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.
8 p.m.
Liberal
Annie Koutrakis Liberal Vimy, QC
What was the basis for including a different approach to MAID eligibility assessments? I wonder if you can go a bit deeper.
8 p.m.
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia and Representative, Federation of Medical Regulatory Authorities of Canada
After the Carter decision.... I think most people who work in my space interpret Carter as not excluding people whose sole underlying medical condition was mental illness, who could be eligible. We were then responding to a number of changes in the law and changes in direction from Parliament.
The mandate came from Health Canada to this working group to provide clarity to the professions and the providers—not just the medical regulators, but nurse regulators—to provide a document of direction for the professions involved.
8 p.m.
Liberal
Annie Koutrakis Liberal Vimy, QC
Dr. Gupta, you very clearly stated that the system is ready. What have you heard from medical practitioners about whether they feel equipped, and how they feel they are equipped, to undertake assessments, provisions and consultations for MAID where mental illness is the sole underlying condition?
8 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
There's a full range of experience, just like there is for MAID now. There are some people who are actively involved. There are some people who are not involved. There are some people who are occasionally involved. I would say the same thing is true for psychiatrists.
As with any new and complex practice—and this is true for everything that we do in medicine—people who are less experienced aren't the people who are going to start. The people who are going to start are people like my colleague Dr. Daws, whom I mentioned in my opening remarks. They have a lot of experience and have seen a lot of patients, and they're the ones who are going to do the initial work while, as Dr. Gamache said, they train and mentor others who wish to become involved.
There will always be people who don't want to be involved, and that is completely fine. The colleges and the law allow for that.
It's interesting that we're talking about the 2%, because, in fact, only 2% of Canadian physicians are MAID providers, so it's a small number of people who wish to be involved. Those people will continue to be involved, some more than others. That's entirely normal.
8 p.m.
Liberal
Annie Koutrakis Liberal Vimy, QC
Dr. Gupta, do you think systems of MAID oversight and quality assurance are adequate across Canada? If so, how?
8 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
Oversight, of course, as you know, is a provincial and territorial responsibility. There are differences between provinces and territories in the mechanisms that they choose to deploy for oversight, from Quebec's Commission sur les soins de fin de vie, which is very formal, to coroners' reviews and ministry oversight committees.
What I can say is that 90% of MAID cases are occurring in jurisdictions with formal oversight processes. One of the benefits of the extra work that has been done—and this is what I meant in my opening remarks—is that those provinces and territories that have less formal mechanisms are working on building more formal mechanisms. This work is actually going to benefit all patients, not just patients with mental disorders.
8:05 p.m.
The Joint Chair Hon. Yonah Martin
Thank you very much.
Next, we'll have Mr. Thériault, for five minutes.
8:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
I want to thank the witnesses for their clear testimony.
Dr. Gamache, I asked the same question earlier, but I don't know if it was understood.
Do you think that expanding access to medical assistance in dying to people with mental disorders could have a preventive effect on those who, for example, have suicidal ideation and are not currently in care? Would expanding this access allow these people, who may want to request medical assistance in dying, to be taken care of? At the moment, we don't know that they need help.
8:05 p.m.
Psychiatrist, Association des médecins psychiatres du Québec
I believe so. Patients are already arriving at the emergency room and requesting medical assistance in dying because of physical problems or significant psychological distress, which triggers a whole process that means they are taken care of more quickly since there are delays in obtaining a response to a medical assistance in dying request.
I would go even further: discussing this request with our patients is part of a therapeutic process that can be very healthy for patients with mental disorders.
8:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
You've told us that an impressive number of health care professional organizations have recommended this expansion.
How do you explain the fact that the Quebec National Assembly didn't want to move forward? I would ask you to keep your answer as brief as possible.
8:05 p.m.
Psychiatrist, Association des médecins psychiatres du Québec
I think it's a matter of social acceptance.
Stigma is everywhere and, unfortunately, it's also in the legislation, in my opinion. We will have to think about how we treat this clientele, which is part of the entire health care process. We have to ask ourselves why it takes so long in the case of mental disorders. Why are these people being treated differently? As has been mentioned a number of times, the track 2 assessments are already very complex, and mental disorders can very well be part of those assessments.
8:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
One of our concerns has to do with preparing people on the ground.
Does the fact that the Government of Quebec has decided not to move forward create a barrier in terms of clinical practice and preparation on the ground in Quebec? If Quebec's Commission on end-of-life care specifies that, legally speaking, the most repressive or harsh legislation must be complied with, how will that work? How are practitioners going to feel?
8:05 p.m.
