Evidence of meeting #39 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 illness.
A video is available from Parliament.
9:05 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much, Madam Chair.
Dr. Sareen, we're in a situation where we're not relitigating the change in the law. That's happened, and Parliament recently gave its voice to that. We have a very narrow focus.
In your opening comments, I think I heard you say that you recommend “an extended pause” on the law coming into effect. Can you elaborate on that a bit more? What do you mean by “an extended pause”?
9:10 p.m.
Physician, Department of Psychiatry, University of Manitoba
It means that we're not going to be ready in another year. Some of these issues are very complicated, and we do not believe that if there's a delay by one year these issues are going to be resolved—around irremediability and around differentiating suicide from MAID. That's why we're asking for an extended pause.
That's what the Quebec government has done. They've looked at this issue very carefully and seen that there is no evidence of guidelines to say that this person has gone through multiple years of treatment and is not going to recover.
9:10 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you.
For practical purposes, this committee has to table a report by January 31. Is that extended pause two or three years? Do you have a number that you think this committee should recommend?
9:10 p.m.
Physician, Department of Psychiatry, University of Manitoba
We would recommend an indefinite pause.
9:10 p.m.
Physician, Department of Psychiatry, University of Manitoba
Again, people with mental disorders in track two are still having access, but it's really around the physical health issues.
Our group feels that it's an indefinite pause.
9:10 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
I'm borrowing from your expertise with the patients you deal with. Say someone is coming in and seeking MAID for a mental disorder as a sole underlying medical condition; because their death is not reasonably foreseeable, they're going to come under the track two process.
There's a requirement, of course, to have two professionals look at it. If one practitioner is having difficulty determining whether this is a legitimate request for MAID or a manifestation of suicidal ideation, does the requirement for another professional stepping in not give you a little bit of comfort due to the fact that two professionals are required to arrive at the same conclusion?
9:10 p.m.
Physician, Department of Psychiatry, University of Manitoba
It goes back to the idea that there's no clinical practice and no guidelines to differentiate this.
I am not only the department head, but I'm also the Shared Health lead. We worked in Manitoba with our MAID team and our college to try to come up with criteria. The college and the MAID team said to ask a psychiatrist about when they would say it's time to give MAID instead of giving people treatment. There's no evidence to guide us on that.
You can have two opinions, but if it's not seated in evidence, then people are just deciding to provide MAID instead of treatment.
9:10 p.m.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
All right. Thank you very much.
I will leave my questions there.
9:10 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Thank you, Mr. MacGregor.
Thank you, Dr. Sareen.
We will now go to senators for questions.
Dr. Mégie, you may go ahead for three minutes.
9:10 p.m.
Marie-Françoise Mégie
Thank you, Mr. Chair.
Dr. Sareen, I have just a quick question for you.
In your opening statement, you said that if MAID were made available, it would lead to many unnecessary deaths.
Is the availability of MAID and eligibility for MAID the same thing, in your eyes?
9:10 p.m.
Physician, Department of Psychiatry, University of Manitoba
No, that's not how I perceive it. The important thing to note is around suicide contagion. When a society makes MAID available, the population believes it is a way to end suffering. In other jurisdictions that have had MAID available for mental disorders, not only are there deaths due to MAID, but there are also deaths related to non-MAID suicides.
I just want to emphasize that it's not a suicide prevention mechanism. It's really a way.... We're actually going to make not only suicide deaths go up, but also MAID deaths go up.
I really want to emphasize that people have lots of untreated mental illnesses and addictions in our society, and we should be spending a lot more energy on trying to make sure that people are getting evidence-based care, rather than focusing as much on MAID. There have clearly been reports about people in British Columbia showing up to the emergency department and somebody saying, “Have you thought about MAID?” We've had veterans who have been asked if they would rather have MAID, instead of a wheelchair.
We really have to be thoughtful about the unintended consequences here of making MAID available for mental disorders in Canada, and these safeguards are false reassurances.
Really, we don't agree with proceeding at this point.
9:15 p.m.
Marie-Françoise Mégie
Do I have any time left?
9:15 p.m.
Marie-Françoise Mégie
If I understand correctly, you do trust your colleagues to assess the risk of suicide. It already says in black and white that someone in a state of suicidal crisis is not eligible for MAID. It says that clearly, and it's stated over and over again.
What do you think of people who provide MAID to a person in crisis? Is there a way to stop that from happening? It is not good medicine and it is not MAID.
9:15 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Thank you, Ms. Mégie.
You have 10 seconds to answer, Mr. Sareen.
9:15 p.m.
Physician, Department of Psychiatry, University of Manitoba
Again, I would emphasize that I don't have any objections to MAID itself for physical illness or when people are dying. We're talking about MAID for mental disorders as a sole underlying condition, and there is no evidence to differentiate a MAID request from a suicide request. Whether it's planned—
9:15 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Thank you, Dr. Sareen.
Senator Wallin, the floor is yours for three minutes.
9:15 p.m.
Senator, Saskatchewan, CSG
I just have a comment as we begin here. You've repeatedly said there is no evidence yet on access to MAID for mental illness. I want to state, for the record, that of course there isn't. It's not the law yet, so it's hard to collect the data and the information on a practice that doesn't exist.
I have two questions for you. I'll pose them both, and then you can answer them.
Whom exactly do you represent? Have you actually consulted with all of the psychiatrists in your departments, hospitals or universities, or as chairs? Have you done this?
Second, can you give us either a legal or a medical, clinical definition of “suicide contagion”? Is that a medical fact? Is that a legal construct? What does that mean?
9:15 p.m.
Physician, Department of Psychiatry, University of Manitoba
I consulted my department of psychiatry last year. We did a survey. I represent the department of psychiatry at the University of Manitoba and Shared Health. My colleagues are department chairs, and they're represented individually. They are in the position of trying to take this information and implement education and training.
9:15 p.m.
Physician, Department of Psychiatry, University of Manitoba
I speak for 150 psychiatrists in Manitoba.
9:15 p.m.
Physician, Department of Psychiatry, University of Manitoba
The majority of them do, yes.