Thank you so much, Chair.
Thank you for the opportunity to speak to the Special Joint Committee on Medical Assistance in Dying.
I would like to acknowledge that the University of Manitoba campuses are located on the original lands of the Anishinabe, Cree, Oji-Cree, Dakota and Dene peoples, and on the homeland of the Métis nation. We respect the treaties that were made on these territories, acknowledge the harms and mistakes of the past and dedicate ourselves to moving forward in partnership with indigenous communities in a spirit of reconciliation and collaboration.
With regard to this testimony, I have no conscientious objection to MAID. I am an adult psychiatrist with clinical and research experience in suicide prevention for over 20 years, with over 400 peer-reviewed publications, 150 in suicide prevention.
In 2019, I testified on behalf of the Attorney General of Canada in the Truchon case. I co-chaired the federal 2016 expert panel on suicide prevention in the military with Dr. Rakesh Jetly.
Today, I am representing the department of psychiatry at the University of Manitoba and Shared Health in Manitoba. I am here with Dr. Pierre Gagnon, department chair of psychiatry at Université Laval, but we are also representing six other department chairs of psychiatry departments in multiple provinces in the country: Jack Haggarty from the Northern Ontario School of Medicine, Karin Neufeld from McMaster, Gustavo Turecki from McGill, Sarah Noble from Memorial University, Simon Hatcher from the University of Ottawa, and Leslie Flynn from Queen's University. Collectively, we have decades of experience in clinical practice, suicide research and responsibility for education and training of psychiatrists and medical learners.
We strongly recommend an extended pause on expanding MAID to include mental disorders as the sole underlying medical condition in Canada, because we're simply not ready. In our experience, people recover from long periods—“long” meaning decades—of suffering with depression, anxiety, schizophrenia and addictions with appropriate evidence-based treatments. We strongly believe that making MAID available for mental disorders will facilitate unnecessary deaths in Canada and negatively impact suicide prevention efforts. The clinical role is to instill hope, not to lead patients toward death.
We have carefully reviewed the 2023 Health Canada model standard for MAID. In September 2023, we wrote to the federal ministers expressing the following concerns. The standard does not require the involvement of a psychiatrist in the assessment process for all MAID assessments for mental disorders. There is no international or accepted definition of irremediability in mental disorders and addictions; you can look at past treatments, but the most important question is what is going to happen in the future. There is no accepted operational definition to differentiate suicidal ideation and medical assistance in dying requests among people who are not dying. There are inadequate safeguards to protect vulnerable groups that are disproportionately affected by mental disorders. Due to geographic barriers, patients in underserved areas will be more likely to obtain MAID instead of evidence-based care. International experience has clearly demonstrated that MAID is being used in common and treatable mental disorders and is not reserved for the very rare and refractory conditions. The Health Canada standard does not guide psychiatrists on how many treatment trials are required before recommending MAID, because there's no evidence on this particular issue.
The proponents of MAID believe that it is discriminatory to exclude people with mental disorders from accessing MAID, but we completely disagree with this. Equity does not mean each person gets the same treatment. Unlike physical conditions that drive MAID requests, we do not understand the biological basis of mental disorders and addictions, but we know that they can resolve over time. The real discrimination and lack of equity is not providing care for people with mental disorders and addictions.
Advocates of expanding MAID suggest that only a small fraction of psychiatrists need to be trained to prepare for MAID in 2024. Again, we disagree. Should MAID eligibility expand, all Canadian psychiatrists will need to grapple with how to deal with suicidal ideation in the context of mental illness. They will need to determine when to refer for MAID versus addressing suicidal ideation with medications, treatment and sometimes involuntary hospitalization.
Repeated Canadian surveys demonstrate that most psychiatrists are not in favour of MAID, and the Canadian Mental Health Association and the Canadian Association for Suicide Prevention are against the expansion of MAID to include mental disorders. Finally—