Psychiatrist, Association des médecins psychiatres du Québec
Practitioners will indeed feel caught between two acts.
That said, we have been experiencing discord for a few years in a number of respects. Doctors will certainly respect the requests of the Quebec Ministry of Health and Social Services and the recommendations of the CEOs.
We'll comply, but we'll have to tell our patients, some of whom are already asking us for medical assistance in dying, that they'll have to wait until it's permitted and that the choice has been different in Canada.
8:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Will they have to wait until it is allowed by the Criminal Code or by Quebec?
8:05 p.m.
Psychiatrist, Association des médecins psychiatres du Québec
Well, in Quebec, it probably won't be allowed in the health care organization.
In Quebec, medical assistance in dying is health care. If the ministry of health and the Government of Quebec tell us that this type of care cannot be provided, hospitals and organizations won't be able to provide it.
8:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Dr. Gupta, you said we're ready.
Have enough people received the necessary training to proceed with medical assistance in dying soon, as in, by March 2024?
8:10 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
I think so.
I think we have to distinguish between the psychiatrist who acts as a consultant and the psychiatrist who acts as the assessor. Psychiatrists already participate as consultants with the two physicians or two specialized nurse practitioners. They do assessments. This is already being done. Psychiatrists in that role already have the necessary skills. There are also psychiatrists who do assessments, and there will be more and more of them thanks to the training that's now in place.
8:10 p.m.
The Joint Chair Hon. Yonah Martin
Thank you very much.
Last, I will go to Mr. Angus, for five minutes.
8:10 p.m.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Thank you.
Thank you, doctors, for your great expertise.
It has been suggested that some of us who were raising questions about being ready want to relitigate MAID. I'm not one of them. I've had some very close friends choose MAID so they could have an end of life that they had control over with their families. These were very profound moments. I respect that. I'm trying to see how.... I deal with families, with people who have deep mental illness and depression. How can I assure them that this process is done with all the care necessary?
Dr. Gamache, you said that those who would be eligible would have been involved in the medical community for decades. If someone comes in with deep and significant suffering, deep depression, perhaps addiction and suicidal ideation, but hasn't been involved for decades, would they still be eligible?
8:10 p.m.
Psychiatrist, Association des médecins psychiatres du Québec
I don't think so, not if they can't access treatment. As Dr. Gupta said, people are discriminated against in two ways: first, they may not have access to treatment; and, second, they won't get access to MAID.
There has to be a significant record of treatment attempts, and they'll have to have had the time to have an exhaustive conversation with the patients. Then they can reach that conclusion, as they would for someone with a major physical problem.
However, if people don't have access to services, I don't think they can access MAID. That's very clear the way track two is currently laid out.
8:10 p.m.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Thank you for that.
I'm trying to get my head around this issue of discrimination against the right to MAID, or discrimination against the right to proper medical treatment.
Dr. Gupta, you said the federal government had stepped up above and beyond in making sure of everything that was necessary. In the work that I do as a member of Parliament, we're screaming for the federal government to step up all the time on mental health, but it doesn't.
I represent northern rural communities that are isolated, where we have suicide deaths from gunshots. We have people with deep mental illness who just run off into the woods, and the family can't find them. I'm having a problem here with saying that we're ready to have a really clinical, clear process for people to end their lives, but we don't have the tools in place to be ready to keep people through these times of crisis.
You're on the front line. What do you see?
8:10 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
I think we can all agree. Whatever views we have about MAID for persons with mental disorders, we can all agree that mental health services and addictions services in this country could stand to be improved, and there could be much greater access.
I think what Dr. Gamache is pointing out is that these unfortunate souls who do not have proper access to care will not be eligible for MAID anyway.
8:10 p.m.
NDP
Charlie Angus NDP Timmins—James Bay, ON
I appreciate that. I don't know anything about medicine. I dropped out of high school to play in a punk band. My life experience is dealing with families in crisis. That's what I do as a member of Parliament. We deal with this all the time.
It is a very emotional issue for people. I have a really hard time going back to them and saying “Don't worry; there will be a process for MAID” but not being able to tell them there will be a process for their loved one to get treatment.
Who is eligible, and who is not? If it's deep depression, I know people who have had deep depression for years. I know people who have been deeply suicidal for years. I'm reading all the clinical reports on how they should be treated and how they should assessed. To me, it doesn't sound like the real world. It sounds like an ideal situation of someone who sought this, who comes through the door and has made an informed decision. We're dealing with people who live in storms of darkness and upheaval, and then they settle down and their families go with them.
What are the provisions that separate that?
8:15 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
Is that for me or for Dr. Gamache?