Good morning, members of the committee.
I think it is appropriate for me to address you in French.
My name is Guillaume Barbès-Morin and I am a psychiatric physician. I appear before you today as a representative of the Advisory Committee on Medical Assistance in Dying of the Association des médecins psychiatres du Québec. I have been working for 16 years as a general psychiatrist in a small community in northwestern Quebec near the Ontario border, called Rouyn-Noranda. It is a small community of 45,000 people, far from Montreal, Toronto and Ottawa.
I work with a general clientele consisting of both adolescents and people at the end of life, in a variety of clinical settings such as emergency rooms, hospitals and outpatient offices. I assess, at the request of their primary care physician, people with simple problems, as well as people experiencing extremely serious problems and who need support, medical follow‑up, and lifelong care.
I am also asked to sometimes act as a consultant in situations where people request medical assistance in dying and we're trying to determine if their mental state is interfering with their ability to make decisions. That's a clientele I'm familiar with as well.
I would like to present to you the position of our association's Advisory Committee on Medical Assistance in Dying.
First, it is essential for us that all stakeholders understand our role, which is not to promote medical assistance in dying in general, or when a mental health problem is the only medical problem at issue. As a matter of fact, we emphasize that there is no clinical justification for routinely refusing all requests for medical assistance in dying from individuals whose only medical condition is a mental health problem. In our opinion, people with such problems deserve to have their suffering heard and assessed, even in the context of medical assistance in dying. At the same time, we are very sensitive to the fact that this must be done properly, as all the committee's work demonstrates.
It is also fundamental for us to make clear that medical assistance in dying should never be considered an alternative to accessible and adequate mental health services.
On the other hand, I would like to mention one important element. In our view, the complexity inherent in such problems is not new. It is already well known to physicians who currently evaluate situations involving medical assistance in dying. These situations involve people who are often already very vulnerable in social and other ways. The vulnerability of people with mental health problems is not something new. Mechanisms already exist to take this into consideration, and clinicians already surround themselves with multidisciplinary teams to try and best assess all of the relevant factors.
It is also very important for our committee to make it clear that the mental health issues targeted by requests for medical assistance in dying are in fact very serious mental illness issues. For us, it is important to make a clear distinction between psychological and mental suffering, which is very present everywhere in our society, and serious mental illness. The latter is a very specific and fortunately very rare thing. In our opinion, it is important to make a clear distinction in all this.
I went through the exercise of trying to determine what proportion of my patients, in the course of my personal practice, might have been eligible for medical assistance in dying under recognized criteria. Of the hundreds of patients I've assessed in my 16 years of practice, I would say that only three or four could have been eligible. We are talking about people who were suffering from extremely serious problems. Unfortunately, they couldn't find relief in all the treatments we had to offer that were available to them. I remind you that we are talking about very serious cases here, which are fortunately very rare.
That is the point I was trying to make. I'll be happy to answer your questions.