Thank you for this opportunity.
My name is Stefanie Green, and I'm a physician with 30 years of clinical experience.
In June 2016, I began working almost exclusively in assisted dying. You may read of my credentials in my written brief. I've no personal or professional stake in the outcome of your deliberations, but I remain committed to providing the highest standard of medical care possible under any and all legislation.
If the purpose of this committee is “to verify the degree of preparedness attained for a safe and adequate application of MAID” in MD-SUMC situations, your work should not be complicated. Clearly, there is a high degree of preparedness. I point your attention to the numerous readiness activities plainly outlined in the written brief of CAMAP, and those referenced by Dr. Mona Gupta and Dr. Douglas Grant, and tonight by Professor Downie.
There is readiness at the federal level. There is stated preparedness by the medical and nursing regulatory bodies, as well as by professional associations. Clinical teams in British Columbia, Alberta, Saskatchewan, Ontario and Nova Scotia have all confirmed their readiness. I can speak more to this in our discussion if you wish.
Regardless of what this committee ultimately recommends, I am most concerned that it be based on fact and not on any fundamental misunderstanding. I submit the following three points of information for clarity.
Number one, consensus is not and has never been required in the development of medical practice. There's no consensus on many medical practices—hormone replacement therapy for women, safe injection sites, use of ketamine for treatment-resistant depression. This lack of consensus is not taken as a reason or justification to prohibit these practices. There is no consensus among clinicians about MAID itself, yet that did not and does not stop MAID from being permitted under the law.
Medical practice does not start with training all clinicians before the practice is permitted; rather, it starts with training some, who then train others over time. Only clinicians with the professional competence to provide the intervention are permitted to do so, by the standards already published and already enforced by the colleges of physicians and surgeons or colleges of nurses in every province and territory.
Any suggestion that consensus is required before moving forward with MD-SUMC is opposition to MAID disguising itself as a benchmark.
Number two, legislation is clear regarding MAID eligibility. We need to stop focusing our attention on a person's diagnosis, mental disorder or otherwise, and look to the eligibility criteria—the condition must be incurable, irreversible, unrelievable.
Clinical understanding and implementation of MAID legislation continues to evolve and mature. The recently published model practice standard for MAID has contributed significantly to this understanding.
As an experienced MAID practitioner and as one who teaches others how to approach this practice, I would state as clearly as possible for your recognition that in situations of MD-SUMC, someone in crisis is not eligible for MAID. Someone who is newly diagnosed is not eligible for MAID. Someone who hasn't had treatment, or refuses all treatments with no rationale, or is seeking MAID due to socio-economic vulnerabilities is not eligible for MAID.
Number three, we have enough psychiatrists already involved to move forward. Legislation requires two independent clinicians to find a patient eligible before they can proceed. For patients whose natural death is not reasonably foreseeable, a clinician with expertise in the condition causing the person's suffering must also be involved.
Psychiatrists may therefore potentially play two different roles: they may be assessors or providers of MAID, although few will be required for this role, or they may be consulted as clinicians with experience in the condition causing the person's suffering. Psychiatrists are already being consulted as clinicians with expertise in many applications, because they already possess the skills and training to be considered experts in their field. Canada has nearly 5,000 psychiatrists already adequately trained to continue to fulfill their role of expertise in MD-SUMC situations.
Over 100 psychiatrists have already registered their interest in becoming involved in MD-SUMC. This represents 2% of all psychiatrists in Canada. Last year, about 2% of all physicians in Canada provided 13,000 MAID procedures. I would suggest that 2% of our psychiatrists are sufficient to consult on what is rationally expected to be significantly fewer MD-SUMC cases.
Preparedness for MD-SUMC is clear. Please do not let misinformation distract or cloud your deliberations on this point.
Thank you.