Medical Assistance in Dying Committee on May 26th, 2022

[The Joint Chair, Liberal, Marc Garneau]

We're at the end of that. Perhaps catch that up later.

[Dr. Mona Gupta]

Okay. I'll catch it up later. I've made a note.

[The Joint Chair, Liberal, Marc Garneau]

Just for everybody's information, we'll now go to another round just like the one we've completed—three, three, two and two—and then we'll go to the senators.

We'll begin round number three. I believe it's Mr. Cooper.

You have three minutes.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you very much, Mr. Joint Chair.

Dr. Gupta, do you believe that it is an acceptable—

[Luc Thériault, Bloc, Montcalm, QC]

Sorry to interrupt, Mr. Cooper.

Mr. Chair, there is no interpretation.

[The Joint Chair, Liberal, Marc Garneau]

Thank you very much.

We'll pause for a second here. I'll stop the clock. We appear to have a translation problem.

We will just pause until that's resolved.

[Luc Thériault, Bloc, Montcalm, QC]

It's back on, Mr. Chair.

[The Joint Chair, Liberal, Marc Garneau]

Very well.

Mr. Cooper, I had stopped your clock, but you can resume now.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Mr. Joint Chair.

Dr. Gupta, do you believe that it is an acceptable risk that persons suffering from mental health issues, who could get better, could prematurely end their lives? Is that an acceptable risk?

[Dr. Mona Gupta]

I think you're asking about the very heart of MAID. I think the question is, who should decide whether that's an acceptable risk? In allowing MAID in our country, we've said that is a choice for that individual to make that request.

That's what we tried to say in the report. Look, we understand there are benefits and risks, but that is what this practice is all about. It's giving the individual that opportunity, given a bunch of conditions and conditions of the law and so on.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

In short, the answer to my question is, yes, you believe that it is acceptable that people could prematurely end their lives?

[Dr. Mona Gupta]

I think it's acceptable for the individual to make that decision, yes.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

In your report on page 40, it is stated that “it is difficult, if not impossible, for clinicians to make accurate predictions about the future of an individual patient.” How do you square that with the statutory requirement? It seems to be logically inconsistent to say, on the one hand, that it may be impossible to predict and, as you know, in order to satisfy “irremediable”, it must be established that the person is suffering from an incurable illness, is in an irreversible state of decline and, of course, is enduring intolerable suffering.

I'm having a real tough time squaring this.

[Dr. Mona Gupta]

Thanks for bringing that up. I think now we're getting into the really interesting details of clinical practice, because you're going to have folks to whom you can't say anything. Maybe the person hasn't had adequate treatment, what they've had you can't figure out from the file or whether their treatment was optimized, etc., or they haven't had proper social supports. You say, look, there's too much uncertainty here. I can't say anything useful here about what's going to happen in this person's course of illness. I'm not going to find this person eligible.

Then there will be other cases where, in fact, the person has had a very long course of treatment, decades of care, high-quality care, and has reached an informed and capable choice that they want to access MAID. I think those two kinds of clinical situations and everything in between complicate things.

We spoke to that in the report.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

I'm sorry to interrupt—

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

—but based upon what criteria would a MAID assessor make such a determination? Your report doesn't provide any criteria, any specific safeguards. It barely speaks of “on a case-by-case basis” that the physician and the patient—

[Dr. Mona Gupta]

Go ahead.

[The Joint Chair, Liberal, Marc Garneau]

Be very quick.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

—come to a determination on that question of irremediability.

[Dr. Mona Gupta]

The criteria are the criteria that we would use to assess the severity of any chronic condition. They're based on what the person has already had. That's what we do all the time when we have to make determinations, as we mentioned in the report, about long-term disability, for example, or in any other context where psychiatrists and other physicians, in fact, are asked to say something about the person's, say, access to benefits on the basis of being ill, etc. It's based on that same kind of approach.

[The Joint Chair, Liberal, Marc Garneau]

Thank you.

Mr. Maloney, you have three minutes.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Thank you, Mr. Joint Chair.

Just quickly, Dr. Gupta, first of all, let me add my thanks to the long list of those who are grateful for everything that you've done, including being here today.

I just want to pick up on something that Mr. Cooper asked you. He did what lawyers sometimes do. He loaded the question with the answer, and he used the word “prematurely” when he was asking you if you thought it was an acceptable risk for people to prematurely end their lives.

I just want to give you an opportunity to answer that question again, because your answer suggested to me that you were saying it's up to the individual, which is the point you were trying to emphasize, not the premature aspect of his question. Is that fair?

[Dr. Mona Gupta]

Yes, that's fair. I understood the question to mean before they died of whatever they're going to die of if they lived their whole life, so in that sense, it's premature. Yes, it's up to the individual to make a decision, on the basis of the totality of their medical circumstances, whether they have reached that point.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Thank you. That's what I thought.

By that definition of “premature”, you could apply it to many circumstances. I get that. Thank you.

One of your recommendations, of course, was the training of assessors and providers. Do you think this should be a mandatory component of the medical school curriculum?

[Dr. Mona Gupta]

That is a very good question. Let me think about that.

I think probably that learning about assisted dying and end-of-life care more generally should be mandatory, because I think it's something that practically every clinician is going to encounter.

It's still a minority of people who are providing and assessing patients for MAID, so I don't know if medical school is the place where it ought to be mandatory, but perhaps later on in training, when people are developing what their future practice is going to look like, I think that's where something mandatory ought to happen. I do think the idea of training that's very focused on MAID assessment and provision is a worthwhile idea. I don't think it's just enough to learn about the law and then hope that practitioners can figure it out.