Medical Assistance in Dying Committee on May 25th, 2022

[Sean Krausert]

No, I didn't say that. I said that CASP supports the right of individuals who are capable of making decisions to access MAID when death is foreseeable, and we don't take those into account. I do know that in other jurisdictions where this has been entered in, suicide rates did not drop, which means there were additional deaths because of MAID.

[Stan Kutcher]

That's pretty clear. Suicide rates didn't go down, to your knowledge, when MAID was being discussed in the public domain.

My question now is for our other witness. It's on psilocybin. We know that for psilocybin, there's an emerging database for its use in palliative care, and that's good.

What proportion of people seeking MAID for mental illness are currently cured or effectively treated by psilocybin?

[Dr. Valorie Masuda]

I deal with patients who have significant moral distress related to cancer, so that's palliative.

[Stan Kutcher]

That's what I heard you say, but we're talking about MAID here, so I'm asking you this question. I don't want the panel to be misguided. What proportion of people seeking MAID for mental illness are cured or effectively treated by psilocybin?

[Dr. Valorie Masuda]

I can say that currently we don't have access to psilocybin, so we cannot make any claims until we have good clinical trials.

[Stan Kutcher]

But in the United States—

[Dr. Valorie Masuda]

There is clinical data available in the United States.

[Stan Kutcher]

What does it say?

[Dr. Valorie Masuda]

For people with chronic mental illness, and we're looking at chronic depression and anxiety disorders—

[Stan Kutcher]

We're talking about MAID, not just chronic anxiety disorders, because that's not the MAID universe. People who are seeking MAID—

[Dr. Valorie Masuda]

No, this is for chronic mental illness.

[Stan Kutcher]

That's not the universe for MAID. We're talking about MAID, so let's focus on MAID. For the people seeking MAID—that's the question—what is the evidence that psilocybin is effective in treating them?

[Dr. Valorie Masuda]

Well, we don't know that information because—

[Stan Kutcher]

So we don't know.

[Dr. Valorie Masuda]

—we don't have patients seeking MAID for chronic mental illness yet.

[Stan Kutcher]

That's fine, so we don't have that information. What you're talking to us about is very speculative, and you're extrapolating from use in palliative care and demoralization to people whose sole underlying condition is a mental disorder.

[Dr. Valorie Masuda]

No, because there is clinical evidence in the States that MDMA and psilocybin are effective treatments for chronic mental illness as well.

[Stan Kutcher]

No, but this is for people seeking MAID.

[Dr. Valorie Masuda]

Well, we don't know that because people can't seek MAID for chronic mental illness yet.

[Stan Kutcher]

There we go. The fact that we don't have evidence and you're extrapolating from other data is important.

Dr. McKenzie, you make really good points, and obviously the social determinants of health are essential to establish. Do you think people seeking MAID who are in precarious living situations, who are racialized or are minorities—anybody like that—should be offered those interventions as part of the assessment of MAID?

[Dr. Kwame McKenzie]

Yes. I think we should do as much as we can to try to alleviate people's suffering. I'm probably different from the other panellists because I'm a psychiatrist who has seen a lot of suffering over the last 30 years, and I don't want people to suffer needlessly, so I would balance people's rights to make their own decisions with what can be reasonably offered by the state. I'd like as much offered as possible, but in a democracy, everybody can't have everything. We know that, so I think there's a balance.

I'm always really happy to see people being very positive about possibilities of miracle treatments in psychiatry, but I've been doing this for 30 years and I've seen miracle treatments come and go, and I've still seen a lot of suffering in mental health. I focus on the social determinants of health because some of them can be ameliorated.

[Stan Kutcher]

All right. Thank you very much.

[The Joint Chair, Liberal, Marc Garneau]

Thank you, Doctor.

Thank you, Senator.

We'll now go to Senator Wallin.

[Pamela Wallin]

Thank you, Chair.

If I could, I have a quick point for Dr. Masuda.

You made the statement—and we've heard this from other witnesses from time to time—that MAID is being offered up as a solution to psychological, psychiatric or social problems, etc. Do you have any evidence or the name of a doctor or a MAID provider who has offered up MAID without process to somebody who is just feeling down or doesn't have a place to live?

I'm sorry, but I can't hear you.

[The Joint Chair, Liberal, Marc Garneau]

Dr. Masuda, we see that you're unmuted, but we can't hear you.