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.
Senator, Quebec (Rougement), ISG
Dr. Gupta, do you have any final advice for the committee? Do you have any comment to make after all this work?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
I would like to be able to call a friend. That is what participants on a television show do.
If I may, I will think about your question and provide an answer later on.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Thank you.
Liberal
Senator, Nova Scotia, ISG
Thank you very much, Chair.
Thank you, Dr. Gupta, for your thoughtful and well-considered testimony.
I noticed in the report that you made suggestions that will not only provide solid safeguards for individuals seeking MAID for solely a mental illness, but also for all people seeking MAID.
Do you think your report would make a substantive contribution to the practice of MAID in general in Canada?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Thank you for the question.
We were mindful of the fact that it wasn't our place to take on many different new mandates. At the same time, and as I tried to present in my opening remarks, our analysis took us there, because the things that people are worried about in the practice of MAID are not unique to mental disorders. We were a bit stuck and said that these things are really important but they are not just important for people with mental disorders. These recommendations are important any time you're concerned about the incurability of a condition.
This is an approach. Any time you're concerned about suicidality, here's an approach and a way to think about it. I hope that our recommendations will be considered to be useful in track two, and even in track one. Suicidality exists in track one, and questions about capacity exist in track one as well.
Thank you for the question, and, yes, that was our hope as a panel.
Senator, Nova Scotia, ISG
Thank you for that.
Specifically, it's fascinating that Senator Mégie, who is also a physician, homed in on the same three things that I'm going to ask you about right now: the national framework for protective oversight, the framework for case review, and the importance of the ministry of health adding the additional research components that you put into your report.
Would you agree that the Minister of Health could actually start putting those in right now?
Then second, for the other two, protective oversight and the case review, do you think it would be feasible for the federal government to convene provincial and territorial governments and the other appropriate stakeholders to start moving that ahead immediately?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
I think data collection and research are things that fall squarely within the competence of the federal government. Other governments, as well, can do those things, but the federal government is doing them now and can take on those recommendations if it wishes.
As for case review and perspective, we recognize this is something that has to be done in collaboration between the federal government and the provincial and territorial governments. We'd like to see the federal government take a leadership role, exactly as you said, in convening the relevant parties to work on that, and it might be that there are different ways of approaching case review and perspective oversight in different provinces.
I don't think the panel has a view on whether they need to be exactly the same. but that the principles we have articulated be put in place.
Liberal
Pierre Dalphond
Thank you, Mr. Chair.
Dr. Gupta, thank you for your participation, and in particular for having chaired a group that issued such an important report.
The chair of Canadian Psychiatric Association appeared just before you. You may have listened to her. In order to improve your report, she said that national standards would have to be established that would apply to all psychiatrists and other assessors taking part in the process. Psychiatrists will be taking part in the process because at least one of the two assessors has to be an expert.
Do you think it is possible to create national standards or suggestions, national parameters, that would apply, by March 2023?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
That is a big question.
As you know, health care falls under provincial jurisdiction. I do not think the federal government can decide for the provinces how they should approach MAID or tell clinicians across the country how they should go about it.
That said, I think there is already a national organization, the Canadian association of MAID assessors and providers, or CAMPAP, that plays a leading role by publishing various background documents, clinical guidelines, and so forth. The association is currently conducting a project on practice standards, guidelines, and best practices for MAID.
In practice, clinicians will turn to this kind of training and documentation to be familiar with the details of what they have to do every day. Even if it were possible for the federal government to work with the provinces and magically create a national system, I do not think this is the area in which clinicians need help and directives. Rather, I think they need to know what to do, and how to assess a given thing. That is in the hands of national organizations in any case.
Yes, I think it is possible. I think the national training program will be offered this fall. Work on this is already well advanced.
Pierre Dalphond
Do you think support from the professional bodies would make it possible to standardize all of this?
There are already various national medical standards.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Yes, indeed.
I do not share the opinion of my colleague, Dr. Wiebe. I think the regulatory bodies have a special and important role to play.
Quebec's college of physicians has really become a leader in this regard. The beauty of a regulatory body is that all clinicians have to be members and the advice provided is mandatory.
I understand that their role is somewhat different in other provinces, but I think that if they approve training, that gives the members an important signal that they have to follow the training created and that they cannot do it informally on their own.
Liberal
Liberal
The Joint Chair Liberal Marc Garneau
The order doesn't matter that much, but it was for Senator Wallin. Perhaps I didn't say it clearly enough.
I'm assuming Senator Wallin is still with us. I'm not hearing anything.
Why don't you go ahead, Senator Martin?
The Joint Chair Hon. Yonah Martin
Thank you.
Dr. Gupta, I'm also quite concerned about the consistent policies and standards for our country. At the same time, I'm mindful of the differences between rural and urban Canada and specifically the indigenous peoples, Métis and Inuit. There are cultural differences.
I'm trying to understand how, with a March 23 deadline, we can prepare for all of these different groups based on this consistent standard and policy. Would you speak a bit more about how we will achieve this?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Thank you. That's an excellent question.
In recommending what we did with respect to consultation, we really took to heart the advice provided to us by our three members of indigenous identity. While they believe that there are many members of indigenous communities who are supportive of MAID and who, as individuals, may wish in the future to either access MAID or support their family members in accessing MAID, they also recognize that it is important that these consultations occur. This is something they've been expecting, in fact, since MAID was first permitted, and it ought to be made good on.
What are the best mechanisms to achieve that? Where we landed was that this ought to happen at a provincial level, perhaps with the collaboration and leadership of the federal government. Because the communities are very different, having a single kind of indigenous, pan-Canadian consultation wouldn't necessarily work or reflect the important differences and nuances between the many indigenous communities that are out there.
Whether it can be done in a way that would respect the March deadline, I think it's for those communities to express themselves on that.
The Joint Chair Hon. Yonah Martin
The question is, how do we do that? How do these communities find the resources to be able to do that?
In your report at page 35, it says, “As a result of the creation of laws that provide access to MAiD, concerns have been raised by Indigenous leaders and communities that it is easier for people in their communities to access a way to die than to access the resources they need to live”.
Change and improvements on many of the reserves and in the first nations communities are very challenging at best and very slow. I'm really concerned about this deadline. What would you say in response to this specific quote?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
I think that's something that we need to ask indigenous leaders and indigenous communities. How exactly do they want to move forward with this? I do believe that the Government of Canada is increasingly working in partnership with these communities, recognizing on a variety of different subjects their leadership and their ability to make decisions for their own communities.
I think it's a very good question that ought to be discussed and those communities ought to be engaged on it.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you very much, Senator Martin.
We'll now proceed with round two, which is a shorter round. This is with the MPs, and we'll start with Mr. Stephen Ellis.
You have three minutes.