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.
8:15 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Thanks.
The next questions will be asked by senators.
First up is Senator Mégie for three minutes.
8:15 p.m.
Marie-Françoise Mégie
I thought I heard someone ask about how long the needs assessment is. Having experience in professional development, I'd like to ask Dr. Green or Ms. Campbell a question.
How will the length of the needs assessment affect the training modules you're putting together? Is there a difference between ongoing professional development and MAID training with respect to the needs assessment?
8:15 p.m.
Nurse Practitioner, Canadian Association of MAiD Assessors and Providers
If you're asking whether the module training and the hours put into that are different from ongoing professional development, I would say they're complementary. The modules provide, certainly, a basis of learning that supports that standardization, but we continue to learn. What we knew in 2016 isn't what we know today, and ongoing professional development only adds to the basis of the curriculum.
8:15 p.m.
Marie-Françoise Mégie
Do you have anything to add, Dr. Green?
8:15 p.m.
President, MAID Practitioner, Advisor to BC Ministry of Health, As an Individual
I'm not sure I understand the basis of your question. I would think that the curriculum project is in fact ongoing professional development. If you're talking about the medical schools and the nursing schools, we're hoping to be in that space as well, but I don't think that's what you're asking—
8:15 p.m.
Marie-Françoise Mégie
Sorry to cut you off, but I just heard some questions around the table.
Does the length of the needs assessment affect how you design the modules? I wouldn't think so, because a needs assessment is time limited. Nevertheless, is there a difference between a needs assessment as part of ongoing professional development and a MAID needs assessment?
8:15 p.m.
President, MAID Practitioner, Advisor to BC Ministry of Health, As an Individual
I'm sorry. I still don't understand the question.
The needs assessment I referred to before was in order to develop the content of the project. That was an ongoing, months-long process that was done in combination with the gathering of evaluations from other training sessions that happened in the previous seven years. There was an abundance of information from previous training, ongoing training and the needs assessment itself, which was a separate assessment specifically for this particular curriculum development, and that was all put together to help inform the subject matter experts as they developed and implemented the content for this curriculum. I think it's all a crescendo coming together.
8:15 p.m.
Liberal
8:15 p.m.
Mohamed-Iqbal Ravalia
Thank you, Chair.
My question is for Professor Gubitz.
Professor, could you clarify for me the process and the potential timelines that an individual with a treatment-resistant or incurable mental illness would have to follow prior to being considered for—
8:15 p.m.
President, MAID Practitioner, Advisor to BC Ministry of Health, As an Individual
We've lost audio. There's no sound.
8:15 p.m.
Liberal
The Joint Chair Liberal René Arseneault
Okay. I'll stop the time.
Can you hear us now?
Is the sound better now?
8:15 p.m.
President, MAID Practitioner, Advisor to BC Ministry of Health, As an Individual
There you are.
8:20 p.m.
Mohamed-Iqbal Ravalia
Thank you very much.
This is a question for Professor Gubitz.
Professor, could you clarify for me the process and potential timelines that an individual with a treatment-resistant or incurable mental illness would have to follow prior to being considered for MD-SUMC? I'm asking this for clarity, given the rather angry, condescending, demeaning and sometime ludicrous non-scientific inaccuracies regarding access to MAID for MD-SUMC that have been bandied around.
Thank you.
8:20 p.m.
Head, Division of Neurology, Department of Medicine, Dalhousie University and Nova Scotia Health Authority
The essence of the answer is that the patient who is asking for medically assisted death would have to be able to provide a very detailed history, or a detailed history must be able to be provided about them. That would often come from multiple sources. For patients with psychiatric and mental health disorders, often this is through collateral investigations through psychologists, through a detailed review of patient records, through collaboration with previous family physicians, counsellors, family members, etc. in order for a psychiatrist to come up with an overall diagnostic impression and to be able to assess whether or not all of the avenues have been explored reasonably to ensure that this patient has been using or has attempted to use all of the appropriate treatments for them.
