I'm talking about the reliability of psychiatric diagnoses. There's good research that shows that psychiatric diagnoses are as reliable as other medical diagnoses. This is in spite of the fact that we don't have biological markers like blood tests or X-rays to make psychiatric diagnoses. The reason for that is that the brain's a very complicated organ and we don't understand it.
However, the courts have certainly relied on psychiatric diagnoses over many years. In fact, the Truchon case in Quebec, which ended up with Bill C-7 being introduced, relied extensively on psychiatric diagnosis. The madam justice found that a psychiatrist can make accurate diagnoses.
In my opening statements—which you have—I've included a table showing that, compared to other medical diagnoses, psychiatric diagnoses are just as reliable.
The second thing I want to talk about is whether psychiatric illness is irremediable. Mental illness usually isn't a terminal illness, unless you're looking at conditions like Alzheimer's. Under current law, one does not have to have a terminal illness as a requirement for MAID.
I think it's instructive to look at the case of A.B. from Ontario, where a judge granted MAID for a woman who had osteoarthritis. This is not a condition that is terminal or usually results in death. The judge agreed to providing MAID for A.B. because she looked at the whole person. One cannot look just at a diagnosis. You have to understand the nature of the human experience of the person who's sitting in front of you. Don't rely entirely on what the diagnosis is. It's the person that we're interested in here.
In a more recent decision, Justice Baudouin granted Jean Truchon, a disabled man, his request for MAID. In the judgment—which I'm sure you've had—on paragraph 466 it says, “The physicians involved are able to distinguish a suicidal patient from a patient seeking medical assistance in dying.” That was one of her conclusions.
Unlike the previous witness, I think, when it's tried in a court of law, the judge has accepted that psychiatrists can distinguish between suicidal thinking and people who are seeking MAID. I'm in agreement with that.
Now, “irremediable” is a term that's used when there are no more treatments available that are “acceptable” to the patient. Under law, the patient cannot be forced to take any types of treatments that are available. They must agree. If a person refuses additional treatment, I would, therefore, consider them to be irremediable. One of the major controversies in psychiatry is whether people with depression should be forced to have electroconvulsive therapy. I think the law is quite clear. The patient must agree. If they don't agree and there are no other treatments available, then the person has an irremediable condition.
We're not talking here about people who have been depressed for a day or have had six months of distress. We're talking about people who have been psychiatrically ill for years and have tried many different treatments—medication, psychotherapy and so on. All of the cases you've heard quoted from the Netherlands are chronic patients with many years of treatment.
The next thing I want to speak about is whether the vulnerable need protection. Again, this has been tried in court with both the Carter case and Truchon case. There is no evidence that vulnerable people are at risk for MAID. In fact, if you look at the actual people who are receiving MAID, they are typically white, well educated and well off. You could easily argue that the marginalized communities are disadvantaged because they're not accessing MAID. In the Truchon case, Justice Baudouin equally found that the disadvantaged are not being taken advantage of and you must do each case at a time.
I thought I would talk to you about the two cases I've been involved with.
One was a woman, E.F. This was extensively reviewed by Madam Justice Baudouin in her judgment. E.F. was a woman with a conversion disorder. She had the condition for about 10 years. It's a complicated psychiatric neurological condition. In the end, a justice in the Queen's Bench granted her MAID. The Attorney General of Canada appealed it and the court of appeal granted it based entirely on the psychiatric diagnosis.
That was before Bill C-14, when the rules flowed out of the Carter decision. We know from Carter that psychiatric illness was not an exclusion.
If you look carefully at Bill C-14, there is nothing that excludes psychiatric patients. Again, this was a finding from Madam Justice Baudouin in the Truchon case.
I, personally, was involved with a woman who was in her forties. She'd had an eating disorder for many years. She'd had every known treatment. The family was richly resourced. She'd been to treatment centres in the United States. I interviewed her and her father, who was a retired Supreme Court justice. Her father said knowingly that he understood the situation and it broke his heart to agree with his daughter that she needed an assisted death. In the end, it was his opinion that she should have an assisted death. After a full assessment program, she did have an assisted death. Those are the only two patients that I've been personally involved with.
The numbers across Canada up to this point are enormously small and they will, incidentally, continue to be small as well. If we look at the Benelux countries, there are very few patients who actually get approved for psychiatric illness leading to MAID, so we don't have to worry about a tsunami of psychiatric patients lining up, applying for MAID and being approved for that.
