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.
Conservative
Shelby Kramp-Neuman Conservative Hastings—Lennox and Addington, ON
Do you feel there's a consensus among psychiatrists to move forward with MAID for mental illness?
Physician, Department of Psychiatry, University of Manitoba
There have been repeated surveys on this issue. We were one of the first to do this survey in 2017. The majority of surveys have shown that the majority of psychiatrists are against MAID for mental illness, because of all the factors we have discussed, such as no evidence of guidelines around irremediability. The idea around irremediability that you heard in the testimony was around how many trials a person has had over the last number of years.
I can tell you a story about a patient I treated—
The Joint Chair Hon. Yonah Martin
I'm sorry, Dr. Sareen. It's past the five minutes. Thank you very much for that.
Next, we'll go to Mr. Maloney.
November 21st, 2023 / 8:55 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thanks, Madam Chair.
Doctor, I'm going to pick up where my colleague left off.
The issue of readiness, from my perspective, is a consideration of whether it's irremediable or not. If you have 10 doctors examining a patient who has terminal lung cancer, they're all going to agree it's not going to get better. However, if you have 10 psychiatrists examining somebody with a mental disorder, you're going to have varying degrees of opinion.
Do you agree with that?
Physician, Department of Psychiatry, University of Manitoba
Absolutely.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Some of those opinions aren't about severity. Some of them are about whether or not it's curable or can get better. Is that right?
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
That's the nut of it.
Do you believe, Doctor, that there are cases of people suffering from a mental disorder that is irremediable?
Let me rephrase that. The reason I'm asking is that the challenge is in determining which ones those are. I'm not sure we're at a stage now where there are safeguards to identify the cases where you'll get 10 out of 10 doctors saying, “It's irremediable.”
That's a fairer way to put it, I think.
Physician, Department of Psychiatry, University of Manitoba
Yes.
Again, I have seen it personally. The story I was going to tell you was about a patient of mine who had stroke-related OCD symptoms in her sixties. I treated her for about two to three years with different types of medication. We tried ECT, and over a five-year period, we were able to get her feeling better. She was able to live 10-15 years afterwards, and she only died related to COVID.
Again, the science is not there. As you said, when you have cancer, a physical biology is driving the death. In mental disorders, there is no biological factor. This is where irremediability is impossible to define.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
I think you've already answered this. You've read the definition of “incurable” in the model practice standard—although we haven't seen the model practice standard. I think you made it clear you don't think the language in this is strong enough.
Physician, Department of Psychiatry, University of Manitoba
Yes, that's correct.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
It's language that might be strong enough to protect a doctor in a legal setting, but it's not strong enough to close off all the problems from a medical perspective. Is that a fair way to put it?
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Have you looked at or taken the...? I think it's module seven of the practice standard for mental health. Have you completed it yourself?
Physician, Department of Psychiatry, University of Manitoba
I registered to look at it in preparation for this meeting, but I have not reviewed it yet.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Are you aware of the content of it, generally? Do you know what the curriculum is, if I can put it that way?
Physician, Department of Psychiatry, University of Manitoba
No, I have not seen it. Again, I have not seen the details of it.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Have you talked to other practitioners or psychiatrists who have completed it, and received their opinion on whether it's adequate or not?
Physician, Department of Psychiatry, University of Manitoba
In my jurisdiction, Manitoba, I'm not aware of any psychiatrists who have completed it.
I have one psychiatrist who is part of the medical assistance in dying team. He went to the June meeting, and he was quite concerned about the lack of safety around MAID for mental disorders. He was quite concerned that cases considered to be slam dunk for getting MAID were quite treatable, especially in older adults.
What I'm hearing is quite a bit of concern around this.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
You mentioned today that you're speaking on behalf of not only your colleague Dr. Gagnon, who is with us today, but also six other physicians from six other institutions. How did your group come together?
In the event that I run out of time when you're answering that question, my final question is, can we ever be ready?
Physician, Department of Psychiatry, University of Manitoba
We're part of the Association of Chairs of Psychiatry. We're eight chairs out of the 17 medical schools. That's how we came together.
I don't think that right now the evidence is clear enough to guide us to be ready at any time in the near future.
The Joint Chair Hon. Yonah Martin
Thank you very much.
Next, we have Monsieur Thériault, for five minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
Dr. Sareen, how long have you been a psychiatrist?