Medical Assistance in Dying Committee on April 27th, 2026

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you so much.

Thank you to the witnesses.

Dr. Close, you've talked about the regulation of MAID—guidelines, training and best practices. Would it be helpful, in a case in which the sole underlying condition is a mental illness, to have some sort of documentation?

In Ontario, I believe there are clinician aides essentially documenting that a clinician has gone through a whole series of questions around the reason for the request for MAID. In other words, in the case of mental illness, it's documentation that says so many treatments had been provided, with details and so on, and were not successful. I'm thinking of the chronic schizophrenic who has tried everything, including electroshock. Would it be helpful to have a uniform assessment tool, in writing or digital, that would be available for review?

[Eliana Close]

Regulatory design and system design are important parts of regulation. Forms can help clinicians know that they are going through the required steps they should be going through.

I don't think there could be a form that could say, “You must go through and try five different treatments before this is allowed.” That would be overly prescriptive, but the form itself can be a way of translating legislative safeguards or other best practices so that clinicians are going through those steps.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Dr. Grant, do you in Nova Scotia, as a college, have any requirements for very specific steps that under the current situation with MAID a clinician is required to go through?

[Douglas Grant]

Our professional standard, which is on our website and available to the public and the profession, is very prescriptive. It's quite step-by-step. It very much aligns with all of the legislation in the Carter decision, and it's the foundation for the clinical protocols in place at the Nova Scotia Health Authority. Ours is just the professional standard.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

You would create such a standard for the sole underlying condition of mental illness.

[Douglas Grant]

I'm certain that we would adapt the one we have in place.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

I have no further questions.

[The Joint Vice-Chair, Hon. Pierre Dalphond]

Thank you very much.

We're going to suspend for the vote in the House of Commons.

Witnesses, please stay and stand by, because we're going to resume after the vote in about 15 or 20 minutes from now.

Thank you very much. I'm sorry for the interruption.

[The Joint Vice-Chair, Hon. Pierre Dalphond]

We're resuming.

Thank you very much to all those who have been waiting patiently for this panel and the next. There was a vote and we had to suspend.

There are only three questioners left for this panel.

Madame DeBellefeuille, go ahead, please.

[Claude DeBellefeuille, Bloc, Beauharnois—Salaberry—Soulanges—Huntingdon, QC]

Thank you, Mr. Chair.

Dr. Grant, you said that if lawmakers decided to expand MAID eligibility to people with mental illnesses, Nova Scotia would be ready.

If we decided to recommend expanding MAID access, would you be worried that it would encourage people in Nova Scotia to end their lives?

[Douglas Grant]

No, I would not be worried about that, but I'm not a clinician working in that space. I would be confident that the assessment for eligibility for MAID would be done in a reasoned way.

As we were saying during the break, a patient whose sole underlying medical condition is a mental disorder is not a patient who's being assessed for MAID at three in the morning by an emergency department physician. That assessment is being made over time by two separate clinicians after there's been a demonstration of enduring suffering and marked decline.

No, I would not be worried about that.

[Pierre Dalphond]

Thank you.

[The Joint Chair, Liberal, Marcus Powlowski]

Senator Moodie, you have one minute and 42 seconds.

[Rosemary Moodie]

Thank you, Chair.

Dr. Grant, would your college look to guidance documents from professional associations when setting your own practice standards and assessing a clinician's practice?

[Douglas Grant]

Absolutely. When we developed our professional standard on MAID initially—it's been edited a number of times over the years as the law has changed—we started with the decision in Carter. Then we looked at Bill C-14 and Bill C-7. We had consultation with the CMPA, the CMA and various stakeholders throughout the space. The beauty of being in a small province like Nova Scotia is that I've had the benefit of working closely with the clinical team and the administrative team that oversees the delivery of medical assistance in dying.

It's very much a collaborative effort.

[Rosemary Moodie]

I know that you meet with your colleagues in other colleges from time to time. When you meet with your colleagues from the other regulatory colleges across Canada, does MAID practice stand out as an area of poor practice, with unethical and unprofessional practices being common?

[Douglas Grant]

I'm sorry. I didn't hear what you said.

[Rosemary Moodie]

When you meet with your colleagues, are you talking about MAID practice standing out as an area of poor practice, with unethical concerns in professional practices?

[Douglas Grant]

No. Quite frankly, it's the opposite. It's an area where really passionate physicians are drawn to work.

[Rosemary Moodie]

Thank you.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you.

Senator Osler has the floor for one minute and 42 seconds.

[F. Gigi Osler]

Thank you, Chair.

Dr. Grant, this committee has heard very different pictures of the safety of MAID practice from a regulatory point of view. How do you as a regulator reconcile these very divergent views?

[Douglas Grant]

Well, it's hard to answer to anecdotes that I know nothing about. As I was saying earlier, there's an arithmetic of compassion. One extraordinary story can have an enormous influence against thousands of other cases. MAID, in the context of all the medicine that's being delivered and the ever-changing, progressive changes in medicine, is extraordinarily regulated and monitored.

I really do admire the testimony given by Dr. Close earlier. I hope the committee appreciates the levels of this matrix of regulation that takes place, from the coal face all the way up to the regulator's desk.

[F. Gigi Osler]

Thank you, Dr. Grant.

Thank you, Chair.

[The Joint Vice-Chair, Hon. Pierre Dalphond]

That completes the second panel.

On behalf of the committee to all members of the panel, thank you very much.

We'll suspend for a few minutes to bring on the third panel.