Thank you, Madam Chair, for the chance to speak.
My name is Sonu Gaind. I'm a professor at the University of Toronto and chief of psychiatry at Humber River Hospital, where I serve a diverse population, including marginalized communities. I'm a former president of both the Canadian Psychiatric Association and the Ontario Psychiatric Association and I sat on the Council of Canadian Academies panel on mental illness. I've worked in psycho-oncology with dying patients and their families throughout my career.
I'm speaking as an individual; I'm not representing any group I work with.
I'm also physician chair of my hospital's MAID team and not a conscientious objector. I don't bring any particular ideology to the issue other than advocating for evidence. I believe sensitive public policies like this demand a non-ideological, evidence-based approach. I've seen the benefits of MAID in appropriate situations like Mr. Baylis'. I have also been sensitized to the dangers of MAID in inappropriate points. I've come to realize that our MAID expansion to non-dying disabled and those suffering from solely mental illness is a tale of two cities—of two worlds, actually.
Evidence shows that when death is foreseeable, people seek MAID to preserve dignity and autonomy to avoid a painful death. Those seeking MAID in these situations tend to be, in researchers' words, white, more educated and more privileged. That's been used to suggest that MAID is safe to expand to other situations.
However, when expanded to the non-dying disabled for mental illness, that association completely flips. A different group gets MAID. These are the group of non-dying marginalized, who have never had autonomy to live a life with dignity. Rather that death with dignity, they are seeking an escape from life's suffering. They do overlap with those who are suicidal in the traditional sense.
Evidence shows that this group is more marginalized and has unresolved psychosocial suffering, such as loneliness and isolation. A terrifying gender gap emerges of twice as many women as men receiving death to avoid life suffering.
Introduced to help avoid painful deaths, MAID expansion provides these marginalized, non-dying people with death to escape painful lives. Worse, many of these people could have gotten better. CAMH, the Canadian Association for Suicide Prevention and others have concluded that evidence shows we cannot predict irremediability of mental illness in any individual.
I can't comment on the federal mental illness panel's specific recommendations, since their report is delayed. Still, the panel cannot manufacture non-existent evidence. That panel was charged with recommending protocols, guidance and safeguards on how to implement MAID for mental illness, not with reviewing whether that can safely be done.
That and the sunset clause is not how science works. No drug company is told their sleeping pill will be approved in two years without evidence of effectiveness or safety while being asked to develop instructions in the meantime on how to use the pill. The sunset clause and the federal panel's mandate are based on less evidence than is required for introducing any sleeping pill.
In bypassing the primary safeguard against premature death, which is getting MAID only when we can predict irremediability, any other so-called safeguards can be no more than false reassurances and lip service. Marginalized people in despair who could get better will get MAID. I think it bodes ill that a member of the 12-person panel resigned months ago, though her name remains on the public website.
While over 85% of Ontario psychiatrists who responded in a recent survey supported MAID in general, less than 30% agree with MAID for solely mental illness. They opposed the sunset clause by a 3:1 margin. The Quebec commission has now recommended against providing MAID for sole mental illness.
Last March in the House, Monsieur Thériault said, “If the expert panel and special committee arrive at the conclusion that mental health should be excluded, it will be excluded.” The panel's narrow charge would have prevented them even considering excluding mental health. I call on you now to listen to the evidence and honour that commitment through this special committee.
I grew up hearing the story of the Komagata Maru and about those who were refused entry to Canada and sent back to India, some to their deaths. As a child, it showed me that the policy, the continuous passage act, could ostensibly be the same for everyone, yet in actuality be racist towards some. I view our current MAID expansion the same way. That's the tale of two worlds. It's the same law, but with different impacts on different groups.
It's a myth that expanded MAID is just about autonomy. The planned expansion and sunset clause may increase privileged autonomy for some to die with dignity, but it will do so by sacrificing other marginalized Canadians to premature deaths for escaping painful lives that society failed to allow them to live with dignity. That's not my Canada, and it should not be yours.
Thank you for listening. I'd be happy to answer any questions.