Evidence of meeting #38 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 maid.
A video is available from Parliament.
Chair, End of Life Working Group, The Canadian Bar Association
No. I said there are 37,000 lawyers who are part of the Canadian Bar Association.
Chair, End of Life Working Group, The Canadian Bar Association
I represent the end of life working group, which is a subcommittee of the Canadian Bar Association.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
I'm going to ask both of you this question.
Is it fair to say that there is not consensus between the legal community and the medical community—in your case, the psychiatric community—about the state of readiness? I'm aware of a number of organizations that have made it clear that they believe they are not ready.
The Joint Chair Hon. Yonah Martin
I'm sorry, but we are out of time.
Perhaps there could be a quick answer, a yes or no. Is there consensus? Okay.
I'm sorry about that. We'll move on to the next questioner.
Monsieur Thériault, you have five minutes.
Luc Thériault Bloc Montcalm, QC
Thank you very much.
Dr. Freeland, Ms. Birenbaum said earlier that she thought we had to move forward in March 2024. Do you share that view, or does your association?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
Just to clarify, are you asking me if our association is of the same opinion as the Canadian Bar Association, that we should go forward in March with MAID for mental illness?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
It's a complex issue. Part of what we've been trying to state is that we are working towards readiness. The important thing from a Canadian Psychiatric Association point of view is that we are one part of a team of health care providers who are involved in medical assistance in dying for mental illness. Many of the things we are worrying about have already been part of the assessments for MAID. For people with any track two condition, many of the things we're thinking about are related to issues there.
Bloc
Luc Thériault Bloc Montcalm, QC
Okay.
I thought my question was simple. You're not in a position to give me a yes or no answer. I understand that.
In a number of writings, it is said that, roughly speaking, 50% of psychiatrists are reluctant to make medical assistance in dying available to people with mental disorders. In the brief you submitted to the joint committee in May 2022, you wrote:
… it is essential that at least one independent psychiatrist who has expertise in the mental disorder in question completes a comprehensive clinical assessment to validate whether the patient has received an accurate diagnosis and if they have had access to evidence-based mental health assessment, treatment and supports for an adequate period of time based on generally accepted standards of care.
This view, that an independent psychiatrist with expertise in the mental disorder in question is needed, is also found in recommendation 10 of the final report of the expert panel on medical assistance in dying and mental illness.
Do you think we have the necessary resources to implement that recommendation?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
The first thing I will restate is that I believe psychiatrists do have expertise in some of the areas that are pertinent to assessment in MAID, such as the diagnosis and understanding of refractory illness, capacity issues and the assessment of suicide. What we've learned is more about MAID and its delivery, and we understand that no one profession can do this alone. We do feel that in most cases of MAID for mental illness—
Bloc
Luc Thériault Bloc Montcalm, QC
You're not answering my question. Perhaps it's a problem with the interpretation.
Mr. Chair, I hope you'll take that into account in the allocation of my speaking time.
I'm asking you whether we have enough resources and psychiatrists to respond to recommendation 10 of the expert panel on medical assistance in dying and to the similar recommendation you put in your brief.
Was my question clear enough?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
What you're asking me is whether we have enough psychiatry resources to do this. We have to step back and say that when we look at mental health and addictions, we don't have enough resources for all kinds of things that we do in the delivery of mental health care and the provision of expert opinion on the different issues. That being said, where an expert opinion is needed in MAID, we need to gather the necessary information to determine eligibility. People may need to wait for that resource to occur—to get the right information that's needed to make a decision.
Do we have enough psychiatrists specifically for MAID? We probably do not. Do we have enough psychiatrists for the delivery of mental health care in general? We do not necessarily, and the same applies for many other medical specialities, where people may wait for an expert opinion for other conditions that are being considered for track two.
Bloc
Luc Thériault Bloc Montcalm, QC
If I understand correctly, you want to make the obligation to have an independent psychiatrist who is an expert in the mental disorder an additional safeguard, and you're telling us this evening that you don't know whether we have the resources to offer medical assistance in dying to people with mental disorders.
