David Fraser, The Canadian Press
OTTAWA – Leading experts involved in carrying out the expansion of Canadian medical care in the dying regime to people whose only underlying condition is a mental disorder disagree that this reform should be delayed.
One expert says a delay would ease pressure on the ‘rushed process’ of developing practice guidelines for complex cases, saying training modules for practitioners won’t be ready until later this year or early next year as soon as possible. But another expert believes there is no need to wait any longer.
The system was expected to include such patients starting next March, after a two-year expiration provision incorporated into a 2021 Medical Assistance in Death (MAD) Act update.
Although a panel of experts has determined that adequate safeguards are in place, the federal government announced last week that it intends to legislate to further delay reform. He didn’t say how long.
“Not everyone is ready,” Justice Minister David Lametti said during the announcement.
Madeline Li, a psychiatrist who cares for cancer patients and sits on several committees related to MAID, says the Liberal government is still working on developing practice guidelines for cases of patients whose only underlying condition is a mental.
She said she is happy with the decision to delay expanding the law and that the delay will allow her and others to “properly implement” the guidelines.
“We’ve only really started preparing recently,” he said, adding that the government didn’t convene its expert group to develop the guidelines until the autumn. “They installed it very quickly. Just a few months ago, this panel was convened to have a first draft.
He said as of last week a draft of the guidelines was still under peer review.
“We had to complete everything by March, so the process was rushed, but we haven’t done the rigorous review of the evidence yet,” he added.
Once finalized, the guidelines will be sent to provincial and territorial bodies for incorporation into legislation, and then implemented into professional practice through medical schools.
“All of this had to be done before March, which was never going to happen, Ms. Li estimates. Now we have time to do it.”
The psychiatrist said training modules for expanding the law are still under development.
He said a curriculum he’s helping to develop will teach doctors to consider the psychological factors that drive the desire to die and teach them how to assess vulnerable patients considering medically assisted dying and how to center their thinking around equity and diversity. .
“We’ll probably finalize it in the spring for a soft launch,” he said. It won’t be ready for an official launch until later this year or early next year at the earliest.”
Ms. Li said that once the program is ready, it will need to be shared across the country with medical professionals “so that there is some consistency and practice across the country.”
“It wasn’t going to be done by March,” Li said.
Jocelyn Downie, a law professor and medical ethicist at Dalhousie University, doesn’t think delay is the right decision.
According to her, we shouldn’t wait for all doctors in Canada to say they are ready to provide medical assistance in the event of death to people whose only existing condition is a mental health disorder, to launch the reform.
“Doctors who don’t think they’re ready to go have a professional obligation not to participate in MAID,” says Dr. Downies.
When the MAID laws went into effect in 2016, he stressed that not all doctors were prepared. The protocols were still under development. The drug was still acquired.
“Doctors didn’t provide medical care in the event of death because they didn’t have what they needed to provide it,” he said. You didn’t need a time limit in the law to prevent that from happening. Doctors who were not trained did not provide medical assistance in the event of death.”
Ms Downie says she wants a strong system that doesn’t impose rules on people with mental disorders that no one else has to follow.
He said medical schools might be ready for an extension of the law in the spring, that technical briefings on standards of practice were already underway, and educational seminars with physicians were already the order of the day.
“It happens that people are preparing, they also have hope, then we move the program because, suddenly, we are not ready on other parameters”, he argues.
