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.
Physician, Department of Psychiatry, University of Manitoba
It's probably close to 120.
Physician, Department of Psychiatry, University of Manitoba
There are about 150. There are more than that, actually. I'm just talking about my department.
Senator, Saskatchewan, CSG
That's what I thought.
Maybe you could answer the other question, then, about whether suicide contagion is a recognized legal or clinical condition.
Physician, Department of Psychiatry, University of Manitoba
The contagion effects around suicide.... When there's a celebrity who dies by suicide.... There's clearly been lots of evidence around it. I was part of co-authoring the Canadian Psychiatric Association's media guidelines around suicide contagion in 2008. It's been worldwide.
As far as suicide prevention—
Senator, Saskatchewan, CSG
No, no. Does it have a legal status or a clinical status?
Of course, we can read in the newspaper online that there are copycats, but that's different.
Physician, Department of Psychiatry, University of Manitoba
In small communities, there's been clear evidence that there have been suicide contagion effects, where multiple people have died based on one person dying. That's been—
Senator, Saskatchewan, CSG
Do you think that would be a condition in the context of MAID?
Physician, Department of Psychiatry, University of Manitoba
I do believe that, yes.
Liberal
The Joint Chair Liberal René Arseneault
Thank you, Ms. Wallin.
The last question will be asked by Dr. Ravalia.
You have three minutes.
Mohamed-Iqbal Ravalia
Thank you, Chair.
Thank you, Dr. Sareen, for your testimony.
I'm just curious. You're seven of 17 chairs who have made this statement. Have you had any dialogue with the other 10 chairs who represent psychiatric associations about what their point of view may be?
Physician, Department of Psychiatry, University of Manitoba
Today's testimony is from eight chairs out of 16 right now. One department doesn't have a chair.
Yes, we've had lots of discussion around this issue. There are a variety of political reasons the other chairs are not here, but they were part of the statement that was made last year, and the issues we brought up last year have still not been resolved.
Mohamed-Iqbal Ravalia
Two of the largest psychiatric associations in Canada—the Canadian Psychiatric Association, with approximately 2,500 members, and the Quebec Psychiatric Association, with approximately 1,200 members—have both taken the position that people with mental disorders should have the same rights as people affected by other medical conditions. Would you be able to comment on that point?
Physician, Department of Psychiatry, University of Manitoba
I just want to add that when CPA testified two weeks ago, they said that they had not been fully supportive of MAID. They talked about the idea of equity, but we addressed in our comments that equity doesn't mean equal treatment. The majority of the surveys done have shown that the majority of psychiatrists are not in favour of MAID for mental illness.
Mohamed-Iqbal Ravalia
I want you to speak to the 2% of psychiatrists and 2% of other clinicians, including medical doctors and nurse practitioners, who have signed up and completed module seven of the national standards and are now proceeding and willing to explore the issue of MAID in individuals with mental illness.
Physician, Department of Psychiatry, University of Manitoba
Again, there's controversy on this issue. What we're trying to provide here is scientific evidence around determining and differentiating suicide from MAID and around irremediability. We don't agree with the fact that people with mental illness should have access to MAID when there are potential treatments that can help them recover.
Mohamed-Iqbal Ravalia
We've heard from expert witnesses that suicidality is actually a clear exclusionary factor for individuals seeking MAID, and that these assessments are intense and deep, multifactorial, and often take a significant period of time.
In your own practice, have you ever come across a clinical situation where you've tried absolutely everything within current base standards and were not able to provide a responsible approach to improving that individual's mental illness?
Physician, Department of Psychiatry, University of Manitoba
There are cases that suffer, but the idea is to sit with somebody who is depressed and hopeless and help them with their recovery.
Liberal
The Joint Chair Liberal René Arseneault
We now go to Senator Martin.
The floor is yours for three minutes.
The Joint Chair Hon. Yonah Martin
Thank you.
Dr. Sareen, psychiatry is a very specialized field and practice, but I know that we don't have enough across the country, so the Health Canada health standard, I believe, does not require that the MAID assessor be a psychiatrist.
What are your thoughts on that?
Physician, Department of Psychiatry, University of Manitoba
Again, we are very concerned about that because psychiatrists are extremely important in assessing suicidality and depression, as well as treatments. Even in addictions, people often have an underlying mental disorder, like post-traumatic stress disorder or depression, and that can be missed. Psychiatrists are also involved in second- and third-level treatments beyond medications. Therefore, we're very concerned.
An example would be somebody who has a brain tumour. Although there are a limited number of neurosurgeons, a neurosurgeon has to make the time and effort to help assess.
We strongly believe that psychiatrists have to be part of the assessment process.
The Joint Chair Hon. Yonah Martin
You haven't seen the CAMAP module seven, the training module. Is that correct?
Physician, Department of Psychiatry, University of Manitoba
I have not.
The Joint Chair Hon. Yonah Martin
I am curious about what that would look like from your standpoint as a psychiatrist. I'm assuming that psychiatrist specialists would have been part of its development. However, you haven't seen it.
Is it possible for me to ask Dr. Gagnon a question? It's a simple one: Is there consensus among Quebec psychiatrists that we are ready to move forward with MAID for mental illness?
Dr. Pierre Gagnon Director of Department of Psychiatry and Neurosciences, Université Laval, As an Individual
I'm going to answer in French, if that's all right.
No, there isn't a consensus. That is why the National Assembly of Quebec decided not to expand MAID to individuals whose sole medical condition was a mental disorder. Quebec went through that whole debate, and obviously, the Association des médecins psychiatres du Québec had a say, among others.
What Dr. Sareen just said is absolutely true. The same thing was said in Quebec. We can't move forward with this right now. We aren't ready. That is why the National Assembly of Quebec chose not to even put the issue on its agenda. It's too complicated. The issue is controversial among patients, families, members of the public, psychiatrists, politicians and so on.
It's something that requires lengthy study. That's why Dr. Sareen called for an indefinite pause on the measure. It's extremely complex and causes controversy on every level.