Western Standard - Special Joint Committee shares concerns on MAiD for mental illness

00:00:00.000 Hello everyone, my name is Leah Muschett. I'm a reporter here at the Western Standard and today

00:00:09.260 our guest is Ramona Coelho. She is a family physician based in London, Ontario. She was on

00:00:16.140 the Ontario's MAID Death Review Committee in which reviews and evaluates MAID deaths in the province

00:00:22.640 and was recently on the Federal Special Joint Committee on MAID. So we're going to talk to her

00:00:29.400 basically just about MAID and her concerns on the expansion of the legislation, which will include

00:00:35.900 mental illness as of 2027, at least it's supposed to. So yeah, thank you very much for joining us

00:00:42.720 today, Ramona. We really appreciate it. So as a doctor that deals with lots of patients, including

00:00:49.680 lots of patients with mental illness, do you think that this is a good decision to expand it to

00:00:55.760 the legislation for mental illness? And if not, why not?

00:01:00.780 Thanks, Leah. That's a great question. I have been concerned from the beginning about this

00:01:06.160 legislation, especially in 2021, when they offered expansion to people who were not dying,

00:01:12.480 but with physical disabilities. As you mentioned, I'm a family doctor, but I take care of a

00:01:18.940 particularly marginalized population. So I work in a lower, a lot of my patients have a lower

00:01:25.660 socioeconomic status they have many barriers to access to care i take care of people who have a

00:01:31.660 lot of chronic pain mental health and addictions my sister actually is a psychiatrist who helps

00:01:37.820 me because i have a very complex population and i have been concerned that even under track two

00:01:46.300 that my patients have been offered made as i shared in parliament and other places

00:01:51.420 were being offered MAID very quickly or during hospitalizations when they were vulnerable,

00:01:57.980 without a deep dive of their suffering, even under track two. With the expansion of mental

00:02:03.660 illness in 2027, I have even further concerns. So for mental illness, there is no evidence-based

00:02:11.820 reliable way to assess irremediability. So medical assistance in dying when it was introduced in

00:02:19.900 2016 was with the intention that we were going to end people's lives who we could not help their

00:02:28.220 suffering and that their condition could not get better by as it stands now with people with mental 0.62

00:02:35.100 illness they they can suffer and in our society we can we can make their suffering further when 0.87

00:02:39.900 they're thrown into poverty or when they're excluded or lonely or or lose their jobs and

00:02:45.500 all of these things that can can actually further mental illness. But what we cannot do is we cannot

00:02:52.540 accurately predict if someone will suffer to the end of their life, we cannot say that their

00:02:57.660 condition is irremediable. So if made for mental illness comes into being in 2027, we will be

00:03:04.780 ending the lives of people who potentially have suffered a lot, but who had the potential to get 0.64

00:03:09.740 better, we will not get it right, we don't have the evidence to be able to get it right. And we

00:03:13.900 we would be ending we would be wrongly ending people who would have gone on to recover and

00:03:18.780 and live meaningful and happy lives most of them okay well uh jumping off of that i wanted to know

00:03:26.980 because i don't think many viewers would know and i certainly do not know it as a doctor if uh

00:03:33.600 someone under that legislation when it's expanded to mental illness do you have to be able to offer

00:03:39.700 them made as a uh i guess yeah trait treatment method or is that like an optional thing for you

00:03:49.940 yeah it's a very good question actually like in different places um have enacted this differently

00:03:55.700 like even provincially um but federally we have a model practice standard which suggests that we

00:04:03.140 bring up medical assistance and dying to people we think would want it and would qualify

00:04:08.340 And, you know, as Harvey Chachnov also shared at the special joint committee, he was the panel after me, you know, it's like offering, he likened it to going to a restaurant and offering hemlock on the menu.

00:04:22.740 You're not forcing anyone to take it by putting it there.

00:04:25.820 There could be an inducement to suicide, even under track two.

