Medical Assistance in Dying Committee on Oct. 4th, 2022

[The Joint Chair, Hon. Yonah Martin]

Be very brief, Dr. Kelleher.

[Dr. Eric Kelleher]

Can he clarify the question, please? I didn't hear the question clearly.

[The Joint Chair, Hon. Yonah Martin]

My apologies, but we have run out of time on this one.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

Thank you.

We can move on to the next person.

[The Joint Chair, Hon. Yonah Martin]

We'll move to the next questioner, Monsieur Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Madam Chair.

I have the following question for you, Mr. Henick, because your testimony was based on your personal experience. You also heard Dr. Grou's testimony.

If you have read the panel's report, what makes you think you would have been eligible for medical assistance in dying when you were not well?

You look very young—younger than I look at least. What makes you think you would have had access?

[Mark Henick]

Thank you for that question and the opportunity to follow up on that.

I am convinced that I would have been an eligible candidate. I had been in and out of hospital involuntarily more than half a dozen times. I had been transferred to different hospitals. I was on locked wards. I was on more than a dozen different medications, and nothing really seemed to work. I talked to plenty of different doctors. It was chronic and persistent for enough years that I absolutely would have been a candidate, and should this legislation have continued to unfold toward allowing so-called mature minors, I would probably have qualified much earlier on.

I am so grateful, so eternally grateful, that MAID for mental illness was not available when I was struggling, because I was convinced that I wouldn't live to see another day, and I have. I think everybody deserves that opportunity too. If you really look at the root causes of why people are struggling for so long, it's not that the treatments don't work. We have lots of evidence to suggest that they do and that the real problem is access and getting connected to those treatments, which was exactly what I experienced.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Henick. You've answered the question. I'm sorry for interrupting you.

Since I don't have much time, I'll now turn to Dr. Grou.

Dr. Grou, you've read the report as well. You've told us that you support it.

If we were to move in the direction of allowing requests for medical assistance in dying from people with mentally illness when that would be the only medical reason given, how could that be considered an impediment to suicide prevention?

[Dr. Christine Grou]

Suicide prevention is an important area to continue to work on, including providing access to care and continuity of care. There is clearly a ways to go in this regard.

However, suicidal patients shouldn't all be lumped together. For suicidal patients where this is an expression of the moment, an impulsive expression, and who are doing better two weeks later, we should continue to treat them and do prevention work.

The situation is very different in the case of a person who has a physical health problem, who no longer has any quality of life and who becomes suicidal in a thoughtful and reasoned way. In that case, we will consider medical assistance in dying.

Take someone who has a mental health problem that they can't break free of, who can't get better, and who has suffered intolerably for a long time. That person could also, in a thoughtful and rational way, prioritize the quality of their life over the sanctity of life and have a desire for death. This suicidal person, who wants to die, is therefore more like a person who might apply for medical assistance in dying and may be the one to do so. Not all suicidal people are the same, and not all motivations and suicides are the same.

If you're talking about someone who has thought long and hard, who has been offered treatment, and even different treatment options, who has a treatment program that hasn't worked, who wants to stop suffering, and who is contemplating death, there are two choices. I can assure you that there are patients who are going to take their lives anyway in a context like that and in a thoughtful way. Would we rather force them to die alone, in conditions that are sometimes risky, or would we rather allow them this care, which is offered to any other patient, so they can have a more supported, more dignified and safer death?

In both cases, perhaps we should give these patients access to medical assistance in dying. If we don't, isn't that denying them a fundamental right and, again, taking a step backwards in mental health by saying that we're going to respect the autonomy of all patients in their choice of treatment, in their desire to be treated or not, and even in taking responsibility for their treatment? Isn't that saying that we will respect their autonomy for everything, but not for their request for medical assistance in dying, and that we will exclude them once again? This sets mental health and the rights of mental health patients back by half a century.

[The Joint Chair, Hon. Yonah Martin]

Merci.

Mr. MacGregor, the floor is yours for five minutes.

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

Thank you, Madam Co-Chair.

Thank you to the panellists for being with us today.

Mr. Henick, I'd like to start with you. I appreciate your coming before our committee and sharing your personal story.

Ultimately, what was the treatment that led to your success and where you are today? I'd like to know a little bit more about the medical professional who was involved in helping you with where you are today and about the treatment that made your personal story a successful one.

[Mark Henick]

I wish I could tell you that it was something more eloquent than luck and time, because some of the treatments I received made me a lot worse. There is a well-known warning on prescribing antidepressants to kids—now if they're under 30, but especially if they're just teenagers, as I was. I was on more than a dozen different antidepressants, antipsychotics, anxiolytics, sleeping pills, hypnotics, anti-seizure medications prescribed off-label for various reasons, and a number of others.

In some ways my treatment actually hindered my recovery. What I experienced with my in-patient hospitalizations was largely traumatic.

