EXPERT ADVISORY GROUP (EAG) BRIEF TO 2023 AMAD/MAID PARLIAMENTARY COMMITTEE

NOVEMBER 16, 2023 

The November 2023 Brief was written by Dr. Sonu Gaind (@Psych_MD) and Prof. Trudo Lemmens (@TrudoLemmens) to address inaccuracies in key assertions and claims that had been made to parliamentarians during deliberations regarding the planned March 2024 expansion of MAID for sole mental illness conditions (you can read the original Oct 14, 2023 letter to parliamentarians containing those inaccuracies via the lower link, left column).

Check also the brief downloadable on the top left by noted legal expert Prof. Archibald Kaiser.

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Click here or on the link to the right to download the complete 2023 brief

Below is a shortened summary of the brief (note: you are encouraged to view the full document [pdf file via above link] for the full context and background informing the much shorter summary below)

SUMMARY REBUTTAL OF PROF. DOWNIE/DR. GUPTA DOCUMENT

Prepared by Dr. K.S.Gaind and Prof. Trudo Lemmens
on behalf of the Expert Advisory Group on MAID

November 16, 2023

Refer to full brief at https://www.eagmaid.org/brief-2023

 This summary rebuts assertions (identified as bolded text starting each section, our rebuttals following in italics) made to parliamentarians by Prof. Jocelyn Downie/Dr. Mona Gupta in their October 14, 2023 document “Responses to Common Concerns about MAiD MD-SUMC”.

(i) “If MAiD MD-SUMC is allowed, a person will be able to walk into an Emergency Room and get MAID when they are going through a difficult time. This is false.”

 A misleading caricature of actual concerns, which include:

(1) those suffering from mental illness will be told their situation is “irremediable”, when evidence shows those predictions cannot be made and will be wrong over half the time.

(2) assessors will claim they are not providing MAID for mental illness to suicidal people, but evidence shows suicidal wishes fueled by mental illness cannot be distinguished from psychiatric MAID requests.

(ii) “A person with MD-SUMC could ask for MAiD and receive it the next day. This is false. MD-SUMC MAiD requests…require a minimum of 90 days between the request approval and provision.”

Another straw person argument, however we have concern some interpret the track two 90 day assessment period meaning the *assessor* simply claims their initial clinical assessment started 90 days before providing MAID, and the patient need not have requested MAID at the start of that period (i.e. that 90 days *do not* need to elapse between request approval and provision). Getting psychiatric care often takes much longer than 90 days, some assessors (Dr. Ellen Wiebe) have said they would consider someone on a long enough waiting list to qualify for MAID.

(iii) “A request for MAiD MD-SUMC is fundamentally different (wrt assessing incurability and suicidality) from a request based on a physical condition. No one has provided evidence to support this statement.”

 Prof. Downie/Dr. Gupta ignore significant evidence showing:

·       Inability to predict irremediability of mental illnesses in individuals (less than 50% accuracy, far different from more predictable medical disorders).

·       Inability to distinguish suicidality from mental illness from motivations for MAID MD-SUMC. Senator Kutcher’s assertions that making these distinctions is part of the “core competencies of psychiatry” are not based on evidence.

·       Evidence of marginalized being at higher risk of premature death by MAID MD-SUMC, including the 2:1 gender gap of women to men getting MAID for mental illness.

(iv) “People can access MAiD in Canada because they are living in poverty. No one who has made this claim has provided any evidence this is the case.”

 People have received MAID indicating they were driven by poverty, not by their illness symptoms. CAMAP president Konia Trouton admitted the suffering people get MAID approval for does not have to be related to illness suffering.

Prof. Downie/Dr. Gupta ignore data showing populations seeking MAID MD-SUMC have unresolved socio-economic suffering.

 There are no safeguards preventing poverty, housing insecurity, loneliness, etc, from significantly fueling MAID requests. Prof. Downie/Dr. Gupta cite a Downar et al article claiming “socioeconomic deprivation appears…to be protective against MAiD.” That paper has been refuted by an unprecedented over 170 scholars, clinicians and researchers signing a rebuttal in the same journal [https://www.liebertpub.com/doi/10.1089/jpm.2023.0581].

(v) “…to establish a person has an incurable mental disorder a person will have had to have an extensive treatment history.”

 This is a misleading reassurance given by those who were in positions to recommend Canada introduce additional safeguards. Canada’s laws *do not* require a person to have had past treatments. This false reassurance is doubly concerning given Dr. Gupta’s 2022 panel failed to recommend legislative safeguards requiring past treatments before receiving MAID MD-SUMC.

(viii) “Other countries have greater protections for people with mental disorders. This is false. No country in the world that allows assisted dying has a mental disorder exclusion clause.”

 This is a deceptive argument.  Most jurisdictions other than the Benelux countries restrict MAID to end of life conditions, thus MAID MD-SUMC is not permitted in most jurisdictions even in the absence of a specific exclusion.

(ix) “The majority of psychiatrists are against MAiD MD-SUMC - No evidence has been presented to support this. Canada’s two largest psychiatric associations (CPA with ~2500 and AMPQ with ~1200 members) have take the position people with mental disorders should have the same rights as people affected by other medical conditions. CAMH has reversed its previous opposition to MAiD for persons with mental disorders in a public statement in March of 2023.”

Virtually every assertion made in this claim is demonstrably false.

·       Evidence has been presented showing most psychiatrists, typically by a 2:1 margin, oppose MAID for sole mental illness despite not being conscientious objectors, including from an OMA Section on Psychiatry (which has over 2000 members, nearly double AMPQ) survey.

·       Even most AMPQ psychiatrists would likely oppose the implementation of MAID MD-SUMC as planned for March 2024.

·       The CPA Position on MAID and mental illness is not based on member consultations.

·       Prof. Downie/Dr. Gupta mischaracterize CAMH’s position, CAMH has not “reversed its previous opposition” to MAID MD-SUMC.

(xi) “An exclusion clause for MAiD MD-SUMC is constitutional - This is false.”

The constitutionality of an exclusion clause for MAID MD-SUMC has not been tested in the courts. Legal scholars have argued there is no legal requirement for government to expand MAID MD-SUMC (https://www.law.utoronto.ca/blog/faculty/letter-federal-cabinet-about-governments-legal-claims-related-maid-mental-illness).

(xii) “The Canadian MAiD system is not ready for safe implementation of MAiD MD-SUMC.  This is false.”

Canada is not ready for safe implementation of MAID MD-SUMC, even CPA Chair Alison Freeland acknowledged in November 7 testimony that “I don’t think I can say from a CPA perspective that all the readiness is there”.

Prof. Downie/Dr. Gupta argued MAID MD-SUMC was ready to implement March 2023, their continued claim is nothing new. The continued lack of readiness reflects ongoing absence of evidence that MAID MD-SUMC can be safely implemented, and reassurances have been provided but no safeguards implemented.

Please see full rebuttal document through links above

The Expert Advisory Group (EAG) on MAiD consists of diverse experts, psychiatrists and clinicians, including those involved in MAiD teams, psychologists, legal experts, medical ethicists and researchers, Indigenous leaders, those with lived experience and other cross sectionalities.  The EAG issued its first report in February 2020 and reconvened following release of the federal Panel on MAID and Mental Illness report in May 2022