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.
3:30 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Dr. Freeland, would you say psychiatrists are, to some extent, focused on heroic measures?
3:30 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
Again, speaking for the Canadian Psychiatric Association, we're founded on following evidence-based practice. We look at clinical practice guidelines.
If I think about clinical practice guidelines, the concept of a heroic measure is probably not well articulated there. I believe practitioners go above and beyond for patients and really think about what might be helpful for them. Despite that, there are people, as you've heard, that have outcomes that do not respond to a full complement of evidence-based interventions in addition to maybe some other unique innovative interventions.
3:30 p.m.
Professor, As an Individual
I know there has been some focus on heroic measures in this discussion, but I also think it's important to say, as someone who is a practitioner in the tertiary care centre, that I've seen many people who have been judged to have irremediable illness in the community, who are referred to our service and who receive higher-level psychiatric treatments, such as neurostimulation, and some of the older medications we have, such as monoamine oxidase inhibitors. Without great difficulty, we're able to essentially change their situation from being irremediable to remediable.
The concern here is that people will be inappropriately considered irremediable, when in fact you don't need heroic measures. You just need really solid care to alleviate suffering.
3:30 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
Just to follow up on that point, I think neurostimulation and older medications are all things that.... I've practised ECT and I've seen some pretty incredible responses.
That being said, ECT is a daunting prospect for a patient. It has a number of benefits and side effects. So do monoamine oxidase inhibitors. Again, it always comes down to the fact that the treatment may or may not be available and the question of whether it is the right treatment for that patient. Patients have different reasons for saying yes or no to those treatments.
I've also seen many people receive ECT, monoamine oxidase inhibitors and many psychiatric medication combinations and experience only side effects with no benefit.
3:35 p.m.
The Joint Chair Hon. Yonah Martin
Thank you very much.
We now have, to end off this first round, Monsieur Boulerice for five minutes.
3:35 p.m.
NDP
Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC
Thank you, Madam Chair.
My first question is for Ms. Freeland.
You talked about socio-economic determinants that could push people to experience mental illness. There does indeed seem to be a strong correlation between poverty and social inequality and an increased risk of mental illness.
How much could addressing those socio-economic factors—the possible causes of mental illness—help avoid a situation where people are requesting MAID because of mental health issues?
3:35 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
Thank you for the question.
As I understand it, the question is whether, if we spend more time focused on addressing socio-economic determinants and their impact on people's experience of their health issues, we would avoid having to take on MAID as a solution.
You know, I think as part of thinking about treatment, and certainly again from a CPA perspective, the idea of biopsychosocial interventions to treat mental illness is really important and part of evidence-based care. We think about assessing and treating the biological symptoms of illness using a variety of measures and treatments, but in addition think about psychological measures and consider the social circumstances in which somebody lives.
When somebody has appropriate access to a treatment team that's able to provide biopsychosocial interventions, that should go a long way to trying to ensure that we are providing people with the best kind of care, which is what we would all want to do in a situation with somebody who has either physical or mental health issues and who is thinking about ending their life because of the nature of their experiences.
As I said, one of the first and primary safeguards is to ensure that people have the right access to treatment. That being said, there may still be circumstances in which somebody has experienced something in their life or they're in a unique circumstance where, regardless of what a treatment team can do, it doesn't specifically meet that patient's individual needs. If that is considered to be the only way to try to mitigate MAID, I don't believe that's something that will happen. I think that's why we have to think about those things in a very fulsome way and understand them as part of the safeguards and do the best we can to help steer people in a direction of hope and recovery, and then think about what safeguards we need to have in place to ensure people are not going too quickly to explore MAID as an option.
3:35 p.m.
NDP
Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC
Thank you very much, Dr. Freeland.
Now, I'm going to ask a simple question, and if there's enough time, I'd like all three witnesses to answer.
Something that has come up a number of times in our discussion is whether the experts and science are able to make a clear distinction between someone who is suicidal and someone whose suffering would exclude them from eligibility for MAID. That strikes me as a basic question.
Ms. Freeland, are you able to say to a patient, a person, that they are suicidal or that they are living with suffering that excludes them from MAID? Is it possible to make that determination reasonably but, above all, scientifically?
3:35 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
I think those are issues that we want to continue to understand and explore. As trained psychiatrists we do get experience in how to tease those things apart—to understand socio-economic suffering versus the experience of having suicidal ideation as a symptom of illness. Very careful assessment using a fulsome team, seeking a second opinion where needed, is important for us to try to understand and tease out those things. Where that's applicable to the issue of medical assistance in dying, thinking about the appropriateness of new curricula that help train psychiatrists to think very specifically in this area and appropriately assess and be able to sort those things through will be important going forward.
3:35 p.m.
Professor, As an Individual
I would answer that we can all try. We are all experts. We can do our best. However, it's never been the subject of rigorous scientific study, no.
3:35 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
I'd simply answer yes, and unequivocally yes. This is the core part of psychiatric training. I understand the need for good scientific analysis, but there are many reasons why the science in this area is difficult to conduct. All the best science we have points towards a very clear difference between the type of suffering that happens in MAID requests and the general suicidal patient who presents to a hospital or to a psychiatric clinic.
3:40 p.m.
The Joint Chair Hon. Yonah Martin
Thank you very much.
Thank you to all of our witnesses.
We're going to the round with senators, and I will turn this over to Monsieur Garneau.
3:40 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator.
We'll start with Senator Mégie.
Given that one of the senators will not be in this round, I'll give the first three senators four minutes each.
Senator Mégie, you may go ahead. You have four minutes.
3:40 p.m.
The Joint Chair Hon. Yonah Martin
Mr. Joint Chair, Senator Dalphond is present, so there are five of us here.
3:40 p.m.
Senator, Saskatchewan, CSG
He was referring to me. I am going to forfeit my time.
3:40 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you.
Senator Mégie, you may go ahead. You have four minutes.
3:40 p.m.
Senator, Quebec (Rougement), ISG
Thank you, Mr. Chair.
My question is for all three witnesses or whoever wishes to answer.
A witness in the first panel said that suicide rates had gone up in countries where MAID was available to people whose sole diagnosis was mental illness.
How do you explain that? Is it possible that the so-called suicide figures also take into account assisted suicide deaths?
3:40 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
To get the ball rolling, I'm going to suggest Dr. Freeland, followed by Mr. Sinyor, followed by Dr. Black, if you wish to respond.
3:40 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
Thank you very much.
I will skip this question, because from a CPA perspective, we haven't specifically studied that, and I don't feel I can give a representative response. You have my apologies.
3:40 p.m.
Professor, As an Individual
I would say that I've seen both argued and, frankly, it's another area where people are often just looking at curves without actual statistical analysis accounting for other factors that may affect suicide rates. However, certainly I think you have to be concerned about an increase in suicide rates in the context of MAID.
As I said, my major expertise and research are around public messaging, and when you share with the public the idea that death is an appropriate response to mental suffering, you see more suicides. That's one of the things that the Government of Canada certainly needs to grapple with, if that's the message that is being sent.