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.
3:40 p.m.
Liberal
3:40 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
Yes. I have done these analyses. I've actually submitted the evidence to the committee. There is no evidence to support the notion that suicide rates have increased in countries that have adopted MAID, nor in states that have adopted MAID. I have submitted that evidence to the committee.
It's a positive claim, and it would require some pretty significant evidence. It's absolutely true that it's fraught to compare countries in the best of times. When you're looking at curves and things, what I would say is that the rates are generally parallel to those in neighbouring states and countries that didn't.
There is no notion to support that whatsoever that I'm aware of.
3:40 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator Mégie.
We'll now go to Senator Kutcher.
You have four minutes.
3:40 p.m.
Senator, Nova Scotia, ISG
Thank you very much, Mr. Chair.
I have a question for Dr. Black and then for Dr. Freeland.
Let's follow the suicide rate discussion.
Since Bill C-14 came into Canadian play, there has been lots and lots of public discussion about MAID in the media—all over the place in Canada. What has happened to suicide rates in Canada since MAID was introduced, generally and specifically to the population of those over 50 or so, who would more generally seek MAID?
3:40 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
Thank you for the question.
I provided that evidence in my brief to the committee. There has been no significant change to suicide rates since the implementation of MAID, despite many proclamations that it would increase, by supposed experts, prior to the passing of MAID. It reminds me a lot of what happened during the initial phases of COVID, when a number of experts stepped forward and said that suicide rates would increase then as well. In fact, we saw a significant decrease in suicide rates in 2020.
There has been no impact in a negative way on suicides since the introduction of MAID.
3:40 p.m.
Senator, Nova Scotia, ISG
Would it be safe to say then that all this public messaging around MAID has not led to increased suicides?
3:45 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
There are so many factors that go into a nation's global rate. Whenever we look at a large population rate like the Canadian average, we're including a number of people with a number of different experiences. I'm always careful to not make a positive claim where one doesn't exist.
I would say that evidence that an increase has occurred because of MAID messaging is not substantiated.
3:45 p.m.
Senator, Nova Scotia, ISG
Thank you.
Dr. Freeland, thank you very much for tackling this issue of who decides whether the suffering is intolerable.
If I understand correctly, your perspective is that a competent person's own experience of suffering dictates what they choose to do. A psychiatrist needs to offer all options to the patient, but it's the person, not the psychiatrist, who decides what will happen, if the person is competent.
There have been concerns raised that some psychiatrists will never accept that a patient's suffering is not remediable. In such a situation, where the psychiatrist feels that the patient's suffering is not irremediable and wants the patient to keep going and trying but the patient says that enough is enough, what happens in that relationship? How should they proceed together?
3:45 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
I think in those kinds of challenging situations....
Maybe I would just preface this by saying that, ideally, these are shared decisions because the patient is listening to the psychiatrist's perspective and input, and we are there to think about hope and recovery. At the same time, we have to listen to a competent patient's perspective and what they want to come up with a decision that forges a path forward for the patient that they find appropriate for them.
Where a patient feels that they perhaps are not getting what they feel they might need from a practitioner, I think the solution would be similar to what patients do when they experience that in many different medical predicaments. There are opportunities to reach out, request a second opinion, ask for a re-evaluation or maybe come to a shared decision around what next steps should be taken, and then maybe have a second opinion.
I think there are different alternatives, but ideally these are transparent, informed conversations between two people who care about somebody's outcome, treatment and care.
3:45 p.m.
Liberal
3:45 p.m.
Pierre Dalphond
Thank you, Mr. Chair.
Thank you to the witnesses for their illuminating insights. You're giving us a lot of food for thought.
Since I have only three and a half minutes left, my questions will be for Dr. Freeland.
Dr. Freeland, I understand your association has been quite interested in the issue of access to MAID for mental disorders and you co-chair a committee—a working group—on this.
Can you tell us how many members are on that committee? Did your subgroup study the report from the task force?
