Thank you so much.
I would like to start out by thanking the committee for inviting me to give testimony for your important study.
I have practised and taught emergency medicine for over 30 years in a teaching hospital that had a psychiatric ER unit. I am also a clinician-scientist, and I was a member of the research ethics committee of the same hospital for seven years. I am therefore well aware of the notions of capacity to consent to care, of suicidal risk, of informed consent and the right to self-determination. I am now at the end of my career and my practice almost exclusively consists of providing medical assistance in dying.
At the ER unit, I was called upon to evaluate hundreds of patients suffering from mental disorders who were at crisis point. I remember one patient who was receiving excellent support from multidisciplinary teams within our system, but for whom effective treatment options were limited. At one point, she started to suffer from major health problems and decided to refuse treatment. This was not enough, unfortunately, and she took her own life after suffering for many years. Perhaps she could have had a more serene death.
My time as a member of the ethics committee was also an enriching experience. I think that the current debate is similar in many ways to research ethics. It seems that by claiming to protect vulnerable populations, we ignore them or exclude them from the accepted rules that apply to the general population. Paradoxically, we find ourselves discriminating against them, which by definition is contrary to our ethics.
The current law already establishes conditions for eligibility to medical assistance in dying, and these conditions could very well be applied to mental disorders. Of course, in cases where a mental disorder is the sole underlying medical condition, we do see some difficulties in applying the rules, especially when it comes to establishing capacity, incurability and irreversible decline. Moreover, it is not always easy to distinguish between suicidal ideation and a reasonable request for MAID.
In those cases, what conditions or safeguards would we need?
As a practitioner providing MAID, I believe it would be important and necessary that the professional opinion of a psychiatrist be part of the file to confirm the incurability and the irreversibility of the patient's mental disorder, as well as the absence of criteria contraindicating MAID. That said, I do not think that the two assessors have to be psychiatrists, especially as a lack of resources could constitute a huge barrier, especially in remote areas.
If the attending psychiatrist wishes to be an assessor, that person would be, in my opinion, the most appropriate candidate. That person would be able to establish the grievous and incurable nature of the disorder affecting his or her patient, their suffering as well as their capacity to consent. I believe that by requiring a second psychiatric evaluation in these circumstances, we would be creating another barrier that would unduly reduce these patients' access to MAID.
In conclusion, I believe it is important to eliminate the discrimination surrounding access to MAID for patients for whom a mental disorder is the sole underlying medical condition. It is possible, with the appropriate framework, to ensure that these patients are deemed eligible. However, the framework must not constitute an insurmountable barrier to patients who are suffering hugely.
I thank you for your attention and I would be pleased to answer any questions.