00:04:29.340 And one of my patients who went on the BBC shared how her mother was repeatedly offered medical assistance in dying when she declined it. She wanted palliative care, she went home, they even called it home.

00:04:42.340 And the suggestion of medical assistance in dying, which is part of the Canadian legislation, they're saying they're not suggesting suicide, they're suggesting MAID.

00:04:53.340 made but that suggestion in itself is very dangerous to me and it would make it so that

00:04:59.100 some practitioners who have a more lax approach to made legislation would potentially be offering

00:05:05.580 this to very vulnerable people as as the story that we heard about already in Vancouver of the

00:05:10.380 lady who was suicidal and went to the hospital and someone discussed medical assistance and dying

00:05:15.420 with her. I also wanted to ask about, there's an MP at the joint committee that asked you,

00:05:24.140 whose name was Marcus Pawlowski, he asked you about the, I guess people are making, well,

00:05:30.780 doctors who are administering MAID are making money off of it, administering MAID, and so I wanted

00:05:36.860 to get your opinion. Do you think this, people who are doing this to make money, which there seems to

00:05:43.980 be some are doing will do it more under the new provisions of mental illness yeah so what i told

00:05:53.580 mp pelowski is that i i can't know people's hearts or their financial gains but i do know that there

00:06:00.860 are a small number of providers who have a very lax approach who have boasted in public and in

00:06:07.420 the media that they take the cases that no one wants um and and basically they do this full time

00:06:16.220 and which is very different from practice in other places that you can have these providers

00:06:21.900 who've done like 500 like 500 plus people's lives it does beg the question i guess of financial

00:06:29.100 incentives but i i think it also could be about these people misunderstanding that there can be

00:06:37.420 compassionate care still, like ending these people's lives prematurely when there was so

00:06:42.700 much more that we had left to offer them. I'm really worried about that.

00:06:49.620 Okay. As provisions currently stand, do you still believe it's like way too general as to,

00:06:58.300 especially track two? I've been very vocal. You know, the May Death Review Committee,

00:07:03.940 which I'm a former member, you can see those cases are public. So for many years,

00:07:08.660 when people tried to share their stories in the media, you would have parliamentarians and

00:07:13.380 made lobbyists or made advocates saying that they were fake stories. We even heard this

00:07:17.460 in parliamentary committee now, you know, these stories, the physicians can't speak back,

00:07:21.540 we don't know the whole story. I feel this is very unkind, we wouldn't do this to people who

00:07:26.340 say that they are suffering and want made, but people have attacked these people who've come

00:07:30.340 forward with their stories but the may death review committee has published their cases these

00:07:34.900 are government audited cases where we've reviewed their health files and and they're real and you

00:07:41.380 can see that there are problems all along like i would say in track one um you know of a lack

00:07:46.980 of capacity so someone who's delirious or has progressed to dementia or people who there is

00:07:54.260 coercion, like I mean coercion broadly, like a potential coercive influences that would affect

00:08:02.420 their voluntariness, like if there's caregiver burnout in their partner, or if they're not

00:08:07.620 getting access to their care. And then in track two, in the May Death Review Committee report,

00:08:13.940 there are some very, very sad cases of, of people who had their mental health largely untreated

00:08:21.540 and were seeking MAID for mental health suffering and had their lives ended potentially because

00:08:29.220 they also had a disability. You could see that in the Track 2 stats that a lot of people could not

00:08:34.820 list a next of kin, so a family member. They would be listing a lawyer or a doctor or a friend,

00:08:40.740 but all that speaks to potential social isolation. In the Track 2 stats that are released from the

00:08:47.780 ministry of health in these reports you can see that the offerings that were given to people

00:08:53.300 in track 2 made often are drug related but not mental health or disability like less than 50

00:08:59.300 were offered the those things and less than 10 of patients were offered community solutions

00:09:05.380 or income support and and for people with disabilities who the un um has said you know

00:09:11.540 we are excluding them for life or they're living below the poverty line a lot of their suffering

