Medical Assistance in Dying Committee on Nov. 7th, 2023

[Charlie Angus, NDP, Timmins—James Bay, ON]

It is for either one.

[The Joint Chair, Hon. Yonah Martin]

You have 30 seconds. Answer very briefly, please.

[Dr. Claire Gamache]

We may observe tremendous distress in the people close to us, but it's true that, in the psychiatrist's office, distress looks different. There's a lot of analysis and assessment. People don't ask friends, colleagues or MPs for MAID; they ask the physician who's been treating them for a long time and who has looked at the treatment options with them.

That's part of my answer.

[The Joint Chair, Hon. Yonah Martin]

Thank you to all our witnesses.

We will go now to questions from the senators.

[The Joint Chair, Liberal, René Arseneault]

Senator Mégie, you have three minutes.

[Marie-Françoise Mégie]

Thank you, Mr. Chair.

My question is for Dr. Gupta and Dr. Gamache, and I'd like brief answers.

Last year, a psychiatrist appeared before our committee. On the subject of an individual's eligibility for MAID, she said there were so many important criteria to consider that, out of all the cases she had seen in 30 years of practice, she had encountered only three people who were eligible, given the long-term treatment, chronic disease, and so on.

What are your thoughts on that?

[Dr. Mona Gupta]

I agree. I would say more or less the same thing. In 23 years, I've encountered maybe two people who would meet the criteria.

[Dr. Claire Gamache]

I'd say the same.

[Marie-Françoise Mégie]

Thank you.

I think what I've been hearing is that, until all psychiatrists have the training to participate in MAID, we won't be ready. However, there are lots of family physicians and health professionals, and they don't all participate.

What are your thoughts on that as far as psychiatrists go? We don't need them all to have the training before we can proceed, do we?

[Dr. Mona Gupta]

As I said, it's been seven years, and only 2% of all physicians in Canada assess certain patients' eligibility for MAID and deliver it.

We need a small number of people who are prepared to work with a small number of patients. Of course not everyone in the medical professions will have the same level of training and be up to date on all practices. People specialize and work with specific clients. That's normal.

There's no such thing as a practice that everyone has the same level of training and upgrading for.

[Marie-Françoise Mégie]

Thank you.

Thank you, Mr. Chair.

[The Joint Chair, Liberal, René Arseneault]

Thank you, Senator Mégie.

Next is Senator Kutcher for two minutes.

[Stanley Kutcher]

Thank you, Chair.

Just before I ask the question, can we ask Dr. Freeland to give us the two papers she referred to in her testimony for us to look at? Maybe the clerk could ask for them.

Dr. Gupta, there seems to be a bit of confusion between providing treatment for mental illness and providing MAID. If a patient wants treatment, would they actually be eligible to receive MAID?

[Dr. Mona Gupta]

No.

[Stanley Kutcher]

Okay. I think that's clear. Thank you.

The other part here is that there seems to be confusion between assessors and consultants. More psychiatrists are taking on the training to become assessors, but we already have psychiatrists who are consultants around MAID. We expect that the number of people seeking MAID for mental illness will be very small.

Do we actually have enough people in the profession who could provide the consultation that is needed and, as the profession grows and develops, will more become assessors as well? I think there's confusion between the two.

[Dr. Mona Gupta]

I know that I personally have never been involved in or aware of any case where a psychiatric consultant was needed to support assessors and it was not possible to obtain a psychiatric consultation. Dr. Gamache has a view of the entire province of Quebec and can probably comment on that better than I can.

That's correct. We're already doing that work as consultants, as the safeguards, the persons with expertise, and we will continue to do that work. I think people are becoming more and more interested as time passes in becoming assessors, and they are doing training and are learning from their already experienced colleagues how to do that work as well.

[Stanley Kutcher]

There have been some psychiatrists who are opposed to the whole concept of readiness. Have any of your colleagues ever participated in any of the work to develop readiness criteria? Have they asked to participate or is there a perspective that readiness will never exist and therefore why participate in discussing readiness?

[Dr. Mona Gupta]

I'm not inside their minds, so I can't tell you what they're thinking, but I'm really glad you brought that up, because I think some of the voices that are saying we are not ready have contributed nothing to becoming ready.

I would submit that one way of assessing whether somebody is sincere about concerns about readiness—as opposed to, as Dr. Grant said, using that as a way to express opposition—is to see what they have contributed towards becoming ready. Somebody who is sincerely concerned about readiness is going to get involved. Those voices have not been involved even when opportunities have clearly been presented to them.

[Stanley Kutcher]

You have a sacred duty here as regulators. Would regulators agree to allow the practice of MAID if the proper standards for the practice of MAID were not in place?

[Dr. Douglas Grant]

No.

[The Joint Chair, Liberal, René Arseneault]

Thank you, Dr. Grant.

That's all for this moment, Mr. Kutcher.

Senator Dalphond, you have three minutes.

[Pierre Dalphond]

I want to thank the three witnesses for participating in our meeting.

Dr. Gamache, you said that the board of directors of the Association des médecins psychiatres du Québec approved your organization's position on MAID and that it was put to the annual assembly in 2021.

Would it be accurate to say that you speak on behalf of an organization that consulted its entire membership?

[Dr. Claire Gamache]

It was presented at the annual assembly. There was no vote on it, but it was presented to all of our members.

We will continue to work with all of those people.

[Pierre Dalphond]

You're also of the opinion that psychiatrists have enough training to avoid making mistakes.

[Dr. Claire Gamache]

We're already trained for track two.

It's exactly the same track for patients with mental illness.