Indian envoy warns of 'big red line,' days after charges laid in Nijjar case
India's envoy to Canada insists relations between the two countries are positive overall, despite what he describes as 'a lot of noise.'
Canada is not ready to expand medical assistance in dying for people with a mental disorder, leaving psychiatrists across the country "incredibly concerned" about patients needing better access to care, including for addiction services, says a group representing the specialists across the country.
The Association of Chairs of Psychiatry in Canada, which includes heads of psychiatry departments at all 17 medical schools, issued a statement Thursday calling for a delay to the change set to be implemented in mid-March.
Lack of public education on suicide prevention as well as an agreed-upon definition of irremediability, or at what point someone will not be able to recover, are also important, unresolved issues, the statement says.
"As a collective organization, we recognize that a lot of work is being done in Canada on this issue," Dr. Valerie Taylor, who heads the group, said in the statement.
"Further time is required to increase awareness of this change and establish guidelines and standards to which clinicians, patients and the public can turn to for more education and information," said Taylor, who is also chair of the psychiatry department at the University of Calgary.
A statement from the office of federal Health Minister Jean-Yves Duclos says Canada is committed to implementing MAID for those with a mental disorder by keeping their safety and security at the forefront.
"We will continue to listen to the experts, including those at the front lines and those with lived experience, and collaborate with our provincial and territorial counterparts to ensure that a strong framework is in place to guide MAID assessors and providers before MAID becomes available to those for whom mental disorders is the sole underlying condition."
The office did not say whether the implementation expected on March 17 would be delayed.
Dr. Jitender Sareen, head of the psychiatry department at the University of Manitoba, said many controversial issues were discussed at the group's annual meeting in October regarding which patients with a mental disorder could be eligible for MAID, seven years after the practice was legalized in Canada for those with a physical ailment.
"If a person wants MAID solely for mental health conditions, we don't have the clear standards around definitions of who's eligible. How many assessments and what kinds of assessment would they actually need?" he said.
Sareen also called for training for health providers doing the assessments to begin sooner than its expected rollout next fall. Psychiatrists want clarity on what could be a request for suicide compared with MAID, leaving them to determine a path toward treatment or providing euthanasia, he added.
"There is still controversy around that between providers. Some people believe suicide is impulsive and self-destructive. But that's not necessarily the case. People can have thoughts about suicide without a mental health condition, an active condition like depression or schizophrenia."
Patients in rural communities may lack access to mental health care, and those struggling with addiction who have little to no access to harm-reduction services like supervised injection sites could also be left suffering until they try to seek MAID as a way out, said Sareen, who specializes in addiction services.
"We're in the middle of an opioid epidemic. And we're in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are the highest ever," he said.
"As a group of department heads in the country who are responsible for medical education both for psychiatrists and residents, we're saying, 'Look, let's put things aside as far as whether we agree with this law change or not.' We're just concerned we're not ready for March."
The federal parliamentary committee reviewing the law to expand MAID to those with a mental disorder issued an interim report in June and expected to publish a final report in October. However, it has been delayed until February.
The final report of an expert panel was released in May with 19 recommendations, including training for doctors and nurse practitioners assessing MAID requests to address topics like the impact of race, socioeconomic status and cultural sensitivity.
The report also said the expansion of MAID raises additional challenges involving those who are elderly, have neurodevelopmental or intellectual disabilities and people who are in prison, where the prevalence of mental disorders is high compared with the general population.
The panel relied on evidence from Belgium and the Netherlands, which it said have the most extensive set of safeguards, protocols and guidance overall.
Dr. Derryck Smith, a psychiatrist in Vancouver and a past board member of Dying With Dignity, said that while there is no doubt that MAID is a divisive topic among his peers across Canada, he believes there's a need to wait for the special parliamentary committee's final report "before we try to slow the process down."
Smith said lack of access to care for mental health is no different than that for physical ailments so any delay in implementing the new law is a basis for discrimination.
"The health-care system is crumbling around us but that's a different matter altogether," he said. "What concerns me as well is what is so special about psychiatric illness? Why are we putting stigma around psychiatric illness?"
The Canadian Mental Health Association said it is focused on ensuring Canadians have access to universal mental health care with supports that are fully integrated into the public system and available for free.
"This includes recognizing the social determinants that are prerequisites for good mental health by providing housing and income and food supports that help keep people well, safe and out of poverty, and which create conditions that may mitigate requests for MAID," it said in a statement.
This report by The Canadian Press was first published Dec. 1, 2022.
This story was produced with financial assistance from the Canadian Medical Association.
India's envoy to Canada insists relations between the two countries are positive overall, despite what he describes as 'a lot of noise.'
With Donald Trump sitting just feet away, Stormy Daniels testified Tuesday at the former president's hush money trial about a sexual encounter the porn actor says they had in 2006 that resulted in her being paid to keep silent during the presidential race 10 years later.
The U.S. paused a shipment of bombs to Israel last week over concerns that Israel was approaching a decision on launching a full-scale assault on the southern Gaza city of Rafah against the wishes of the U.S.
Footage from dozens of security cameras in the area of Drake’s Bridle Path mansion could be the key to identifying the suspect responsible for shooting and seriously injuring a security guard outside the rapper’s sprawling home early Tuesday morning, a former Toronto homicide detective says.
A chicken farmer near Mattawa made an 'eggstraordinary' find Friday morning when she discovered one of her hens laid an egg close to three times the size of an average large chicken egg.
Susan Buckner, best known for playing peppy Rydell High School cheerleader Patty Simcox in the 1978 classic movie musical 'Grease,' has died. She was 72.
Accused killer Jeremy Skibicki could have a challenging time convincing a judge that he is not criminally responsible for the deaths of four Indigenous women, a legal analyst says.
A Calgary bylaw requiring businesses to charge a minimum bag fee and only provide single-use items when requested has officially been tossed.
Two Nova Scotia men are dead after a boat they were travelling in sank in the Annapolis River in Granville Centre, N.S., on Monday.
An Ontario man says he paid more than $7,700 for a luxury villa he found on a popular travel website -- but the listing was fake.
Whether passionate about Poirot or hungry for Holmes, Winnipeg mystery obsessives have had a local haunt for over 30 years in which to search out their latest page-turners.
Eighty-two-year-old Susan Neufeldt and 90-year-old Ulrich Richter are no spring chickens, but their love blossomed over the weekend with their wedding at Pine View Manor just outside of Rosthern.
Alberta Ballet's double-bill production of 'Der Wolf' and 'The Rite of Spring' marks not only its final show of the season, but the last production for twin sisters Alexandra and Jennifer Gibson.
A mother goose and her goslings caused a bit of a traffic jam on a busy stretch of the Trans-Canada Highway near Vancouver Saturday.
A British Columbia mayor has been censured by city council – stripping him of his travel and lobbying budgets and removing him from city committees – for allegedly distributing a book that questions the history of Indigenous residential schools in Canada.
Three men in Quebec from the same family have fathered more than 600 children.
A group of SaskPower workers recently received special recognition at the legislature – for their efforts in repairing one of Saskatchewan's largest power plants after it was knocked offline for months following a serious flood last summer.
A police officer on Montreal's South Shore anonymously donated a kidney that wound up drastically changing the life of a schoolteacher living on dialysis.