Physician-Assisted Dying committee  Thank you. Members of the Special Joint Committee on Physician-Assisted Dying, thank you for the opportunity to appear before you today to share our perspectives on this extremely important topic. My name is Tarek Rajji. I'm the chief of geriatric psychiatry at the Centre for A

Physician-Assisted Dying committee  By training, yes. That's part of the training for all GPs; they can make a diagnosis of a psychiatric condition. Sometimes when it's not a straightforward psychiatric condition, they may refer the individual for a consultation.

Physician-Assisted Dying committee  By straightforward, I mean following the way that we make a diagnosis. Clinically, there is a textbook where there's very clear criteria about how to make a diagnosis of a major depressive disorder or schizophrenia. When the presentation is not consistent with one of the criteria

Physician-Assisted Dying committee  That's a great question. We also discussed that at our panel at CAMH. I think it's critical to have a comprehensive capacity assessment for someone who has a mental illness but is suffering from a non-mental illness which could be the grievous and irremediable condition. As you

Physician-Assisted Dying committee  Thank you for the question. I will address the issue of the participation of a psychiatrist in these committees, and maybe Kristin can also talk about other potential members of such committees. It's also something we discussed in our panel at CAMH. For individuals who don't hav

Physician-Assisted Dying committee  Yes.

Physician-Assisted Dying committee  This is a question that I think we are also starting to discuss at our panel at CAMH. I don't think we have clear, specific recommendations at this point. The complexity of the issue is that the capacity changes, and that's why the advance directives are important. When individua

Physician-Assisted Dying committee  I understand the complexity of it and I think there needs to be a more in-depth discussion about the advance directive in such individuals. It is not black or white.

Physician-Assisted Dying committee  To give a completely hypothetical example, if someone has an illness like schizophrenia and they are having an acute episode of psychosis and they are thinking of death or requesting suicide or requesting PAD, it's because of a hypothetical belief that if they don't die, then the

Physician-Assisted Dying committee  In the case where someone is requesting PAD because of schizophrenia, this is where the irremediable nature of the illness is not clear. We can't define it clearly. In the example I gave, some individuals are not acutely psychotic, but they believe there is no hope that they will

Physician-Assisted Dying committee  In the first example, it's hard to make a case for eligibility just because of the mental illness, because the belief will probably still be driven by the mental illness, or the implications of the mental illness, that they are subjected to. In the second example, they could be e

Physician-Assisted Dying committee  That's very fine, thank you.

Physician-Assisted Dying committee  When I was talking about the irremediable nature of the illness, I was thinking of three concepts. The first is the natural history of the illness itself. There is no proximity of death or inevitable death associated with mental illness the way there is with some other medical di

Physician-Assisted Dying committee  We don't know. We don't have enough knowledge about this. Most people would have had some form of treatment. Whether it's because of the treatment or natural history, it's hard to tell what is causing that. These are longitudinal studies that would take 10 years, 20 years, 40 yea

Physician-Assisted Dying committee  Yes.