SoVote

Decentralized Democracy

House Committee

44th Parl. 1st Sess.
February 15, 2024
The Chair (Mr. Sean Casey (Charlottetown, Lib.))
  • 07:04:05 p.m.
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I call this meeting to order. Welcome to meeting number 102 of the House of Commons Standing Committee on Health. Happy Valentine's Day, everyone. This is a wonderful way to spend Valentine's evening. I am feeling the love here already. Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders. To the folks who are participating virtually, you have interpretation available to you. You have the choice on the bottom of your screen of floor, English or French. Please don't take any screenshots or photos of your screen during the meeting. In accordance with the routine motion, I am informing the committee that all remote participants, except one, have completed the required connection tests in advance of the meeting. We will test Ms. Long, if necessary, when we get to her. The subject matter of this meeting is Bill C-62. Pursuant to the order of reference of Tuesday, February 13, 2024, the committee is commencing its study of an act to amend An Act to amend the Criminal Code, regarding medical assistance in dying, no. 2. I'd like to welcome our first panel of witnesses. Appearing as individuals, we have Dr. Pierre Gagnon, psychiatrist, by video conference, and Dr. K. Sonu Gaind, professor of psychiatry at the faculty of medicine at the University of Toronto, who is here with us in person. Dr. Georges L'Espérance, president of the Association québécoise pour le droit de mourir dans la dignité, will also be testifying by video conference. Dying With Dignity Canada is also with us virtually, represented by CEO Helen Long. Thank you all for taking the time to appear today. As it was explained, you will each have five minutes for your opening statements. Dr. Gagnon, we will start with you. You have five minutes to give your presentation.
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Dr. Pierre Gagnon (Psychiatrist, As an Individual)
  • 07:06:45 p.m.
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Good evening, honourable members. I appreciate the opportunity to share some thoughts on this bill. The first thing I can confirm, as a Quebec psychiatrist, is that certain documents or rumours have been circulating. It has been said that the Quebec psychiatric community is largely in favour of this expansion, which is not true, or that implementing the practice of euthanasia for patients with psychiatric disorders would not generate problems or controversy, which is not true either. I would like to share a few points with you this evening, which can be boiled down to the following. We should start off by recognizing that suicidal ideation is one of the main and intrinsic symptoms associated with most serious psychiatric disorders. Furthermore, it is clinically impossible, even for the most gifted psychiatrists, to differentiate suicidal ideation from what would be considered a genuine request for euthanasia or medical assistance in dying by interviewing and assessing a patient. The other thing is that all diseases are different. You can't apply the same criteria in every case. Psychiatric disorders are long-term disorders which seriously affect the will to live. The will to live and die ebbs and flows; this has been shown in a number of studies. Against all odds, patients eventually adapt and want to live. The principle of non-discrimination or equality for persons with psychiatric disorders is to provide treatment tailored to the patient's individual condition, not to provide the same treatment to all persons for all illnesses. In our opinion, the principle of equality means that we should offer treatments tailored to the individual's situation. With psychiatric disorders, there is always a degree of uncertainty in terms of prognosis, which means that the notion of irremedialness not present. As a result, this criterion for medical assistance in dying is not met. Similarly, having patients refuse treatment comes with the territory when we are dealing with mental disorders. There is no other field that requires practitioners to obtain court-ordered treatment as frequently as we do in order to treat patients against their will, because they lose all perspective about their condition. It is therefore inconceivable that we should let the patient decide that a doctor should end his or her life, when science proves day after day that these people can be helped, that their condition can be improved and that they can even find a way back to a fulfilling life. In addition, the relationship between the patient and mental heathcare professionals, as well as the attitude of healthcare professionals, can play a particularly important role. The duty of psychiatrists and other healthcare professionals is always to try to instill hope, which is very valuable therapeutically. I would also like to point out that when people argue passionately in favour of medical assistance in dying or euthanasia for people primarily suffering from mental disorders, they often give as an example rare or very serious psychiatric disorders that have resisted all treatment. In fact, studies published on cohorts of patients who had undergone euthanasia in countries such as Belgium and the Netherlands show, on the contrary, that much more common and treatable disorders were present in patients who received euthanasia. In fact, a study published in JAMA Psychiatry showed that in 55% of cases, depressive disorders were the main psychiatric diagnosis. The majority of patients who had undergone euthanasia had a personality disorder or were lonely and socially isolated; 70% of those people were women, whereas suicide is more prevalent in men. Another study of Belgian patients with mental disorders requesting euthanasia showed that there had been an idiosyncratic and excessive expansion of the concept of intolerable suffering. This study revealed that psychiatrists had accepted that a significant component of intolerable suffering that made a person eligible for euthanasia could be due to social, economic and even existential factors, such as the loss of a loved one, friend or pet, financial problems or the feeling of being a burden to society. As a result, it is the most vulnerable people, not those with severe and untreatable mental disorders, who are usually given euthanasia. I'll leave it there. I look forward to your questions. Thank you.
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