Medical Assistance in Dying Committee on Nov. 21st, 2023

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you for that.

What criterion is set out in the CAMAP curriculum with respect to assessing with certainty that there is irremediability in the case of mental illness?

[Dr. Stefanie Green]

Again, I'm not sure who it's for, but I'd be happy to answer.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Ms. Green, I was asking about something from the CAMAP curriculum. I would think CAMAP would answer.

[Julie Campbell]

I'm sorry, but can you repeat the question?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

My time is being eaten by.... Am I losing time because they keep...?

Well, this is ridiculous.

What criterion is set out in the CAMAP curriculum with respect to assessing irremediability in the case of mental illness?

[Julie Campbell]

The CAMAP curriculum is quite comprehensive, and each patient is assessed individually using the expertise of people like psychiatrists for those patients, so we would be consulting with them. I'm not a psychiatrist, so if I had that patient, I certainly would be consulting with a psychiatrist around that patient, not just on one condition, but on the patient as a whole.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

So, it would be on a case-by-case basis. Is that the guidance?

[Julie Campbell]

That's right. Each individual is an individual and has a myriad of conditions, just as we've seen for the past seven years that patients with cancer can have mental disorders.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

So there's no listing of criteria saying, here's what you look for to determine irremediability with certainty. That was an issue—predicting it with certainty.

[The Joint Chair, Liberal, René Arseneault]

I think Mr. Gubitz raised his hand.

[Dr. Gordon Gubitz]

Perhaps I could help, sir.

With respect to the curriculum, the curriculum is a case-based curriculum, and it begins with a series of cases that become increasingly more complex as they go through the discussions. In some of the early cases, the person who was experiencing the mental health issue clearly would not qualify for MAID because they did not meet the criteria, all the way through to more advanced cases in which the clinical course for the patient has been demonstrated to be irremediable—

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

I'm sorry to interrupt, sir, but I'm asking what the criteria are. What are the criteria?

Further to that, what science is that based on?

[Dr. Gordon Gubitz]

At the present time, the criteria are based on the ability of the clinician to assess the patient and provide a diagnosis and provide a prognosis based on their past history and how they've been treated. As Dr. Green mentioned in her remarks, a person who has just been diagnosed with a health care problem would not be eligible, and a person who has refused to consider various different treatment options would not be eligible. The sorts of patients who would be eligible would be those who've been treated for many years—

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

What I'm hearing you say is that there are no criteria, that we're back to where we were a year ago with the expert panel report, and that this is going to be decided simply on a case-by-case basis. I see the model practice standard. There's no guidance there either, so what we have is no guidance.

[The Joint Chair, Liberal, René Arseneault]

Thank you, Mr. Cooper.

Over to you, Ms. Koutrakis, for five minutes.

[Annie Koutrakis, Liberal, Vimy, QC]

Thank you, Mr. Chair.

I guess this is a good segue after my colleague Michael Cooper's questions.

Any one of our witnesses can answer this. What steps were taken to ascertain the training needs of MAID practitioners, in particular with respect to MAID and MD-SUMC?

That's for any of the witnesses, whoever wants to answer.

[Dr. Gordon Gubitz]

Sure, I can begin.

When the training curriculum was developed, it was based on other curricula that the Canadian Association of MAiD Assessors and Providers had been doing on an ongoing basis anyway. Each of those experiences resulted in evaluations about the content, about future needs and about things that we would like to do to become better MAID assessors and providers going forward.

A lot of that focused then on providing a detailed basic assessment all the way to more complex things, including complicated track two patients with mental health as the sole underlying condition, recognizing that nobody has practised mental health as the sole underlying condition yet, so there will be some learning going forward.

[Dr. Stefanie Green]

I would add that the curriculum project also did a needs assessment as they were beginning the process of developing content, and that was a large survey across the country of multiple clinicians, both those with and those without experience, seeing what they were looking for and what they were seeking in an educational program. We took that, along with the evaluation that we'd had from the past seven years of CAMAP training experiences, and put it together with the combined subject matter expertise of the committee of people developing the content.

There were quite a number of inputs on the content development.

[Annie Koutrakis, Liberal, Vimy, QC]

Does Ms. Campbell want to chime in?

[Julie Campbell]

Yes. That module was also piloted, so we took the feedback that came from each module to determine whether it met the needs assessment as well.

The project came from that broad space based on other curricula and what we need, and then moved forward into development with a whole series of experts and stakeholders and reviews. Then it was piloted to a group of people, and that information was reviewed, as well.

[Annie Koutrakis, Liberal, Vimy, QC]

Ms. Campbell, when you say “experts and stakeholders”, would you be able to clarify for us whether that included indigenous communities, persons with disabilities, persons with mental disorders or any other potential vulnerable groups?

[Julie Campbell]

It did. I don't have a list in front of me, but we certainly can submit a list, if you're interested.

[Annie Koutrakis, Liberal, Vimy, QC]

That would be great.

How long did it take to ascertain what the training needs would be? Was this over two months? Was it over a year?

Dr. Gubitz, go ahead.

[Dr. Gordon Gubitz]

As mentioned, the training needs were an ongoing assessment from the very beginning of CAMAP's origins in terms of how it was training individuals. The survey that we did across the country took the better part of three or four months. It was completed in English and in French in various jurisdictions and then had to be compiled. From that came the seven modules, with the eighth additional module looking at the resilience of practitioners, which is woven through the other modules.

[Annie Koutrakis, Liberal, Vimy, QC]

Dr. Green, are you aware of any significant differences between the model practice standard for MAID and standards that have already been established or are being developed across Canada?