Section 4 of this bill would prohibit any person from requiring an individual to disclose the results of a genetic test as a condition of providing insurance. This is contrary to this key principle of ``equal information.'' Worse yet, if this principle is not respected, it will lead to something we call ``anti-selection.''
Anti-selection occurs when an insurance applicant knows that he or she represents a higher claims risk and the insurer does not know this. As a result, the person is more likely to benefit from insurance and at a lower cost than would otherwise be the case. This leads the individual to apply for more insurance. This is not just theoretical. This is a fact that has been shown by a great deal of research. This leads to an overall increase in the cost of the insurance, as we have just heard today, and we are not talking about trivial amounts.
A recent research report by the CIA concluded that if insurers were not able to access the results of genetic tests the impact would be substantial, and the numbers provided show this.
Canadians are sensitive to the price of insurance. A significant increase in the cost is likely to result in a large number of Canadians, particularly less affluent ones, choosing not to purchase life and health insurance coverage. This would leave these people unprotected from what may befall them in life, be it premature death, serious health problems or disability. I must say the backstop at the end of the day would be the government.
[Translation]
However, as an industry, we are sensitive to the needs of Canadians who may be affected by adverse genetic test results. Therefore, as we announced last week, the industry has established an industry code that will apply to all our members. We distributed copies to all committee members.
[English]
The industry code that we provided last week will require all members to adhere to the following: One, it will ensure that no Canadian will be asked to take a genetic test as a condition of obtaining insurance; two, it will support medical research and its benefits, as insurers will not ask for genetic test results from applicants as long as they or their physician have not been made aware of the results; three, it will ensure companies do not require the genetic test results of any person other than the proposed insured person nor seek to obtain those genetic test results independently; four, where an applicant informs the insurer they are considering taking a genetic test, insurers will provide them with a clear, plain language notice of the implications of taking such a test; five, it will require companies to assist applicants who are not eligible for insurance; six, it will require companies to keep themselves informed of developments in genetics that affect insurance and incorporate new information into underwriting practices; seven, it will require companies to have a dispute resolution system to deal with complaints relating to underwriting decisions involving a genetic test result; and eight, it will require companies to certify annually that insurers are complying with these commitments.
We want to ensure that Canadians make informed decisions regarding genetic tests, including what to expect when applying for insurance, while continuing to help Canadians protect their families from unexpected events.
Regarding other concerns with the bill, we want to note clause 9 of the bill, which would amend the Canadian Human Rights Act. This would apply to federal employers and is also relevant to our industry when we provide insurance products to federal employees. The amendments would make ``genetic characteristics'' a prohibited ground of discrimination under the CHRA. The term ``genetic characteristics'' is highly problematic as it covers a much broader set of information than genetic test results. Indeed, the term could be read to include family history and would, therefore, restrict the industry's ability to use family history as a factor in assessing risk. Such a change would go to the core of how insurance has worked since the industry's inception.
Finally, we would note that it is not clear that the federal government has the authority to implement the provisions contained in Bill S-201. We believe that this is a significant question, and we encourage the committee to review it.
[Translation]
In conclusion, the industry greatly appreciates this opportunity to participate in the committee's review of Bill S- 201. We would be pleased to answer any questions you may have. Thank you.
[English]
Thank you very much for your attention.
The Deputy Chair: Now I would turn to Karen Jensen from the Canadian Association of Counsel to Employers.
Karen Jensen, Partner, Norton Rose Fulbright, Canadian Association of Counsel to Employers: Good evening. It's a great honour to be invited to speak to you today about such an important topic. By way of background, I am the Vice- Chairperson of the Human Rights Committee of the Canadian Association of Counsel to Employers, or CACE, as we are known. CACE is an association of management-side labour and employment lawyers across Canada. I'm also a former full-time member of the Canadian Human Rights Tribunal where I adjudicated and mediated complex human rights disputes. I have been practising labour, employment and human rights law for over 20 years.
First let me say that CACE views this issue as an extremely important one. The advances that have been made in the area of genetic testing and genetic treatment for serious illnesses and conditions are nothing short of breathtaking. Clearly, it is in everyone's interest to ensure that people are able to take full advantage of these breakthroughs without fear of discrimination on the basis of genetic characteristics by employers or potential employers.
However, the questions that CACE is asking are threefold. Firstly, given the current state of the law in Canada, is Bill S-201 necessary? Secondly, will it have unintended negative effects? Finally, will the bill withstand constitutional scrutiny?
With regard to the first question, whether Bill S-201 is necessary, I think it is important to point out that there does not appear to be evidence at this time of widespread discrimination in employment on the basis of genetic characteristics or requirements by employers to provide the results of genetic tests. There just doesn't seem to be evidence of that widespread problem, and there is a study I'm aware of that was done in British Columbia on this issue, which you might wish to look at, and it reveals this very small number of people who perceive that there may be a problem but, as of yet, no record of complaints.
Furthermore, it should be noted that every jurisdiction in Canada provides robust protection of both the privacy and the human rights of employees and potential employees. In every province and territory, and at the federal level as well, employers are not permitted to discriminate against employees or candidates for employment on the ground of disability.