00:09:16.260 has to do with those things. And so if we're ending their lives without offering them,

00:09:21.700 you know, assistance to live, inclusion in society, that's really worrisome to me,

00:09:27.620 especially because our medical evidence says that, you know, in terms of suffering and,

00:09:33.220 and coping, a lot of it has to do with our social network, with feeling that we matter,

00:09:43.220 like people people care about us and so i'm very concerned about track two as well but also

00:09:49.220 aspects of track one as well um yeah i'm i watched like um a few of the special joint

00:09:56.100 committees and eclipse that were um surfacing and going kind of viral online and it seems like

00:10:01.700 there is lots of people uh lots of experts saying that this is not a good decision and um to expand

00:10:08.740 And I just want to get your opinion from going to the special joint committee.

00:10:13.900 Do you believe that they might have a change of heart and not proceed with the mental illness provision?

00:10:21.480 I think it would be very disgraceful if this government went for it with their provision, given that there has been no change in the medical evidence.

00:10:30.740 I also think they need to stop just having another delay.

00:10:33.900 You know, something that I shared about in committee, because someone came to committee, a pro-made activist, said, you know, every time you delay, she gave a concrete example of some people who committed suicide.

00:10:46.760 But what I shared is that, you know, the government message that MAID will be a solution for mental illness in itself, based on what we understand about suicide prevention research, creates a message, a social contagion message of suicidality.

00:11:03.260 it could actually drive people to desperation and and and see that death is the best answer

00:11:10.940 to their life suffering and that's because messages affect our choice so when we um you know

00:11:17.900 there are a lot of our suicide prevention networks and frameworks are built on the idea that we need

00:11:23.020 to help people understand that there's always hope and that recovery is possible and when we start to

00:11:29.020 tell people that yeah death is coming and death will be a good answer for you well we're we could

00:11:36.540 be inducing people to suicide um also on that note i don't recall exactly where i heard it but

00:11:46.140 i'm pretty sure it was either in the netherlands or somewhere where they also allow uh assisted

00:11:51.500 suicide that more women are also tend to be the people who are getting it the most yes so

00:11:59.020 There were Isabel Grant and Liz Sheehy, who are two legal scholars who have mostly done their work on domestic violence against women, but have shown that, you know, mental illness and women are higher victims of trauma and abuse and therefore have higher levels of mental illness.

00:12:24.900 And they quoted the studies, which I don't have in front of me, which showed an overwhelming number of young women accessing psychiatric euthanasia.

00:12:36.520 So do you think that might be something that might happen in Canada if it were to go through, like more women getting it?

00:12:44.340 for Track 2 MAID, which is outside the end-of-life context. We have more women accessing that, 0.97

00:12:52.680 younger women who tend to be poorer. That's in the Health Canada reports, but also in the

00:12:58.540 Track 2 MAID reports from Ontario. And Health Canada explains that away by, well, tries to

00:13:04.900 explain it away by saying, you know, women have more chronic illness, and therefore that's why

00:13:09.540 there are more women choosing MAID. But the people with chronic illness are not dying. The question

00:13:15.620 is why do women with chronic illness want to die? And when you have these other surrounding stats,

00:13:21.380 like increasing poverty, increasing isolation, not enough finances, hardships to live, right?

00:13:32.500 those are really concerning. Hmm, yeah, well, okay, I guess I want to talk a little bit about

00:13:40.820 the story, about that, sorry, what, sorry, what was the person's name that released the letter?

00:13:48.980 Professor Trudeau Lemons. Trudeau Lemons, okay, yeah, he released the letter about the MDRC,

00:13:55.060 The acronym, I think it is, for the Ontario May Death Review Committee is reducing its members.

00:14:01.440 And basically, I just wanted to get your thoughts on what they're doing to kind of transform this committee and whether you think it's a good idea.

