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.
7:05 p.m.
Senator, Nova Scotia, ISG
It is available for psychiatrists and for any other physician in the country who wishes to take it.
7:05 p.m.
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
That's correct.
7:05 p.m.
Senator, Nova Scotia, ISG
Are there ongoing programs right now for more psychiatrists? Five months ago, how many psychiatrists had taken the program?
7:05 p.m.
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
There wouldn't have been any, because we didn't have—
7:05 p.m.
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
That's correct. I will say that for the one I tried to register for, I am now on a wait-list because I can't [Inaudible—Editor].
7:05 p.m.
Senator, Nova Scotia, ISG
I can do my math.
The point here is that we're on a trajectory for creating competencies. I know of no speciality in medicine where all the competencies are done on day one. We have a huge trajectory for creating competency. We have to be careful not to give an improper idea about medical training.
I'll go to Ms. Birenbaum.
We're seeing some confusion in the committee about assessing readiness between provincial jurisdiction and federal jurisdiction. Our job as the federal government is to assess readiness solely in terms of steps within the federal government's jurisdiction.
I'm wondering whether you think the exclusion of people is a limit on charter rights. What prospects do you think a claim of lack of readiness would have as a justification for a limit on rights? How would the Supreme Court look at a justification of provincial non-readiness?
7:10 p.m.
Chair, End of Life Working Group, The Canadian Bar Association
I can only indicate that we've had about nine years to think about this. I think there have been three years of delay, during which there was an absolute exclusion. I think a court would consider the fact that there have been so many years available, if they look at whether or not it's a justifiable exclusion.
I also think that—
7:10 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Thank you, Ms. Birenbaum.
Senator Dalphond, you now have the floor for three minutes.
November 7th, 2023 / 7:10 p.m.
Pierre Dalphond Senator, Quebec (De Lorimier), PSG
Thank you, Mr. Chair.
7:10 p.m.
Senator, Quebec (De Lorimier), PSG
Maybe I will follow up on Senator Kutcher's question to you, Ms. Birenbaum. I will give you a few more minutes to complete your answer. I had similar questions.
How can the law navigate potential tensions between the Charter of Rights—guaranteed rights, as you referred to mentally ill patients also having rights—and the fact that we may also need to have the proper standards and training in place to protect vulnerable persons? How do we balance the absolute right, in one sense, to have access with the right to protect the vulnerable? If the conclusion of the committee is that there's not enough readiness, would you say that goes to the standards in section 1 of the charter?
7:10 p.m.
Chair, End of Life Working Group, The Canadian Bar Association
Certainly a lack of readiness could go to section 1 of the charter. However, looking at the legal framework for protecting a vulnerable person, I think there are protections built into that. A person must be capable, first of all. That is what people do all the time in health care. Is the person capable of making this decision? You're going to root out the people who are incapable; then you're going to see whether there were enough treatments looked at, etc. Have the means been established?
Going through the MAID assessment process is itself a guarantee of protection of the vulnerable. That would go to the weight of section 1. There are significant protections there.
7:10 p.m.
Senator, Quebec (De Lorimier), PSG
Should we make a distinction between legal protections and practical protections in the field?
7:10 p.m.
Chair, End of Life Working Group, The Canadian Bar Association
I'm assuming, given that health care practitioners have criminal liability, that they have to sign off that all the criteria have been met. If they haven't been met, they are criminally liable. In my experience with MAID practitioners—and I've known quite a few—they take this very seriously. In terms of practicalities, I'm hopeful they will abide by the legal parameters.
7:10 p.m.
Liberal
7:10 p.m.
Flordeliz Osler Senator, Manitoba, CSG
Thank you, Mr. Chair.
Thank you to the witnesses for being here today.
My questions are for Dr. Freeland.
We've heard there are psychiatrists who have started training. My question is, how prepared are psychiatrists who are either involved in assessing MAID requests or acting as consultants to MAID assessors? Can you give us an idea of how prepared they are now, and how prepared they will be in five months?
7:10 p.m.
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
Again, where there are requirements for consultation with an expert, I believe psychiatrists are prepared to do that. It is part of their core business to provide expert consultation around key areas of diagnosis, review of treatment plans, capacity assessments, suicidal assessments, comorbidities, etc.
In terms of any practitioner who is now looking at how to become involved in being an assessor of eligibility, we know some psychiatrists are already involved in doing that. We had one of them presenting at a conference last month. Others are actively involved in that. It is a small number who are actively part of the provision.
There will be growth in the number of psychiatrists involved in those two specific areas. I don't anticipate there will be a lot of psychiatrists being the assessors of eligibility and providers of MAID. I think the area where we will see the involvement of psychiatrists is as experts in the assessment of illness and some of the important aspects of that.
7:15 p.m.
Senator, Manitoba, CSG
Dr. Freeland, has it ever occurred that a new practice in psychiatry has started and some individual psychiatrists were not ready to be involved, but that practice went ahead anyway? How did the CPA respond to such occurrences—for example, ketamine or psilocybin treatment?
7:15 p.m.
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
Those are great examples, and a couple that I would have raised. The rTMS would be another one. These are active, new practices and innovative aspects of psychiatric treatment and care. There are a limited number of people who have expertise in them. The CPA becomes involved because of our focus on the mission of ensuring that we provide educational opportunities or access to them to help people learn more and become more engaged and familiar with some of these things. That is how we offer opportunities to our members in those areas.
7:15 p.m.
Senator F. Gigi Osler
Thank you.
7:15 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Mrs. Martin, the floor is yours for three minutes. I'll be tight on time.
7:15 p.m.
The Joint Chair Hon. Yonah Martin
Thank you.
I know there have been questions about readiness, and there is concern about the overall readiness. You've responded to some of the questions about the lack of....
I'm curious about a survey from October 1, 2023, of psychiatrists in Manitoba. Only 33% of them responded that they were in favour of the legislation and legalizing MAID for mental illness. In that same survey, 65% of respondents said they do not have enough awareness or understanding of MAID. This speaks to the lack of readiness or concerns of readiness.
Would you first speak to the 33% of psychiatrists who are in favour of the legislation?