In a decision rendered by the Supreme Court of Canada in 2000, the court stated that a disability may be actual or perceived. The case in particular dealing with the City of Montreal and the City of Boisbriand involved two job applicants who underwent pre-employment medical testing as a condition to being hired for jobs as a gardener- horticulturalist and a police officer with the City of Montreal. The medical tests revealed that the two applicants had anomalies of the spinal column. Despite the fact that the anomalies were asymptomatic, in fact they didn't even know they had these anomalies until the tests were done, the two were not hired for the jobs that they had applied for.
The Supreme Court of Canada held that this constituted discrimination on the basis of disability, even though the applicants did not have any functional limitations and were totally asymptomatic. The court held that the right to equality and protection against discrimination provided by human rights legislation throughout the country cannot be achieved unless we recognize that discriminatory acts may be based as much on perception as on actual disability. The City of Montreal case on perceived disability has been applied in human rights tribunals and courts throughout the country, despite the fact that it was based on Quebec's human rights legislation.
As a result, an individual who has been denied a job on the basis of a genetic test that reveals a genetic abnormality, which creates no functional limitations affecting the applicant's ability to safely do the job, would have every right to complain under the applicable human rights legislation that he or she had been a victim of discrimination on the basis of perceived disability.
Moreover, most employers are well aware that they do not have the right to demand pre-employment medical screening unless two conditions are met. First, the individual must have been given a conditional offer of employment. Second, the medical screening must be limited to tests for conditions that will prevent the worker from performing the requirements of that particular job safely. Even then, employers do not have the right to ask for the diagnosis provided through the testing. Rather, they are permitted only to know whether the individual is fit to safely perform the requirements of the job with or without accommodation.
In Canada, if a test reveals that someone has a functional limitation that will affect his or her ability to do the job, the employer cannot simply refuse to hire the candidate. Rather, according to the Supreme Court of Canada in a decision rendered in 1999, referred to as the Meiorin decision, the employer must accommodate the individual's limitations unless to do so would cause the employer undue hardship. That means that an individual with a genetic characteristic that has resulted in a physical or mental limitation could not be denied a job because of that limitation unless it was impossible for the employer to accommodate the individual for cost, safety or health reasons.
The standard that employers are held to in justifying a refusal to employ or to continue to employ people with disabilities is extremely high. Only when the accommodation of the disabled individual will result in undue hardship will the employer be justified in refusing to hire or continue to employ that person.
With respect to individuals who currently hold a job and who fear that their employer may discriminate against them if the employer were to find out about their genetic characteristics, the law in Canada is quite clear that employers do not have an unconditional right to full disclosure of the employee's medical situation. Generally speaking, medical information can be required only to establish an employee's fitness to work or to justify an absence for illness or disability-related reasons.
Again, like the pre-employment medical testing situation, an employer is not entitled to the diagnosis but can ask only about the expected length of the disability, the prognosis for recovery and the kinds of restrictions that might impact on the individual's ability to perform the functions of their job.
Recently, the Supreme Court of Canada has underscored the restricted right of employers to employees' medical information in the Irving Pulp & Paper decision that was released last year. In that case, the court determined that random drug and alcohol testing of employees in safety-sensitive positions is not permitted unless there's clear evidence of widespread abuse of drugs and alcohol. The intrusion upon employees' private medical information was simply not justified by a categorical statement about the need for safety.
There are also legislated protections on how medical information can be collected, used and disseminated, including the federal Personal Information Protection and Electronic Documents Act, otherwise known as PIPEDA, and provincial privacy acts that include special legislation for use of medical information.
In a recent case involving PIPEDA, the Assistant Privacy Commissioner of Canada considered a complaint brought by a former employee of a telecommunications company. In this case, the former employee alleged that the employer was unnecessarily collecting personal medical information. To assist in the administration of its long-term disability program, the company required its employees to file claim forms and medical reports with the employer's human resources office.
The Assistant Privacy Commissioner concluded that the company was in violation of privacy principles because the collection of employee medical information was not reasonably necessary. The disability plan was managed by a third- party insurance company, and employees should have been able to submit their information directly to the insurer without disclosing the information to the employer.
Finally, the Canada Labour Code prohibits unjust dismissals under Part III. This would, in most cases, extend to dismissals on the basis of the results of genetic tests unless a legitimate reason for such a decision existed. The reason would have to meet the requirements that I've just reviewed under the Canadian Human Rights Act, since that act applies to all decisions made under the Canada Labour Code.
Based on this kind of analysis, CACE is of the view that the current legislation in Canada is sufficient to provide protection against intrusion on employee privacy, unjust dismissal and discrimination in employment on the basis of genetic characteristics.
Furthermore, CACE worries that there are unintended negative consequences that may flow from the introduction of legislation like Bill S-201. The strict prohibition contemplated by the bill against genetic testing or discrimination for genetic characteristics includes criminal penalties that go far beyond the penalties contemplated for other types of discrimination, including discrimination on the basis of disability. As such, genetic discrimination will be placed in a special category above other types of discrimination should this bill be implemented. It sets up a kind of hierarchy of rights, which is something that the Supreme Court of Canada has specifically rejected.
