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.
Senator, Nova Scotia, ISG
No, I didn't ask that. I asked, did you actually take the training program?
Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, As an Individual
I read the module.
Senator, Nova Scotia, ISG
We need to finish this, because the module is not the training program.
Conservative
The Vice-Chair Conservative Shelby Kramp-Neuman
No. We've been more than generous with the time. It's been more than three minutes. We need to move on.
Conservative
The Joint Chair Hon. Yonah Martin
Thank you.
My question is for Dr. Gaind.
You mentioned in your testimony European data and the gender gap that was emerging. Do you think it's important for Health Canada to collect data on the socio-economic conditions that the people who are administered MAID live through?
Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, As an Individual
Yes, I do.
I was quite disappointed that the data that would be valuable was not actually provided in the last report that came out, for the 2022 data. Despite that, there are signals in there that suggest signs of trouble for the expansion that's happening.
I'm happy to elaborate on those, if you like.
Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, As an Individual
Absolutely.
The data collection right now to pick out marginalization.... This is what we're talking about. The idea that many people still get it for cancer and other things, that's true; but we're expanding it to allow other people to get it for all sorts of other reasons. If we ignore that the marginalized can seek it for reasons different from those of the privileged, that's a problem.
We're not collecting the data properly—or at least it's not being reported—except we have seen some increases in striking things. The largest area of increase, I believe, was the “other” category. That went up to 15%—and that's 15% of 13,000 deaths, I'll remind you. It is now the third most reported category. In that, there is a gender gap' its 17% women to 12.8% men.
The “other” category also includes frailty. You see a similar gender gap, with more women getting MAID for multiple comorbidities, such as arthritis and hearing loss, with 12% versus about 8.3% for males. In all of this, about one-third of people get it citing that they feel they are a burden on their family. There is even more of a gender gap if you then break it down to the non-reasonably foreseeable death, track two, numbers. There, the gender gaps go to up to 60% higher for females than for males.
The Joint Chair Hon. Yonah Martin
Well, 13,000 is a very astounding number to me.
I was talking to an official from a country comparable to Canada. Their numbers are in the hundreds. I'm actually shocked by the numbers, themselves.
You're saying that Health Canada should be reporting in greater detail the quality, the nature and the adequacy of services people receive before they access MAID.
Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, As an Individual
The Joint Chair Hon. Yonah Martin
Thank you.
We're going into the second round of questions.
We have Mr. Cooper, for three minutes.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
My questions will be for Dr. Gaind.
Dr. Gaind, Health Canada came out with recent data on MAID for 2022. Do you have any comments or observations on that data and, more specifically, on anything that may be relevant to the question of expanding MAID for mental illness?
Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, As an Individual
I do, and actually I started to allude to that in the prior answer as well. There are some gender differentials—the gender gap—that are emerging in some areas of MAID, including track two and the other areas that I spoke about.
Obviously, on the headline numbers being 4.1% of all Canadian deaths, I have to say that the way Health Canada has reported on that surprises me. It seems rather blasé. They say that it's a steady rate of increase of 30% every year. That wasn't the math when I went to school, so whether that's something that maybe should raise eyebrows.... No other country in the world has had that sort of increase in their first six or seven years of implementing MAID policies. I don't know what it means, but it is significant.
The other thing, which is concerning to me, is we honestly don't know how many people truly were track one. I read the CAMAP guidelines. They essentially say:
A person may meet the “reasonably foreseeable” criterion if they have demonstrated a clear and serious intent to take steps to make their natural death happen soon or to cause their death to be predictable. Examples might include stated declarations to refuse antibiotic treatment of current or future serious infection...or to voluntarily cease eating and drinking.
I had heard anecdotally of some people being converted, so to speak, from track two to track one. In their guidelines, they actually say you can do that, so I don't even know how many truly were track two versus track one. If you also look at the refusals, the rejection numbers of MAID, you see it's remarkably low. There are troubling signs in the numbers.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
It has been asserted by Dr. Gupta, as well as other activists, like Jocelyn Downie, that excluding persons suffering solely from an underlying mental health disorder constitutes a paternalistic assumption that such individuals are unable to make autonomous decisions.
I'd be interested in your comments on that.
Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, As an Individual
I disagree with that.
We have a piece in impactethics.ca today that addresses that. Even when somebody is able to make a fully autonomous choice, if the assessor thinks they can do something that they can't, that's the problem. It's not about the autonomous choice of the patient; it's about the assessor pretending that they are doing an assessment that they can't.
The Joint Chair Hon. Yonah Martin
Thank you very much, Dr. Gaind.
We have Mr. Maloney. You have three minutes.
Liberal
Liberal
Francis Scarpaleggia Liberal Lac-Saint-Louis, QC
Thank you, Mr. Maloney. That's very gracious of you.
When you're in this part of the batting order, if I may say, all of one's questions have already been asked; nonetheless, I'll revisit some things.
You said, Dr. Gaind, that the training programs are not based on evidence.