00:14:12.440 Yeah, so Trudeau Lemons, Professor Trudeau Lemons wrote a letter that he then presented

00:14:20.200 to the Globe and Mail and to other newspaper outlets sharing that we were told that the

00:14:26.420 committee, there's a new call for committee, so our contracts have ended, and that new

00:14:34.700 call will only include non, like MAID providers mostly, and then non-clinician member, non-MAID

00:14:44.900 clinician members who are supportive of the practice of MAID. And in his letter, he comments,

00:14:50.980 he quotes that, you know, they said that, you know, this is legislation and so people who are

00:14:56.440 against the legislation or against MAID might not understand the practice of MAID. And what's very

00:15:02.240 concerning about that is that a lot of people who are the care

00:15:08.860 specialists, like for palliative care, or disability care, or

00:15:13.040 mental health care, have a lot of concerns about how medical

00:15:17.180 assistance in dying is being practiced in Canada, because they

00:15:21.000 understand the medical evidence about recovery, and the

00:15:25.100 treatments that can be offered. And perhaps that's why a lot of

00:15:28.360 them don't do MAID. And so excluding that pool from the coroner's table, in my mind, could

00:15:36.440 potentially limit the critiques and could affect public health safety recommendations, right? And

00:15:45.080 even the coroner in his own call, his new call out, his old call out in 2023, you know, talked about

00:15:51.980 public safety and this more was focused on guiding and supporting MAID clinicians.

00:15:58.940 We do definitely need guidance and support for MAID clinicians but we absolutely also need

00:16:04.780 oversight and we need actually more than what the coroner is doing. We need enforcement

00:16:11.740 repercussions if people do stray from the law because basically this is an exemption

00:16:17.900 to homicide and assisted suicide that is what it is it is a criminal exemption federally and so if

00:16:24.300 people are not practicing according to the legislative standards they could be basically

00:16:31.340 they are ending lives without those protections that they're supposed to have to do made

00:16:37.660 and and basically as the global mail said i think the globe mail did an op-ed like some weeks ago

00:16:42.860 saying that we need to have repercussions for this because otherwise people are going to continue

00:16:49.920 to do this. And certain maid providers have even said when they saw that their colleagues were

00:16:54.760 doing something and there was no repercussions, well, they went ahead and expanded their approach

00:16:59.800 to their practice. And I think that that's very dangerous. I'm not talking about all maid clinicians.

00:17:04.620 I think a lot of maid clinicians do try very hard to practice as per the legislative requirements,

00:17:09.680 but there are some that have been even publicly defiant of them and very proud of the fact that

00:17:14.640 they practice at the edge of the law or even beyond the law i would say yeah also on that note

00:17:21.680 i i guess i just want to ask like how come they are reducing the amount of people as well is it

00:17:28.000 just because they don't believe they need that many they just thought it was too many if you can

00:17:33.280 answer that question yeah i don't want to speak for the corner like and i i don't want to reveal

00:17:38.480 more than I think it's public. But that that that part about

00:17:42.800 reducing the numbers could just be to make it more practical.

00:17:47.800 There were 16 of us, it's a lot of people. I wouldn't say that

00:17:51.960 that's my main concern. My main concern is that having voices

00:17:57.720 that are critical. Yes, maybe make it harder for consensus,

00:18:03.840 but are necessary if this is actually about oversight, right? You don't want to have,

00:18:10.440 for example, and this sounds, it's just for comparison, not because it's the same issue,

00:18:15.620 but if you had like a tobacco safety panel, and then you populated it only with people who were

00:18:24.540 potentially stakeholders in tobacco, like tobacco farmers, tobacco lobbyists,

00:18:30.380 um I would think that that would dilute the input that was given about the safeties needed to

00:18:38.060 protect from tobacco um just explain my thought process there okay yeah well um yeah well thank

00:18:48.320 you very much for coming on Ramona I really appreciate your time um yeah so thank you

Western Standard - May 01, 2026

Special Joint Committee shares concerns on MAiD for mental illness

Episode Stats

People

Summary

Transcript