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Medical Assistance in Dying committee Thank you and hello. I'm Dr. Marie Nicolini, and I'm pleased to be here today talking to the committee. I'm a medical doctor and a psychiatrist with a Ph.D. in bioethics. I was trained in Belgium, where the practice of MAID for mental disorders has been permitted for 20 years.
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee Thank you for your question. I'll briefly respond to the numbers. The number is correct. The number of MAID cases for mental disorders has been fluctuating both in the Netherlands and in Belgium. It's 1% to 2% of the total number of cases. It is important to note that when we ta
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee I think that's right for that point, yes.
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee Could you briefly clarify the last point?
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee I want to make sure I understand.
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee Yes, of course. We all agree that evaluations themselves are done by clinicians very comprehensively and in good conscience. The point about there not being standards is important, because if we do not have standards for what it means for a disease to be incurable, we cannot det
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee I said it is a finding of my research, based on the best practice.
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee That is right.
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee I will respond in English. What I have stated is not a matter of personal opinion; they are my conclusions based on the extensive research that I have done. I had started researching this area when I was practising in Belgium and I decided to pursue neutral research on this top
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee To the point about prognosis, my research has shown.... We have actually, my co-authors and I, extensively looked at the question of prognosis prediction in psychiatry, looking at treatment-resistant depression as a paradigm case, looking both at clinicians' predictions and preci
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee Another way of saying what I've said before is that what's peculiar about mental disorders is that the staging models we have do not correlate with prognosis. When we talk about something incurable or irreversible, what we know is that someone can rate very high on that staging m
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee This goes to my point earlier. I agree that a number of patients—in fact, many patients—will have a long history of prior psychiatric treatment. The question for individual MAID assessors is knowing whether or not they will truly not recover. That is what it means to meet the i
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee I want to clarify that I've not just reviewed the literature; I've actually studied a large sample of Dutch cases in which we looked at patient characteristics, their evaluations, how the requirements were applied and so on. The Netherlands is the only country, as I'm sure you'
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee These are not data that are published by the Dutch government.
October 4th, 2022Committee meeting
Dr. Marie Nicolini
Medical Assistance in Dying committee We can say something based on the data of the end-of-life clinic, the Expertisecentrum Euthanasie, but that is not what the government publishes: In fact, it's a characteristic of the practice, a matter of practice, that we do not know how many get granted and how many get denied
October 4th, 2022Committee meeting
Dr. Marie Nicolini