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.
Liberal
President, Ontario Association for ACT and FACT
Do you want an honest answer?
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I just want a quick and simple answer, so I can move on to Dr. Wiebe.
President, Ontario Association for ACT and FACT
The simple answer is, of course, all psychiatrists are passionately committed to the relief of suffering. We listen to the suffering and are doing our best to relieve it. How do I serve my patients—
President, Ontario Association for ACT and FACT
—if they die instead of heal?
President, Ontario Association for ACT and FACT
I'm wondering why you didn't want an answer to my question.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Because I have only five minutes, Dr. Maher, and you should not be questioning me about what I need to hear from witnesses today.
Dr. Wiebe, you were saying that you agree with the results of the expert panel.
I think you have dealt with many cases, and you have been an assessor for a long time. Who do you think, at the end of the day, should be the one who decides what is intolerable, even if it means not accepting any further treatment because that treatment for them is intolerable?
As an Individual
There's only one person and that's the patient themselves. They are the ones who are suffering and have suffered, and they are the ones who can choose. We can't have anybody else making that decision. They are the ones who decide that it is unbearable and that they want a peaceful and dignified death.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Help me here. Walk me through what you do when you're assessing someone. Do you have to give them every single option that is available to them, and then do you make the decision? How do you go through this?
Tell me. Give me a step-by-step.
As an Individual
With cancer, it's relatively easy. There are standard protocols. They have to have been offered the treatment, but they don't need to have taken it. For mental illness, it is not so standard because psychotherapy is different from one person to another. As we heard, there are many different psychiatric medications and other treatments, like electroconvulsive therapy.
We need to make sure that the patient has been offered a number of different treatments, that they are reasonable treatments and that they have tried or seriously considered—the law says “seriously considered”—and we—
Liberal
The Joint Chair Hon. Yonah Martin
Dr. Wiebe, complete your sentence and then we'll go to the next questioner. Thank you.
As an Individual
It's just that the patient has to have seriously considered the treatment options.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
I thank all the witnesses for their enlightening testimony.
I will address Professor Vrakas first.
I am glad that people can advocate for better living conditions and better investment in mental health, as everyone recognizes that major investments must be made to improve accessibility to care. This has been established by the Council of Canadian Academies and by the expert panel report.
I have heard your argument and I think it needs to be taken into account, and the same goes for Professor Maher's heartfelt plea. We have heard you loud and clear.
For my part, I am not a psychiatrist. I am an MP, and I certainly don't pretend to be an ethicist. Having said that, I question what is in the expert report. This report has already been quoted and I will quote it again:
In considering MAID requests for persons who have mental disorders, it must be recognized that thoughts, plans and actions to bring about one's death may also be a symptom of the very condition which is the basis for a request for MAID.
The expert report does not deny this. It states that mental disorders induce a desire to die and that the assessor must pay close attention. The report states:
In any situation where suicidality is a concern, the clinician must adopt three complementary perspectives: consider a person's capacity to give informed consent or refusal of care, determine whether suicide prevention interventions—including involuntary ones—should be activated, and offer other types of interventions which may be helpful to the person.
Does it reassure you that the report specifies we need to be careful of this aspect? It seems that this is limited to mental disorders. Suicidal tendencies do not manifest in all cases of mental illness. Later in the report, it says that when someone is in crisis, their MAID application will not be granted.
Don't you think this report indicates that precautions should be taken?
Psychologist and Professor, Department of Psychoeducation, Université du Québec à Trois-Rivières, As an Individual
No, I don't agree. When I assess someone's condition, I cannot make that distinction. There is no tool at the moment that would allow me to distinguish a suicidal person from someone who is requesting assisted suicide, meaning medical assistance to die. How can I distinguish between the two?
When you are affected by mental disorders and cognitive distortions, you see things in a darker light and you want to stop suffering. Believe me, I know what it's like, having been there myself. If medical assistance in dying had been available five years ago, I might have asked for it, but the diagnosis was wrong. I was given time to get where I am today.
Bloc
Luc Thériault Bloc Montcalm, QC
Perhaps the question is this: Would you have been eligible?
What I read in the report is that the assessors—I'm not one of them—seem to say that they, themselves, are able to distinguish a suicidal state, which by the way is quite reversible, everyone agrees on that, from chronic and persistent suffering over several decades.
Psychologist and Professor, Department of Psychoeducation, Université du Québec à Trois-Rivières, As an Individual
We have tools to assess suicidality. Suicide prevention is my field of expertise. However, when it comes to differentiating this suffering from that of a person with a mental disorder who wants help to die, there is a fine line. We will definitely overlook some cases, scientifically speaking.
The Joint Chair Hon. Yonah Martin
Thank you, professor Vrakas.
Next we have Mr. MacGregor for five minutes.