Medical Assistance in Dying Committee on April 21st, 2026

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Maher, I understand your frustration. Mental health and mental illness have often been the poor relations of health care systems for years. While I sympathize with your frustration and the suffering you witness every day, I question your testimony tonight, because you seem to suggest that people who don’t think like you are incompetent and that psychiatrists who disagree with you are incompetent.

I am neither a psychiatrist nor a specialist in mental disorders. However, things need to be sorted out.

I have here a document from the Canadian Psychiatric Association. I imagine that not everyone in this association is incompetent. They’ve gone so far as to make clinical recommendations on medical assistance in dying. I have this document in front of me. It is titled “Canadian Clinical Recommendations on Medical Assistance in Dying (MAID): Assessment of the ‘serious and irreversible’ eligibility criterion in people with mental disorders who request MAID and the management of suicide risk during the eligibility assessment process for all MAID requests.”

These people claim they can provide training on the sensitive issues you’ve raised. They do indeed claim that structural vulnerabilities must be taken into account when they are the primary reason for the request. This is clear in the expert panel’s report. I imagine they aren’t all incompetent. The expert panel’s recommendations state that there is no question of continuing the discussion on medical assistance in dying with a patient in a suicidal state.

You have surely read this report. I get the impression that there are several safeguards in place precisely to address the concerns you have and avoid the situations you are denouncing tonight.

So, who should I believe? Are all those who disagree with you incompetent, as you said?

[Dr. John Maher]

My translation was set up at the initial point of contact, but it has not been working.

I’ll try to answer you. If I am—

[Luc Thériault, Bloc, Montcalm, QC]

Excuse me for interrupting. Please wait a moment.

Madam Chair, the witnesses should be told that there is a way to hear the French interpretation. I demand that my time not be wasted on witnesses who were not provided with the necessary assistance prior to the hearing so that they can hear what I have to say.

This is the first time this has happened here, but it has happened before. I would like us to take the time to tell the witnesses how to hear the interpreters. We cannot have a discussion on issues as sensitive as these if we cannot hear each other and if we do not understand each other.

I expect you to stop the clock. I want the interpretation to take place.

[The Joint Chair, Liberal, Marcus Powlowski]

I will stop the timer, and I will explain this to Dr. Maher.

Do you want to briefly suspend to go through this, or do we get the...?

[Dr. John Maher]

I understand there's a—

[The Joint Chair, Liberal, Marcus Powlowski]

We're going to give Luc his time back so he can ask his question again.

Just so you fully understand, at the bottom of your screen, you can select the appropriate channel for interpretation.

Do you see that?

[Dr. John Maher]

Is it under “audio”?

[The Joint Chair, Liberal, Marcus Powlowski]

We'll suspend for a moment.

[The Joint Chair, Liberal, Marcus Powlowski]

Welcome back.

Mr. Thériault, I will give you the floor again. You may ask your question again.

[Luc Thériault, Bloc, Montcalm, QC]

Since Dr. Maher says he understands my question, we will begin a five-minute discussion.

[The Joint Chair, Liberal, Marcus Powlowski]

Yes, we will start with five minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Agreed.

Dr. Maher, since it seems you have understood the gist of my statement, you may respond. If that is not the case, I will let you know.

[Dr. John Maher]

Certainly, feel free to correct me if necessary.

I didn't use the word “incompetent” in describing colleagues. What I said was colleagues “who lack skill”. A young psychiatrist would, as residents do, lack knowledge. I'm not an expert in anorexia. I'm an expert in schizophrenia and bipolar disorders. We all lack knowledge, to some degree, in some areas of the broad areas of medical psychiatric care.

I also said those who lack “perseverance”, and that, I think, is a key point to be made here. I am a subspecialist psychiatrist, and like a subspecialist in any area.... If I have a complicated cancer, I'm off to Princess Margaret hospital in Toronto. I'm not at my local hospital in Barrie. That's partly what I'm talking about.

