Thank you very much.
Good afternoon, committee members. It's an honour to be with you today. My name is Mark Sinyor. I'm an associate professor of psychiatry at the University of Toronto and a psychiatrist at Sunnybrook Health Sciences Centre who specializes in the treatment of adults with complex mood and anxiety disorders.
My research is focused on suicide prevention. I'm a former vice-president of the board of the Canadian Association for Suicide Prevention, lead author on the Canadian guidelines for responsible media reporting about suicide, a steering group member of the International COVID-19 Suicide Prevention Research Collaboration and I was recently asked to coordinate the International Association for Suicide Prevention's efforts to create a regional suicide prevention network across the 35 countries in the Americas.
I should note that I am not involved in MAID assessment or provision. I am also not a conscientious objector to MAID. To be transparent, my professional agendas, both in general and in these deliberations, are to do my best to help contribute to a Canadian society with fewer suicides and to protect psychiatry as an evidence-based science.
Given that I only have a few minutes, I will focus my remarks on what ought to be the overriding issue in your deliberations. As highlighted in the expert panel report, I and some of my colleagues have argued that, like any other medical procedure, physician-assisted death for sole mental illness should be permitted only if there is evidence that the benefits outweigh the harms. In their recently tabled report, the expert panel noted that they “considered this possibility but did not arrive at this conclusion.”
The imperative to do no harm has been a foundational principle of medicine for thousands of years and underpins the modern principles of evidence-based medicine, which call for us to undertake scientific evaluation of the benefits and harms of our treatments to determine whether delivering them is ethical. If, as a country, we're going to reject these ideas, first, we should be aware that we're doing so and, second, we ought to have a compelling reason.
In short, we are essentially missing all of the necessary scientific evidence to evaluate the safety of physician-assisted death for mental illness. If I had more time, I could list many examples, but let me focus on the fact that there is absolutely no research on the reliability of physician predictions of the irremediability of illness or suffering in psychiatric conditions. To my knowledge, there is not a single study.
Advocates for the practice are suggesting that we have safeguards, because the practice carries many inherent dangers. This is the entire reason for safeguards. We do not propose safeguards for practices that are already safe, but the degree to which any proposed safeguards actually fix that problem is entirely unquantified. No one has provided you with those numbers because there has been absolutely no research and they don't exist. As a result, if this goes forward, MAID assessors will have no idea how often they are wrong when they make a determination of eligibility in the context of physician-assisted death for sole mental illness. They could be making an error 2% of the time or 95% of the time. That information should be at the forefront of this discussion, yet it is absent altogether.
There are many other examples of evidence about serious harms that are simply missing, such as rigorous study of the impact on suicide and its prevention. Nothing in life or in medicine is certain. All of our treatments carry potential benefits and potential harms. In medicine, we deal in probabilities. Doctors help patients make decisions in cancer treatment, for example, by sharing that chemotherapy might result in survival 90% of the time or only 10% of the time. In neither case do we know the outcome for certain, but those numbers are crucial in helping patients make informed decisions. In physician-assisted death for sole mental illness, we have no numbers at all. Neither we nor our patients would have any idea how often our judgments of irremediability are simply wrong. This is completely different from MAID applied for end-of-life situations or for progressive and incurable neurological illnesses, where clinical prediction of irremediability is based in evidence.
In the context of physician-assisted death for sole mental illness, life or death decisions will be made based on hunches and guesswork that could be wildly inaccurate. The uncertainties and potential for mistakes in mental illness are enormous and, therefore, the ethical imperative to study harms in advance of legislation is accordingly immense.
What is so disconcerting here is that we could conduct the necessary studies. We demand evidence on benefits and harms before legalizing natural health products, new medicines and vaccines. Why skip that step in such a profound deliberation as the one you are engaged in now? I would argue that we owe it to our fellow Canadians with mental illness to have the necessary scientific information in hand before making such a consequential decision.
Thank you. I wish health and well-being to all during the pandemic.