- Member of Parliament
- Member of Parliament
- Liberal
- Thunder Bay—Rainy River
- Ontario
- Voting Attendance: 65%
- Expenses Last Quarter: $144,359.62
- Government Page
Madam Speaker, I have read the recommendations of the committee of the Quebec National Assembly. I am interested in this, as the member is a Quebecker who seems to be opposed to it. The perception of a lot of us outside of Quebec is that the greatest support for more liberal approaches to medical assistance in dying is from Quebec. Is this not the case? Would she like to comment on that?
72 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, my guess is that if this were to go to the Supreme Court, it might well say that this kind of difficult decision, which involves balancing competing ethical values, is best left to the elected representatives, who are accountable to the people. We are the elected representatives, not the Senate. I have a lot of sympathy with what my colleague has to say.
65 words
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, I have not in fact read the report. At the moment, the problem is that we have 10 provinces and three territories that are all expected to come up with the appropriate safeguards, and I do not think any of them have actually publicly come forward with those safeguards.
I would further suggest that it ought not be the colleges of physicians and surgeons that are put in the position to have to put those safeguards in. It is up to us, the elected representatives who are accountable to the people, who ought to be the ones making those decisions, not the colleges of physicians and surgeons.
I would agree with the member that one person who stays in suffering is too many; however, I would also suggest that one person whose life is taken prematurely because of an overly liberal approach to MAID and the pain that that causes, particularly to the family, ought to be something we consider before making any decision that would allow that to happen.
172 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, the question before us now is really the coming date for implementation, which is mid-March. The intention of the legislation right now is to give us more time, and that is entirely appropriate.
We pride ourselves on making our decisions based on evidence. If we are going to make decisions based on evidence, then this certainly has to be given more time, which means that there has to be a delay on this so that it does not come into effect in March. What comes after is for us to determine. I personally think there ought to be indefinite time until we get this right.
108 words
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, I support this legislation putting a one-year hold on allowing MAID for mental illness.
We need to hold off on this until we have a broader consensus as to if and how we are going to do this. We need more safeguards in place. If we are going to do this, we need to make sure that we do it right. I do not think that we ought to have an automatic start date in one year as is planned.
To be clear, yes, I support this legislation in that MAID for mental illness will not be allowed beginning in March. However, from my perspective, we ought to make this hold indefinite. I know there are a lot of people out there who are really worried about this legislation because they have loved ones who are going through a hard time and they think, probably rightly, that some of those people will want to access MAID.
There are parents, siblings, partners, spouses and friends who are worried. Parents touch my heart the most because they are worried that the lives of their children could be affected. I can certainly sympathize with this because I have six children of my own. One does not have to be a parent to realize that almost everyone goes through a difficult time at some point in their life, hence our concern.
I know there are also a lot of psychiatrists out there who are really worried about this. There are psychiatrists who know that if their patients were to have more treatment, they would probably get better, but they are requesting MAID at this time.
Both these groups have legitimate concerns about this legislation. At the moment, I do not think the safeguards are in place, and if implemented now, the law would end up affecting a lot of people in a way that was not intended.
What is the intention of the law? I would submit that the intention of MAID for mental illness is that it should only apply to a very small group of hard-core cases. This seems to be the case in Holland, where only one in a thousand people, I am told, who apply for MAID for mental illness are actually granted it.
It is not intended for a 25-year-old who was abused as a child and has had intermittent depression ever since. It is not intended for the 30-something-year-old who remains depressed a couple years after the breakup of a marriage. It is not intended for somebody who is schizophrenic and is fine on their medication, but having stopped their medication, now wants to access MAID.
Some out there may say, “Why not? It should be the individual's choice”. As a teenager, I read Jean-Paul Sartre, and at the time, I agreed with him that the ultimate choice in life is being over nothingness. Perhaps I still agree with this. However, neither suicide nor attempted suicide is illegal in Canada. The question today is what role, if any, the state has in assisting suicide.
I worked a lot of years as an emergency room doctor, and I saw many people who were suicidal. My job was to assess whether people were suicidal, and if they were, to bring them into the hospital even if it was against their will. The law gave me the power to do so.
