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.
Liberal
The Joint Chair Liberal Marcus Powlowski
Yes, if you could send us all of these studies from Holland, as we've previously mentioned, we'd appreciate that.
Liberal
The Joint Chair Liberal Marcus Powlowski
We will now go to the second round of questioning.
Mr. Cooper, you have three minutes.
Conservative
Michael Cooper Conservative St. Albert—Sturgeon River, AB
Thank you, Mr. Chair.
Dr. Sockalingam, consistent with the testimony of other psychiatrists who came before this committee, you indicated that there is no specific scientific way to project the future course of mental illness. Given that, would it be fair to say that any prediction would amount to a clinical hunch?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
Clinical judgment is where we are basing any kind of prediction at this current time. As I said before, research has been under way for several years to try to explore indicators to help us prognosticate better, but we are a long way away.
Conservative
Michael Cooper Conservative St. Albert—Sturgeon River, AB
Would it be fair to say that it's quite common for psychiatrists to disagree with each other on the future course of mental illnesses?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
I would say so, and even on the diagnosis itself. As others have highlighted, there are studies showing—including from the initial field studies of the DSM-5, for example—that there are differences in diagnosis and that they change over time.
Conservative
Michael Cooper Conservative St. Albert—Sturgeon River, AB
Given the difficulty in predicting irremediability and the fact that there is no scientifically objective way, would it be fair to say that if this expansion were to move ahead, there would be a high rate of error in which persons who could get better and go on to lead healthy and happy lives would have their lives prematurely ended?
As Dr. Sonu Gaind said, it would be akin to flipping a coin. Would you agree?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
Yes. We would be using clinical judgment. If we were to go forward, there would be times when there might have been a chance to provide treatments that people may not have had access to or not been aware of, and there may be times when a person's illness would have improved but we may have predicted incorrectly.
Conservative
Michael Cooper Conservative St. Albert—Sturgeon River, AB
You spoke about the CPA guidance, and you noted that it fails to provide any scientific criteria with respect to predicting irremediability, likely because there are no such criteria.
The CPA guidance does use the practice standard from Health Canada, but that looks back on a retrospective basis. I take it you would agree that's insufficient. Is that correct?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
That is insufficient.
I applaud the CPA for trying to come up with guidance, but we're limited by the literature and the evidence, and the evidence is based on retrospective data. It's a process document as opposed to criteria or an objective assessment.
Liberal
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you, Chair.
Thank you to both of our witnesses.
Dr. Sockalingam, I will continue with you.
You said at one point that any such diagnosis is entirely subjective when it comes to mental illness. Do you say that to some degree because the symptoms are subjective?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
The symptoms are not subjective, and I wouldn't say it's entirely subjective. We have diagnostic criteria that are based on symptoms and have evolved over time.
We don't have objective markers. We don't have a test, and those markers aren't necessarily limited to diagnosis. They're limited to even prognosis. For example, in certain neurological conditions and cancers, we can prognosticate more definitely on who's going to respond to what treatment and for how long and what their duration of illness might be.
Liberal
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
You just put it much better than I could have.
When people come to you or another psychiatrist with a mental health condition, you're relying on information that they are conveying to you verbally. There are some indicators and markers you can use, but unlike a physical medical condition where there's an MRI, an X-ray or something, there's not as much physical evidence available to you as a diagnostic tool.
Is that right?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
That is correct. We have some data points, but nothing that we could definitively hang our hat on for this particular discussion today.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
That's what's going to lead to the inconsistent diagnosis that Mr. Cooper was alluding to. If somebody has terminal lung cancer, and 10 doctors examine that patient, they're all going to agree the patient has lung cancer. If 10 psychiatrists examine somebody who has a mental health condition, you're going to get different diagnoses.
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
That is correct. It happens in our clinical care when people are admitted to different hospitals.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Very rarely are you going to get 10 out of 10. It could happen, but it's very rare and it's not going to happen in the vast majority of cases.
Is that fair?
Senior Vice-President, Education, and Chief Medical Officer, Centre for Addiction and Mental Health
That is correct.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay.
I want to talk about another thing. We've been talking about consensus at this committee quite a bit, and I think at times people are confusing ethical consensus with medical consensus.
In the situation I'm talking about with lung cancer, you will get a consensus. If there's a lack of consensus in the medical community or in the general public about whether to proceed with MAID, it's basically an ethical issue and a moral issue, whereas when you're talking about mental health, really the consensus you can't achieve is the medical consensus.
Is that fair?