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.
Conservative
Ed Fast Conservative Abbotsford, BC
It did not require mentally ill persons to be included either, did it?
Chair, End of Life Working Group, The Canadian Bar Association
That is correct. It didn't say “thou must”—
Conservative
Ed Fast Conservative Abbotsford, BC
I'm stating the obvious when I say that this is about life and death. Wouldn't it be more appropriate to have the federal government send this to the Supreme Court by way of reference rather than gambling on the lives of the mentally ill?
Chair, End of Life Working Group, The Canadian Bar Association
The CBA has not considered this. In my own view in thinking about this, given our thoughts about vulnerability, I don't think, in this sense, that the group would feel this way, but we would have to check.
The Joint Chair Hon. Yonah Martin
Thank you.
Next we will go to Mr. Fisher for three minutes.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Thank you very much, Madam Chair.
I want to thank our witnesses for being here. We have such a narrow mandate that you'll be hearing, and are already hearing, a bit of repetition and a bit of different phrasing of some of the questions. The narrow mandate, of course, is just to verify the degree of preparedness attained for a safe and adequate application of MAID.
I've always supported MAID. Every time there was a MAID vote, I voted for it. I support the safeguards and I certainly support the Charter of Rights.
Dr. Freeland, your organization takes no position, but perhaps I can ask you this as an individual: Do you think the health system is ready for an expansion of MAID eligibility for individuals whose sole underlying medical condition is a mental disorder?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
Thank you for that question. I'm just reflecting on it as an individual.
I work in Ontario, which is a complicated province. There are lots of different health care systems there. I think there is still work to be done at a local level to ensure that the entire system has created a coordinated point of access.
The encouraging thing is that where I am, there is now a provincial group looking at a community of practice around medical assistance in dying, particularly for a mental disorder. In Toronto, where I work, we now have a coordinated working group sponsored by the two local Toronto hospitals, which, again, is turning its mind to how to do this. It is represented by a number of different health professionals and includes psychiatry. In fact, the Toronto working group is co-chaired by two psychiatrists.
I think people are working hard knowing that there is a date in mind to get to a place of readiness and knowing that readiness is never going to be perfect. When we think about readiness in this context compared to when MAID came out way back with Bill C-14, there's been a lot more work done on the national approach around standards and available curriculum, and I think many different organizations are engaging health care teams around how to best understand this.
I am definitely not a MAID expansionist. I just truly believe that it's very stigmatizing—and this is my personal belief—to take a group of patients and say to them, “You can't even be considered for something because you have a mental illness.”
I believe that very few people would be found eligible should this go ahead with respect to mental illness. Ms. Birenbaum has clearly outlined all of the safeguards and processes we'd have to get through to get to that point.
Those would be my personal reflections, not the CPA's reflections.
The Joint Chair Hon. Yonah Martin
All right, thank you.
We'll go next to Mr. Thériault for two minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
A number of people who talk about mental disorders as the sole underlying medical conditions claim that people who are suicidal and in crisis or are depressed could have access to medical assistance in dying, whereas nothing in the expert report says that. In fact, it says the opposite.
My question is for both witnesses. I would ask them to give a brief answer.
Do you think that expanding medical assistance in dying to people with mental disorders could have a preventive effect in suicidal individuals?
For example, if a suicidal person, the day after the amended act is passed, raises their hand and says that they want to have access to medical assistance in dying, at least we will know that they need help and can be taken care of when, at the moment, they are completely abandoned and could make attempt suicide.
Isn't this a preventive measure?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
Was that directed to me?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
That's a great question, and I think there is a lot of debate about that.
First of all, I think if we were all living in a perfect health care system, we would assume that people have quick access to an assessment at the onset of suicidality and would ensure they have rapid access to treatment and care in the system. I think that's something we all strive for broadly in the health care system.
With respect to people accessing an expert assessment because of an ask around medical assistance in dying, I think there has been some debate about the fact that, when you see a psychiatrist and are able to explore your illness and understand diagnosis and treatment options, many people who get to that stage may in fact not be eligible.
Again, I'm going to put my personal hat on. One of the important parts about readiness—and it's something we've talked about in Ontario—is the navigation back into the health care system. When you look at the standards, there is a requirement to continue to provide ongoing treatment and care for people who are not found eligible for MAID. In this context, there is that opportunity.
NDP
Charlie Angus NDP Timmins—James Bay, ON
Thank you, Dr. Freeland.
I want to go back to the question of whether we're ready for March 2024. You said that Canada had decided we were going down this road. I would say that the Senate, which is not elected, threw in a date and told us to live with it, and the Liberal government agreed. That date was March 2023. As it approached, they panicked, so now it's March 2024.
This is a huge Rubicon we're crossing, so what's more important? Is it the date or getting it right? Would you suggest that we take the time to do this right? If it's proven that it's not going to affect a lot of people and that there are going to be all these safeguards, do we need to meet the arbitrary date that was put in between the Liberal government and the Senate, or should we do this in light of the bigger and broader consensus that we need to achieve to make sure people are protected?
Chair of the Board of Directors and Co-Chair of MAID Working Group, Canadian Psychiatric Association
That's a difficult question to answer, because we are still five months away, and the rate of activity to get ready continues to accelerate. We continue to see people engaging around this, and systems of care are beginning to evolve around it. That's where it's challenging to say whether we're going to be ready against the date that has been selected.
It's already been put off once, and I think there has been substantive work done, but—
NDP
Charlie Angus NDP Timmins—James Bay, ON
This isn't like opening a business; these are people's lives and deaths right now. Things may be moving fast, but given the huge disparities in health across this country—and this country is very large—there are huge differences. Yes, things may be moving fast, but can I go back and reassure people?
