Evidence of meeting #8 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 suffering.
A recording is available from Parliament.
Doctor, As an Individual
No, I have not, because really what I am looking for—
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I have only five minutes, so could you just give me yes-or-no answers, please?
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Psilocybin is just a drug that is under that sort of use right now, but there are no conclusions. There have been no clinical studies about psilocybin, really. However, you're suggesting that it's a cure-all.
Doctor, As an Individual
There are studies using psilocybin in the treatment of—
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Is it a cure-all? Do you think it's a cure-all for any irremediable problem for people who are not in imminent danger of death?
Doctor, As an Individual
I do not think it is a cure-all by any means, but it has—
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thanks very much, Dr. Masuda.
I'd like to go to Mr. Krausert.
Mr. Krausert, I am so glad to see that you are with us today and that you did not succumb to your bouts of depression and suicidal ideation.
You have talked a little bit about the fact that you've been helped. Obviously, this is good. All of us believe it's good. Do you believe, as Dr. Smith said earlier on, that the courts, through very long cross-examination, have actually decided in certain cases, Truchon being one, that trained psychiatrists have the ability to distinguish between suicidal ideation, which could be temporary, and a mental illness that is irreversible?
I noted that the courts also said that the ability to decide whether something is irremediable or not, or intolerable or not, is something that only a patient can decide, because they know what they're living in, they know what they believe, and they know what their options are. Given good options and all of the informed consent, a patient has the right to decide whether or not they qualify as having irremediable suffering and whether they wish to have the treatment that is being offered to them because, for them, the treatment is not something they want to accept.
Courts have ruled positively on those things. Do you agree with those things?
Executive Director, Canadian Association for Suicide Prevention
No, I don't. My personal experience tells me that you can be in a state of mind and suffering from severe depression that you believe is going to last the rest of your life. If somebody were to ask me if I was ever going to get better, I would have said definitively that I will not get better and that it has gone on too long.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you, Mr. Krausert, but you are the person living in your own body and, as we heard from Dr. Smith, the whole human being must be looked at here: that whole person with the brain that is now being afflicted by some sort of different way of looking at the world or by mental illness. This is part of the overall human being that we're talking about, and the courts have ruled that this is very different.
You have learned a particular lesson from your own experience that is not necessarily for every human being who is suffering from a mental illness and from a chronic illness for which they decide they do not want any more treatment, which is different from suicidal ideation, by the way.
Do you really believe that this should be done, as MAID is suggesting, on a case-by-case basis, dealing with physicians who have that ability to understand competency, to understand the difference between suicide and and irremediable and intolerable suffering, and who can therefore make those decisions to assist a patient who has all the informed consent available in terms of all their options?
Do you agree that this is an individual thing and that we can't use your experience to define what another human being's experience would be in a given case?
Executive Director, Canadian Association for Suicide Prevention
The answer is no, because—
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you.
Thank you very much, Mr. Krausert. I don't have any time.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
My first question is for Mr. Krausert.
I must have read this report ten times or so and I think I will read it again.
You raised a lot of questions that were also on my mind.
Recommendation 8 refers to the consistency, durability and well-considered nature of a MAID request. It says:
Assessors should ensure that the requester's wish for death is consistent […], unambiguous and rationally considered during a period of stability, not during a period of crisis.
I am glad you are still with us, but from my understanding of the report, even if you had made a request, you would not have been eligible for MAID when you were at your lowest point.
Clarification is provided a bit further on that helped me understand which people were being referred to. One case is mentioned. I will read out an excerpt and you can tell me whether you think this woman should be eligible for MAID:
C. is a 70‑year‑old woman with severe major depressive disorder and post-traumatic stress disorder diagnosed at age 18. She has expressed a desire to die since she was 20 years old and has made approximately 30 suicide attempts during her life, many of which were severe enough to require medical hospitalization. She is unable to work and does not wish to have any social relationships because of her mental state. She has requested MAID because the symptoms of her disorders have been refractory to over 35 recognized psychosocial interventions and somatic (medication and neuromodulatory) treatments and she does not want to try any more. She has no plan to attempt suicide at present.
In your opinion and based on your experience, should this lady have access to MAID following a rigorous evaluation process?
Executive Director, Canadian Association for Suicide Prevention
I don't think so.
In the particular case that you gave, the condition has gone on for a long time. It's not unreasonable to think that it's going to last for a long time. Also, to my mind, you said she doesn't want to undergo further treatment. The question really is whether we want to be a party to helping people die prematurely.
I think that, in the absence of absolute evidence, data, that shows objectively that this is never going to be treated so that the suffering can be reduced, we have to say no. I'll tell you, subjectively, that the condition isolates you. The condition lies to you, and it is simply not the truth for so many people. While you might be able to find a case here or there of there being no other way, you're going to find as many cases of people who end their lives prematurely when they could have gotten so much better.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you for making the effort to answer my question. It is much appreciated.
Bloc
Luc Thériault Bloc Montcalm, QC
I am not a psychiatrist, but I think there are moments when treatment, the chronic nature of a mental illness, crosses a line. Essentially, it is as though treating that state, that mental illness, is a form of extended palliative care. The illness is not cured and it is even difficult to control the suffering, the pain. It is in those cases that we see requests for MAID. For people working in palliative care, this seems to be a finding and a request. In my opinion, the answer should be a yes in those cases. So I disagree with you on that.
I do not have a question; I just wanted to make a comment.
The Joint Chair Hon. Yonah Martin
Thank you, Mr. Thériault.
Next we will have Mr. MacGregor for five minutes.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you very much, Madam Co-Chair.
I'd like to start my questions with Dr. Masuda.
Thank you so much for joining our committee and helping guide us through this topic. I want to expand on your opening statement in which you were talking about the patients you have helped treat with psilocybin therapy.
For full disclosure to my honourable committee members, I did write a letter of support for that section 56 exemption, because I think new and innovative treatments are necessary.
Dr. Masuda, I know that in a previous exchange with Dr. Fry, she did say that it is not a cure-all. I am just wondering if you could maybe expand a bit on the potential promise that it holds. For instance, are we just on the tip of the iceberg of what this potentially could mean for interventions?
Doctor, As an Individual
This is a treatment where, if there's clinical indication, I do offer it—the clinical indication of people who are stuck in a thought process of hopelessness and demoralization, and they are truly stuck.
I had a patient in her early thirties who had extremely complex pain that we could not manage. She had been through a tertiary care unit, she had every conceivable pain option offered to her, and we just could not manage her existential distress. She couldn't communicate. She was a ball of.... She was a mess, weeping.... She couldn't interact with her friends or family. Truly, she was suffering a deep, deep suffering.
She was the second patient in Canada to receive a section 56 exemption. With her, 24 hours later, after administering this one medication, it broke that trap, that place where often you hear psychiatrists and therapists say, “My patient got to a point where I couldn't get past it.” Well, it broke past that, and within 24 hours she had no pain. We were ramping down her pain medication. She was alert and orientated. She could actually talk about death and dying, and she could re-establish the connections between her friends and family.
Since that time, I've had 19 other patients who have had really deep suffering, and we've had no other therapies for this until now. I think this is a breakthrough. I've seen people in a state where they just can't get through, whether they're drinking too much and they can't stop drinking, they cannot interact with their friends and family, or they're stuck in a terror state because they're dying. Within 24 hours, we see a complete change in that.
There are many studies. There are functional MRI studies. We know how these drugs work, but they've been restricted and unavailable to patients.