Am I coming to the right conclusion?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
No, I think I'm saying that what we understand is there are not enough resources in many aspects of health care. What we know is that in terms of the number of psychiatrists available to Canadians, there are probably not enough and we continue to have a wait-list for people to access expertise.
The Joint Chair Hon. Yonah Martin
Thank you, Dr. Freeland.
We have Mr. Angus, who's online tonight.
You have five minutes.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Thank you, Chair.
I have a simple question, Dr. Freeland. In four months, Canada's going to cross a line that we probably won't come back from. Are we ready?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
I think that's part of what we're trying to ascertain today.
In thinking about readiness, there are different aspects to readiness. Are we ready from a national perspective? Do we have the appropriate national standards? I think we do have those. Do we have a nationally available training curriculum for people? I think we've been able to do that. When we think about—
NDP
Charlie Angus NDP Timmins—James Bay, ON
Do you think so? I'm sorry. The committee's final report in February 2023 noted, “there has not been sufficient time to develop the standards of practice” that “are key to ensuring a thoughtful, consistent approach to MAID”.
I have found, in all my years of Parliament, that things don't move very fast. To suddenly go from February to now and say we're ready...I have a really hard time buying that. We were given an arbitrary date on this by the unelected Senate, which threw in March 2023. Then the Liberals moved it to 2024.
Can you tell me with assurance that I can go back to the people I represent and tell them not to worry, that if their loved one who's severely depressed decides he's going to end his life, it will be done right with all the provisions and protections? Can you tell me that I can tell people those protections are in place now, because in four months this will become law?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
I don't think that from a CPA perspective I can say all the readiness is there, because for health systems readiness, the CPA wouldn't have all the information necessary to make a comment on that. I can comment on clinical readiness and standards.
NDP
Charlie Angus NDP Timmins—James Bay, ON
That's crucial. We're supposed to know it's going to be “rationally considered during a period of stability, not during a period of crisis”, which may require serial assessments.
That sounds great, but that is not like anything I've ever seen in the real world. We deal in our office with people who have severe depression. We deal with families that deal with loved ones who are in a deep, dark, black hole, and we deal with the fact that many families don't have doctors or have never seen a psychiatrist.
In four months, thanks to how this has been set up, this becomes law and someone who's in a deep, dark depression can end their life. How do I tell their family that everything was done to make sure they had all their agency? How do I tell them not to worry, that if this person who's in a deep, dark depression decides to end their life, the process is there to protect them?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
I think one thing we have to think a bit about is that just because somebody applies for an assessment for medical assistance in dying does not mean they become eligible for it.
The standards, with advice to the professions as part of the standards, clearly articulate some of the things that need to be carefully considered as part of an assessment. I believe there's been a lot of thought and attention to build those standards, disseminate them and provide advice. From that perspective, we do have those things.
NDP
Charlie Angus NDP Timmins—James Bay, ON
I don't doubt that and I'm not questioning the deep integrity of people in the psychiatric profession, but we have a situation.... I deal in the real world. I don't deal in what should be; I deal with what I see. I represent the Far North, where we have a horrific suicide crisis in indigenous communities. We have an ongoing mental health crisis, in fact, to the point that states of emergency have been declared.
When I ask you if we are ready, I need to know that I can go back to Treaty 9 and say, yes, for a loved one who's severely depressed and wandering the streets, if they decide they're going to end their life, all the protections are in place to make sure this was done right. If those protections aren't right, it's our duty to tell the public we're not ready.
Can you tell me the protections are there?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
I don't think I can do that.
I believe that a lot of time and effort has been put into doing this. I am reflective of some of the comments my colleague made at the beginning of this. We've had quite a long time to think about it.
We have allowed other complex medical disorders to be involved in track two MAID, with a lot of similar issues related to mental disorder, so we have to think about that.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Certainly, but we have a deadline of four months that the Liberal government has put on us, so in four months this becomes law. We break for the Christmas season very soon, and then we're out for January.
Again, I need to be able to tell people not to worry; when this becomes law, all these things will have been thought out. I haven't heard that answer yet.