Another thing that worries employers is the lack of definition of the term ``genetic characteristics.'' The term is so broad that it encompasses every human trait imaginable. One wonders whether traits like stubbornness, insubordination, insolence or other traits that formerly were the responsibility of the individual could be considered genetic characteristics that cannot be helped and in relation to which employers would be forbidden from making any workplace decisions.
We've had experience in Canada with the introduction of poorly defined terms into the Canadian Human Rights Act, such as ``family status,'' which resulted in decades of costly litigation yielding contradictory results until clarity was finally achieved. In the interim, employers were uncertain how to deal with complaints of discrimination based on the ill or undefined term. It is absolutely critical that any prohibited ground of discrimination be clearly defined or understood. Employers need this. Vague definitions will lead to uncertainty, unnecessary disputes and endless litigation.
Finally, the revisions to the Canada Labour Code include a blanket prohibition on the use of genetic testing without the written permission of the employee. This may go beyond what is really needed to ensure privacy and freedom of choice. Currently, employees can refuse to undergo tests that are not relevant to job requirements and safety. Furthermore, if the tests reveal a need for accommodation, they cannot be fired unless the accommodation creates undue hardship. There may be circumstances in which a genetic test will actually assist in accommodating the employee and will ensure that he or she can safely perform the requirements of the job. Prohibiting employers from asking for those tests to be performed may be unnecessary and unhelpful.
Recently, an arbitrator upheld an employer's right to ask employees to undergo a stress test for jobs that made heavy cardiovascular demands on workers. The union argued that requiring a stress test was discriminatory and employees should not be required to submit to the test, but the arbitrator disagreed. He found the test to be helpful to avoid cardiac arrest and death in the workplace. The same may well be true of some genetic tests, and the requirements of the CHRA would prevent employers from demanding such tests when they are not justified.
Of course, our last concern is that the bill may not pass constitutional muster, as it would appear to trench heavily on the provinces' jurisdiction under section 92.13 of the Constitution Act, 1867.
In conclusion, the issue of genetic testing and discrimination on the basis of genetic characteristics is an important one that is certainly garnering much attention of late. However, if there are to be modifications of complex legislation such as the Canada Labour Code and the Canadian Human Rights Act, which have a profound impact on labour and employment relations in Canada, stakeholders should first be consulted. I heartily agree that more discussion is needed in this area before legislation is introduced. We must be careful not to import legal restrictions and systems from places like the United States, where access to basic health care is very much intertwined with employment. Such is not the case in Canada.
Furthermore, we have legal protections in place in Canada that may obviate the need for legislation like this that has the potential to do more harm than good.
Thank you, and I'm happy to remain and answer questions.
The Deputy Chair: Thank you very much. I will now turn to the list of senators who have questions.
Senator Cowan: I have a number of questions, which doesn't surprise you. Perhaps I'll ask some questions, and when I've had my turn maybe you could interrupt me and I can go to a second round if I haven't completed my questions. Agreeable?
The Deputy Chair: Yes.
Senator Cowan: I don't want to deprive my colleagues of the chance to do that.
You spoke about the concerns that this would result in term life insurance policy rates rising by 30 per cent for males and 50 per cent for females. As I understand it, in Britain, where they introduced a moratorium in 2001, between 2001 and 2012 — and this is according to a study by Professor Thomas of the University of Kent, and his name has been submitted to the committee as somebody who could provide some assistance in this area — term life insurance rates fell by 25 per cent in Britain between 2001 and 2012 and critical illness insurance prices fell by 25 per cent from 2004 to 2013.
Why would the Canadian experience be exactly the reverse, a 30 per cent to 50 per cent increase, while the experience in Britain has been a decrease of 25 per cent?
Mr. Howard: Thank you, Senator Cowan. There are actually a number of reasons why that would be the case.
First, when the moratorium was accepted in the U.K., the rate of testing was exceptionally low. You could have an impact on the overall results only when you have a significantly large number of people who are actually tested. The testing rate, even today, in the U.K. is significantly lower than the rate of testing in Canada, and the rate of testing has been going up exponentially.
As you yourself said, back in 2001 there were very few conditions for which there were tests or scientific studies that could support that mortality would be higher. That's very different now. There are a number of scientific studies that show there are many genes; I included only 13 in my model, but those 13 alone would cause quite a significant impact.
Second, in the U.K., just as a matter of the culture, people tend to buy life insurance to back a mortgage. If you don't have a mortgage, you don't get life insurance. When you get a mortgage, you get it to cover the amount of the mortgage, not substantially more. So there would be very little anti-selection by amount. That is, those who test positive would not go out and buy a lot more insurance than those who test negative or are not tested. I don't think you will find that will happen in Canada. It will be the very opposite: Those who test positive, given the opportunity under your bill to buy $1 million of insurance, will very likely take that opportunity.