[Luc Thériault, Bloc, Montcalm, QC]

I understand. So you believe that others lack your expertise.

I referred you to the document from the Canadian Psychiatric Association.

Have you ever had to assess a patient who requested medical assistance in dying?

Have you taken training from that association on assessing eligibility criteria?

Do you consider this document to be incompetent?

Do you believe that, from the outset, it is impossible to assess a patient? In your opinion, is it impossible to conduct such an assessment?

[Dr. John Maher]

I think there's a fundamental understanding of the capacity assessment you're talking about. You're not assessing whether someone is eligible for MAID. You're assessing whether they understand and appreciate the consequences of refusing psychiatric care. If they understand that, they're free to do whatever they want. If they want MAID, they're free to request MAID.

The capacity—

[Luc Thériault, Bloc, Montcalm, QC]

Excuse me for interrupting. That is not what the expert panel’s report says.

The expert panel’s report makes it very clear that just because someone raises their hand and says they want medical assistance in dying does not mean they will be eligible. To determine whether people are eligible for medical assistance in dying, the report sets out a series of principles and precautions that must be considered. As such, it is not true that simply refusing treatment is sufficient to qualify for medical assistance in dying. This report tells us the opposite.

I imagine that if you are an expert on schizophrenia, or, in any case, if you have cured everyone struggling with schizophrenia, you are truly qualified to receive the Nobel Prize in Medicine. However, schizophrenia is also a disease that is not easily treated. It is possible that you might lose a patient. It is possible that after 30 years, a patient might have had enough, because their suffering has not been alleviated.

What we are saying here is that there is no question of considering that a patient who is in a suicidal state should have access to medical assistance in dying. Assessing decision-making capacity seems to be a specialty of psychiatrists, and some of your colleagues tell us that it is entirely possible to do things by the book, which you claim is not possible.

I agree with you that we need more resources to treat people and that we need to be even more proactive and provide care early on, but these are two completely different issues. Here, the question is whether we should continue to keep someone who is at the end of their rope in palliative care indefinitely—which is all you are capable of doing, since you do not cure the person.

[The Joint Chair, Liberal, Marcus Powlowski]

Dr. Maher, you have 15 seconds.

[Dr. John Maher]

You said two things that I didn't say. I didn't say that if you're found capable, you're eligible for MAID. I did not say that.

I am an absolute expert in capacity assessment, so the logical distinction I make is valid. I am saying that the CPA has some things wrong about capacity. If you look at the capacity literature, you'll get only about 75% agreement. If you have 25% of psychiatrists saying “capable” or “not capable”, that's a problem. That's an operational problem.

Then when the CPA says we can do this, it's a claim that is not defensible because if you're mistaken here and if you say someone is capable and they're not.... Lots of people pretend to be quite rational and can manage it for a while, which is why expertise matters and why relationship matters.

You've said two things I didn't say. In terms of long-term suffering—

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you, Dr. Maher. We have to go on.

Senator Dalphond, you have the floor for three minutes.

[Pierre Dalphond, Senator, Quebec (De Lorimier), ISG]

Thank you, Mr. Chair.

Dr. Maher, I'm interested in data. You referred to some data, but I would like you to provide support for that. You said that 93% of psychiatrists are opposed to MAID for mental illness.

Where did you get the 93% number?

[Dr. John Maher]

That was from an OMA survey, wherein 90% oppose it without standard treatments being attempted first, at least. As far as I can tell, there is no recent data saying what the absolute opposition is, because there have not been continuing surveys.

The data I provided on Canadians being opposed was from an Angus Reid survey.

[Pierre Dalphond]

However, you said that it was 93% of psychiatrists, not Canadians. It's people who are supposed to be able to evaluate or assess capacity.

Did you say that number came from a survey?

[Dr. John Maher]

Yes, it was from the Ontario Medical Association survey.

[Pierre Dalphond]

Could you provide—

[Dr. John Maher]

A survey is never of everyone. There would be hundreds of people responding.