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.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
Ms. Long, in your written submission, you said, “Individuals experiencing suicidality...will not be eligible.”
Before this committee, Dr. Sonu Gaind, Dr. John Maher, Dr. Allison Crawford, Dr. Sandip Gandham, Dr. Margaret McKinnon, Dr. Jitender Sareen and Dr. Sanjeev Sockalingam all testified that physicians cannot accurately distinguish between the desire to die by MAID and suicidality.
They are physicians. You are not. What do you know that they don't?
Chief Executive Officer, Dying with Dignity Canada
I would just point to the physicians—there have been a much smaller number here—who did comment that they are able to assess suicidality, like Dr. Gupta and others.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
It doesn't concern you that many of them don't believe they have the capacity to do that, as physicians.
Chief Executive Officer, Dying with Dignity Canada
Those who are prepared to do the work believe they have the capacity. Should they be in a situation where they don't feel they can assess that, I am quite confident they would consult others with expertise, or they would deny the person eligibility approval.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
Your organization has a record of suing institutions that do not feel it is suitable to offer this.
Are you saying that you will waive this in the future when a practitioner does not feel this is an appropriate course of action to take?
Chief Executive Officer, Dying with Dignity Canada
Our institution has a record of supporting legal challenges that support charter rights.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
Okay. Therefore, you will potentially sue practitioners who don't want to provide MAID for people with mental illness.
Chief Executive Officer, Dying with Dignity Canada
No, we will not. Every clinician has the ability to decide when and if they wish to assess for or provide MAID. There will never be a lawsuit from us forcing clinicians to take any kind of action.
Our lawsuits are focused on constitutionality and charter rights.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
We have seen through a lot of the testimony we heard and a lot of the research on this an intersection between mental illness and external factors like loneliness, poverty, insecurity and lack of social network.
How many of those things do you feel should justify someone in seeking MAID?
Chief Executive Officer, Dying with Dignity Canada
Those are not factors that are part of the eligibility criteria.
There are several papers. Dr. James Downar, Jocelyn Downie and others present evidence saying that things like social isolation are not factors that support MAID.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
Your written testimony says that MAID, if expanded to people with mental illness as a sole criterion, “would not expand access to individuals recently diagnosed with a mental illness or those who have never received treatment for their mental illness.”
Where in the law we're reviewing is that spelled out precisely?
Chief Executive Officer, Dying with Dignity Canada
That is not in the legislation, but it would form part of the eligibility criteria in the assessment a clinician provides.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
Would you support a reform that puts this in ink in the legislation?
Chief Executive Officer, Dying with Dignity Canada
Generally speaking, that is not detailed in legislation. It's in practice standards. It's in guidelines. It's in college materials. It's in training modules. It's in all the other pieces that exist.
Conservative
Andrew Lawton Conservative Elgin—St. Thomas—London South, ON
It doesn't exist—the clarity you say is there.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Mr. Lawton.
Mr. Fragiskatos, go ahead for three minutes.
Liberal
Peter Fragiskatos Liberal London Centre, ON
Thank you very much, Chair.
This is the first meeting I'm attending as a new member on the Liberal side. I look forward to working with colleagues on the Conservative side, with the Bloc, of course, and with senators. It's a very important subject, to say the least.
On that note, I'll turn to Ms. Long.
I'll make reference to the first panellist we had. It really left an impression on me when we had a witness say that, in the vast majority of cases they've observed—they are an expert on the subject making particular reference to the Netherlands but going beyond that, as well—those seeking medical assistance in dying for reasons of mental illness are “living in poverty”. They're traumatized. They are living in deep trauma. That left an impression, I think, on all of us. It implies many things about this debate.
How do you take that comment, Ms. Long?
Chief Executive Officer, Dying with Dignity Canada
I think we all recognize that we could do more to support individuals living in poverty or needing access to mental health supports. In that same panel, you heard testimony that we are able to assess and consider those factors in assessing for MAID.
Liberal
Peter Fragiskatos Liberal London Centre, ON
That's fine, but I also heard in that testimony when something seems irremediable and the door towards a cure seems absolutely shut, suddenly it can open.
Mr. Schadenberg, can you touch on this? There is a lot to be said about those living with mental illness and not having any hope, but suddenly, a door of hope can open. What would it mean if the government and parliamentarians endorsed a view of medical assistance in dying that would allow for this to happen?
Executive Director, Euthanasia Prevention Coalition
When the debate on this issue began again, we asked people to send us stories of their personal experiences. I received a story from a person named Andrea, who spoke about living with significant mental illness between the years of 2011 and 2016. She was in a psych ward six times, and she would have wanted MAID if it had been available to her. It was not available, and she's happy to be alive.
Someone named Catherine sent us a similar letter about attempting suicide several times. She truly was treated as if she were a hard case, irremediable, but then something changed in her life. She's now married and stable. She has a child. She's fully employed, and she's happy to be alive.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you.
Mrs. DeBellefeuille, you have the floor for two minutes.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
Thank you, Mr. Chair.
Ms. Long, we know that there are cases pending and legal proceedings involving people with mental illness who want medical assistance in dying. By deciding not to expand access to it, or at least to continue the discussion, we're basically giving patients the burden of having the legislation clarified. I find this quite unfair.
Do you think that we could ask the Supreme Court whether, in its opinion, discrimination against people with a mental illness when it comes to access to medical assistance in dying respects the spirit of the charter?
Before making a decision on whether the sunset clause should continue, do you think that we should ask the Supreme Court for its opinion?
Chief Executive Officer, Dying with Dignity Canada
That step was not taken when the law came out. In fact, the government at the time acknowledged that it felt it would be overruled by the Supreme Court, but it's certainly a step that could be taken.
In an earlier meeting, I think Senator Dalphond made the point that it places the burden on patients. That is certainly true and perhaps not where the burden should be.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
We all know examples of people who ultimately decided to end their lives because they could no longer tolerate living, despite all the family and psychiatric support.
What would you say to people in this type of situation, should the committee decide to remove this option from the legislation?
Chief Executive Officer, Dying with Dignity Canada
Yes, it's very difficult. We have done a lot of work through ASIST, safeTALK and intervention training. We make referrals on a regular basis to 988 mental health resources across the country. With very limited success, we tried to work with a number of organizations to set up warm hand-offs for those individuals who truly need support and who are not really seeking access to MAID. We make wellness calls on occasion, when we have to.
I would urge the committee, with whatever recommendation you make, to provide clarity and provide a timeline as far as possible before the March deadline. There are individuals who have put a lot of hope in this. At each deadline, we have seen losses because of the frustration, upset, disappointment and distress.