People call me about this. This is an issue people are deeply concerned about, because they have loved ones who have deep, dark mental illnesses they cannot get treatment for because treatment doesn't exist. It's the date that matters.
The Joint Chair Hon. Yonah Martin
Thank you.
We are at 7:30 and need to get ready for our second panel.
Thank you to our witnesses this evening for taking our questions.
Liberal
The Joint Chair Liberal René Arseneault
We're back.
I would like to make a few comments for the benefit of the new witnesses.
Before speaking, please wait until the chair recognizes you by name. A reminder that all comments should be addressed through the chair. When speaking, please speak slowly and clearly. I would ask those in the room to speak very close to their microphones in order to help the interpreters.
Interpretation in this video conference will work like in an in-person committee meeting. For those participating by video conference, you have the choice, at the bottom of your screen, of floor, English or French. When you are not speaking, please keep your microphone on mute.
I would now like to welcome the witnesses for the second panel. Joining us by video conference, we have Dr. Mona Gupta, psychiatrist and researcher at the Centre hospitalier de l'Université de Montréal.
I welcome Dr. Douglas Grant, representing the Federation of Medical Regulatory Authorities of Canada.
Lastly, we have Dr. Claire Gamache, psychiatrist and president of the Association des médecins psychiatres du Québec.
Thank you all for being with us today.
I'll now give the floor to the joint co-chair, Senator Martin.
The Joint Chair Hon. Yonah Martin
Thank you to our witnesses. We will begin with opening remarks by Dr. Gupta, followed by Dr. Grant and Dr. Gamache.
Dr. Gupta, you have the floor for five minutes.
Dr. Mona Gupta Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
Thank you very much, Madam Chair, and thank you, all, for the invitation to meet with you today.
I'm a psychiatrist and bioethics researcher at the University of Montreal. I've had the opportunity and the privilege to be closely involved in the public conversation about assisted dying for persons with mental disorders as their sole underlying medical condition—MDSUMC for the rest of my remarks—since its beginning.
I served as a member of the CCA working group on MAID for MDSUMC mandated by Bill C-14. I chaired the federal expert panel on MAID and mental illness, mandated by Bill C-7. More recently, I led the work of Health Canada's MAID practice standards task group, and I also led the working group that developed CAMAP's educational module for MAID and mental disorders.
It is from this vantage point that I want to share some observations about readiness.
When the Government of Canada made the decision to include persons with mental disorders as their sole underlying medical condition on equal terms with all other medically ill suffering persons whose natural deaths were not reasonably foreseeable, it committed to do three things: constitute an expert panel on MAID and mental illness, strike a special joint parliamentary committee to further study the matter, and revise its data collection system. As we know, the federal government has fulfilled these commitments.
When the federal government made the decision to extend the exclusion for an additional year, it spoke about the need for extra time to ensure that two major deliverables—the CAMAP MAID curriculum and the model practice standard for MAID—were complete. As we know, these activities are complete. The standard has been in the hands of physicians and nurse regulators since April of this year, and they are adopting or adapting the standard as appropriate within their jurisdiction. The CAMAP MAID curriculum was launched in September 2023 and has been offered already, numerous times, to physicians and nurse practitioners.
Several other initiatives have occurred since December 2022, including a national MAID MDSUMC preparatory workshop with delegates from every province and territory, including MAID assessors, providers and psychiatrists. There has also been a national system readiness workshop to share knowledge about administrative processes.
Most provinces and territories are working with frontline clinicians, regulators and administrative authorities to ensure that clinical processes are appropriately tailored for requesters with mental disorders. I have provided several examples of these activities in my brief.
A few weeks ago, I taught the CAMAP MAID and mental disorders module to a group of about 20 psychiatrists, family physicians and nurse practitioners in Vancouver. Beforehand, the colleague co-leading the session, an experienced family physician and MAID assessor and provider, Dr. Tanja Daws, bounded up to me. Even though MAID MDSUMC is not allowed, she said, I've already had patients with all the same types of issues in the case studies we cover in the module.
What struck me about Dr. Daws' comment is that persons with mental disorders as their sole underlying condition who make requests for MAID will be in the careful hands of experienced clinicians who, over these last seven years, have already handled the full range of complexities in their MAID practice that MDSUMC requests may present. Her comment also confirms what the expert panel concluded, that the complexities so often attributed to mental disorders are not, in fact, unique to mental disorders and are already being handled in our MAID system today.
The work that has been undertaken on MAID MDSUMC since 2017 has been thorough, the processes transparent and collaborative. The Government of Canada has fulfilled every commitment concerning readiness that it made. It has also made unprecedented contributions to health care professional education and regulation, which well exceed the scope of its jurisdictional responsibilities.
As my colleagues Dr. Gamache and Dr. Grant know better than I, the other essential actors in health care and in the MAID system—regulators and professional associations—have been active concerning MAID since 2015. They will continue to fulfill their mandates. In the case of the regulators, this is guiding clinicians towards safe MAID practice in the public interest, and in the case of professional associations, ensuring their members are equipped to participate in MAID if they choose to do so.
By far, more thought, care and capacity building have been done for persons with mental disorders as their sole underlying medical condition than for any others. This is a good thing, and this work will have the added benefit of strengthening Canada's MAID system for all patients.
If you were to ask me what I need if tomorrow I had to assess MAID eligibility for a person with a mental disorder as their sole underlying medical condition, the answer is nothing. The work has been done. We are ready.