Another thing: In the U.K. there is no provision for viatical settlements. Not everyone may be aware of viatical settlements.
Senator Cowan: What does the word ``viatical'' mean?
Mr. Howard: I don't know what it means, but I know what a viatical settlement is. There are companies allowed in Quebec, Saskatchewan, New Brunswick and Nova Scotia where people can sell their life insurance policies to them for cash and then the company continues to pay the premiums and eventually collects the death claim.
For example, Senator Cowan, you mentioned hypertrophic cardiomyopathy. If you had a genetic test done to show that you had that condition, a fair price for your life insurance would probably be about 30 cents on the dollar. So you go out and buy $1 million because you've had that test done. The insurance company doesn't know you've had the test done. You get a $1-million policy, and the next day you sell it for $300,000 cash to a viatical company. The next day you go and buy another $1-million policy and you sell that for another $300,000 cash.
This is a very significant benefit because of that genetic test, because of the way this system operates. That is not present in the U.K. It is here in Canada.
Senator Cowan: In the four provinces you mentioned?
Mr. Howard: Yes, that's correct.
Senator Cowan: It's illegal elsewhere?
Mr. Howard: Yes. The other thing I would say is the reason you haven't seen it in the U.K. is that there's still statistical fluctuation around these events, and where there are few people in the population because there have been few genetic tests in the past, then it would be very difficult to identify death claims that result from those who tested positive and therefore bought insurance at what they themselves believed to be an unfairly low price. Because the companies aren't collecting the information, it's absolutely impossible for them to do those studies.
Senator Cowan: If I can continue with you, sir, your report assumes that 75 per cent of people who test positive will go out and apply for life insurance and apply for as much as they can get, $1million or more. Where did the 75 per cent come from?
Mr. Howard: Obviously, there are no studies because this is not something that's been around. We don't have the ban yet, so the circumstances don't actually exist. But I would suggest to the senators here the thought experiment. I recently —
Senator Cowan: No, but you picked 75 per cent. Excuse me. Why 75 per cent and not 80 per cent or 40 per cent or 60 per cent?
Mr. Howard: Actually, in the first round of the model I used 100 per cent.
Senator Cowan: Okay. Why?
Mr. Howard: There will be some conditions that people will decide it's not worth it. There will be circumstances, but I think relatively few. Most people who test positive will know — because of the publicity that the Parliament of Canada will give, if nothing else — that there is an advantage that they now have that they did not have before, that they can get insurance at a price that's dramatically lower than is consistent with the risk that they're facing. People buy lottery tickets because they think that they can win. With this one, they've got the odds in their favour rather than against them.
Senator Cowan: Then it is a lottery. You're saying, ``I'm buying it because I'm going to die.'' We're talking about genetic tests. We're not talking about the Huntington's example. We're talking about a test that indicates you have a gene that might, to a greater or lesser extent, lead you to develop a particular condition in the future.
Mr. Howard: Absolutely.
Senator Cowan: You said that 75 per cent of those people would go out and buy policies. How many Canadians could buy a $1-million policy in any event? How many? What percentage of Canadians?
Mr. Howard: It depends on the age; if it's your age, then probably not so many. Someone aged 20, I would say an awful lot of people could, well over half of the population. But if you knew you had a probability of dying five times higher than the population, I think you'd find a way to get the money. If it was someone in my family who had that test, I'd pay the premiums for them. Wouldn't you?
Senator Cowan: Let's take another situation. Senator Andreychuk and I were talking earlier about choosing to take a test or not to take a test. Let's suppose she and I have exactly the same predisposition for something. I decide I'm going to take the test. She decides, for her own reasons — good reasons — she's not going to take that test. I would have to disclose the results of that test now, and I either would not be able to get insurance or would pay a higher premium for it. She would not know, and I would be able to take such preventive measures — change of lifestyle and that sort of thing — that might delay or prevent the onset of that, which surely is a good thing from society's point of view; she would not. How is that good public policy, or how is that even good for the insurance industry?
Mr. Howard: But, senator, what if you tested negative? Then you would have a substantially lower risk. Even if you had a family history of the disease, that wouldn't be held against you because of the negative test. So the test actually is in your favour, not working against you.
Senator Cowan: But we're back to the lottery again.
Mr. Howard: Indeed, but that would be true if you're succumbing to any number of diseases that might render you uninsurable. You don't know whether it would come, but tomorrow symptoms may appear. That's not unusual within the scope of the life insurance industry.
We actually have here some medical directors and chief underwriters of insurance companies, and they could answer that question probably better than I could, if you wish to pose it to them.
Senator Cowan: In the introduction to your report, you talked about the possibility of someone avoiding the onset of the disease by having the testing and taking some preventative action — surgery or medication or lifestyle change. That's mentioned in the introduction, but you haven't mentioned it again in the balance of your report. How did your calculations take that possibility into account?
Mr. Howard: In my model, I assumed there are a number of things to consider. I start with a positive test. Not all of those who test positive will be insurable, for other reasons. They may already have a condition which would not allow them to get insurance. They could be ruled out because of that. It could be a matter of the family history, and the person would be insured at a higher premium because of that family history. That's an issue that's not taken into account.
