Thank you very much for having me.
Good evening, members of the committee.
I appreciate this opportunity to testify on a matter of profound concern to the people across the country who are afflicted with severe, treatment-resistant mental disorders. I'm drawing upon a submission we made to the special joint committee in November 2023.
This is an issue that concerns us deeply at Dying with Dignity Canada because it speaks to the rights of persons who have both historically and presently been deprived of section 7 and 15 charter rights to make autonomous and lawful decisions concerning their end-of-life choices simply because their illness is psychiatric in nature and not physical.
The bill before you would extend the denial of access to MAID assessment for those whose sole underlying condition is a mental disorder for a further three years, until March 2027.
Given that Bill C-7, which brought in the right to a MAID assessment for those whose death was not imminently foreseeable, passed in 2021 with a sunset clause excluding that access for those with a mental disorder for two years, which was extended for a further year, means that persons in this category will have been denied for six years the same set of MAID entitlements as those with a physical illness.
It is outrageous to suggest that the development of a regime for MAID MDSUMC needs six years. It is especially egregious given that all of the metrics the government set for readiness in its last delay have been met. We have a nationally accredited curriculum and willing, competent assessment providers. We have practice standards against which regulators of physicians and nurse practitioners can oversee that conduct.
No new metrics are set in Bill C-62. What more is left to do? We need to look to those who are doing the work of providing MAID assessments and provisions; the regulatory bodies charged with the oversight of clinicians' conduct; the 127 physicians and nurse practitioners across this country who have confirmed in writing that the MAID system, MAID assessors and providers and psychiatrists who wish to be involved in MAID MDSUMC and who have testified that they are ready; the regulatory authorities; and, most importantly, patients with severe, treatment-refractory conditions who are ready for MAID MDSUMC.
No new metrics have been established for this delay. Adequate safeguards are in place, including the requirement for a minimum 90-day assessment period, the need to consult with an individual with expertise, a psychiatrist in these cases, and so forth.
We endorse the coming into force of MDSUMC because we have a duty to safeguard the rights of all Canadians. In this case, it's a small group of people tragically afflicted with acute, treatment-resistant mental disorders who, despite many interventions over long periods of time, have experienced unremitting suffering in their lives that cannot be relieved.
At DWDC, we hear from those who, for reasons of fear, embarrassment or stigma, are reluctant to speak publicly about their afflictions but who know only too well what deep, unrelenting suffering means. Even more regrettably, we hear from those who will not speak publicly for fear of being ostracized by their own communities. Often their voices are drowned out by those purporting to speak for them.
You're likely all familiar with the story of John Scully, who has spoken publicly for several years about his mental disorder, but I also hear from Jane and Cathy and others who are not able to speak publicly.
Canada regrettably has a long history of paternalism and arbitrary denial of rights for those with mental disorders, and we have often unfairly conflated mental illness with a lack of capacity. In Starson v. Swayze, the Supreme Court of Canada, discussing the need to redress decades of unfair presumption of incapacity in relation to the mentally ill, wrote, “For this reason it is particularly important that autonomy and self determination be given priority when assessing individuals in this group.”
Every year we hear from thousands of people across Canada who are seeking information or navigating the MAID coordination program across the country. Since Bill C-7 passed, the proportion of these individuals who identify as having a mental disorder as either a sole underlying medical condition or a comorbidity continues to rise.
We anticipate that many of these individuals will likely never be found eligible for MAID MDSUMC, but we cannot continue to deny them the right to apply. Doing so only serves to create further distress and angst. They have been left in an untenable position, unable to apply and suffering grievously.