Many people would ask what right I have to tell someone what to do with their body and say that it should be their own choice. My response to them is that I think there are two legitimate reasons for the state intervening to prevent suicide.
One is in order to protect people from themselves. When someone is in the depths of depression, they do not see a light at the end of the tunnel. They cannot contemplate the possibility, let alone the probability, that they are going to get better. That is the nature of depression. That is what makes someone suicidal. Most of us know that, eventually, with a change of circumstances and enough time, people actually do get better.
The other legitimate reason for the state to interfere is to protect loved ones. A person who commits suicide is dead; they feel no pain. However, the loved ones continue to live the rest of their lives with the anguish of losing someone, often haunted by feelings that perhaps it was because of something they did or did not do.
The suicidal individual's inability to appreciate the possibility that they might get better should certainly make us reluctant to allow MAID for people with mental illnesses. Some people would ask whether there are people who really will not get better and who are irremediable. That is the requirement of law: The illness has to be irremediable.
The problem with that is that doctors are not really good at determining who is irremediable. Doctors do not have a crystal ball that can predict the future. In fact, studies show that doctors are not good at determining who is irremediable.
A recently published study by Nicolini et al. looked at clinicians' ability to determine irremediability for treatment-resistant depression. It reviewed 14 different studies. I will cite its conclusion: “Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard for irremediability cannot be met”. Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of MAID assessments.
As a long-time doctor, I find it absolutely mind-boggling that there are practitioners out there who are willing to administer MAID to someone knowing that perhaps with a bit of extra time the person would have gotten better. Good doctors worry about making mistakes. Good doctors do not want to kill off their patients. It seems to me that if there is even one person who is administered MAID and who, if they had not been given MAID, would have gone on to a happy life, that is a horrific tragedy. I would say it is something akin to capital punishment when it turns out the person was actually not guilty of the crime. If this happens, it is certainly on the conscience of every one of us in this place.
The number of people we can confidently say are irremediable is probably small. Some would say no, but I would offer a few comments. One is that anyone under 40 should never be considered irremediable, and in fact anyone under 60, unless they have had ongoing years of illness. I would also suggest that somebody who has not tried every kind of treatment and has not seen a lot of doctors and therapists should not be considered irremediable. Who is left? Perhaps if there is some 75-year-old who has no family and who has undergone many years of illnesses, tried every sort of treatment available and seen numerous doctors and no one can help, then maybe, and I emphasize the “maybe”, they should be considered for this.
Do I believe that the law, as implemented now, would really be confined to that small number of cases? No, absolutely not. Like a lot of members, I have been paying attention to the media and have heard of the many cases where we are just left shaking our heads that somebody would allow MAID for that. The reality is that there are a lot of practitioners out there with a very liberal approach to allowing medical assistance in dying, who seem to be willing to base it on perhaps just a phone call, practitioners who do not think it is necessary to talk to the family, to get to know the patient, or to consult someone who knows the patient.
Some people will say that the decision about standards of care and safeguards should be left to the colleges of physicians and surgeons. As a 35-year member of the College of Physicians and Surgeons of Ontario, I totally disagree with that. This is not the kind of decision that is normally left to the colleges, nor should it be; this is the kind of decision that should be left to the elected representatives, who in turn are accountable to the people.
In summary, if we are going to allow medical assistance in dying for mental illness, it should be to an exceedingly limited number of people. If we were to implement the law as it is now, I think a lot of people would be getting it whom the law was not really intended for, nor do I think we are that close, so I think there should be no fixed date on which this law comes into effect. When are we going to know we are ready to do this? I would suggest it would be when there is some consensus from the psychiatric community. From all the surveys I have seen, the majority of psychiatrists are against this, which is certainly one indicator.
We need to take however much time is necessary to do this right. This is not like other decisions made by the House of Commons. If we mistakenly take a life, all of the politicians in this room, all of the bureaucrats in Ottawa and all of the Supreme Court justices cannot bring that life back.
1594 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
- menumenu
- notificationsnotifications
- home
- mailmail
- searchsearch
