00:00:00.000Hello everyone, my name is Leah Muschett. I'm a reporter here at the Western Standard and today
00:00:09.260our guest is Ramona Coelho. She is a family physician based in London, Ontario. She was on
00:00:16.140the Ontario's MAID Death Review Committee in which reviews and evaluates MAID deaths in the province
00:00:22.640and was recently on the Federal Special Joint Committee on MAID. So we're going to talk to her
00:00:29.400basically just about MAID and her concerns on the expansion of the legislation, which will include
00:00:35.900mental illness as of 2027, at least it's supposed to. So yeah, thank you very much for joining us
00:00:42.720today, Ramona. We really appreciate it. So as a doctor that deals with lots of patients, including
00:00:49.680lots of patients with mental illness, do you think that this is a good decision to expand it to
00:00:55.760the legislation for mental illness? And if not, why not?
00:01:00.780Thanks, Leah. That's a great question. I have been concerned from the beginning about this
00:01:06.160legislation, especially in 2021, when they offered expansion to people who were not dying,
00:01:12.480but with physical disabilities. As you mentioned, I'm a family doctor, but I take care of a
00:01:18.940particularly marginalized population. So I work in a lower, a lot of my patients have a lower
00:01:25.660socioeconomic status they have many barriers to access to care i take care of people who have a
00:01:31.660lot of chronic pain mental health and addictions my sister actually is a psychiatrist who helps
00:01:37.820me because i have a very complex population and i have been concerned that even under track two
00:01:46.300that my patients have been offered made as i shared in parliament and other places
00:01:51.420were being offered MAID very quickly or during hospitalizations when they were vulnerable,
00:01:57.980without a deep dive of their suffering, even under track two. With the expansion of mental
00:02:03.660illness in 2027, I have even further concerns. So for mental illness, there is no evidence-based
00:02:11.820reliable way to assess irremediability. So medical assistance in dying when it was introduced in
00:02:19.9002016 was with the intention that we were going to end people's lives who we could not help their
00:02:28.220suffering and that their condition could not get better by as it stands now with people with mental
00:02:35.100illness they they can suffer and in our society we can we can make their suffering further when
00:02:39.900they're thrown into poverty or when they're excluded or lonely or or lose their jobs and
00:02:45.500all of these things that can can actually further mental illness. But what we cannot do is we cannot
00:02:52.540accurately predict if someone will suffer to the end of their life, we cannot say that their
00:02:57.660condition is irremediable. So if made for mental illness comes into being in 2027, we will be
00:03:04.780ending the lives of people who potentially have suffered a lot, but who had the potential to get
00:03:09.740better, we will not get it right, we don't have the evidence to be able to get it right. And we
00:03:13.900we would be ending we would be wrongly ending people who would have gone on to recover and
00:03:18.780and live meaningful and happy lives most of them okay well uh jumping off of that i wanted to know
00:03:26.980because i don't think many viewers would know and i certainly do not know it as a doctor if uh
00:03:33.600someone under that legislation when it's expanded to mental illness do you have to be able to offer
00:03:39.700them made as a uh i guess yeah trait treatment method or is that like an optional thing for you
00:03:49.940yeah it's a very good question actually like in different places um have enacted this differently
00:03:55.700like even provincially um but federally we have a model practice standard which suggests that we
00:04:03.140bring up medical assistance and dying to people we think would want it and would qualify
00:04:08.340And, 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.
00:04:22.740You're not forcing anyone to take it by putting it there.
00:04:25.820There could be an inducement to suicide, even under track two.
00:04:29.340And 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.
00:04:42.340And 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.
00:04:53.340made but that suggestion in itself is very dangerous to me and it would make it so that
00:04:59.100some practitioners who have a more lax approach to made legislation would potentially be offering
00:05:05.580this to very vulnerable people as as the story that we heard about already in Vancouver of the
00:05:10.380lady who was suicidal and went to the hospital and someone discussed medical assistance and dying
00:05:15.420with her. I also wanted to ask about, there's an MP at the joint committee that asked you,
00:05:24.140whose name was Marcus Pawlowski, he asked you about the, I guess people are making, well,
00:05:30.780doctors who are administering MAID are making money off of it, administering MAID, and so I wanted
00:05:36.860to get your opinion. Do you think this, people who are doing this to make money, which there seems to
00:05:43.980be some are doing will do it more under the new provisions of mental illness yeah so what i told
00:05:53.580mp pelowski is that i i can't know people's hearts or their financial gains but i do know that there
00:06:00.860are a small number of providers who have a very lax approach who have boasted in public and in
00:06:07.420the media that they take the cases that no one wants um and and basically they do this full time
00:06:16.220and which is very different from practice in other places that you can have these providers
00:06:21.900who've done like 500 like 500 plus people's lives it does beg the question i guess of financial
00:06:29.100incentives but i i think it also could be about these people misunderstanding that there can be
00:06:37.420compassionate care still, like ending these people's lives prematurely when there was so
00:06:42.700much more that we had left to offer them. I'm really worried about that.
