Good morning, everyone.
My name is Dr. Claire Gamache. I'm the president of the Association des médecins psychiatres du Québec.
We thank the House of Commons for the invitation and the opportunity to discuss these sensitive issues.
The Association des médecins psychiatres du Québec, or AMPQ, is one of the 35 associations affiliated with the FMSQ, the Fédération des médecins spécialistes du Québec, which represents 1,200 psychiatrists.
The association is a union that strives for optimal conditions of practice for its members, but since its inception, the association has been interested in the organization of care, access to mental health services, and the improvement of public literacy on mental disorders.
From the outset of the discussions on medical assistance in dying when mental disorders are the sole underlying medical condition, the AMPQ was involved and took part in the conversation.
We participated in the Standing Committee on Justice and Human Rights' consultations on Bill C‑7, the presentation of the position statement of the Collège des médecins du Québec in October 2020, the presentation to the Commission on end-of-life care of the AMPQ's discussion paper entitled “Access to medical assistance in dying for people with mental disorders”, at the national forum on the evolution of the Act respecting end-of-life care, and the consultations of the Special Commission on the Evolution of the Act respecting end-of-life care.
In 2020, the AMPQ's board of directors approved the position that people whose sole underlying medical condition is a mental disorder should not be systematically excluded from medical assistance in dying.
At the request of the Collège des médecins du Québec and the Commission sur les soins de fin de vie, the AMPQ published a discussion paper including a proposal on how medical assistance in dying could be organized within the province of Quebec. That brief was produced with the input of a patient partner and a member representing caregivers.
The AMPQ presented its work to its members at its annual meeting in 2021.
To educate its members, the AMPQ offers continuing professional development activities at its annual conferences and a day of update on medical assistance in dying for medical specialists in Quebec. That day will be held on November 17, 2023, with a session specifically on mental disorder as the sole underlying medical condition.
The AMPQ testified before the parliamentary committee responsible for studying Bill 11 in Quebec. During its testimony, the AMPQ advised the government not to include an exclusion clause for persons with mental disorders. A number of professional associations, including the Fédération des médecins spécialistes du Québec, the Fédération des médecins omnipraticiens du Québec and a number of regulatory bodies, including the Collège des médecins du Québec, the Ordre des psychologues du Québec, the Ordre des infirmières et infirmiers du Québec, and the Ordre des travailleurs sociaux et des thérapeutes conjugale et familiale du Québec, as well as the Commission des droits de la personne et des droits de la jeunesse du Québec, have expressed a similar opinion to that of the AMPQ.
In addition to its regular activities, the AMPQ sat on the national steering committee of the Canadian Association of MAiD Assessors and Providers and reviewed the program as a whole.
All of the AMPQ's interventions and participation in the conversation surrounding medical assistance in dying are intended to raise awareness of the reality of people with mental disorders, their loved ones and the caregivers who support them.
Our experience shows that mental disorders remain little-known and that their effects on life courses are poorly understood by the public.
When we talk about MAID when mental disorder is the sole underlying medical condition, we're talking about patients who we've been following for decades who have tried multiple therapies and treatments.
As you heard from Dr. Gupta, psychiatrists on the ground are already involved in assessing, in various forms, a complex clientele in the MAID processes. They participate in second assessments, collaborative assessments with GPs, and as in any new care, there will be graduated skills development through pairing, mentoring, and training.
The main objective of the AMPQ is to combat stigma by using its expertise and experience with the most vulnerable. However, to avoid perpetuating this stigma and discrimination, inclusion is the best option.