But those who pass those two hurdles, they have the insurance. There's a probability that works into my model. Some of those will eventually develop the disease and some will not. For those who do not develop the disease, I assume they will have mortality that's normal for the population. For those who develop the disease, they will have an increase in mortality — not immediately, but gradually, over time, their mortality will increase. That will result in deaths occurring at a higher proportion than with the general population. I then take into account the deaths that have occurred. That's how I calculate the impact on mortality experience and, therefore, the effect on the premium rates.
Senator Cowan: I had a couple of questions, Mr. Swedlove, but perhaps I will wait for the second round.
Senator Eggleton: When Senator Cowan was giving his presentation earlier, I referred to two different kinds of genetic tests: predictive and diagnostic. Do you have any idea what the percentage of each of those would be? How many people go for a predictive test at this point in time?
Dr. Judy Beamish, Vice President and Chief Medical Director, Sun Life Financial, Canadian Life and Health Insurance Association: I'm an internist and a cardiologist by training. I have engaged in clinical practice to a greater or lesser extent over a number of years and currently work full-time as an insurance medical director.
There are a variety of different types of testing in addition to predictive and diagnostic. There are also, for example, newborn screening-type tests. There are also tests that might be done, for example, for paternity reasons or for looking for carrier status for people concerned not about their own genetic condition but about that in their children. For example, if you carry the Tay-Sachs gene, you do not want your mate to also carry it because that would put your offspring at risk. It's no personal risk to adults, just to the offspring.
There are a whole variety of reasons why people would undergo genetic testing. I have not seen any breakdown in any countries as to the various numbers, but I suspect it's a continuously changing field.
Senator Eggleton: My simple understanding is that the predictive test is one where you're in good health and you go to find out if something is coming down the line because of your family history or your genetics, whereas with the diagnostic one you're not well and you go and you find out you've got this problem because you inherited it in some way. I realize you're saying there are variations on all of these.
Dr. Beamish: I think your basic idea is correct.
Senator Eggleton: Does the industry have a concern about this bill in either one of those or both of those?
Frank Zinatelli, Vice President and General Counsel, Canadian Life and Health Insurance Association: I think Mr. Swedlove would be the person to respond to that.
Mr. Swedlove: Yes, I think the industry has concerns with the concept that there isn't equal information on both sides because that leads to anti-selection and increased costs for the broader population. The concern is a broader one, senator.
Senator Eggleton: Let's get to this matter of increased costs because the actuaries association actually put a number on it, saying those aged between 20 and 60 would increase by 30 per cent for males and 50 per cent for females, if a ban is imposed. How does that happen? These kinds of tests, particularly of the predictive variety, have been around only a short period of time. How do we suddenly say that there's going to be these big increases if this information can't be made available? You've been going for centuries — decades at least in Canada — and it hasn't been a big factor. It wasn't available, particularly of the predictive variety.
Mr. Swedlove: Well, it comes down to this: What does each side know about the condition of the individual who's being insured? Sure, it's correct that genetic testing is still fairly new and before you didn't know the results, but then you don't get any anti-selection. That is, you don't have a situation where people are actually purchasing insurance because they know that the odds are in their favour of collecting that insurance.
I think just reflecting on what has happened in the past is not particularly indicative. In any event, genetic testing, as the senator noted in his comments, is a field that's expanding greatly. Indeed, one would expect that as the numbers of tests become available that are relevant to one's health, it will affect the cost clearly and the chances of contacting diseases.
Senator Eggleton: Yes, but I don't know how you come out with these numbers. That's a very general statement. This one is a very specific one about the cost increases.
Let me ask you about this matter of people who get a test and then go out and buy big amounts of insurance. There is a section in Senator Cowan's proposed bill, clause 6, that permits the disclosure of the results of genetic tests already taken where there is a contract of insurance for an amount that exceeds $1 million or that pays a benefit of more than $75,000 per annum. Does that not take care of the person who goes out and buys a lot of insurance suddenly?
Mr. Swedlove: I believe the numbers that the Canadian Institute of Actuaries used assumed a $-million policy maximum that could occur. Therefore, the numbers that you see from the CIA reflect what is stated in the bill. Indeed, the bill talks about $1 million per policy as opposed to $1 million per individual, which is more serious than what the numbers —
Senator Eggleton: But it allows for an exemption, which means you can get the information.
Mr. Swedlove: Over and above that $1 million, yes.
Senator Eggleton: Do you think the amount should be different? The intent of that section is to try to prevent people from getting their test done and then saying ``Oh, my goodness. I'm going to get this disease down the line. I better go out and buy tons of insurance.'' Believe me, a lot of the population can't afford to buy tons of insurance.
Nevertheless, doesn't that section prevent that? If you think the $1 million and the $75,000 per annum payout benefit should be different, what do you think should be different in terms of the numbers?
Mr. Swedlove: Our belief is that there should be equal information on both sides, and the amounts that they pay in insurance should reflect the risks associated with that individual. That is the only way it's fair to everybody.
