Thank you, Madam Chair and members of the special committee, for your invitation to the Canadian Psychological Association to appear before you this evening.
My name is Dr. Eleanor Gittens, and I am the sitting president of the CPA. I'm a professor and program coordinator in the addictions treatment and prevention program at Georgian College. I'm joined by Dr. Sam Mikail, who is a CPA past president and an adjunct clinical faculty member at the University of Waterloo.
The CPA is the national association for the practice, science and education of psychology. There are approximately 19,000 registered psychologists in Canada.
The CPA recognizes the significant work of the special joint committee on such a sensitive and delicate matter as medical assistance in dying. In considering the pending application of MAID where mental disorder is the sole underlying medical condition, the CPA made a series of recommendations in response to the report of the expert panel on MAID and mental disorders, released in May 2022. This was in advance of the special joint committee's June 2022 interim report. These recommendations have been shared with the ministers of Mental Health and Addictions, Health and Justice, as well as the committee.
The CPA also created the Task Force on End-of-Life and produced two reports. The first was in 2018. It discussed various issues related to MAID, such as decisional capacity, advance directives and the role of psychologists. The other was in 2020. It outlined practice guidelines for psychologists involved in end-of-life decisions.
In the interest of time, we will not cover all the recommendations in our reports, but we would like to highlight the following.
First, the expert panel's report currently recommends that an independent assessor should be involved with MAID where a mental disorder is the sole underlying medical condition. It names psychiatrists as the experts. We fully agree these cases will require an assessment independent of the treating team or provider. However, we strongly recommend that psychologists be named as additional expert assessors in these cases. Psychologists are the country's largest group of regulated mental health care providers able to assess, diagnose and treat mental disorders. We can offer expertise relevant to MAID decisions while expanding the qualified assessor pool. Psychologists' expertise in the administration and interpretation of objective measurements has established validity, reliability and embedded indices aimed at identifying inconsistent responding, feigned responding, symptom exaggeration and suicidal ideation or intent. This is vital to the assessment of individuals requesting MAID where a mental disorder is the sole underlying medical condition.
Second, in the development of the newly established curriculum for MAID assessors, the CPA has not been given an opportunity to review or provide input. Given psychologists' expertise in the development, administration and interpretation of psychometric measures for the purpose of complex assessments, we see this as a significant oversight. When it comes to a decision regarding end of life, and when that decision may be impacted by even the slightest possibility of compromised decision-making due to impaired cognitive functioning, the highest standard of care must be taken in conducting objective assessments, in order to guide the final determination of eligibility. Psychologists, as specialists in the assessment and diagnosis of cognitive functioning, are uniquely positioned to ensure this standard of care.
Given this training, and because they also have extensive training in research methods, psychologists should be equally involved in MAID research questions on end-of-life care when a mental disorder is the sole underlying medical condition. Here we refer to recommendation 19, which states, “The federal government should fund both targeted and investigator-initiated periodic research on questions relating to the practice of MAiD”.
Third, we would also like to address the expert panel's recommendation 2: “MAiD assessors should establish incurability with reference to treatment attempts made up to that point, outcomes of those treatments, and severity and duration of illness, disease or disability.”
This recommendation—