Evidence of meeting #4 for Medical Assistance in Dying in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was equality.
A recording is available from Parliament.
Senator, Quebec (De Lorimier), ISG
Okay. Could you provide a link so we can have access to that survey?
Senator, Quebec (De Lorimier), ISG
I understand, from your answer, that the survey asked whether they should not have access to MAID unless they have tried other things.
Isn't that what you said?
Psychiatrist, Ontario Association for ACT & FACT
Yes, it was unless standard treatments have been provided.
Senator, Quebec (De Lorimier), ISG
Were the psychiatrists asked whether they would still be opposed to access to MAID if, at that time, standard care and treatment had been provided for a few years?
Psychiatrist, Ontario Association for ACT & FACT
No, it wasn't asked. The question asked was how many people supported MAID for mental illness, and the answer was only 3%.
Senator, Quebec (De Lorimier), ISG
Okay. That's without treatment. You also said that the rate of suicide is increasing in jurisdictions providing access to MAID for mental illness.
Which data are you referring to?
Psychiatrist, Ontario Association for ACT & FACT
There have been about five studies published at this point. Jones would be one of the obvious authors who has done research on this. It's recent research, because it was prompted by MAID and various countries starting euthanasia programs. It's solid data.
Senator, Quebec (De Lorimier), ISG
Would you mind providing us with copies of these five studies you rely on?
Psychiatrist, Ontario Association for ACT & FACT
I'm certainly happy to do that.
Liberal
The Joint Chair Hon. Yonah Martin (Senator, British Columbia, C)
Thank you, both, for your testimonies.
My first question is for Dr. Lyon.
You explained what happened to your father. I think it's important for us to understand what happened. You said that your family had difficulty getting a MAID clinician to consider the collateral information you tried to share about your father's mental illness.
Based on this direct experience, can you tell us what that revealed to you about how the current system handles mental health evidence, and why that should concern this committee as it examines whether to expand MAID to those suffering from mental illness as a sole underlying condition?
Visiting Research Fellow, Centre for Death and Society, University of Bath, As an Individual
My impression from that experience was that I received conflicting answers from the providers in question.
His MAID provider seemed to suggest that his suicidality was a reason for MAID. In the conversations we had, as I mentioned, she suggested that he might just kill himself without MAID—that suicide was more plausible now, and things like that. Then, when I broached the prospect of his depression, she told me that if he had depression, he would be ineligible for MAID. I didn't quite understand the conflict in those comments: “If he has depression, he can't have MAID, but it's okay to be suicidal.” If you look at the way the right-to-die movement frames this, they have this idea of rational suicide and will start to make a separation there.
His provider said that the psychiatrist would just agree with her when it came to a psychiatric assessment. The psychiatrist's assessment talks about his depression and quotes my father saying something to the effect of.... It's very minimizing language, and it goes on from that. The assessment itself has been described as global to me, and subpar. There is almost a conflict between what the psychiatrist was exploring and the different statements his provider said to me. It was very confusing.
If we look at MAID for mental illness, we're going to get divergent views among individual clinicians. As the law is written, as I understand it—if it comes to pass in 2027—it wouldn't be psychiatrists doing the assessments for mental health cases. It would be the same nurse practitioners, general practitioners or medical practitioners doing these assessments without any training as it is. When we move into that space, we won't have any coherence.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Dr. Lyon and Senator Martin.
I would like to welcome Senator Loffreda to our committee.
You have the floor for three minutes.
Tony Loffreda Senator, Quebec (Shawinigan), ISG
Thank you, Mr. Chair.
Thank you to the doctors, our experts, for being here this evening.
My question is on defining “incurability” in mental illness. Dr. Maher, you went deeply into that. I would like to have Dr. Lyon's expertise on this, if we have time.
There remains significant disagreement as to whether and how a mental disorder can be considered incurable. That's a very important question.
Maybe I'll elaborate on that. Does the current clinical or legal definition provide sufficient clarity to ensure consistent assessments, or does it risk subjective interpretations that could lead to uneven or unsafe application?
I put that question forward because, Dr. Maher, you made some serious claims with respect to suicide and mental illness—whether they are to be allowed or not allowed. I come from an industry where integrity is never negotiable. I've said that a million times. We don't have any doctors who were reported, or what have you. Maybe I could have your opinion on that, or your judgment on that, more importantly.
Psychiatrist, Ontario Association for ACT & FACT
I tried reporting a doctor to one of the provincial colleges and was told that until the patient is dead, there has been no malpractice.
I said that the doctor had come to a conclusion that was flat-out illegal. There were no criteria, by any stretch of the imagination, that would qualify this patient for MAID. Both the family doctor and I told the MAID provider this. The college said that until the person is dead, it's not malpractice. I said that this person is being induced to a suicide plan, has been given the belief that they will be killed and they were offered their date to be killed. The college said that it would do nothing.
I have tried, colleagues have tried and that's what we hit our heads against.
Senator, Quebec (Shawinigan), ISG
You believe the tools, protocols and safeguards in place are faulty or that they could be improved in making a distinction.
Psychiatrist, Ontario Association for ACT & FACT
I am aware of murders that have taken place in Canada for which there was no follow-up. The police have the door shut because the hospitals say it's confidential medical records. From the college—I won't say all colleges—in my experience and that of other colleagues, there is not action. There is not a taste for this.
Yes, I'm aware of homicides.