Evidence of meeting #9 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 treatment.
A video is available from Parliament.
2:45 p.m.
Senator, Nova Scotia, ISG
There is training of assessors and providers, item 15. Would you agree with that as well, and do you have anything to tell our committee about any training programs that are currently being developed?
2:45 p.m.
As an Individual
Thank you.
Yes, Health Canada has partnered with the Canadian Association of MAID Assessors and Providers to set up a national program of education. We have already been doing this, but this will be far more extensive and well done.
2:45 p.m.
Senator, Nova Scotia, ISG
My understanding, and correct me if I'm wrong, was that this was going to be credentialed by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. Is that correct?
2:45 p.m.
Senator, Nova Scotia, ISG
It includes indigenous physicians, indigenous nurses and the Canadian Nurses Association, and multiple other stakeholders in the medical and health-providing fields?
2:45 p.m.
Liberal
2:50 p.m.
Pierre Dalphond
Thank you, Mr. Chair.
Thank you, Mr. Chair.
I thank all the witnesses for their testimony, but I only have three minutes.
My question is for professor Vrakas.
Professor Vrakas, you talked about a crisis, someone going to the emergency room. Obviously, the intervention has to be quick. In other words, there is no time to lose. However, when we talk about accessibility of medical assistance in dying, is there not room for nuance?
Protective measures are already in the Act, including the period of at least 90 days, which is still quite long. Then there are steps. Assessments need to be done by two people, not just one. According to the working group’s recommendations, this second person should specialize in mental illness. There is also a need for those doing the assessment to have specialized training in this field and to work in conjunction with the treatment team.
Don’t you think this system is very different from the reaction to a crisis?
During an assessment, it takes several months to come to the conclusion that the patient is eligible for medical assistance in dying. In your case, you said you wanted to die, but that does not mean you would have been allowed to access medical assistance to die.
2:50 p.m.
Psychologist and Professor, Department of Psychoeducation, Université du Québec à Trois-Rivières, As an Individual
There's a good chance I would have been eligible since treatment had been only somewhat effective for 20 years and I was still experiencing bouts of depression.
They are two different things. A crisis is fleeting. You have a crisis and you get help. When you have a mental illness, you live with the suffering and problems over a long period of time. During that time, you can seek help and you can find out whether you are eligible for MAID. The real problem is access to treatment.
I am a psychologist, and I can't choose to turn away clients. I just received an email from the government asking me to make my services available to the public. Services are desperately needed, and those who are suffering don't have access to the services they need.
No matter how it is structured and no matter what protocols are in place to regulate MAID, it doesn't change the situation. People like me and others are being told that they can access MAID, that they can die, that they can have help to die, and that death is an option. We are told that suicide is not a solution, but that assisted dying is. That sends the message that our situation is hopeless.
When that is presented as an option, the person may choose it because, morally and socially, it is seen as an acceptable solution. Whatever protocols are put in place, it won't change things. That thinking will become mainstream.
2:50 p.m.
Pierre Dalphond
Thank you.
2:50 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator Dalphond.
We now go to Senator Wallin.
Senator Wallin.
2:50 p.m.
Pamela Wallin Senator, Saskatchewan, CSG
Thank you, Chair.
My question is for Dr. Wiebe.
You mentioned that we make this huge distinction between physical illness pain and suffering, and mental illness pain and suffering. Can you really speak to the issue, that when it comes to mental illness it seems that we see it as endlessly fixable and that treatment must be relentless and go on and on and on. We've kind of come to terms with the physical side. We're saying that if you're in intolerable pain, you should be able to have access to MAID. Why do we have that distinction?
2:50 p.m.
As an Individual
Why do we have that distinction? That's not mine to answer, but I can tell you my position here is that chronic conditions are similar whether they're mental or physical. Pancreatic cancer has a very strict trajectory, but the chronic conditions that people are suffering with and for which the treatments are not adequate to make their lives worth living are similar whether they're physical or mental. The suffering's unbearable. The treatments are either inadequate or unacceptable, and they are people who are rationally able to say, “My life is not worth living with this chronic condition,” whether it's mental or physical, because it ruins their lives and it's just not good enough for them. I'm so glad that Canadians have these choices.
2:55 p.m.
Senator, Saskatchewan, CSG
If someone had stage 4 cancer, we wouldn't argue with them or say please take one more round of chemo, please do this or please do that, if they had made this choice, but we seem to want to impose that on people with a mental illness.
2:55 p.m.
As an Individual
Yes, and what I'd say is that it's more like the court case A.B. v. Canada, in which the patient had unbearable disability and pain from her inflammatory arthritis, and she said that it was not good enough. We have treatments. You can certainly say that arthritis is treatable—it is—but it was unbearable for A.B., and the treatments were not good enough for her. That is exactly what happens with mental illness. There are people for whom the treatments aren't good enough. They're still suffering.
2:55 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator Wallin.
Senator Martin, you have three minutes.
2:55 p.m.
The Joint Chair Hon. Yonah Martin
Thank you, Mr. Joint Chair.
Dr. Maher, later, we're going to be hearing from Dr. Gupta from the expert panel on MAID and mental illness to discuss the report. Do you have anything you wish to say about the report or any cautions for our committee?
2:55 p.m.
President, Ontario Association for ACT and FACT
Thank you.
I've known Mona for many years. We're colleagues. She's a smart, wise psychiatrist, but I will say she has information but not knowledge, and she is the first to say out loud that she doesn't work with the sickest people. She has also publicly said that she believes that people should have to have at least 10 years of treatment before you can even start to think about whether someone has irremediable illness.
Apropos the myth that Senator Wallin just threw out there that we're trying to force treatment on anybody, I'm sure that Dr. Gupta would agree we're not forcing treatment on any capable patient. They keep coming because they want help and relief from their suffering. At the risk of sounding insensitive, no one is keeping them from killing themselves. I say this with literally a broken heart because of the number of my patients who have carefully and thoughtfully planned their own deaths. As for this myth that it's tragic and horrible, people keep saying.... It is tragic and horrible in mental illness. We have one study from Switzerland in which 40% of the families report having PTSD or depression after supporting a loved one who's dying.
Dr. Gupta's report brings together plausible evidence but in the same breath says that we can't identify who's irremediable, the key legal criterion we're talking about here. It talks about your duty to review and also says that this is an ethical decision, not a clinical decision. I'm frankly stunned that Dr. Gupta has gone there. I'm also wondering why two people resigned from that panel. I would like to know that story. What you have is a number of very sensitive thoughtful statements but not a single safeguard. In the Benelux countries, you at least have to have tried standard treatment before you get euthanasia. In Canada—
2:55 p.m.
President, Ontario Association for ACT and FACT
—we won't even require standard treatments. It's astonishing.
Thank you.
2:55 p.m.
The Joint Chair Hon. Yonah Martin
I was going to ask this to Dr. Vrakas. Are there any safeguards that could make MAID for mental illness safe?