Thank you so much for that wonderful presentation. This is what I've heard from others as well. Thank you for your courage to speak.
Thank you for inviting me to the committee.
I am happy to give feedback on the eligibility for medical assistance in dying of people whose sole condition is mental illness or disorder. I work as a geriatric psychiatrist whose interest has focused on aging among people with intellectual disabilities, as well as other disability and aging communities. I do a lot of complex capacity assessments for a health authority. I was asked to become involved in the planning process back in 2015, prior to legalization, and I've remained provincially involved now that it has become a provincial program in Saskatchewan.
I have worked with learners at many levels, and I've had involvement in a variety of research processes. We've done projects looking at the large number of medications provided to elderly patients in the last six months of their lives, with results consistent with other data showing that we often provide treatments that are not beneficial at end of life and make end of life more difficult. I've had learners explore my data on unmet needs among people applying for medical assistance in dying, as we very much want to avoid having people end their lives because they have not had appropriate access to resources.
As an approach, we have also looked at the backgrounds of people who have applied for medical assistance in dying. We found that these were largely people with high-income, high-education backgrounds. One of our other projects, from a number of years ago, was with people who had spinal cord injuries. It was about how they felt we should deal with MAID when people with new injuries approach us for it. We got lots of feedback letting us know they feel we needed to be very cautious and involve people who have personal experience and who can give feedback before it proceeds.
I'm talking about my clinical experiences. I'm not an expert on the legal interpretations others have presented on.
This has been very clinically and ethically challenging for all of us involved directly or indirectly. We initially assessed people with severe and untreatable cancers who already had involvement with a cancer clinic and palliative care. They were people with high education and high socio-economic status to whom MAID was available. There was a lot of stigma talking about this, which meant that people were often not accessing full resources because they didn't tell people they were planning to die.
Since 2021, we've largely had people with terminal illnesses and chronic conditions starting out on track 2. These cases have been much more challenging. They have chronic mental disorders, social isolation and demoralization, and they often lack a full understanding of their resources.
I'll give you an example. I saw a homeless patient in a shelter whom I had previously met in hospital. He ended up with no medical care. He did not have his insulin. He did not have his medications for severe neuropathic pain. He didn't even know there was a nurse practitioner who could get involved in this and get his medications. Of course, we did not approve him, but we did get him connected with the appropriate resources. It's sad that it sometimes takes a MAID request to be hooked up with resources.
My primary goal with track 2 patients—these are the ones who are most similar to the patients we're talking about now—has always been to improve quality of life so they don't need to die. This is very intensive. It's somewhat better now that our provincial program has hired social workers to help connect people with resources. Before that, we were doing this, and it was many hours of work. This is a very important thing—how to set up supports for those of us doing these assessments. I don't think the rest of the country has this.
In talking about MAID for mental disorders, there are even more challenges than just track 2. People are often convinced that nothing will ever get them better. Paradoxically, some of our patients tell us that knowing they could have access to a peaceful death, as long as they become engaged with appropriate treatments, might get them to engage with those treatments long enough to stabilize them. We're seeing this with track 2. They really want to die, but they are told they can only get this once they have had some appropriate engagement.
With mental disorders, we really have a hard time knowing how it will go. It often takes years to fully stabilize, and we can't really predict it. It is particularly difficult for young people who have many years left to live. They may be more impulsive and might live long enough to see improvements in many of the interventions. I was talking to a woman in her late thirties who told me, very similarly, that if MAID had been available in her twenties, she’d have long been dead.
I know I'm close to my end—