00:06:49.620Okay. As provisions currently stand, do you still believe it's like way too general as to,
00:06:58.300especially track two? I've been very vocal. You know, the May Death Review Committee,
00:07:03.940which I'm a former member, you can see those cases are public. So for many years,
00:07:08.660when people tried to share their stories in the media, you would have parliamentarians and
00:07:13.380made lobbyists or made advocates saying that they were fake stories. We even heard this
00:07:17.460in parliamentary committee now, you know, these stories, the physicians can't speak back,
00:07:21.540we don't know the whole story. I feel this is very unkind, we wouldn't do this to people who
00:07:26.340say that they are suffering and want made, but people have attacked these people who've come
00:07:30.340forward with their stories but the may death review committee has published their cases these
00:07:34.900are government audited cases where we've reviewed their health files and and they're real and you
00:07:41.380can see that there are problems all along like i would say in track one um you know of a lack
00:07:46.980of capacity so someone who's delirious or has progressed to dementia or people who there is
00:07:54.260coercion, like I mean coercion broadly, like a potential coercive influences that would affect
00:08:02.420their voluntariness, like if there's caregiver burnout in their partner, or if they're not
00:08:07.620getting access to their care. And then in track two, in the May Death Review Committee report,
00:08:13.940there are some very, very sad cases of, of people who had their mental health largely untreated
00:08:21.540and were seeking MAID for mental health suffering and had their lives ended potentially because
00:08:29.220they also had a disability. You could see that in the Track 2 stats that a lot of people could not
00:08:34.820list a next of kin, so a family member. They would be listing a lawyer or a doctor or a friend,
00:08:40.740but all that speaks to potential social isolation. In the Track 2 stats that are released from the
00:08:47.780ministry of health in these reports you can see that the offerings that were given to people
00:08:53.300in track 2 made often are drug related but not mental health or disability like less than 50
00:08:59.300were offered the those things and less than 10 of patients were offered community solutions
00:09:05.380or income support and and for people with disabilities who the un um has said you know
00:09:11.540we are excluding them for life or they're living below the poverty line a lot of their suffering
00:09:16.260has to do with those things. And so if we're ending their lives without offering them,
00:09:21.700you know, assistance to live, inclusion in society, that's really worrisome to me,
00:09:27.620especially because our medical evidence says that, you know, in terms of suffering and,
00:09:33.220and coping, a lot of it has to do with our social network, with feeling that we matter,
00:09:43.220like people people care about us and so i'm very concerned about track two as well but also
00:09:49.220aspects of track one as well um yeah i'm i watched like um a few of the special joint
00:09:56.100committees and eclipse that were um surfacing and going kind of viral online and it seems like
00:10:01.700there is lots of people uh lots of experts saying that this is not a good decision and um to expand
00:10:08.740And I just want to get your opinion from going to the special joint committee.
00:10:13.900Do you believe that they might have a change of heart and not proceed with the mental illness provision?
00:10:21.480I 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.
00:10:30.740I also think they need to stop just having another delay.
00:10:33.900You 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.
00:10:46.760But 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.
00:11:03.260it could actually drive people to desperation and and and see that death is the best answer
00:11:10.940to their life suffering and that's because messages affect our choice so when we um you know
00:11:17.900there are a lot of our suicide prevention networks and frameworks are built on the idea that we need
00:11:23.020to help people understand that there's always hope and that recovery is possible and when we start to
00:11:29.020tell people that yeah death is coming and death will be a good answer for you well we're we could
00:11:36.540be inducing people to suicide um also on that note i don't recall exactly where i heard it but
00:11:46.140i'm pretty sure it was either in the netherlands or somewhere where they also allow uh assisted
00:11:51.500suicide that more women are also tend to be the people who are getting it the most yes so
00:11:59.020There 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.
00:12:24.900And they quoted the studies, which I don't have in front of me, which showed an overwhelming number of young women accessing psychiatric euthanasia.
00:12:36.520So do you think that might be something that might happen in Canada if it were to go through, like more women getting it?
