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.
8:20 p.m.
Senator, Quebec (De Lorimier), PSG
My next question is for Dr. Grant.
You said the regulators are ready and we don't need more preparation. Does this mean that because you're ready as regulators, the practitioners are ready to go forward?
8:20 p.m.
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia and Representative, Federation of Medical Regulatory Authorities of Canada
I would say the practitioners couldn't go forward without the regulators being ready. The regulators will have built on the working group's work. We've all developed the documents.
The regulators will all have direction in place, so that the practitioners—the physicians—will know what's expected of them. More importantly, or as importantly, because our standards face forward, the public will know what they're entitled to.
8:20 p.m.
Senator, Quebec (De Lorimier), PSG
You say this is the case for the 10 provinces and the three territories.
8:20 p.m.
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia and Representative, Federation of Medical Regulatory Authorities of Canada
I can say that the model practice standard that we've developed has been shared with all of the colleges. They've all welcomed it. I've spoken with each of the registrars, who will all use this document in one way or another to have their provincial standard in place.
8:20 p.m.
Senator, Quebec (De Lorimier), PSG
Has each province made it their standard, or is it in the process of being made the standard?
8:20 p.m.
Registrar and Chief Executive Officer, College of Physicians and Surgeons of Nova Scotia and Representative, Federation of Medical Regulatory Authorities of Canada
They will be using this document either to inform their standard or to build their standard upon.
I realize I'm speaking on behalf of everyone. I know that in Nova Scotia we're adopting this standard as a whole.
8:20 p.m.
Liberal
The Joint Chair Liberal René Arseneault
You still have 30 seconds, Senator Dalphond.
Are you good? Okay.
Senator Osler, the floor is yours for three minutes.
8:20 p.m.
Senator, Manitoba, CSG
Thank you, Mr. Chair, and thank you to the witnesses.
My question is for Dr. Gupta.
This committee has heard concerns that anyone experiencing acute emotional distress can be eligible for MAID where a mental disorder is the sole underlying medical condition. Could you please take us through how clinicians have prepared and how clinicians will assess whether a person's request for MAID is a form of suicidal ideation?
8:25 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
Thank you for that question.
Clinicians on the ground are going to be drawing upon the work that has been done by the expert panel and the task group to help clarify how to use these terms in practice.
Even without that work, I am very comfortable saying that I don't think there are any psychiatrists, physicians or nurse practitioners who think that acute distress is the equivalent of a grievous and irremediable medical condition. We all understand that an incurable condition and an advanced stage of irremediable decline requires, as it currently does under track two for other chronic conditions, a long history of failed treatment and an inability to function in a way that gives the person an adequate quality of life.
As to your question about suicidality, suicidality is already part of MAID assessment right now. When people are in crisis, MAID assessments are either not done—if that's what the person is asking for—or they are put on hold so that the crisis can be attended to. It will be exactly the same thing when a person has a mental disorder as their sole condition.
8:25 p.m.
Senator, Manitoba, CSG
Thank you, Dr. Gupta.
Perhaps I'll ask the question of Dr. Gamache.
8:25 p.m.
Psychiatrist, Association des médecins psychiatres du Québec
I'd say the same thing.
Are you asking the same question? Yes? Okay.
Suicidality is already part of our everyday practice in psychiatry. Even people who request MAID because of physical problems or cancer may feel suicidal at times during the process. That means their case has to be reassessed. Sometimes we have to protect them from those ideas. We try to understand why they're thinking that way. That's part of the request for assistance.
As Dr. Gupta said, nobody gets MAID while in a crisis. The process is very long. The wait time for the track two process is 90 days. There's no risk around that in a crisis situation.
8:25 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Thank you very much, Dr. Gamache.
Now we'll end this session with Senator Martin.
8:25 p.m.
The Joint Chair Hon. Yonah Martin
Thank you.
My question is for Dr. Gupta.
The president of the Canadian Society of Addiction Medicine was recently quoted with respect to MAID for those suffering from mental disorders as saying, “it's not fair to exclude people from eligibility purely because their mental disorder might either partly or in full be a substance use disorder.” This suggests that CSAM believes that people suffering solely from addictions should be able to qualify for MAID. Do you agree?
8:25 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
In the same logic of the expert panel, we need to focus on what the complexities are and not what diagnosis the person has. I am not part of that association, and I can't comment on any of their internal discussions, but I would say that in order for a person with a substance use disorder to actually fulfill the criteria, they would have to have an extremely severe condition with probably very severe physical comorbidity along with it.
8:25 p.m.
The Joint Chair Hon. Yonah Martin
Can you point to any safeguards that would prevent someone whose most severe condition is an addiction from being assessed for MAID?
8:25 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
A person can make a request and be assessed, but they're not going to be eligible unless they meet the criteria and the safeguards are respected. Most people with addiction who do not have any of the sequelae of chronic and severe substance abuse would not be eligible.
8:25 p.m.
The Joint Chair Hon. Yonah Martin
I read such statements, but there's also some evidence from European countries that allow MAID for mental illnesses that twice as many women as men get MAID for mental illness—the same ratio of women to men who attempt suicide when they're suffering from mental illness.
How do you explain that gender gap in this European example, and doesn't that concern you for Canada?
8:25 p.m.
Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual
It doesn't concern me, in the sense that I don't think anybody knows what it means. We can make all sorts of hypotheses about what it might mean, but nobody really knows. What I would caution you about is drawing inferences, like the one in your question with respect to male-to-female suicide ratios, because we don't know what it means.
8:25 p.m.
The Joint Chair Hon. Yonah Martin
These are all questions just to say how concerned I am about this looming deadline and the fact that we have heard evidence, even this evening, about our lack of readiness.
On this evidence from Europe, we often talk about evidence that we can draw from and learn from for Canada. These are very concerning examples.
8:30 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Thank you, Senator Martin.
I thank all the witnesses for being here with us, for participating in the process and for answering questions. We know there's never enough time, but those are the rules.
Thank you for coming.
We will now suspend briefly to move in camera to discuss committee business. For our colleague Mr. Angus, who attended virtually, a Zoom link for in camera has been sent already.
We will take about five minutes.
We'll suspend the meeting.