Again, the $1-million number reflects significant increases because that's the number that these gentlemen used in order to make their calculation that they came up with.
Senator Eggleton: Okay. You're not telling me what an alternative would be.
There are a number of countries that have already done this: Austria, Belgium, France, Israel, Norway and Portugal. The U.S. was mentioned, but they may not have gone as far as these other countries, which cover both predictive and diagnostic genetic testing. What do these countries know? Why can they do it and we can't?
Mr. Swedlove: Every insurance market is different. I can't say that the situation that would arise elsewhere would be the same as here, but the market closest to Canada is the insurance industry in the United States. I would note that in the legislation that's adopted in the U.S., they exempt life insurance, critical illness insurance and long-term disability insurance. Those are essentially the areas that we're talking about today. In our view, and in their wisdom, they have exempted those areas from any kind of legislation. If that's something that you would like to be considered for this bill, then we would obviously be supportive of that.
One of the more recent countries to review this issue in earnest was Australia. Australia decided that the principle and concept of equal information and underwriting based on the risk associated with the individual should be maintained. Therefore Australia decided not to put a ban on any kind of genetic testing information flow and, instead, they have adopted an approach similar to the code that we brought forward last week.
Senator Eggleton: You have used the phrase ``equal information'' a lot. Equal information means, okay, person A, you don't need to go get genetic testing and we're not going to ask you to get genetic testing, but if you do get it equal information means you share it with us. Is that right?
Mr. Swedlove: That's correct, sir.
I should note that if you have insurance already in place and, for example, a whole-life policy in place and you then get a genetic test, that information is not relevant to your policy.
Senator Eggleton: That's important to know. It doesn't affect any policies that are in existence before this test is done.
Mr. Swedlove: That's correct.
Senator Nancy Ruth: Mr. Swedlove, I wanted to ask about the new industry code that you've all come out with. Your fifth point said that it will require companies to assist applicants who are not eligible for insurance. How would an insurance company do that?
Mr. Swedlove: I will ask Mr. Zinatelli to provide more detail on that.
Mr. Zinatelli: Thank you senator. The objective of the industry is that if a person is not able to obtain insurance after their application, you want to be as helpful to them as you can. The way to do this is to first indicate to them that there are other insurers. This is a very important matter because the life and health insurance industry is a very competitive market. If you are not able to get insurance at one company you should try a second, third or fourth because different companies have different risk tolerances. Also, different companies focus on ensuring types of conditions they are familiar with because they can then better assess the risk and better understand the level to which they are prepared to ensure people with different conditions.
Another way is to point out, for example, that there are guaranteed products in the market. You can get significant insurance through guaranteed policies that are out there, so those are two ways at least that we can try to help consumers if it turns out that a particular company cannot offer them insurance.
Senator Nancy Ruth: In the last point you say that companies have to report, to ``certify annually.'' This is a self- reporting mechanism. Well, Parliament gets pretty used to self-reporting mechanisms, and I don't put much weight in any of them.
I need to ask: What are the penalties if you see a misinformed report? What kind of weight are you going to throw at companies that are fiddling around?
Mr. Swedlove: Senator, the compliance with the code is obligatory for being members of the Canadian Life and Health Insurance Association, so all our members have agreed to follow the code and to do this self-audit.
Senator Nancy Ruth: Who evaluates the self-reporting?
Mr. Swedlove: They will do a self-audit, but there is no question that if there is non-adherence to that then there will be a lot of pressure on these companies to comply.
Senator Nancy Ruth: How will you know that?
Mr. Swedlove: We will hear from people. Certainly, there are a lot of interest groups out there that will ensure the code is being followed.
Senator Nancy Ruth: How does it work in your industry? It's not like a court, is it?
Mr. Swedlove: Correct. We're not a regulatory agency, and we will rely on our members to show goodwill in doing this, but also the public will be watching, and we expect that they'll live up to the commitments they've made.
Senator Nancy Ruth: Would it be fair to expect those companies who might fudge this line are perhaps those that tolerate more risk?
Mr. Swedlove: No, I don't think so. The focus of insurance companies is to continue to be viable organizations. We have regulators who make sure that that's the case, and that's a very important element of what they do. The risk they take on is a calculated risk, but, as my colleague has noted, with different companies there are different interpretations of risk, and that's why you'll see different underwriting approaches.
Senator Nancy Ruth: When I first looked at Senator Cowan's bill I did think it was just a matter of who was going to make money. Would the insurance companies lose if such a law came in or was it the individual who was going to gain? I must say I was a bit surprised by your examples. Maybe I'm just naive and I don't like pyramid schemes anyway, but it sure smelled. I guess those things happen in life.
It's still all about the money. Is it society's job for the shareholders of an insurance corporation to bear the freight of illness in society, such as we do through our taxation in our provincial health schemes, or is it the individual who has to take all the knocks? For me that's a fundamental question. What kind of response do you have to that?