As Dr. Green mentioned, it's not a snap decision. These are track two patients, and it's going to take months to evaluate many of these people to try to figure out if they're eligible.
8:20 p.m.
Mohamed-Iqbal Ravalia
Dr. Green, could you follow up, then, and tell me, based on your clinical experience, the numbers that would qualify in this situation? Would you be able to perhaps just hazard a guess? Are we talking tens or hundreds?
8:20 p.m.
President, MAID Practitioner, Advisor to BC Ministry of Health, As an Individual
We're talking small numbers, less than hundreds, for sure, in the teens. In the number of patients I've seen over the seven years—there have been hundreds of patients I've seen—very few have come forward due to mental illness up until this point. I cannot imagine that there will be very many out there who will be able to meet all of the rigorous standards. The eligibility criteria are rigorous. The safeguards are robust. It will be quite difficult for those with mental health disorders. I would say that probably for every hundred who apply, I would imagine one or two might be eligible.
8:20 p.m.
Mohamed-Iqbal Ravalia
Thank you for your clarity on those safeguards; it's much appreciated.
8:20 p.m.
Liberal
8:20 p.m.
Senator, Saskatchewan, CSG
Thank you very much.
I want to follow up on the same theme as Senator Ravalia, which is the concern that's often raised about whether there will be too much access to MAID for those with mental illness.
It seems to me—given what you've said, Dr. Green, and what you've said, Dr. Gubitz—that the issue is really on the other side. The concern is about access to it. You both highlighted the fact that it's going to be very difficult and that you're going to have to have documentation that people with mental illness might not be able to provide. You're going to have to see earlier documents from people who have treated them in another way, whether or not they have the capacity to put that all together.
We'll go to Dr. Green first. What is your most serious concern coming at it from that perspective?
8:20 p.m.
President, MAID Practitioner, Advisor to BC Ministry of Health, As an Individual
I have the privilege of sitting with people when they come to me in a desperate situation asking me to help them end their life, which is a very intimate time. When someone comes to do that, they are often desperate, and there are times when I have to tell people that they are ineligible.
The greatest risk here is that people—and I'm not a legal scholar—cannot be told that they're not eligible for legalized medial care in this country based on a diagnosis. That seems blatantly discriminatory. The biggest risk here is people feeling they've been excluded from accessing care that others are able to access. The risk then will become what they will do in that situation.
8:25 p.m.
Senator, Saskatchewan, CSG
Dr. Gubitz, that's what we've been hearing in testimony, that if you're going to make the constitutional argument that they have the same right as others to seek MAID, we put a lot of barriers into this particular category.
8:25 p.m.
Head, Division of Neurology, Department of Medicine, Dalhousie University and Nova Scotia Health Authority
I would agree. For us and the group we're working with in Nova Scotia, the question becomes this: What happens to people who apply for a medically assisted death but who are not eligible? Who cares for them then? Our MAID access team in Nova Scotia is not a treatment team for people with mental health disorders. Sometimes these people lack some of those basic circumstances. They don't have a family physician or nurse practitioner to care for them even for their primary needs. For us, it's then a discussion with our government as to how we care for these people if they're not eligible.
8:25 p.m.
Senator, Saskatchewan, CSG
We heard that before, that we need two tracks, in the sense that there have to be money and system readiness on this side, but there also have to be money, services and system readiness for those who cannot access MAID but who still struggle with mental illness.
Dr. Gubitz, go ahead.
8:25 p.m.
Liberal
The Joint Chair Liberal René Arseneault
I'm sorry, Ms. Wallin.
I'm sorry, Dr. Gubitz. That's all the time we have.
Madame Martin, the floor is yours for three minutes.
8:25 p.m.
The Joint Chair Hon. Yonah Martin
Thank you.
I want to go back to Ms. Campbell.
I didn't hear the answer specifically to my colleague about the criteria set out in the CAMAP curriculum with respect to assessing irremediability in the case of mental illness with certainty. I know you talked about the cases that are discussed. It's on a case-by-case basis, but there must certainly be criteria discussed, a list of things you're instructing the MAID assessors on.