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
James Maloney Liberal Etobicoke—Lakeshore, ON
Yes, learning about the law is not going to help doctors in practical application, in my view.
I'll take the answer as a partial yes, but maybe the focus should be on continuing education and residency programs, perhaps. Is that a better place to do it?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Yes, I think so. There's such a competition in medical school curricula to cram everything into the heads of these poor students in a very short period of time that I think you want to gear training to when people are making career choices.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you.
I think I'm virtually out of time, so I'll stop there.
Thank you, Mr. Joint Chair.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Mr. Maloney.
Mr. Thériault, you have the floor for two minutes.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
I think we'll continue.
Bloc
Luc Thériault Bloc Montcalm, QC
I interrupted you because my main argument was not about social acceptability. My main point is that we have a deadline of March 17, 2023. We're proposing something new, while there are still people to be trained. A full legislature says it has asked the preliminary question that our committee did not ask. As a legislator, I have to take that into account. This assembly asked the preliminary question and decided not to go ahead, because it found that the experts were divided and that there was not a broad enough consensus, as is the case for other aspects—Quebec has always been a pioneer.
How can we ensure that this is put into practice on the ground? It's difficult to implement a measure in the absence of a clear legal framework. The entire National Assembly of Quebec has spoken out against this. That is my main argument.
I am not saying that I am opposed to everything you say. Your report is excellent, in that it aims to present all the precautions to be taken if this were to happen, but we are not in that situation. Sometimes it's better to take the time to do things correctly.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
As I said at the beginning, it's important not to make an exception for mental illness and mental disorders. In fact, mental disorders are already being considered as an important component driving the request. Assessors and health care providers already do this. I don't think there's a big lack of training among people already involved in this practice, since these are cases they see.
As for your comment about social acceptability, it's only if you say that everyone has to agree that the deadline will be too difficult to meet. If we say that consensus may not be the right objective to aim for, the deadline could become more realistic.
Bloc
Luc Thériault Bloc Montcalm, QC
However, the Legislative Assembly unanimously rejects this. That is what will be problematic. That's the discussion I wanted to have with you. Sometimes it's better to have a discussion beforehand—which you haven't done—and take the time to make sure that when it's put into practice, there's consistency on the ground.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
I understand. As a federal legislator, you're in a difficult position as a result of the Quebec decision. I wish you well.
A lot of study and thought had already gone into this. Our report addresses what appears to be contradictions by offering definitions and ways to unravel some of the problems for which the Quebec commission had no solution in December.
Will it be enough? I don't know.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
I would like to add that the professional orders in Quebec are all in favour of this expansion. So I was a little surprised by Quebec's decision, but I understand that because of the differences, the legislators didn't have much choice.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you very much.
Mr. MacGregor, it's over to you for two minutes.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you, Mr. Joint Chair.
Dr. Gupta, I think you were in the process, during my last intervention, of providing an answer to Senator Mégie's previous question. If you'd like to take some time to get that on the record, you can go ahead.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Thank you so much.
My answer is actually not that long or complicated. The question she asked was what my final reflection was after having done all of this work.
I recognize that it's difficult and that these issues are complicated, so we sort of have two choices. One is to say this is too complicated, and we're going to avoid it. The other is to say this is complicated, and let's bring our best resources to bear on it and let's try to come to ground. That's what we did as a panel. There were plenty of divergent views on our panel, but let's try to come to ground on something that makes sense for patients and families.
I am confident that this group will continue to do its good work. I hope, and my advice to you is, that you not avoid the hard issues because they're hard.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
It's safe to say that, with the subject matter before us, that is impossible. It seems that at every meeting we're right into it.
I'll close off with the time I have to thank you again for joining us. We do appreciate your testimony today. Thank you.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Thank you.
Liberal
The Joint Chair Liberal Marc Garneau
Thank you, Mr MacGregor.
We'll now go to a round with the senators of three minutes each. We'll begin with Senator Mégie.
Senator Mégie, you have three minutes.
Senator, Quebec (Rougement), ISG
Thank you, Mr. Chair.
I'd like to discuss the concept of patient autonomy with Dr. Gupta.
Respect for the patient's autonomy is the basis of the decisions to be made when requesting medical assistance in dying. If this autonomy is limited by several types of factors, such as the lack of family or professional support, for example, are there tools available to health professionals—in this case psychiatrists—that would make it possible to accurately and objectively assess the degree of autonomy of the patient when that person decides to request medical assistance in dying?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Does your question concern situations where autonomy is diminished or compromised?
Senator, Quebec (Rougement), ISG
I'm talking about situations that may impede or limit the patient's ability to make a choice.
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
Okay.
The main tool is the fitness criteria that we use in clinical practice in Quebec and in Nova Scotia. We also use the Applebaum criteria, which are complementary.
As you probably know, there's also a movement coming out of the United Nations to respect people's wishes, even when they have a mental disability. We talk about supported decision-making in the report. We didn't want to go too far because this is an issue that requires a lot more thought.
There is legislative reform in Quebec. There is already legislation in British Columbia, and I believe in Alberta as well, where they are putting in place structures for supported decision-making for patients with limited autonomy. This is somewhat the current trend.
It's part of the broader trend of no longer telling people that because they're not capable of making decisions, you force them to do things or you give someone else the right to decide for them.
At this stage, we haven't gone too far. We see that legislative initiatives have already been taken across the country. That being said, that's why we've recommended that data be collected on this.
Liberal
Senator, Nova Scotia, ISG
Thank you very much, Mr. Chair.
Dr. Gupta, earlier today we heard some inflammatory testimony that said MAID is actually a licence to kill. In your report you said that, if there's uncertainty in either capacity assessment or suicidality, the answer is no, you don't proceed with MAID. It seems that your standards have actually been created to ensure that MAID is done in a thoughtful, comprehensive and methodological way that puts the safety of the person at its core.
Am I reading your report correctly?
Associate Clinical Professor, Expert Panel on MAID and Mental Illness
I'm delighted that you read that because, yes, it is exactly what we were aiming for. The folks that you heard from were all clinicians, all colleagues, and we share those concerns. None of us wants to see a situation.... No clinician takes pleasure in the idea that a patient would ever get to that stage, and no clinician wants to encourage a patient to give up hope in the possibility of being well or living better.
Absolutely, we have those worries front of mind the entire time. How could we ensure that the only people to have access would be those who have really had a very significant history of disease and treatment and have really been very thoughtful about this wish at this point in their lives? That was our priority.