Mr. Swedlove: In our view, this is not a zero-sum game. It's not an issue of some people will be better off and everyone else will be the same. What has been shown by the Canadian Institute of Actuaries and is well-documented elsewhere is that if at the end of the day genetic testing cannot be considered in underwriting of policies, then that will affect the premiums elsewhere. This is not a matter of a few people being better off and the insurance people taking a bit of a hit and then everyone else being okay.
Underwriting of insurance is basically taking the total risk associated with a set of people and assigning the costs associated with that. To me this is not an issue of the profits of an insurance company, it's an issue of who gets to pay for this responsibility; and we're saying the pay and the cost of that can be significant.
Mr. Howard: I think you'll find that the insurance companies are strong enough and knowledgeable enough to take care of themselves, but I'm not sure that that's true of the insuring public. There will be higher costs. Unless the premium goes up, then the insurance companies will have to pay. They're not going to do that. The premium for the insuring public will go up, and I believe it will go up very dramatically. The more we know about genetics, the more opportunity there is for that cost to go up to the insuring public, the ordinary Canadians. That's where the cost lies. That's why the Canadian Institute of Actuaries is concerned about the impact of this on the public.
Senator Munson: A number of folks here have referred to the new position statement on industry code on genetic testing for insurance underwriting. Section 5.9 of the new policy, on family member test results, says that insurers will not require the genetic test results of any person other than the proposed insured nor seek to obtain those test results independently.
Is this happening now? Are insurers requiring disclosure of genetic test results for persons who have not even applied to them for insurance?
Mr. Zinatelli: We have heard this anecdotally from folks indicating to us that this sort of thing was happening, and also we had seen that Australia had actually put a provision in their code restricting this. We thought to make it clear that we don't do that. We just wanted to make it clear that companies are looking for the genetic information of the life insured, of the person whose life is going to be insured, and not of other folks in their family. In a sense, it was more a question of clarity to close the loop on that one, as it were.
Senator Munson: Closing the loop, it's not happening anywhere in this country.
Mr. Zinatelli: To my knowledge, it is not. As I said, it was anecdotally something we had heard and, in that other document, we thought, ``Let's put it in and make it clear.''
Senator Munson: I am sure that Senator Cowan has more complex questions to follow up on this sort of thing, but I am just trying to figure out why it was mentioned that the Israeli government has a law. I didn't get an answer in the sense of why Israel felt compelled to do what they did and why other countries seemed to go halfway. Obviously some countries feel that it's not working and a law needs to be put into place to protect people. Do you know if there was a problem in Israel as opposed to Canada?
Mr. Zinatelli: Senator, we don't have that information. Like some other folks that answered the question, we would be happy to look into that, particularly when the provision was put into place, because there was a period following the early 2000s when the human genome was first mapped and there was kind of a reaction to that happening. A number of European jurisdictions, as I think Senator Cowan and others may have suggested, put in some rules, which perhaps in retrospect they may have moved too quickly on. That is certainly a comment I have also heard.
Senator Munson: My third question I think was referred to by Ms. Jensen. Do we know of people in this country who have had genetic testing, and insurance companies see it and they're not going to be insured or employers see the test and say, ``Sorry, you can't work here?'' Do we have this in this country, and do we have it by the hundreds or the thousands of people being discriminated against, or allegedly discriminated against, because they have been genetically tested and were denied insurance by insurance companies or denied a job?
Ms. Jensen: Not to my knowledge, and there are no reported decisions to that effect. The UBC study that I looked at said that 6.4 per cent of the respondents in that study, and I'm sorry I can't tell you how many there are, but 6.4 per cent reported that they felt there had been discrimination in their employment circumstance. Whether that means there was discrimination or whether they were fearing discrimination, it's hard to know. Certainly one thing I have thought about is that employees do not always realize that they do have protection under the Canadian Human Rights Act, under their collective agreements, and under labour and employment law to complain about perceived discrimination on the basis of genetic characteristics. The protection is there for them, should they feel that they are victims of discrimination. Having practised in this area and practised almost exclusively in human rights law at the federal and provincial levels, I have not encountered that ever.
I did also want to apologize for saying ``Bill C.'' I think it rolled off my tongue too easily. No disrespect was meant.
Senator Munson: We know what we're doing here.
Mr. Zinatelli: May I comment on the insurance side? We certainly know of a recent study by professors at McGill where they looked at various past academic papers on the issue of genetic discrimination, and they found that there was no evidence of this happening. This was a couple of years ago. It was just a compilation of all the various studies that have been done. One of the authors was Yann Joly, and there were two other authors. I can make that paper available to you.
Another point may be relevant to your question, and that is that in some of the provinces, it is an unfair and deceptive practice for insurance companies to charge different premiums to individuals of the same class, of the same risk. Insurance companies look at the risk and assess what the level of risk is and then, by law, they are required to charge those people with the same risk a similar price. I think maybe that touches on what you might have been asking about unfair discrimination.
Senator Cowan: Senator Munson asked one of my questions, but there was another one that goes back to the discussion I had with Mr. Howard a few minutes ago. Perhaps I can get Mr. Swedlove and Mr. Zinatelli to comment.
