Physician-Assisted Dying committee  No, those are different. You can clearly have a wish for something, but that doesn't necessarily imply that you have capacity or competence for it. The other issue I'll point out is that capacity assessments—in medicine, we often call them that—are specific to what is being assessed.

Physician-Assisted Dying committee  Yes, although in the case of mental illness being present, it is about how it affects the thought process. In some other illnesses it might be not as much of an issue and would be more about assessing the suffering and irremediable nature of it.

Physician-Assisted Dying committee  I don't have an answer for you on that right now.

Physician-Assisted Dying committee  Actually, we were not saying that nothing is irremediable. That's not what we said.

Physician-Assisted Dying committee  Again, I'll go back to the principles that we're talking about when mental illness is present, and that is the need for a very careful assessment to understand what is influencing the patient's decision-making process. It's not a question of making a value judgment on their decision but a question of evaluating the rationality of all of the pieces that are in the process going toward making the decision.

Physician-Assisted Dying committee  It requires a different skill set with awareness of how the mental illness itself could affect the person's thought processes. That's the difference. If I have an illness in my heart or if I have diabetes, I may well have symptoms from it and I may suffer from it and it can be problematic, but it doesn't necessarily affect how I think about what I have.

Physician-Assisted Dying committee  Exactly. With mental illness, you have the presence of both suffering and symptoms, and you also have influence on the person's thought processes. Teasing that apart is challenging, but we do capacity assessments like that already—not for this purpose, but we do capacity assessments.

Physician-Assisted Dying committee  Yes, absolutely.

Physician-Assisted Dying committee  That's an excellent question, because that gets to the heart of actually some of the other questions about this. In some areas, when we're looking at the impact of suffering and how a person is perceiving and experiencing it, yes, clinically we are often able to do a thorough assessment and tease apart the impact on them.

Physician-Assisted Dying committee  Yes, or you'll miss things, potentially.

Physician-Assisted Dying committee  Again, this is part of why we haven't come with a concrete recommendation on the best way for it to be done. It's because there may be jurisdictional logistics that determine that. In some areas, you may have psychiatrists available who could physically go to the patient, or you may have psychiatrists in some areas who aren't able to physically go.

Physician-Assisted Dying committee  There are many facets to that question. In some cases, if the person has committed suicide, as I was mentioning, it often reflects that they haven't actually had access to psychiatric care. It's not to say all suicide is preventable—

Physician-Assisted Dying committee  As I said, I'm not suggesting that we're saying all suicide is preventable if someone is seeing a psychiatrist. That's not what I was saying. You're asking a bit about what the threshold is for defining something as irremediable. I don't know if that's a question for the profession to answer or for society to answer.

Physician-Assisted Dying committee  As I mentioned, in the vast majority of cases and even in the most severe situations, something can be done to attempt to ameliorate. Failing all of that, it is conceivable that there could be an illness that's irremediable. Honestly, that would have to be assessed on a case-by-case basis.

Physician-Assisted Dying committee  I can't make a definitive statement that nothing ever could. I don't believe that anyone could say that, but I share your difficulty in thinking of many, if any, that would.