Medical Assistance in Dying Committee on Nov. 28th, 2023

[Dr. K. Sonu Gaind]

That's correct.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Could you elaborate on that?

[Dr. K. Sonu Gaind]

I can, especially the two key issues that are problematic for MAID for sole mental illness. The first issue is how you predict irremediability, meaning that the person's condition will not get better. The second is how you supposedly separate suicidality—which benefits from suicide prevention—from motivations of people seeking MAID for psychiatric conditions. There is nothing in there, especially on the latter, that truly talks about how to do that, other than saying you need to make the distinction.

They talk about suicidality as referring to the thoughts, plans or actions to end one's life. They talk about a few other characteristics, and almost all of those also apply to somebody who is asking to end their life through MAID for a psychiatric condition.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

I don't know about the other committee members, but all along I've been operating under the assumption anyway, or this idea, that one would only be eligible after looking over—let's take a number—a 15-20 year span of treatment that did not bear fruit. But you're saying this is not in the law, of course. Did you say it wasn't in the module as well?

[Dr. K. Sonu Gaind]

In the guidance they give, it is true that—

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Is this the Health Canada guidance?

[Dr. K. Sonu Gaind]

Actually, it would also be even from the expert panel report. They do talk about how you should weigh the lengths of treatment, but they don't actually say how many treatments or the lengths or types you should have, which is very different than any other guidance we have, even on issues that don't lead to death.

When we're going through what the next step is for somebody who has treatment-resistant depression, for example, we actually have guidance on the sorts of paths we should take. Here it is left completely up to the assessor, and that's the problem because there are no legislative safeguards there. Some assessors may well be very dedicated and comprehensive; others will not be.

I can tell you—just very briefly—that I was speaking with a colleague yesterday—

[The Joint Chair, Hon. Yonah Martin]

I'm sorry, Dr. Gaind. You have seconds.

[Dr. K. Sonu Gaind]

—about a patient who got MAID while on a pass from psychiatric hospitalization, and the psychiatric team had not even known.

[The Joint Chair, Hon. Yonah Martin]

Thank you very much.

Mr. Thériault, you have two minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Okay. Thank you.

You said earlier that in your 25 years as a psychiatrist, a small number of patients had eluded your help. You weren't able to help them get better. Doesn't that prove that this wouldn't capture a huge number of potential requesters, that only a small number of people would have access to MAID, contrary to what you're saying?

If MAID were made available to them, what conditions would you want to see imposed?

[Dr. K. Sonu Gaind]

I'm going to answer your question from someone who has done a data analysis on this. He's an internationally renowned researcher on MAID and suicide numbers. He estimates that, as a lowball estimate, it will be 1,250 to 2,500 cases per year, but it actually would be higher. The basis of that is that about 5% to 10% of requests for MAID are granted in the Netherlands. When you translate all of that, it suggests that, in Canada, we would end up having between 2,500 to 5,000 requests, and the rules in Canada are more lax—

[Luc Thériault, Bloc, Montcalm, QC]

We already know that.

I asked you a specific question.

[Dr. K. Sonu Gaind]

I'm sorry. I misunderstood. I thought you asked me if it would be a small number of cases, and I said that it wouldn't be. Did I misunderstand the question?

[Luc Thériault, Bloc, Montcalm, QC]

What I said was that you told us that, in your 25 years of practice, a small number of patients had eluded your help. Contrary to what you are arguing, then, no doubt only a small number of patients would be able to request MAID or be eligible for it.

Would the patients you weren't able to help have been eligible for MAID, according to your criteria? Conversely, do you reject the possibility outright because you don't think there are ever appropriate conditions in which people who request MAID should receive it?

That's my question.

[The Joint Chair, Hon. Yonah Martin]

I apologize, Dr.—

[Dr. K. Sonu Gaind]

I see what you're asking, Mr. Thériault. I don't have a time machine, so I cannot go back in time and predict in advance. If I had, many more would have actually thought that they'd never get better.

[The Joint Chair, Hon. Yonah Martin]

Now we have the last questioner, Mr. MacGregor, for two minutes.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Dr. Gaind, I'll ask you a question that I asked one of the witnesses in the first hour's panel.

I've been on this committee from the beginning. What I've struggled with is recognizing the fact that individuals have rights, have agency, have capacity. Those are constitutionally protected rights. However, also, as a society, we have a duty to protect the most vulnerable. I'm indirectly alluding to the constitutional arguments about this: the fact that, yes, we do have rights and freedoms but that those rights and freedoms can be subject to a section 1 analysis, which can place reasonable limits on them.

My question to you as a physician, a psychiatrist with your years of experience on this specific subject, is this: How have you personally approached trying to reconcile the rights of individuals with their agency, their capacity, their ability, to make decisions for their own body versus our collective rights to defend the most vulnerable?

[Dr. K. Sonu Gaind]

That's an excellent question; it gets to the heart of a lot of this.

I can tell you that, at the beginning, I used to end my talks with a precariously balanced kind of picture that suggested that we're going to find one bright balance point, a solid line where things are right on this side and incorrect on that side. I no longer do that because I don't think that we can find a balance point. It's the issue of overinclusion or underinclusion. To me, the question becomes this: Which mistakes do we want to make? I think that offering and providing death under false pretenses is a pretty big mistake.

The other point I'll make is that when we expand to sole mental illness, are offering death under the false pretense of saying, “Your medical condition won't improve”—and more than half of the time we would be wrong in that—and think we can separate suicidality.... These are also people who are more marginalized through psychosocial suffering, which we also know fuels MAID requests as you get further and further away from reasonably foreseeable death. People shift to try to escape a life of suffering, and that's challenging.

[The Joint Chair, Hon. Yonah Martin]

Thank you, Dr. Gaind.

With that, I would like to thank all of our witnesses for your testimony this evening and for answering all our questions. We have reached the end of this panel.

[The Vice-Chair, Conservative, Shelby Kramp-Neuman]

I did see, Chair, that MP Cooper has raised his hand.

[The Joint Chair, Hon. Yonah Martin]

Okay.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Chair.

Just very briefly, I have two questions for the clerk. For the public record, as part of the body of evidence for this study, would he be so kind as to confirm the number of briefs this committee has received? How many will the committee be able to use as part of the body of evidence in its report?

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Madam Chair, we're going into committee business momentarily. I believe this is an issue that, amongst others, will be addressed then. That's not to say it can't surface again. I'm not sure this is the appropriate time to discuss it.