It was only after I was able to go off to college, get a better social support network and start getting into therapy.... I had never had access to psychotherapy in a meaningful way when I was in the acute valley of my struggle. It was only through that kind of social support, time and doing something different with my life that I was able to see that I was capable of so much more than I thought before.

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

I'm sorry to interrupt, but I have limited time and I have a few more questions for you today.

You did state that had medical assistance in dying for a mental disorder as a sole underlying medical condition been available, you would have applied for it. Can you say with certainty, given the guardrails that exist in our Criminal Code, that...? You need those two independent medical practitioners.

It seems to me it's a hypothetical here. You're saying with certainty that it would have been granted, but we can't truly know that for sure, can we?

[Mark Henick]

Well, you yourself can't, but you learn, when you've been an in-patient in a hospital enough times, what to tell doctors in order to get them to do what you need them to do. I was able to get out of hospital when I shouldn't have been. I was able to get into hospital when I shouldn't have been, perhaps. When you're a “frequent flyer”, as I was frequently called, you learn how the system works.

I saw that as a mental health professional, as well. Patients do that all the time.

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

I want to clarify.

For medical assistance in dying for people suffering from physical ailments causing them grievous and irremediable harm, and they're going through that suffering.... Are you in support of that for physical ailments?

[Mark Henick]

Like [Inaudible—Editor].

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

Are you in support of it for someone who has terminal cancer?

[Mark Henick]

Sure. I don't have a blanket opposition to medical assistance in dying, no. I think it's a false comparison between the two, however.

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

I want to dig down on that, because we've had previous witnesses talk about the section 15 rights to equality before and under the law. We know the view the Supreme Court has taken on these things. The fact of the matter is that the law has already been changed. We're looking at this after the fact.

I'm saying this with respect, really. It's a truthful question. How do you reconcile your view with someone's section 15 rights? What if there were someone with a mental disorder who had a completely polar opposite view to yours? Are you saying that your view should override their personal story and subjective experience? I truly want to dig down into your viewpoint on that.

[Mark Henick]

I'm saying that the treatment pathway for each of those conditions is very different. Chances are somebody who has end-stage cancer—as a previous witness mentioned—has a much clearer picture that that their condition is indeed irremediable and that they are indeed going to die anyway or in the foreseeable future, even though that part is different now. They likely didn't experience the same kind and degree of stigma, discrimination and failure of social supports that somebody with a mental health problem or illness did.

I can absolutely defend treating them equally in isolation, because the contexts that lead people to that point are very different.

There's also the added piece that mental illness will, by definition—even if you don't lose decision-making capacity—inform the decisions you make. We can't ignore that context.

[The Joint Chair, Hon. Yonah Martin]

Thank you, Mr. MacGregor.

I will now turn this over to Monsieur Garneau, my joint chair.

Thank you very much.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Senator Martin.

We'll go to the senator round of questions for three minutes each. We'll have to stick to those three minutes.

We'll start with Senator Mégie.

[Marie-Françoise Mégie]

Thank you very much, Mr. Chair.

I'd also like to thank the witnesses for being with us.

My question is for Dr. Grou.

Dr. Grou, you said that you agreed with the idea of not including new guidelines for people whose mental disorder is the sole reason for requesting MAID. You also said that the same guidelines can be used, but they must be properly managed.

Do you have an example of a shift that might have occurred with respect to the guidelines?

I'll ask you a second question right away because I only have three minutes. This will let you organize your answers accordingly.

What could you suggest from a regulatory perspective to guide MAID assessors in the case of individuals with a mental disorder?

[Dr. Christine Grou]

As far as the guidelines are concerned, in fact, the Quebec Commission spéciale sur l’évolution de la Loi concernant les soins de fin de vie believes that the guidelines are adequate, if they are properly interpreted. In terms of operationalization, we have made a series of recommendations because that's where a lot of work needs to be done.

However, there is no doubt that great care must be taken when assessing the patient's personal history, particularly when assessing the likely irreversibility of the mental disorder. It is extremely important to take the time to do this, with the patient and with the family. A history of treatment, outcomes and periods of remission should be taken. For example, it should be determined how long the remissions lasted.

It's necessary to try to establish a kind of pain pathway or pain intensity, even if it's subjective. It's important to be able to estimate the intensity and permanence of the suffering experienced. The other thing that is absolutely fundamental is to ensure, as a society, that there is access to services and that access does not vary from region to region. We must also ensure the quality of services.

The guidelines provide for the services of competent professionals who will inform the person not only of their health problems—because they are often multiple—but also of the treatment options that are available.

The process also includes a reflection period. Consent is a process. In mental health, we have the time to do things properly. We have to look at all the guidelines. Competent professionals must be called upon to provide a proper assessment.

Since ambivalent patients aren't eligible, care must also be taken to ensure that the person's decision is persistent and consistent with their values. A desire for death must not be an expression of the disease or of one of its recurrences.

[The Joint Chair, Liberal, Marc Garneau]

Thank you very much, Dr. Grou.

We'll now go to Senator Kutcher.