Evidence of meeting #7 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 euthanasia.
A recording is available from Parliament.
Liberal
The Joint Chair Liberal Marcus Powlowski
We're at the end of our time.
Thank you.
Mr. Lawton, you have three minutes.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
Thank you very much, Chair.
I'd like to go to you as well, please, Dr. van Os.
In your opening statement, you were talking about this idea of euthanasia as a last resort and the lack of any prescription in Canadian law to mandate that. Earlier, we heard testimony from an advocate of the expansion, Dr. Mona Gupta, who basically said something very similar to what you were mentioning that it would not be appropriate to expect a patient to have tried every treatment available or to force them to try every treatment before going down this road.
Just so I understand the situation in the Netherlands correctly, is that the expectation there?
Professor of Psychiatry, As an Individual
Actually, this is a complicated question, but I'm glad you're asking it. The issue is that there are many treatments that can bring change in mental suffering. These can be social interventions. These can be existential interventions offered by a recovery academy, which is led by peer support workers. It can be a medical intervention, and it can be a complementary intervention, for example.
The thing is that in fact what we see, what is offered to patients, is mostly [Technical difficulty—Editor], like ECT and medication. They're not given options to the social interventions that [Technical difficulty—Editor]
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
I'm sorry. There was a technical glitch there, but I'm limited in my time. I'll move on to another thing, please, Doctor.
We heard on April 21 from Daphne Gilbert. She said that if Canada proceeds with the expansion, “Clinicians agree that only a small number of people will ever meet the stringent eligibility criteria and rigorous safeguards...”. We also heard from another witness, Claire Gamache, who said, “It's a very small number.”
Based on your understanding of it, is there any reasonable conclusion that you could draw similar to what they have drawn from how Canada's laws are structured on this?
Professor of Psychiatry, As an Individual
Yes, but the dynamics are a bit different.
First, I think the problem is not so much how many people meet the criteria. It's that we can't agree on the criteria. Nobody can. That's the first problem.
The second problem is that once you have a procedure in place that people can apply for, desperate people will come and ask for it, and there will be unbearable suffering because it is so difficult to get the procedure. That's what we see in the Netherlands. A lot of the unbearable suffering in euthanasia procedures is caused by the fact that people think it is an option and then they become embedded and tunnelled in that particular wish.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Dr. van Os.
Mr. Maloney, you have three minutes.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you, Chair.
I want to thank all of the witnesses, particularly given the time.
We've heard from a great number of witnesses with a diversity of opinions, and your voice is very much appreciated.
Dr. van Veen, I want to start with you.
Sir, you started by saying at some point that “autonomy is...fundamental”. I agree with that. You then went on to say that “mercy” is necessary. I think I got that right: Mercy is paramount.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Yes. I agree with both.
Then you went on to say that a doctor and a patient can decide collectively that you've “suffered enough” in a mental health situation and access MAID. Did I get that part right?
Liberal
Psychiatrist, As an Individual
No. In detail in the Dutch law, in shorthand we call it “irremediability”, but the Dutch law requires of us that the doctor has to establish irremediability, and the doctor and patient, in the process of shared decision-making, have to establish that there are no reasonable other options. Shared decision-making is part of our law.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Okay. Would you agree with me that reaching that consensus or reaching that conclusion of irremediability is based on subjective complaints made by the patient and the subjective analysis carried out by the doctor?
Psychiatrist, As an Individual
All complaints are subjective from the patient's side, and I think the doctor—
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Thank you, Doctor. I'm limited in time.
That's the difference between mental health cases and terminal cancer, as Dr. van Os referred to. In the situation you're describing where you're doing this on a subjective basis, isn't that really what Dr. van Os was getting at when he said MAID for mental health is suicide assisted by a doctor?
Psychiatrist, As an Individual
I cannot comment on Dr. van Os's statements.
On the side of the doctor, it's not subjective. It's intersubjective. There are multiple doctors involved.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
Doctor, it has to be subjective because there are no physical tests that I'm aware of that can determine that you have a permanent mental illness. You can't have a CAT scan. You can't have any other type of test that'll show that—
Liberal
Psychiatrist, As an Individual
There's not a CAT scan that can show the suffering from cancer, for instance, so suffering is always subjective.
Liberal
James Maloney Liberal Etobicoke—Lakeshore, ON
No, the CAT scan shows you have cancer. A CAT scan will not show you have a mental illness. That's my point.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Mr. Maloney.
Mrs. DeBellefeuille, you have the floor for two minutes.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
Thank you, Mr. Chair.
We'll continue our conversation, Dr. van Veen. I share your opinion that a person who comes to you, who has suffered for much of their life and who can't stop their suffering, can decide for themselves what they want to do in consultation with their doctor.
The latest report by Canadian experts that we saw shows that, given the fairly tight criteria, it's almost impossible for a 30‑year‑old to qualify for medical assistance in dying. We must prove that the person has taken medication, received follow‑up care and undergone therapies, and that, after a few years of unsuccessful treatment, the suffering persists. That's what it takes for a person to have the right to decide for themselves.
I would now like to address an issue raised by my colleague concerning cases involving irreversible suffering. If you have schizophrenia and you have been in therapy for 20 years or so without seeing any results, and you're suffering, it seems that you have the right, as a patient and as an individual, in consultation with the doctor evaluating you and with all the professionals, to decide whether you want to continue to live with your quality of life.
I often hear a form of paternalism from some of my colleagues around the table. They're not able to trust a person's ability to make a decision. Would it be better to say that we can allow these people to make this decision, but take a case‑by‑case approach, since some may have the right to do so? If we fail to listen, we'll be discriminating against a minority of people who could have the right to put an end to their years of suffering.
Liberal
The Joint Chair Liberal Marcus Powlowski
That's quite a lengthy question with not a lot of time to respond, in fact, no time. I will give a brief opportunity for a response.
Mrs. DeBellefeuille, whom are you asking?