We were talking about the effect, the large increases in premiums that would result if this kind of legislation were in place. I pointed out to him that the experience in Britain has been exactly the reverse. He gave his explanation as to why that was so. There are variations of this kind of legislative regime. It can either be diagnostic or predictive, cover one or both. Sometimes it's an industry registry guideline. Other times there are bans or moratoriums. Various types of mechanisms are used.
Are you aware of any insurance market where the kinds of rate increases that Mr. Howard talks about have in fact taken place and where the kind of detrimental effect upon the insurance market that he describes has taken place?
Mr. Swedlove: When you're doing international comparisons, it can be difficult. I will give one example. In continental Europe, long-term insurance is not a big product. Most of the product that is sold is short-term, a kind of term insurance that applies. Almost by definition, this situation would not arise in some of the countries that you have identified in continental Europe simply because if there is a genetic test that may suggest that 10 to 15 years from now you might be more likely for premature death, you would not be able to purchase a product that would assist you in that regard.
Senator Cowan: A whole-life policy?
Mr. Swedlove: That is right. If you had to buy an individual term, you would have to buy 10 years of it potentially and still be paying for it without having any costs associated with it. Canada has an industry that is very much focused on whole-life policy, long-term policies. That's the basis of our industry since its inception, so therefore I think the impact would be significantly greater.
Also, I just simply believe that, as Mr. Howard noted, we don't really know the impact and the results of these countries because we don't have the experience yet to demonstrate it, so one has to be predictive in going forward in terms of the impact that would occur. I understand that was the basis of Mr. Howard's model.
Senator Cowan: Surely you make predictions based upon past experience. That's what you do.
Mr. Swedlove: It can only be past experience if you know the results related to the genetic test. If there's a ban in those countries, how would you even know the results?
Senator Cowan: Let's take insurance markets in other countries that deal with whole-life. What has been the impact there?
Mr. Swedlove: That could be a smaller proportion in continental Europe. We have already heard about the U.K. situation. Australia does have some longer-term insurance and has chosen not to go this direction.
You have to reflect on the individual insurance market that exists. We can find out what has occurred in Israel and some of these other countries and see to what extent their experience is similar to ours, but we believe, based on some pretty hard empirical evidence with underwriting experts, that the impact would be significant.
Senator Cowan: Does the experience that you speak about in Europe apply to Israel as well? Is their insurance market primarily term insurance rather than whole-life?
Mr. Swedlove: Senator, I don't know the Israeli experience. We'll look into that.
Senator Cowan: Mr. Zinatelli, at one point you said in response to Senator Eggleton or Senator Nancy Ruth that some countries may have jumped the gun and brought in regulations that they now regret. Those weren't your terms but something like that.
Are there countries you're aware of that have imposed a ban or moratorium or made some legislative intervention and have now pulled back from that?
Mr. Zinatelli: Not to my knowledge, senator. I have heard those comments anecdotally from people in academia who look at those things in detail, but I don't know of anybody who has retracted. As one can foresee, once a ban is put in place, it would be very difficult to go back.
Senator Cowan: Are there not instances where a moratorium or a voluntary code has moved into protection in legislation?
Mr. Zinatelli: In this area, the only moratorium that we've discussed today is certainly the U.K., and it continues to be a moratorium that is renewed on, I think, a five-year basis. I do not know of an experience where there have been other moratoria in other countries, senator.
Senator Andreychuk: Just curiosity, I have to admit; Ms. Jensen, I want to go back and read what you've said because you've covered a lot of legal points and that's my area of interest. You were talking about discrimination, and certainly there are no hierarchies of human rights. Therefore, the DNA has been equated to disabilities, and you're looking at the human rights discriminations, et cetera, vis-à-vis employment. Has DNA, if you have studied it, been used elsewhere other than in the employment area as a discrimination, or is this a unique field that we're first starting with our DNA information?
Ms. Jensen: To my knowledge, yes, this is the area where I could see potential. The federal Human Rights Act and all the human rights legislation cover things like goods and services, accommodation and so on. Obviously, insurance falls within contracts or services, so potentially, that's where the litigation around discrimination on the basis of genetic testing would happen, under the protection that's provided against discrimination in the provision of services or in the formation of contracts. That's where you would find that sort of protection.
I'm not aware of genetic testing being held up as a barrier in the provision of any other kind of service or accommodation at all, but I do see why the link to employment is there, certainly around issues like benefit provisions.
It's also worth noting that most human rights legislation provides exemptions for employers against claims of discrimination on the basis that the employee did not qualify for a benefit plan, for example, because they failed to meet the health requirements. So there are benefit regulations under the CHRA that specifically exempt employers from insurance-related discrimination, from anything that anyone could act on or bring a complaint on. So these kinds of reforms would need to be examined more carefully to see the relationship between those exemptions and the reform proposals.
The Deputy Chair: Seeing no other questions, I call an end to the meeting.
Thank you, senators, and thank you, witnesses, for being here this evening.
(The committee adjourned.)