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

[Pierre Dalphond]

Thank you, Mr. Chair.

My question will be for Dr. Grou and perhaps also Dr. Marleau.

Brian Mishara, a professor at the Université du Québec à Montréal and director of the Centre de recherche et d'intervention sur le suicide, enjeux éthiques et pratiques de fin de vie, has studied the practice in the Netherlands. He concluded that the average assessment of a person requesting medical assistance in dying for mental health reasons took 10 months—a fairly lengthy process—and that only 5% of requests were granted.

Dr. Grou, from what I heard earlier, in 30 years you've seen two cases that met the criteria suggested by the special committee that recommended guidelines.

In your experience as a clinical psychologist and president of the Ordre des psychologues du Québec, do you think that the trend observed in the Netherlands would probably be the same here in Canada?

[Dr. Christine Grou]

I always have trouble formulating a hypothetical answer when there are no data.

I can speak from my clinical experience, though. I did work in psychiatry for 25 years and chaired the ethics committee.

In general, patients with mental disorders want to live, get better and recover. This is the case for the majority of patients. The majority of health problems are treatable, even those that are complex or unresponsive.

In my life, I have seen two cases, one of which involved a patient who was very determined to end his life and who wanted to die humanely because he was not capable of living.

You know, in psychiatry we sometimes meet people whose lives give the impression that all the misery has been dumped on them. When I talk about misery, I'm talking about human misery, trauma, hardship, fighting, illness, lack of resources, poverty and social isolation.

There are cases where all of these elements are concentrated in one person. This often occurs in cases of severe mental disorder. I haven't often seen people who spontaneously say they have a desire for death or want to die.

Let's take the eligibility criteria. I truly believe that nothing is simple for caregivers who are trained to treat health problems and rehabilitate patients.

You know, in ethics, we find that it's much harder to respect a patient's decision when it offends our values, when it goes against what we want for them. So when we offer a treatment, and we think it's going to work, we establish a therapeutic alliance, and generally the patient wants it, because they want to get better—

[The Joint Chair, Liberal, Marc Garneau]

I'm sorry to have to interrupt you, Dr. Grou.

We will go to Senator Martin now for three minutes.

[The Joint Chair, Hon. Yonah Martin]

Thank you, Mr. Chair.

Thank you to all of the witnesses for appearing before our committee.

My first question is for Mr. Henick.

Some witnesses have told this committee that excluding people who suffer solely from mental disorders is discrimination. As a person who advocates for this community, what are your thoughts on that?

[Mark Henick]

I think that people with mental health problems and illnesses are already being discriminated against routinely. Our rights are routinely violated, and that's actually the problem. That's what's getting us to the point where we feel we have no other option than to request MAID. There has already been a long line of violations to the rights of people with mental illnesses that, in my view, supersedes any further action in this regard.

[The Joint Chair, Hon. Yonah Martin]

Thank you. On a personal level, I just want to say that your testimony was very compelling, and it does give all of us hope for the way that we can be looking at people with mental disorders, so thank you for your strength and courage.

Dr. Kelleher, witnesses have provided conflicting testimony as to whether MAID can be entirely distinguished from suicide. It's really important for us to have an answer to that question. Would you share your thoughts on that?

[Dr. Eric Kelleher]

Often there is a suggestion that there are differences between the patient who has a depressive illness and who is suicidal and one who has MAID. In practice, there is very little difference to distinguish between those two things. There is very little suicidal behaviour—whether it's lethal or non-lethal, of course—without planning. In fact, impulsive attempts are associated with people who have, possibly, a lower psychopathology. Individuals who make planned attempts at suicide are more likely to be depressed and hopeless compared to those who make unplanned attempts.

The clinical profile, as my colleague Dr. Nicolini highlighted earlier, appears to be similar in MAID and suicidal behaviour, as evidenced by the high prevalence of women in both situations. Therefore, it's unclear whether or not we can draw a firm distinction between MAID and suicidality, which poses a major problem for the practice of MAID for mental disorders.

[The Joint Chair, Hon. Yonah Martin]

That concludes this second panel, and we are exactly on time.

Again, thank you to all of our witnesses for helping us work through this very difficult topic and for lending us your expertise.

Colleagues, with that, I call this meeting to an end. We are adjourned.