Thank you for the question. I think it's a very important one because, in my opinion, Canadians have been given false reassurances that the sort of suicidality you're talking about—that's a result of mental illness symptoms—can somehow be separated from other motivations leading to MAID requests for mental illness.
The evidence in the few European countries that allow and provide MAID for mental illness shows that to not be true. In fact, there are overlapping characteristics between those populations. The key issue here is that, when people with suicidality from mental illness attempt suicide, they do not typically succeed nor do they typically try again.
That 2:1 ratio of women to men that I mentioned is a stunning gender gap on which I have not heard a single expansion proponent address in any meaningful way. I would very much appreciate it if any of the other witnesses tonight are willing to address that. However, we think that this stunning gender gap of 2:1 women to men getting psychiatric MAID in the European countries reflects gender-based marginalization. For any psychiatrist, that should be a terrifying statistic because it parallels the 2:1 gender gap of women to men who attempt suicide when mentally ill. Most do not end their lives by suicide, and most do not try again.
What it points out is that, for people with suicidality from mental illness, we try to bring interventions and suicide prevention that can help, but we have no way of knowing whether we should be doing that or saying no and instead sending them through door B where we're going to facilitate their suicide.
The CAMAP guidelines, in my opinion—and I have openly said this—dangerously provide a reassurance that they're doing something that they do not do and that they cannot do. I've looked at those, and this is actually quite literally their stuff on suicide. It's 10 slides. They say that it takes about 10 minutes to go through it, and that includes a four-minute audio clip. There is nothing in there that actually helps separate the suicidality that we want to help with suicide prevention from psychiatric MAID requests except that one about impulsivity. They focus on impulsivity. The reality is that the evidence shows—and this is from the CCA report—that “in Western countries such as Canada, impulsive suicides constitute a small percentage of all suicide deaths, and they often occur when the person has consumed alcohol”.
It goes on, but the point is that many suicides here are not impulsive, so that doesn't help differentiate. The only other differentiating characteristic, when you go through their whole list of questions, is literally, “Is the person planning on doing it themselves, or have they come to you as a MAID assessor?”
Is that how we're deciding what's suicidal and what isn't?