I want to start by mentioning that all clinicians.... I'm going to say “physicians”, because I'm a physician, so I'm going to speak for my own profession. All physicians have a statutory regulatory obligation to be competent before we undertake any clinical activity.
The thing that prevents me from doing ECT, even though it's something psychiatrists do, is that I'm not trained to do it personally. It is the same thing that would prevent me from engaging in MAID assessment with a patient who had a condition that I was unfamiliar with, or in a circumstance that I was not comfortable managing in my role as a psychiatrist. We already have a basic obligation not to engage in therapeutic acts for which we are not trained. That applies to every single thing we do. That applies to MAID as well.
We have a responsibility to acquire those competencies once we have finished our training, because then we're in the wild and we have to make sure that if we're doing new things, we acquire those competencies.
There are different ways to obtain competencies. One is to follow formal training programs. One is to do it under the supervision and mentorship of colleagues. In the MAID space, in fact, we have both of those things. We have a formal training program that has been developed by CAMAP, the Canadian Association of MAID Assessors and Providers, which covers the full range of MAID activities and is available to physicians and nurse practitioners, but CAMAP is not the only provider of training in MAID. For example, the Université Laval offered a comprehensive MAID training course. Practitioners will get their training from the provider that is available to them, and there are outlets for mentorship, supervision and case consultation should they need it.
I just want to come back to the last point. Senator Martin raised it, and it is the most important of them all. It is that if you do not have expertise in the patient's condition for track 2, you must obtain a consultation with a person who has that expertise. That's not merely a question of clinical judgment; that is a statutory requirement.
I think the combination of the law, professional guidance, training, mentorship, supervision and case consultation through structures that provinces and territories have put in place provide a comprehensive way to ensure that practitioners achieve their competencies and continue to develop in their professional abilities with contact and interaction and guidance from their colleagues.