Medical Assistance in Dying Committee on April 27th, 2026

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

Thank you, Dr. Gubitz.

[The Joint Chair, Liberal, Marcus Powlowski]

We'll turn now to questioning by senators.

I would note that since Senator Dalphond is not going to ask a question, we can give them each three minutes.

We'll start with Senator Moodie for three minutes.

[Rosemary Moodie, Senator, Ontario, ISG]

Thank you, Mr. Chair.

Dr. Gubitz, you've encountered individuals who have made suicide attempts in the past. You've encountered individuals who say that if they're not found eligible for MAID, they will complete a suicide attempt. You've encountered individuals who have suicidal thinking at the time of the request. Is this so? Is suicidality something that arises in MAID practice, even though persons with mental illness as the sole underlying cause are excluded right now?

[Gordon Gubitz]

As clinicians, we encounter patients who have suicidal thoughts, actions and ideations in every aspect of our clinical work. [Technical difficulty—Editor] who has recently been diagnosed with ALS.

[Rosemary Moodie]

I have another question. Really, I'm finding it very interesting to listen to the discussion.

In my experience, when there is no expertise available in a particular town, province or location in this country, physicians don't just get up and provide that service. If expertise is not available, unfortunately a service is not available. Is it your expectation that there will be physicians who suddenly decide they're going to provide MAID, even without the expertise that is needed?

[Gordon Gubitz]

According to everything we understand from how assessments are to be done and the regulations around that, it's not possible to complete an entire MAID assessment without the opinion of somebody who has expertise in the condition. If I assess a patient who has a high spinal cord injury, and I have no expertise in that area, I am compelled to speak to a colleague or make a referral to somebody who has that expertise.

I could give you an example, if you wish.

[Rosemary Moodie]

Could you? Thank you.

[Gordon Gubitz]

I followed a patient with trigeminal neuralgia, a very painful facial disorder. The young woman did not tolerate any of the medications. She had two separate surgeries to require this to happen. She came to me asking for MAID after she'd lost 40 pounds and was no longer able to eat except very painfully.

I referred her back to the surgeons, who did a cross-country assessment. They had a video conference call about this person in particular to determine whether or not anything else could be done for her. We sent her to pain specialists, who were not able to add anything else. She went on to have a medically assisted death at a weight of 70 pounds.

[Rosemary Moodie]

Thank you.

Mr. Chair, I assume that I have no more time.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you.

Next is Senator Osler for three minutes.

[F. Gigi Osler, Senator, Manitoba, CSG]

Thanks, Chair.

Thank you to all the witnesses for being here today.

Dr. Gubitz, we've been told that the justification for the exclusion is that mental disorders and physical disorders are different. The way they are different is that mental disorders do not have a predictable course, but physical disorders do. Can you give some examples of neurological conditions that do not have a predictable course?

Second, when you have to determine if a person's neurological condition is a grievous and irremediable medical condition, and the prognosis is not certain, how do you come to a determination on whether the person's condition fulfills this criteria?

[Gordon Gubitz]

In terms of specific neurological disorders, one might think about certain types of movement disorders, such as Parkinson's disease, which could have a variable presentation lasting from several years to dozens of years, in which case a person has to go through life with those symptoms and try to manage as best they can. Some of the neurodegenerative problems and certain of the less common dementias may have presentations like that.

On the second question, for people we have not yet determined have a grievous and irremediable medical condition, in most serious neurological disorders the answer is time. In serious neurological disorders, things get worse over time. The example, once again, is something like motor neurone disease or ALS, where you're starting off with a twitch in a foot and ending up in a wheelchair two years later, fed by a tube.

[F. Gigi Osler]

I think I have time for a third question.

We've also heard testimony that the CAMAP curriculum has not dealt appropriately with ableism embedded in our society. Can you respond to that?

[Gordon Gubitz]

Ableism is mentioned in several different components of the curriculum. The most notable would be in topic four, which assesses capacity and vulnerability. There are specific bits within the curriculum that deal with ableism.

I'll finish with some advice we provide to assessors and providers.

The first is that they acknowledge that persons with a disability requesting MAID have experienced trauma and that the medical system and society at large may have contributed to this. This would be an acknowledgement that this exists for a person with a disability.

The second is avoiding presumptions about their experience and making sure they're engaged in specific and detailed conversations within the context that the patient will allow us to be involved. Sometimes that involves collaboration with other health professionals, social workers, case workers and people they have been involved with.

The third and perhaps most important part is to try to distinguish between the suffering caused by the medical illness, disease or disability and the suffering caused by injustice, discrimination, stigma and exclusion. That's hard to do. They can be interwoven.

There's no perfect answer to this; I will agree with that, but we must—

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you, Dr. Gubitz.

Senator Wells, you have three minutes.

[Kristopher Wells, Senator, Alberta, PSG]

Thank you.

My questions are for Dr. Gubitz.

We've heard a lot about consensus. From your perspective, can you tell me whether there was consensus when track 1 came in?

[Gordon Gubitz]

Casting my eye back, I think because the parameters were so small—grievous and irremediable—and there was no mention of track 2 at that time, when MAID practice originally began with track 1—Dr. Green can speak to this, and I believe Dr. Thorpe can as well—we were basically, if you'll pardon the expression, reaching for the low-hanging fruit. These were people who were at the very end of their lives and were suffering tremendously, mostly from cancer, end-stage heart failure or end-stage failure of another organ, and clearly met all the criteria.

[Kristopher Wells]

I'm going to switch to the curriculum.

Can you speak about the consultation that's been done to design the curriculum and what you've heard from clinicians on how they are using the guidance?

[Gordon Gubitz]

A document was submitted through the clerk called the “Development of a Canadian Medical Assistance in Dying Curriculum for Healthcare Providers”. It exists as a document and it provides all the detailed background. Those of us involved in medical education are not educational experts, so we relied on Queen's University's department of higher education to put us through an entire process that was very evidence-based and that adopted the highest of educational standards.

In the feedback we've had on the curriculum thus far, well over 95% of the people who attended the curriculum felt it was beneficial and would have improved their MAID practice, and a good proportion of those who had not provided MAID were interested in beginning to incorporate MAID into their careers.

[Kristopher Wells]

With the recent guidance and materials that have been developed, can you talk about the particular gaps you were trying to address?

[Gordon Gubitz]

I'm sorry; gaps with respect to....

[Kristopher Wells]

From what you've heard, in moving to the sole underlying condition of mental illness and the new guidance and materials, what was missing from the knowledge that providers had that you have now been able to provide them?

[Gordon Gubitz]

The development of the curriculum allowed folks to go through the curriculum from the beginning to learn how to do an assessment, etc., through vulnerability and capacity, complex cases and all of the other modules to get to module 7. Very few people would have taken the seventh module as a stand-alone, because it presumed a significant amount of background knowledge of all the issues that have come before.

I think people who have taken the curriculum of module 7 are better prepared than the average person to deal with the question about mental health as a sole underlying condition, and we would encourage more people to partake in the curriculum as it goes forward. We think it's an excellent product.

[Kristopher Wells]

How many hours would you say the totality of that curriculum is?

[Gordon Gubitz]

It's 27 hours for the entire curriculum.