Proposal 1 focusses on allowing proper member engagement and development of an evidence-based Position Statement. CPA leadership has been unwilling to revise the 2020 Position Statement, which many have felt has damaged the credibility of the association, and been unhelpful if not harmful in evolving policy discussions.

Proposal 1

That, given the lack of membership engagement and broader consultation in development of the 2020 CPA Position Statement on Medical Assistance in Dying (MAiD), that the 2020 CPA Position Statement on MAiD be rescinded.

Background Statement

Issues related to Medical Assistance in Dying (MAiD) and mental illness are complex.  The 2020 CPA Position Statement on MAiD, released in March 2020, was developed by the Professional Standards and Practice (PSP) Committee without any engagement or awareness of membership, without expert external consultation, and without internal consultation of groups like the CPA Research Committee.  The CPA sought no input from membership in well over a year prior to the Position Statement being released, including seeking no input since the September 2019 Truchon ruling that signalled that MAiD would be expanding beyond end-of-life conditions.  The CPA conducted a member survey in October 2020, but a Position Statement cannot be informed by a consultation process that occurs after its release.  This survey was the first membership engagement on MAiD in over two years, and even in this survey* the CPA did not ask whether members agreed with the CPA Position Statement.  The CPA refused to allow discussion of the CPA Position Statement on the 2020 AGM agenda, despite requests from several members.

The processes surrounding the Position Statement failed to respect the role of members on a complex issue which members have expressed significant desire to have input in.

In addition to the flawed development process, the Position Statement itself has been identified as being problematic and potentially harmful during a time when national MAiD policy is being formed, as noted in peer reviewed pieces published in CPA’s own scientific journal (https://bit.ly/3iskf9v ; https://bit.ly/3wd9R9w ).  The Statement offers no evidence-based guidance on issues related to mental illness and makes no reference to any mental health or mental illness literature or evidence.  While the CPA still officially claims to members that “the CPA has not taken a position on whether MAiD should be available in situations where mental illness is the sole underlying medical condition”, policy makers, public and the media have taken the CPA Position as being one unequivocally supporting MAiD for mental illness (https://bit.ly/3zAf90R ).

For these reasons, Proposal 1 is being forwarded for member consideration with the aim of having the current Position Statement rescinded to allow for proper member engagement and consultation in informing a Position Statement.This Proposal is being forwarded in the spirit of good governance, and of ensuring our patients receive appropriate standards of evidence-based care as MAiD expands beyond end-of-life conditions, with common sense safeguards at a minimum.

There may be minor changes to the above text in the actual proposal at the 2021 CPA AGM

* Notes regarding the 2020 CPA MAiD survey:

  • Senior psychiatrists have criticized the 2020 CPA survey, done 6 months after release of the CPA Position, as being biased and an example of Noam Chomsky’s ‘manufactured consent’.

  • When providing input as legislation was being deliberated, and when no survey results had been shared with members or the public, CPA Chair Forsythe wrote to Senator Jaffer (Chair of the Senate Committee reviewing MAiD) on February 5, 2021 to provide selective results to a single question from the CPA survey done in October 2020, to suggest that “there appears to have been a shift in psychiatrists’ perspectives on access to MAiD solely for mental illness” while legislation to allow MAiD for sole mental illness was being debated. CPA leadership did not share results of the October 2020 survey with members or the public until March 18, the day after Bill C7 had already passed and received Royal Assent with the arbitrary “sunset clause” predetermining MAiD for sole mental illness be provided by March 2023.

  • CPA has continued to refuse member requests for data transparency, and has refused to provide members disaggregated Likert scale responses to their own member survey to allow transparent comparison of strength of member views (instead CPA has only provided aggregated ‘agree/strongly agree’ vs ‘disagree/strongly disagree’ responses, which can potentially allow misinterpretation of a false equivalence between strength of views by for example falsely equating 100 mildly supportive responses with 100 strongly opposed ones).