Good afternoon, Chairs and honourable members of the committee.
My name is David Roberge, and I am a member of the end of life working group of the Canadian Bar Association.
On behalf of the CBA, thank you for the opportunity to address this committee.
The Canadian Bar Association, or CBA, is a national association of 36,000 legal specialists from across the country. The CBA end-of-life working group comprises a cross-section of members from diverse areas of expertise, including constitutional and human rights law, criminal justice, and health law.
The CBA has demonstrated an abiding commitment to clarifying the law about end-of-life decision-making and stressing the importance of a pan-Canadian approach consistent with the criterial established by the Supreme Court of Canada in Carter.
We acknowledge that medical assistance in dying is complex and raises important issues and diverse views. This is perhaps even more so in cases of mental illness. The CBA recognizes the importance of appropriate health care and social support for people living with mental illness. Meanwhile, we must realize that the suffering of these individuals is no less real than those of individuals with physical illnesses.
As such, the framework should recognize the rights of persons with mental illness to make their own health care decisions, including MAID, in a manner that balances autonomy and appropriate safeguards.
In a nutshell, the CBA's position regarding the issue of MAID and mental illness as the sole underlying medical condition is as follows.
Firstly, Parliament should authorize MAID in some cases of mental illness pursuant to a patient-centric approach and provided appropriate safeguards are in place.
Secondly, Parliament must ensure that any additional safeguards, whether they relate to the expertise of the assessor, timelines, or informed consent, do not unduly prolong the suffering of patients would otherwise be eligible for MAID.
Thirdly, Parliament should ensure that in cases of mental illness, MAID aligns with current best practices in mental health care.
While some issues pertaining to MAID and mental illness would be more appropriately addressed by medical experts, the CBA wishes to highlight key considerations on the topic of appropriate safeguards from a legal perspective.
As to the scope of the law, Parliament must clearly define the scope of MAID in the case of mental illness to avoid any ambiguity on the applicable protocols and safeguards.
As to the assessor's expertise, in view of the inherent complexity of mental illnesses, Parliament might wish to require that one of the MAID assessors be a psychiatrist. Access to those specialists in practice must also be considered, because any delays could unduly prolong the patient's suffering.
Regarding time limits, currently, for situations where natural death is not foreseeable, at least 90 days must elapse between the initial request and the administration of MAID. An appropriate period is required to enable MAID assessors to conduct a full review of the patient's circumstances. Parliament must be mindful of the risk of arbitrariness in setting time limits, irrespective of the nature of the mental disorder.
Turning to informed consent, the patient requesting MAID must have been offered reasonable therapeutic solutions in order to make an informed choice. The opportunity to strengthen informed consent criteria is the subject of debate. In this regard, the CBA maintains that consideration must be given to the health care standards guidelines of provincial governments and professional regulatory bodies.