00:12:44.340for Track 2 MAID, which is outside the end-of-life context. We have more women accessing that,
00:12:52.680younger women who tend to be poorer. That's in the Health Canada reports, but also in the
00:12:58.540Track 2 MAID reports from Ontario. And Health Canada explains that away by, well, tries to
00:13:04.900explain it away by saying, you know, women have more chronic illness, and therefore that's why
00:13:09.540there are more women choosing MAID. But the people with chronic illness are not dying. The question
00:13:15.620is why do women with chronic illness want to die? And when you have these other surrounding stats,
00:13:21.380like increasing poverty, increasing isolation, not enough finances, hardships to live, right?
00:13:32.500those are really concerning. Hmm, yeah, well, okay, I guess I want to talk a little bit about
00:13:40.820the story, about that, sorry, what, sorry, what was the person's name that released the letter?
00:13:48.980Professor Trudeau Lemons. Trudeau Lemons, okay, yeah, he released the letter about the MDRC,
00:13:55.060The acronym, I think it is, for the Ontario May Death Review Committee is reducing its members.
00:14:01.440And 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.
00:14:12.440Yeah, so Trudeau Lemons, Professor Trudeau Lemons wrote a letter that he then presented
00:14:20.200to the Globe and Mail and to other newspaper outlets sharing that we were told that the
00:14:26.420committee, there's a new call for committee, so our contracts have ended, and that new
00:14:34.700call will only include non, like MAID providers mostly, and then non-clinician member, non-MAID
00:14:44.900clinician members who are supportive of the practice of MAID. And in his letter, he comments,
00:14:50.980he quotes that, you know, they said that, you know, this is legislation and so people who are
00:14:56.440against the legislation or against MAID might not understand the practice of MAID. And what's very
00:15:02.240concerning about that is that a lot of people who are the care
00:15:08.860specialists, like for palliative care, or disability care, or
00:15:13.040mental health care, have a lot of concerns about how medical
00:15:17.180assistance in dying is being practiced in Canada, because they
00:15:21.000understand the medical evidence about recovery, and the
00:15:25.100treatments that can be offered. And perhaps that's why a lot of
00:15:28.360them don't do MAID. And so excluding that pool from the coroner's table, in my mind, could
00:15:36.440potentially limit the critiques and could affect public health safety recommendations, right? And
00:15:45.080even the coroner in his own call, his new call out, his old call out in 2023, you know, talked about
00:15:51.980public safety and this more was focused on guiding and supporting MAID clinicians.
00:15:58.940We do definitely need guidance and support for MAID clinicians but we absolutely also need
00:16:04.780oversight and we need actually more than what the coroner is doing. We need enforcement
00:16:11.740repercussions if people do stray from the law because basically this is an exemption
00:16:17.900to homicide and assisted suicide that is what it is it is a criminal exemption federally and so if
00:16:24.300people are not practicing according to the legislative standards they could be basically
00:16:31.340they are ending lives without those protections that they're supposed to have to do made
00:16:37.660and and basically as the global mail said i think the globe mail did an op-ed like some weeks ago
00:16:42.860saying that we need to have repercussions for this because otherwise people are going to continue
00:16:49.920to do this. And certain maid providers have even said when they saw that their colleagues were
00:16:54.760doing something and there was no repercussions, well, they went ahead and expanded their approach
00:16:59.800to their practice. And I think that that's very dangerous. I'm not talking about all maid clinicians.
00:17:04.620I think a lot of maid clinicians do try very hard to practice as per the legislative requirements,
00:17:09.680but there are some that have been even publicly defiant of them and very proud of the fact that
00:17:14.640they practice at the edge of the law or even beyond the law i would say yeah also on that note
00:17:21.680i i guess i just want to ask like how come they are reducing the amount of people as well is it
00:17:28.000just because they don't believe they need that many they just thought it was too many if you can
00:17:33.280answer that question yeah i don't want to speak for the corner like and i i don't want to reveal
00:17:38.480more than I think it's public. But that that that part about
00:17:42.800reducing the numbers could just be to make it more practical.
00:17:47.800There were 16 of us, it's a lot of people. I wouldn't say that
00:17:51.960that's my main concern. My main concern is that having voices
00:17:57.720that are critical. Yes, maybe make it harder for consensus,
00:18:03.840but are necessary if this is actually about oversight, right? You don't want to have,
00:18:10.440for example, and this sounds, it's just for comparison, not because it's the same issue,
00:18:15.620but if you had like a tobacco safety panel, and then you populated it only with people who were
00:18:24.540potentially stakeholders in tobacco, like tobacco farmers, tobacco lobbyists,
00:18:30.380um I would think that that would dilute the input that was given about the safeties needed to
00:18:38.060protect from tobacco um just explain my thought process there okay yeah well um yeah well thank
00:18:48.320you very much for coming on Ramona I really appreciate your time um yeah so thank you