Evidence of meeting #6 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 research.
A recording is available from Parliament.
Brian Mishara
I do not at all share that view.
I have spent my life working in suicide prevention. I have started help lines in different countries and in Montreal. I've worked—
Senator, Ontario, ISG
You will get a chance to answer.
Is it your view, Dr. Mishara, that people who are suffering intolerably and who have tried all appropriate levels of treatment and all appropriate supports, all of which these individuals, who continue to suffer, deem to have failed, should keep trying these failed treatments and that they must wait for the realization of some research to perhaps come in the future? Is it your opinion that they must continue to live with this intolerable suffering? Is this your view, Dr. Mishara?
Brian Mishara
I believe that, first of all, the treatment for suicide involves a human being caring about them, believing that they can find hope regardless of this hopeless situation they feel they are in, and embarking with them on helping them to get the help and support they need.
If you look at the reasons people give, it is not because of the symptoms of their illness. It is often because of loneliness, an inability to be in a relationship or have a job and feeling the stigma of a mental illness and its impact along those lines. If you look at the reports of why people are asking for MAID, even not for mental illness, it's almost never physical pain. It's emotional suffering. It's equally a result of living in our society where, when you have a mental illness, you can't get a good job and people abandon you.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Senator. Your three minutes are up.
Go ahead, Senator Osler, for three minutes.
Flordeliz Gigi) Osler (Senator, Manitoba, CSG
Thank you, Chair.
Thank you to both witnesses for being here today. I'm going to start with Dr. Sockalingam and go to Professor Mishara if there's time.
This committee has heard testimony from different experts on what they think patients should do, and less from patients with lived experience, particularly those who are in support of MAID where mental illness is the sole underlying medical condition.
It's a two-part question.
My first question, Dr. Sockalingam, is this: Are you aware that there are people with lived experience with mental disorders who have publicly stated a willingness to bring a different perspective from those who have been invited to appear before this committee?
My second question, would you agree that having people with lived experience, with a diversity of views, experiences and expertise, before the committee would allow the committee to better meet its obligations to make recommendations on this difficult issue?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
Again, I would say that in my experience in the process of our own journey at CAMH, in our recommendations and statements, previously and currently, we've tried to engage the most diverse patients, including people who have stated, with lived experience, that they're in support of MAID for mental illness.
We are still left with the challenge of.... We're not arguing “grievousness” from that standpoint, but there is the definition of “irremediability” and the differentiation of whether that request is occurring and whether people are seeking MAID in the context of their mental illness. Is that differentiated or can that be differentiated from suicidal intent as part of the illness itself?
I think, from that standpoint, your question is should we include people...? We should always, and we have tried to at CAMH as well. I would agree.
We're still stuck with some of the.... I'm an assessor for MAID. I'm still stuck with the struggle, based on the lack of evidence, guidance or objectiveness, to feel comfortable that I'd be making a decision and be able to prognosticate for an individual what their long-term course would be. That's the tension here.
The answer is, yes, we should have diverse views.
Flordeliz (Gigi) Osler
Thank you.
What I've heard from you is you said, yes, you're aware of people with lived experience and diverse opinions, and at CAMH you did try to hear from a diversity of patients with views.
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
One hundred per cent.
Liberal
The Joint Chair Liberal Marcus Powlowski
Professor, you only have about five seconds, so answer briefly.
Brian Mishara
I appreciate how much people care about the suffering, but suicide prevention works. Every single person I have spoken with who was suicidal felt exactly like described, and most of them got hope.
Flordeliz (Gigi) Osler
I understand, and I don't want to cut you off. I know we're out of time.
My question was about centring patients—
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Senator Osler. Your time is up.
Go ahead, Senator Wells, for three minutes.
Kristopher Wells Senator, Alberta, PSG
Thank you.
Professor Mishara, in your previous testimony to this committee in 2022, you stated that, “In the Netherlands only 5% of requests for MAID for a mental disorder are granted” and “Even in medical cases of terminal illness, 40% of requests are refused because the doctor believes there [are ways to treat] suffering, and hardly any of those who are refused repeat their request after trying the treatments.”
Do you know whether these statistics are still the case in the Netherlands—I think you went into that a little bit—and if so, wouldn't that demonstrate that the Netherlands actually has a robust safeguard system for MAID MI-SUMC that Canada can learn from?
Brian Mishara
That's gone down a little bit. It's 3% of the requests for MAID for mental illness that are approved now. There is one clinic that gets 85% of the requests, and they approve 13.6% of their requests.
The problem is that this was sort of under the radar. There were a couple of cases—
Senator, Alberta, PSG
I don't want to go too much into that. It's maybe not relevant to our example here in Canada.
The question was whether there is anything you think we can learn from the Netherlands' experience—you said MAID requests are actually going down—for the Canadian experience.
Brian Mishara
The numbers for mental illness are skyrocketing now. The percentage they're approving has gone down about 40%. It's gotten to the point where it's an epidemic of young people, mostly.
Senator, Alberta, PSG
I have limited time.
You don't think there's anything Canada should take or learn from the experience in the Netherlands. Is that correct?
Brian Mishara
There's a danger in offering MAID for mental illness, because this communicates to a vulnerable population, in which, in many instances, suicidality is a symptom of their illness.... The desire to die is symptomatic of the illness, and MAID has caused a phenomenon where it's being considered an alternative to treatment rather than getting treatment.
Senator, Alberta, PSG
Are you saying that talking about MAID can lead to a contagion of people wanting to pursue MAID?
Brian Mishara
Showing any death by suicide or by MAID for someone with a mental illness to vulnerable people who have a mental illness and have considered suicide will increase the number of people who will die by that method and the number of people who wouldn't have died but then choose MAID. This happens if you talk about a suicide on a bridge or the metro or someone with a mental illness—