3:45 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
I'm just quickly counting them to give you the right number. We have 12 people on our working group. We went through a pretty rigorous process to request that people apply. A number of our members applied to be on this working group. That process happened a few years ago.
We have people with many differing perspectives on medical assistance in dying, which I think is truly representative of our membership at the CPA. That's why we have focused our work on what the safeguards are if this is coming to fruition and on how we truly educate our membership around understanding what the issues are.
Our group has an upcoming meeting. We have not had a chance yet to review the expert report. I've had a quick look at it, so I won't be able to provide comments formally from the CPA about that, but I would be happy to share those once we've had our meeting.
3:45 p.m.
Pierre Dalphond
Yes, please send us a copy once your subgroup has met.
In the meantime, can you tell us, based on your previous discussions and your understanding of the report, if that report is missing something on some issues. Are there issues that need further study?
3:45 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
Overall, the expert committee report, from my cursory reading, reflects some of the important considerations for safeguards. Some of the things that were mentioned in the report were also things which, from our CPA discussion paper and input from our membership, were areas of concern for psychiatry. Those things seem to have been captured. In fact, one of the appendices reflects some of the areas from CPA in a table that includes the Canadian Bar Association and the CMA. I think that would be there in terms of feedback from the CPA from that perspective.
One of the things to really home in on is the importance of a national, standardized approach to this. As we all know, for all things health care, when things get to a provincial level, there are so many differences in how stuff happens. This is going to be a challenging and important area to demonstrate that, from a safeguard perspective, we've established a very clear set of oversight rules, managing and making sure that the steps we've taken are the right steps to be taken.
Perhaps that would be one area in the report to really home in on from that perspective.
3:50 p.m.
Pierre Dalphond
Do you think it's possible to have these national standards before the contemplated date of these provisions of MAID coming into effect?
3:50 p.m.
Chair of the Board of Directors , Co-Chair of MAiD Working Group, Canadian Psychiatric Association
The expert committee did very good, fast work. From my perspective, that was important and promising. We're going into the summer. I think it will depend on people staying focused and wanting to get that work done by next February.
3:50 p.m.
Pierre Dalphond
Thank you.
3:50 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Senator.
We'll now to go Senator Martin for three minutes.
3:50 p.m.
The Joint Chair Hon. Yonah Martin
Thank you.
Thank you to all of the witnesses.
I'm going to continue from where Senator Dalphond left off with Dr. Freeland and ask Dr. Sinyor and Dr. Black for their comments regarding the expert panel report.
I'll ask Dr. Sinyor first.
3:50 p.m.
Professor, As an Individual
Ultimately, with respect, it appears that the expert panel has done their best to provide you with what they think is correct, and they're entitled to their opinion. My response is that, at the outset of their report, they rejected the idea that we need to ensure that the harms don't outweigh the benefits before going forward, and that deeply concerns me. That's not what we do in medicine. We didn't do that, for example, with vaccines. We waited pretty much a whole year after the vaccine was available before administering it to make sure it was safe, because it could have been a disaster if it had been unsafe.
Why not do that in this instance? In that sense, I disagree with them.
3:50 p.m.
Clinical Assistant Professor, University of British Columbia, As an Individual
I think the report was excellent. I read it and I find that I agreed with most of it. I found it was a pretty good summary of the expertise we currently have on the issue.
3:50 p.m.
The Joint Chair Hon. Yonah Martin
Thank you to all of you once again for your comments and expertise.
It's back to you, Mr. Joint Chair.
3:50 p.m.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you very much.
Thank you to all of the witnesses. We will be getting ready for our next session, but I wanted to thank you on behalf of all of the committee members for your expert testimony today, for being very candid with us, for your opening comments and for answering our questions on what is a challenging file that we take very seriously.
Your input as experts is very highly valued. Thank you very much for taking the time in your busy schedules to be with us today.
With that, we'll suspend this panel. As you know, members, we have to provide a break at this point for our interpreters and others, so we will resume with testimony from Dr. Gupta at 4:30 this afternoon.
Thank you all. This meeting is temporarily suspended.