Medical Assistance in Dying Committee on April 28th, 2026

[Dr. Sanjeev Sockalingam]

That was what I was referring to in my statement. That's correct.

It's the consensus on irremediability and the consensus on differentiating suicidal intent from a request for MAID or a persistent desire to die.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

That takes me to my third point.

[The Joint Chair, Liberal, Marcus Powlowski]

Make it brief.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Okay.

We're talking about equal rights to MAID for people with mental health versus physical conditions. Everybody agrees they should have equal rights, but lacking the ability to have this definitive diagnosis makes it hard to provide that those rights are safe.

Is that fair?

[Dr. Sanjeev Sockalingam]

Exactly. It's safe...and I would just underscore the accessibility—

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

"Protected" is a better word.

[Dr. Sanjeev Sockalingam]

Yes, and the accessibility of treatments that are effective is also a concern.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you, Mr. Maloney.

Mrs. DeBellefeuille, you have the floor for two minutes.

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

Thank you, Mr. Chair.

Professor Mishara, we agree that not everyone whose only medical condition is a mental illness has suicidal thoughts or wants to commit suicide. For some time now, I have felt that a close connection gets drawn between a mental health issue and a desire to end one's life. In my practice, I have met people whose only health issue was a mental illness and who weren't thinking about suicide. They want their suffering to stop, they want good treatment and they want good care. It isn't necessarily a cause-and-effect relationship.

I sometimes get the impression that, to prevent medical assistance in dying from being offered to people whose sole underlying medical condition is a mental illness, mental illness is automatically linked to suicide. Am I wrong to think that not everyone with a mental health problem thinks about suicide?

Is it reasonable for a person who has tried a number of things, undergone treatments, listened to their psychiatrist and taken their medication to have the choice to die with dignity?

It isn't the same thing, Professor Mishara. We seem to be confusing a lot of things and drawing connections that seem a bit narrow to me.

[Brian Mishara]

Excuse me, but I'm going to put on my researcher's hat again. Research indicates that more than 90% of people in Canada who die by suicide have been or could have been diagnosed with mental illness.

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

That means there are 10% of people who don't have a mental illness and who have rights.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you very much, Mrs. DeBellefeuille.

Senator Osler, you have two minutes, please.

[Flordeliz (Gigi) Osler]

Thank you, Mr. Chair.

My question is for Professor Mishara.

Would you agree that a parliamentary committee tasked with making recommendations on this important and complex issue should have before it not only the full range of expert evidence but also patients—

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

I have a point of order.

Mr. Chair, I'm rooting this in chapter 20 of House of Commons Procedure and Practice. This committee has set out, through the work of the subcommittee, a very robust plan, including people with lived experience. The scope of this committee is not to review or ask witnesses to weigh in on how to structure parliamentary committees, which is what the senator is now devoting her second round of questioning to.

The line of questioning is out of scope, but it's also misrepresenting the facts of how this committee is undertaking its work.

[The Joint Chair, Liberal, Marcus Powlowski]

I would suggest, and the chair has some discretion over this, that the line of questioning is broadly related to the topic under discussion. She has one minute and 35 seconds left. I don't think it's going too far out of line to let her ask a question.

[Flordeliz (Gigi) Osler]

Thank you, Mr. Chair.

To be brief, professor, and to allow you the optimal time to answer, can you tell us, from your experience as a researcher, about hearing from patients with a diversity of experiences?

[Brian Mishara]

It certainly enriches our understanding of how to proceed and better help people, because it gives a sense of their whole life and all the complications of their life that are associated with their suffering.

I agree that the suffering of someone with a mental illness can be just as acute or worse than that of someone with a physical illness, but it is not because of the symptoms. It's usually because of a whole constellation of aspects of living with a mental illness, like frustrations, getting help and so forth.

It's more complicated, because in many diagnoses, one of the symptoms of depression is hopelessness. It's a symptom of the illness, so no matter how good things seem, you're going to think it's hopeless: “I'm never going to feel better.” This is related to the illness, which is not being adequately or correctly treated at that point in time. It certainly can point to things a little out of the technical scientific discussions: As a society, how can we better help people with a mental illness so they won't feel so desperate?

It's not just in terms of mental health treatment, which is very difficult to get in Canada, but also in terms of all the other aspects of the life of someone with a mental illness that is profoundly influencing their ability to live a good life in Canada despite their illness.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you, doctor.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

I have a point of order as well, just before we move on.

[The Joint Chair, Liberal, Marcus Powlowski]

Go ahead on the point of order.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

I just want to make sure I correct the record.

Last night we had someone with lived experience, so we need to correct the record after what the senator just said.

Thank you.

[The Joint Chair, Liberal, Marcus Powlowski]

Your point is noted.

Senator Wells, you have two minutes.

[Kristopher Wells]

Thank you.

My question is for Dr. Sockalingam.

Since the Canadian Psychological Association wasn't invited to this committee to discuss its guidance, I want to ask you this: What is CAMH doing to develop the objective markers to determine the mental health condition required?

[Dr. Sanjeev Sockalingam]

I'll take that in a few parts. First, one of the reviews cited came from CAMH, and the recent review is under publication on the difficulty of differentiating suicidality versus requests for MAID. That's part of the work we've been undertaking in the last couple of years. We have another review and synthesis of the literature on irremediability, which has informed our statement.

Second, we are an academic research hospital. We are conducting numerous studies, including looking at youth and following youth over time to look at trajectories for people in differentiation of illness, and also looking at more personalized care in terms of treatment response.

Last, just yesterday, we published a paper on treatment-resistant depression treatments and what can be effective for people who have not responded to other treatments before. We will continue to do that research and work to develop those treatment options for people who may not have responded to many of our traditional treatment forms.

[Kristopher Wells]

Dr. Sockalingam, you said, in a New York Times article published in 2023, that CAMH has “been clear that we have concerns about expansion at this time”, when talking about MAID for MI-SUMC.

Based on your testimony today, do you still feel that we're not ready for this extension? If so, do you think Canada will ever be ready?