Evidence of meeting #18 for Medical Assistance in Dying in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was disorders.
A recording is available from Parliament.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Dr. Grou, I would ask that you wrap it up quickly, because I don't have much time left and I'd like to ask you one more quick question.
President and Psychologist, Ordre des psychologues du Québec
If we respect the person's informed consent, that means we cannot force them to accept all care. Otherwise, it's tantamount to saying that we no longer respect their consent.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
In your opinion, these individuals need to have access to psychotherapy, and yet the availability of services varies greatly, especially in a rural region like the one I represent.
What can you tell us about that?
You say that governments need to acknowledge that.
President and Psychologist, Ordre des psychologues du Québec
What I'm saying is that the MAiD request should not be seen as a failure of the health care system.
When proposing health interventions, one must first have taken history of past interventions done with the person. Prognosis is hard to establish, yes, but it is possible to do it when a person has a long history of mental disorders. So we need to design services to keep people from requesting MAiD out of spite.
We mustn't pit quality of services and access to services against MAiD. We really need to ensure one and enable the other, and not pit them against each other.
The Joint Chair Hon. Yonah Martin
Thank you.
Mr. Cooper, you have the remaining two and a half minutes.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
Thank you, Madam Co-Chair.
Dr. Kelleher, some witnesses have warned this committee about suicide contagion, noting that in countries that allow MAID for mental illness, suicide rates have increased. Other witnesses have disputed those claims.
Based upon your research, what happens to suicide rates in countries that allow MAID for mental disorders?
Consultant Liaison Psychiatrist, Cork University Hospital, As an Individual
It's a really, really good question.
Unfortunately, there isn't a whole lot of information out there. A recent systematic review, one of the highest forms of evidence, was published this year. It said just that: that there isn't a lot of research in this field.
Several studies do report increases in the overall rates of self-initiated death, and in some cases increases in non-assisted suicide in countries that have brought in MAID-type procedures. In particular, women in some of the Benelux countries are increasingly accessing MAID for mental illness. That's a pattern. Typically, women who engage in self-harm choose non-lethal methods to do so. However, there's been a rising number of women with psychiatric illnesses dying from MAID provision for mental illness, which is in contrast to what we see in men.
Certainly some of the trends from Europe are that MAID for mental illness seems to disproportionately affect women, and in some countries it appears to also have a contagion effect in increasing the non-assisted suicide rate. That's something we see in suicide research anyway: There's also a contagion effect when there are suicides locally, and that's why we have very strict media guidelines and reporting about suicide and how it is portrayed in the media.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
Thank you.
Dr. Kelleher, could you provide the studies you have referenced to the committee?
Consultant Liaison Psychiatrist, Cork University Hospital, As an Individual
I can, absolutely. They were both published earlier this year. One is by David Jones, who's in the U.K., and another is by Professor Anne Doherty, who's in Dublin. I can send you those references, yes.
The Joint Chair Hon. Yonah Martin
Thank you, Mr. Cooper.
Next we have Monsieur Arseneault for five minutes.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Thank you, Madam Chair.
My first question is for Mark Henick.
Mr. Henick, thank you for sharing your personal experience and that you overcame mental illness, if I may say so.
Before the end your presentation, you said that if you had not fought your illness, you would have been a victim of MAiD.
Did I understand your testimony correctly?
The Joint Chair Hon. Yonah Martin
The translation is quite delayed.
Which witness did you...?
Mental Health Advocate, As an Individual
I've never applied for medically assisted death.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
You never requested MAiD, but I thought I heard you say that, had it been an option at the time, you would have requested it.
Is that what you said?
Mental Health Advocate, As an Individual
Yes, that's correct.
Had it been available during the peak of my struggles, and in fact throughout the duration of my chronic mental illness, there were many times when I would have applied.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
You never requested MAiD, and you never consulted any assessors to make a request.
Is that right?
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Thank you.
Dr. Grou, if I understood your testimony correctly, you agree with all of the recommendations in the expert panel report.
We often get stuck on the irremediable nature of mental disorders.
Do you have anything to say in connection with that and the recommendations in the expert panel report?
President and Psychologist, Ordre des psychologues du Québec
It is true that it's more complicated to make a prognosis for mental health. That said, it's complicated for some physical conditions too.
Should this apparent complexity lead to the denial of MAiD requests, or should it lead to further consideration of the issue to define better guidelines?
I feel that better guidelines should be developed.
Liberal
President and Psychologist, Ordre des psychologues du Québec
I will give you a very concrete example.
In 25 years of psychiatry and 30 years in a hospital setting, I've seen two cases where patients could have requested MAiD and might have succeeded in getting it. Given the current guidelines, it's impossible to get it at age 20 or 25. Moreover, a patient cannot get it during an untreated episode of major depression or if they don't have a long history of pain and suffering.
If a patient has been suffering for 10 or 15 years despite treatments that an independent expert considers to be relatively optimal, and if therapeutic trials are conducted and, for any number of reasons, a dark cloud still hangs over the patient's head, MAiD might be an option.
It's important to understand that some people have lived extremely hard lives and it can be extremely complex to treat certain health issues. If I say to you that someone has cancer of the soul and and it's untreatable, would you say we should condemn them to a life of suffering? Should they be deprived of that freedom to choose?
I would tend to say you have to take into account the desire for death in someone who is not capable of living and has tried everything. We're not talking about someone who's been abandoned by the health care system. We can look at the nature of the treatment, the longevity of the treatment, the intensity of the suffering and, most importantly, the duration of the suffering, including all the health conditions the patient suffers from.
You also need to consider agreement from the person and their entourage, their family, who have watched them live for 10, 15 or 20 years. In that context, do you truly risk being wrong about the prognosis? I don't think so.
Liberal
René Arseneault Liberal Madawaska—Restigouche, NB
Thank you.
My next question is for Dr. Kelleher.
Dr. Kelleher, has the research and findings you've shared with us today been put into the context of the Carter decision by the Supreme Court of Canada?
I would like to point out that the Carter case, unanimously, guided us in medical assistance in dying based on section 7 of the Canadian Charter of Rights and Freedoms. This section speaks to the right to life, liberty and security of the person.