Evidence of meeting #40 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 camh.
A video is available from Parliament.
Chair, Medical Advisory Committee, Centre for Addiction and Mental Health
I don't have a time. I'm representing CAMH here. We're having discussions within CAMH. It's taking us a long time to think about those guidelines and be more specific than what exists now. The discussions have to happen nationwide, in order to have a sense of how long it's going to take.
I cannot give you an answer in terms of how long this could take.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
In the 30 seconds I have left, can you expand on the previous answer you were about to give about the difficulties professionals could have in separating suicidal ideation from someone making a claim for medical assistance in dying?
Do you want to expand a bit on that, as well?
Chair, Medical Advisory Committee, Centre for Addiction and Mental Health
Yes, it is difficult at this point. There is no clear way to separate suicidal ideation or a suicide plan from requests for MAID. Therefore, there needs to be some discussion to see a consensus and agreement, as professionals, on what part of an individual's history with a particular illness would constitute that separation.
It's not simple.
Conservative
Marie-Françoise Mégie
Thank you, Madam Chair.
My question is for Dr. Gaudreault, from the Collège des médecins du Québec.
Could you tell the committee whether the CMQ already has some sort of rule framework in place to oversee the delivery of MAID by members of the college to people whose sole underlying medical condition is a mental disorder?
President, Collège des médecins du Québec
Sorry, but I didn't understand the whole question.
Marie-Françoise Mégie
Has the college set up or implemented any rules to oversee members who provide MAID to individuals whose sole underlying condition is a mental disorder, or is the college planning any such framework?
President, Collège des médecins du Québec
No, Senator, we haven't done that at all. We are still at the discussion stage.
What we conveyed are really the five conditions that would help guide physicians providing MAID to patients whose sole underlying condition was a mental disorder if that became a possibility.
Marie-Françoise Mégie
Does Quebec have a specific group or groups that provide support for MAID in that circumstance, in other words, for individuals with mental disorders?
President, Collège des médecins du Québec
As I said earlier, we conducted a survey of physicians, and 55% of them wanted the CMQ to develop specific criteria that would help patients struggling with mental disorders access MAID. It is fair to say, then, that the majority of the medical community, just over 50%, would be in favour of moving forward in that case.
Obviously, it's a complex issue. We agree with everything that's been said, but the CMQ believes we need to keep doing this work so these patients can one day have access to MAID.
Conservative
Stanley Kutcher Senator, Nova Scotia, ISG
Thank you, Madam Chair.
Dr. Rajji, you keep telling us that you speak on behalf of CAMH. I have here their latest guidelines and considerations for operationalizing MAID. Just to be clear so that the committee knows, there is nothing in this document that says that more clarity is needed, which were your words. There is nothing in this document that urges further delay. There is nothing in this document that says that consensus guidelines must be consensus based. In fact, there is no phrase like the one you used that says “consensus-based criteria”. This does not appear in the CAMH document. I will share the document with everybody.
In fact, contrary to your personal statement on irremediability, the document reads that CAMH has to address this issue on a case-by-case basis. It reads:
CAMH believes that the determination of whether or not an individual patient is experiencing a grievous and irremediable mental illness that could qualify them for MAID must be based on best clinical judgment and a shared decision-making process with the person making the request and anyone else the person identifies... This determination should be guided by nationally developed practice standards...
Those have been completed. You may not agree with some of them personally, but they have been completed, and they've gone through due process.
The other issue here is that CAMH talks about the importance of every effort to distinguish “a request for MAID, based on an individual’s reasoned determination that life with a grievous and irremediable mental illness is not one they desire” from “suicidality as a symptom of a remediable mental illness”.
You said that could not be done, but that's not what the CAMH document says. I just want to be clear: Are you speaking on your behalf, or are you speaking on CAMH's behalf? I ask because your testimony is contradictory to everything that I read here in the CAMH document.
Chair, Medical Advisory Committee, Centre for Addiction and Mental Health
I'm speaking on behalf of CAMH. The statement I just read was sent by CAMH public affairs to this committee. I'm not seeing clearly that there is contradiction. I'm not speaking on my own behalf; I'm speaking on CAMH's behalf. I can assure you about that.
Senator, Nova Scotia, ISG
Excuse me, I'm sorry; we have such a short period of time. I will table this so that the committee members themselves can look to see if the testimony from the witness and the information from CAMH are congruent or not.
By the way, Dr. Rajji, Dr. Mark Lachmann in Ontario, who is the medical lead of Sinai Health's Bridgepoint Hospital, who has been tasked with addressing MAID SUMC in Ontario, says that "We are; however, ready to move ahead with MAiD SUMC in Ontario as of March 17, 2024." He is in direct contradiction to what you just said. I will table with the committee the full report from Dr. Lachmann.
Conservative
The Vice-Chair Conservative Shelby Kramp-Neuman
Thank you, Senator Kutcher.
Next we have Senator Osler for three minutes.
Flordeliz Gigi) Osler (Senator, Manitoba, CSG)
Thank you, Madam Chair.
My question is for Dr. Rajji.
Dr. Rajji, I was struck by your comment that discussions on quality of care have not been held. This committee did hear from the Federation of Medical Regulatory Authorities of Canada, whose mission is to advance medical regulation on behalf of the public through collaboration, common standards and best practices. When the federation, FMRAC, was here, they, in fact, reported to this committee that they are ready. My question for you is regarding your concerns about the discussions on quality of care not being held. Have you met with FMRAC to discuss your concerns or written to them about the lack of discussions? If so, what was their response?
Chair, Medical Advisory Committee, Centre for Addiction and Mental Health
No, I have not met with them.
Again, these are not my concerns only. These are the concerns of several physicians who are engaged in developing those guidelines. Guidelines are different from standards. I just want to clarify that point as well. The standards document itself, the one developed by the expert panel, states that these are not clinical guidelines, and this is what is missing to ensure quality. That's CAMH's position that we're describing as to why we're not ready.
Flordeliz (Gigi) Osler
If CAMH, indeed, does have these concerns, why have you not had that discussion with the Federation of Medical Authorities of Canada?
Chair, Medical Advisory Committee, Centre for Addiction and Mental Health
We are having internal discussions. We did express this concern to the expert panel when they were developing the model that explained the standards of the regulatory bodies. That was our input. That was our feedback to the expert panel before [Technical difficulty—Editor]
Conservative
The Vice-Chair Conservative Shelby Kramp-Neuman
We will pause for a moment.
Would you care to direct your question to another witness?
Conservative
The Vice-Chair Conservative Shelby Kramp-Neuman
I've paused the time.
Dr. Rajji, your connection is frozen, and we are trying to get you back online.
Dr. Rajji, it looks like you are back.
Chair, Medical Advisory Committee, Centre for Addiction and Mental Health
Yes, I am back. I am sorry about the disconnection of the Internet at the hospital. I'm not sure if you heard my—