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
Now we'll go to Mr. Maloney for four minutes and 15 seconds.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you, Mr. Chair.
I want to thank all of the witnesses for joining us this evening. I've encountered all of you before, I believe, in previous iterations of this committee.
Dr. McKinnon, I want to start with you. You're here as somebody with lived experience, as opposed to somebody who's appearing as a medical psychologist. Is that correct?
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
That's correct, yes.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Just so I'm clear, if I understood your evidence correctly, you are anti-expansion. You do not believe that the law should allow people to apply for MAID whose sole underlying medical condition is mental illness.
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
My belief is that we are not prepared in this country for that to occur, primarily due to the inequities in the allocation of mental health resources and mental health treatments. First-, second- and third-line treatments need to be available to everyone.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you for that.
That is based on your own lived experience, having been through a period of your life when you said you would have sought access to MAID. Is that correct?
Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual
Yes, I would have.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay.
Dr. Thorpe, I wasn't clear with your evidence either. Are you pro-expansion or anti-expansion?
Full Professor, Department of Community Health and Epidemiology and Department of Psychiatry, University of Saskatchewan, As an Individual
I am a middle-of-the-road person who feels that it should be occasionally available in rare circumstances, but not without considerable thought and planning as to how we are going to do it safely on a clinical basis. How are we going to constitute the groups of people who look at this?
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you, Doctor.
That sort of answers my question. I'll put you in the “anti” category, because that gets to the crux of the issue, in my opinion. If we can't arrive at a consensus, then I'm not sure how, as legislators, we can recommend that we proceed.
I'm going to now move to Dr. Green and Dr. Gubitz.
Dr. Green, you were unequivocal in saying that we are clinically ready. You said that you're not here to advise on how legislators should proceed, but then you went on to say we're clinically ready and you have confidence in our system. How can you say that after having listened to Dr. McKinnon's testimony tonight?
MAID Provider, Canadian Association of MAID Assessors and Providers
I'm actually very much in agreement with both of the previous speakers. Dr. Thorpe just expressed very nicely that this should be available in very rare circumstances and only after careful evaluation. I think that's very consistent with what I've said and what CAMAP believes.
I would tell you that clinicians are ready, as we were ready in 2016, as we were ready in 2021 and as we will be ready—
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Doctor, I'm going to interrupt you, because I've heard your evidence the last two times as well. The problem is that we can't pass a law that's as equivocal as you're putting forward. We have to pass a law that either allows it or not. That could put it in the hands of practitioners, and we have to trust the system.
We have had numerous practitioners appear before this committee, this time and the last two times, who said we are not clinically ready and the system is not prepared for multiple reasons, including the fact that we don't have resources. What do you say to that and how do you answer that question after hearing from Dr. McKinnon?
MAID Provider, Canadian Association of MAID Assessors and Providers
The position—
MAID Provider, Canadian Association of MAID Assessors and Providers
I think those clinicians are not ready and so they should not be involved in the work. The few people who are ready could be involved in the work.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Doctor, with all due respect, you know as well as I do that there will be doctors involved in the process who may not have the same level of ethical standards and professional approach to this issue as you do. How can I, in all good conscience, when I have doctor after doctor and professional after professional coming here telling me we're not ready for that reason...? In fact, if I'm not mistaken, you have said in the past that lack of consensus is not a reason to proceed. In my respectful opinion, that is a reason not to proceed.
MAID Provider, Canadian Association of MAID Assessors and Providers
This committee is not going to reach a consensus, and I expect that they will proceed. I expect the Supreme Court doesn't reach a consensus and they will proceed. I expect you can make a difficult decision.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Yes, we're in the business of making difficult decisions, but these decisions are irreversible. What you're asking us.... You're telling us that we have a system that is ironclad and ready to go in passing a law that allows people to end their life. After hearing from Dr. McKinnon, I just don't know how you can say that with any degree of confidence whatsoever, Doctor.
MAID Provider, Canadian Association of MAID Assessors and Providers
Was there a question there?
The Joint Vice-Chair Hon. Pierre Dalphond
The next questions will be from Madame DeBellefeuille.
You may go ahead. You have four minutes and 15 seconds.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
Thank you, Mr. Chair.
Thank you to the interpreters for the excellent job they're doing.
Mr. Gubitz, until March 31, I was a social worker and a member of my professional association. I am a professional who believes in medical assistance in dying, who has advocated for that right and who defends it. Nevertheless, giving people whose sole medical condition is a mental illness access to MAID is very concerning to me. There doesn't seem to be a clinical consensus on how to determine whether a mental illness is irremediable. The irremediability of a condition is more or less the clinical test for determining whether a person is eligible to receive MAID or not.
Can you tell us how you define an irremediable mental illness?
MAID Provider, Canadian Association of MAID Assessors and Providers
The definition of “irremediability” has been discussed at this committee for the last three sessions by experts in psychiatric disease and by legal scholars.
Practically speaking, from the point of view of the Canadian Association of MAID Assessors and Providers, we were required, as requested by Parliament, to come up with training that would allow the average physician and/or nurse practitioner to be engaged in the sort of clinical practice that would allow them—over time and with extensive consultation with the patient, those who support them and those who treat them, and with other collaborative approaches—to really understand the fullness of a person's experience.
In terms of irremediability, that's very difficult to assess in a day, a week or a month. Obviously, we're looking for probably many years of treatment, with all of the technologies, medicines and resources that are available, and with the support of experts in a particular illness, disease or disability. We know that not every clinician who is involved in MAID work will have the experience to deal with every patient who sits in front of them.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
As we know, Quebec has been a leader in advancing MAID, even authorizing advanced requests, which will be allowed even though the Criminal Code wasn't amended. Quebec is moving forward but is apprehensive about expanding MAID access to people whose sole medical condition is a mental illness. It even shut the door on the possibility in 2023, when its last report came out, citing the absence of a strong clinical consensus and especially the fact that professionals weren't necessarily ready to receive and assess such requests.
Do you have an opinion on the work Quebec has done in this area?
MAID Provider, Canadian Association of MAID Assessors and Providers
As a representative of the Canadian association, I don't have a specific opinion about what's gone on in Quebec, but I can speak more nationally. Quebec, of course, is a member of the Canadian Association of MAID Assessors and Providers. Many members from Quebec are there and are involved with our work.
I think what you're speaking about right now is clinical readiness, so how do we determine clinical readiness? We have the Canadian MAID curriculum. You have been provided with a copy of it as well as the paper about the development of the process. We also have guidance documents produced by CAMAP that talk about the very specific things that Dr. Green mentioned in her opening remarks. We have an online assessor forum through the CAMAP group, an online provider forum, and this allows in-time conversations to be held between clinicians to talk about difficult cases. These are all protected by a firewall sort of thing. We have regular difficult case scenario conferences that CAMAP members are invited to attend. They come, they present a case and they hear experts from across the country talk about that.
As Dr. Green mentioned, we have a national CAMAP meeting—it's happening this Thursday, Friday and Saturday in Montreal—and many of the things that are being discussed around this table are being presented as plenary sessions, with lots of complex discussion. Supportive documents include the Canadian Psychiatric Association document, which deals with these things, and the model practice standard, and we have the advice of professionals.