Thank you.
Evidence of meeting #5 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 access.
A recording is available from Parliament.
Evidence of meeting #5 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 access.
A recording is available from Parliament.
The Joint Vice-Chair Hon. Pierre Dalphond
We'll now move to the second round with MPs.
Mr. Patzer, you have two minutes and 33 seconds.
Conservative
Jeremy Patzer Conservative Swift Current—Grasslands—Kindersley, SK
Thank you very much.
Ms. McKinnon, as a mental health professional, a person with lived experience and an internationally recognized expert in traumatic stress, can you distinguish between suicidality and the desire to die?
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
No, I cannot. When I was experiencing suicidality in relation to MAID, I did not distinguish between the desire to die, suicidal ideation and suicidal intent. I just cannot make that distinction as a person with lived experience.
As a professional, I know that for things like “not criminally responsible”, we have reliable and valid scales to assess them, and I don't think we should be holding this decision to a lower standard of evidence.
Conservative
Jeremy Patzer Conservative Swift Current—Grasslands—Kindersley, SK
You said that if MAID for mental health had been available during your period of severe illness, you believe you may not be here today. In your view, what does that say about the danger of treating as irremediable the desire to die of a person who has a mental illness?
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
It's very difficult to conclude that someone has no hope for recovery. One of the hallmarks of a mental health condition, which certainly I know as a person with lived experience, is a belief that it will never end. I certainly felt that way during a time of prolonged depression. That's part and parcel of the disease and the condition, but I think to make the judgment that there is no hope is really difficult. I don't envy health care professionals who have to make that decision. I think it's going to be very difficult for them, should this go through.
Conservative
Jeremy Patzer Conservative Swift Current—Grasslands—Kindersley, SK
Thank you for that.
Finally, you said you had good mental health care, financial means, social support and professional knowledge, yet you still felt at risk. If someone with those supports could feel unsafe under our current system, what does that mean for Canadians who are poor, isolated, living in rural and remote communities, disabled or unable to access specialized care or the first, second and third lines of treatment you referred to?
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
This troubles me deeply, because if we look at international and national guidelines, we have recommendations for first-, second- and third-line therapies. Those are both pharmacological and non-pharmacological treatments. Many Canadians, as we know, have difficulty accessing first-line treatments to get access to treatments that have less evidence but have shown effectiveness for some individuals. I just don't see that happening in our country. I'm sure there are statistics that would support that.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
I have a point of order, Mr. Chair.
The witness isn't speaking loudly enough, so the interpreter can't interpret what they're saying.
The Joint Vice-Chair Hon. Pierre Dalphond
Please move closer to your microphone. We didn't get the last part of your answer.
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
Would you like me to repeat my answer?
The Joint Vice-Chair Hon. Pierre Dalphond
Yes, please repeat the last part of your answer.
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
Certainly.
If we look at national and international guidelines surrounding the treatment of mental health conditions, there are often recommendations, if not in all of these guidelines, for first-, second- and third-line therapies. Those are both pharmacological treatments and psychological treatments.
The majority of Canadians, as we know, may have difficulty accessing a first-line therapy for a mental health condition, let alone the second- and third-line therapies. Where these inequities exist in Canada, it really troubles me that some people will receive MAID for mental health after having received access to all three, particularly if they have financial means. For those who do not.... We can think, for example, of individuals living in Pangnirtung, Nunavut, for whom there's almost a complete absence of mental health and well-being resources.
The Joint Vice-Chair Hon. Pierre Dalphond
Thank you very much.
We now go to Ms. Koutrakis.
Liberal
Annie Koutrakis Liberal Vimy, QC
Thank you, Mr. Chair.
My questions will be for Dr. Green and Dr. Gubitz.
Do you think systems of MAID oversight and quality assurance are adequate and consistent across Canada?
MAID Provider, Canadian Association of MAID Assessors and Providers
The systems of oversight across Canada are provincially and territorially regulated and will vary from province to province and jurisdiction to jurisdiction. There are many groups that have a retrospective chart review and audit, like the Ontario system. There are systems where I'm from in Nova Scotia that have both prospective and retrospective reviews of cases in an arbitrary sort of way.
It's difficult to speak to the totality of the Canadian experience. I think each province and territory is obligated to ensure that regulatory standards are upheld to the level that they can be. That's very important.
Liberal
MAID Provider, Canadian Association of MAID Assessors and Providers
Yes.
Of course, there are the federal legislative requirements for oversight that we just spoke to, and there are territorial oversight mechanisms. There are also professional standards that physicians need to follow that are upheld in every region of the country, and there are often local facility or regional guidelines. There are quite a few layers of oversight out there, and we know that at least 90% of all cases are individually reviewed in the country, according to Health Canada data.
Full Professor, Department of Community Health and Epidemiology and Department of Psychiatry, University of Saskatchewan, As an Individual
I'm sorry, but I don't have anything to add to that.
It does certainly vary across the country.
Liberal
Annie Koutrakis Liberal Vimy, QC
If a consensus is not required in medicine—and we've heard this several times—what threshold of clinical disagreement would, in your view, justify delaying implementation? It sounds to me like it varies across the provinces and territories. What do we need to be mindful of to make sure that the threshold of clinical disagreement justifies delaying implementation?
Dr. Thorpe.
Full Professor, Department of Community Health and Epidemiology and Department of Psychiatry, University of Saskatchewan, As an Individual
That's a tough question. I don't have a good answer to that.
I'm going to pass that to Gord or Dr. Green.
MAID Provider, Canadian Association of MAID Assessors and Providers
Clinical medicine always involves disagreements or differing opinions, depending on how the evidence is acquired, how the patient is examined and the information they provide. One of the reasons we have two assessments for each patient is to ensure that we have a consensus of opinion around the individual case itself.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
Thank you.
Mr. Gubitz, in your practice and given how the practice is developing, would someone experiencing depression and suicidal thoughts be eligible for MAID?