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.
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay. It seems to me that, regardless of what side of this issue you're on, one of the biggest problems or areas of conflict is this issue of whether it's irremediable or not and whether it's permanent or not. That's what that means. Is that right?
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay. In your view, no psychiatrist can ever render an opinion that says a mental disorder is permanent and be accurate. Is that fair to say based on what you told us?
3:25 p.m.
Professor, As an Individual
I think anybody could offer an opinion, but whether that opinion would be solidly grounded in science I think is a very dubious claim.
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay. I have to assume then that, in your opinion, any doctor who does say that is overreaching and not using evidence-based science to inform their psychiatric opinion. Would that be fair?
3:25 p.m.
Professor, As an Individual
I would say so. I just would wish that my colleagues would have better data to act on if we're going to go forward with this.
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you, Dr. Sinyor.
I was a lawyer for 20 years before I went into this profession and I can tell you with absolute certainty that every single day in the province of Ontario you have colleagues in court testifying in psychiatric cases that persons have permanent irremediable medical disorders. Are you here today telling me that those people are all giving opinions that aren't valid?
3:25 p.m.
Professor, As an Individual
I think they're dubious. If you look at the Canadian Mental Health Association, the American Psychiatric Association, the expert advisory group, numerous organizations have clearly said that in fact we can't make such determinations. I'll let Dr. Freeland obviously comment on her end, but the CPA has essentially taken no position on that. The consensus is certainly that there isn't very good evidence for that at all.
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay. You agree then that there's a whole group of doctors out there giving opinions that aren't valid, and that's your view.
3:25 p.m.
Professor, As an Individual
Here's the issue. If someone asks.... You can ask my opinion. Courts can ask people's opinions. If we're asked, we have to provide the best opinion possible, but to make such a consequential decision, I would want better evidence and usually medicine demands that.
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay, so you're not comfortable with it, but I don't think it's fair for you to sit here and say the entire profession is incapable of doing that. I'm going to pose that question to the other two panellists and see what their views are on that, because it seems to me anybody who says that a psychiatrist or somebody in that aspect of the medical profession can't do it is not necessarily giving the profession it's due respect.
Dr. Freeland, what do you think of that?
3:25 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
Speaking from a CPA perspective, I think the perspective from the CPA is that we are trained in a certain way, we are committed to our profession and we follow through on doing assessments and treatment with patients absolutely to the best of our professional ability. I think we all recognize that from an evidence-based perspective there are clinical guidelines and there are practices and standards that we follow, but for many illnesses, when those things haven't worked, there is an unknown that we all operate within. The real importance of working in this area is about finding the balance between a psychiatrist's commitment to provide treatment, care and hope for recovery but really listening to the person's own experience of suffering and the right to make a personal choice in their health care decisions.
When we talk about science, there is a scientific part of that, but we also talk about the importance of the art of working with patients and reflecting that as well. I think that's what we try to do from a CPA perspective.
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you. I appreciate that.
Dr. Black, I don't have much time, so I'll go over to you.
The last thing you said was that no personal opinion should form part of a doctor's view when making an assessment—a view I share. I assume you said that because, in your opinion, there are doctors out there who do have a strong opinion on either side of this thing and it does form part of their opinion. Is that accurate?
3:25 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
Absolutely. I think it's a big problem. When we test the limits of psychiatric science, we have to do that on the positive and negative. If we can't say 100% for certain what's going to happen, we also can't say that treatments will be 100% effective. This is why we put the patient at the core of our decision-making. We give them the best information we can and they make the best decision they can.
3:25 p.m.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
That's ultimately what this is about.
Thank you, Dr. Black.
3:25 p.m.
The Joint Chair Hon. Yonah Martin
Thank you very much.
Next we'll have Monsieur Thériault for five minutes.
3:25 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Madam Chair.
My first question is for all three witnesses.
Is it your view that there is no such thing as an incurable mental illness ever?
Dr. Sinyor, would you like to answer first?
3:30 p.m.
Professor, As an Individual
I'm not sure I fully understood. Maybe I could just clarify. I think the issue is that our ability—
3:30 p.m.
Bloc
3:30 p.m.
Professor, As an Individual
No, I don't think that's what I'm saying. There's a consensus that some mental disorders are incurable, and certainly that the suffering that exists as part of mental disorders might be incurable in certain instances, but we have absolutely no data to identify what those instances are and how often they occur.
3:30 p.m.
Bloc
3:30 p.m.
The Joint Chair Hon. Yonah Martin
All right.
Let's have Dr. Black first, followed by Dr. Freeland.
Go ahead, Dr. Black.
3:30 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
In a previous meeting, Dr. Derryck Smith emphasized the importance of not focusing so much on a diagnosis but on the patient. The patient's experience could very much be untreatable and incurable, and many of the treatments we offer them may or may not work. Our ability to cure everybody is not 100%. Psychiatry has some good outcomes and some poor outcomes, and based off of different trajectories, we see various results. I think it's very safe to say there are many psychiatric disorders that are not curable with the present science.
3:30 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
I would underscore Dr. Black's comments and add that a common verbiage used in psychiatry is the concept of “serious and persistent mental illness”, which in and of itself speaks to the fact that we try to treat people, but many people are left with residual symptoms and experience those symptoms with varying degrees of suffering.