Physician-Assisted Dying committee  Thank you, Mr. Chair. I'll start for us. On behalf of the Canadian Psychiatric Association, we'd like to thank the co-chairs and committee members for this opportunity to present to you on this important issue. My name is Karandeep Sonu Gaind, and I'm president of the CPA. Th

Physician-Assisted Dying committee  Thank you for your very considered question. You know, it is a challenging issue to differentiate, when we're talking about the death of a person, what leads to that death. When we're talking about physician-assisted death or suicide prevention initiatives, it can seem that the

Physician-Assisted Dying committee  Okay. Both lead to the patient's death. That's true. However, one way of looking at it would be that suicide, in our suicide prevention initiatives, occurs when somebody has a desire to die. In physician-assisted death, the patient is suffering with some sort of illness, and the

Physician-Assisted Dying committee  I want to make sure I understand the question properly. Are you asking at what point in the evaluative process should a psychiatrist start getting involved?

Physician-Assisted Dying committee  If there is a mental illness present, then this would apply whether the person is applying for PAD on the grounds of mental illness or whether they're applying on the grounds of a physical illness when they also have a mental illness. We feel that the psychiatrist needs to be inv

Physician-Assisted Dying committee  I think your question actually speaks as well to the idea of patients having access to necessary treatment options even prior to making or requesting this decision. We know that is a huge problem with mental illness. The Canadian Mental Health Commission tells us that only about

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-c

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.

Physician-Assisted Dying committee  With regard to the latter part of the statement, about whether it is common practice, yes, I would say it's common practice in many areas. The primary care physician, the family physician, does play a key role in mental health provision. However, in evaluating the thought proces

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

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

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 profess

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.