(Ottawa) Leading experts involved in crafting the expansion of Canada’s medical assistance in dying regime to people whose only underlying condition is a mental disorder disagree on whether 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 the end of this year or early next year at the earliest. But another expert believes there is no need to wait any longer.
The system was due to include such patients from next March after a two-year sunset provision built into an update to the 2021 Medical Assistance in Dying (MAD) Act.
Although an expert panel has determined that the proper safeguards are in place, the federal government announced last week that it intends to legislate to further delay reform. He did not say for 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 MAID-related committees, says the Liberal government is still working on developing practice guidelines for cases of patients whose only condition underlying is a mental disorder.
She said she was pleased with the decision to delay the law’s expansion, and that the delay will allow her and others to “properly implement” the guidelines.
“We only really started to prepare recently,” she said, adding that the government did not convene its expert group to develop the guidelines until the fall. “They set it up very quickly. Just a few months ago, this panel was convened to have a first draft. »
She said as of last week a draft guideline was still undergoing peer review.
“We had to get it all done by March, so the process was rushed, but we haven’t done the rigorous review of the evidence yet,” she added.
Once finalized, the guidelines will be sent to provincial and territorial bodies for inclusion in regulations, and then incorporated into professional practice through medical schools.
“All this had to be done before March, which would never have happened, estimated Mme Li. Now we have time to do it. »
The psychiatrist said training modules for expanding the law are still being developed.
She said a curriculum she is helping to develop will teach clinicians to consider the psychological factors that drive the desire to die and teach them how to assess vulnerable patients considering medically assisted death — and how to center their reflection on equity and diversity.
“We’ll probably finalize it in the spring for a soft launch,” she said. It won’t be ready for an official launch until the end of the year or early next year at the earliest. »
Mme Li said once the program is ready, it needs to be shared across the country with medical professionals “so that there is some consistency and practice across the country.”
“It wouldn’t have been done by March,” said Ms.me Li.
Jocelyn Downie, a law professor and medical ethics expert at Dalhousie University, doesn’t think a delay is the right decision.
According to her, we should not wait for all clinicians in Canada to say they are ready to provide medical assistance in dying to people whose only existing condition is a mental health disorder, to launch the reform.
“Clinicians who don’t think they’re ready to go have a professional obligation not to participate in MAID,” says Downie.
When the MAID laws came into effect in 2016, she pointed out that not all clinicians were prepared. Protocols were still being developed. Medication was still acquired.
“Clinicians didn’t provide medical assistance in dying because they didn’t have everything they needed to provide it,” she said. You didn’t need a time limit in the law to prevent that from happening. Clinicians who were not trained did not provide medical assistance in dying. »
Mme Downie says she wants a strong system that doesn’t impose rules on people with mental disorders that no one else has to follow.
She said medical schools could have been ready for an expansion of the law in the spring, that technical briefings on standards of practice were already underway, and that educational seminars with clinicians were already on the agenda. March.
“What happens is that people are preparing, they also have hope, then we move the schedule because, suddenly, we are not ready on other parameters,” said she argues.