Proposal 2 is to ensure any CPA positions on MAiD include “common sense” principles that meet the expected standard of professional associations providing policy advice, especially as it relates to patients and potential risks and vulnerabilities. None of the issues identified by this Proposal are included in the 2020 Position Statement that continues to guide CPA policy.
Proposal 2
That, given that MAiD is based on the premise of having an irremediable medical condition, that any CPA policy on MAiD explicitly include guidance on:
(i) the need for evidence and standards regarding whether or not mental illnesses can reliably and prospectively be determined to be irremediable medical conditions, prior to any potential consideration of MAiD being provided for sole psychiatric conditions;
(ii) the need for appropriate treatments having been tried, and supports and services being in place, to ensure that MAiD is not requested as a means to escape social exclusion, nor as a response to psychosocial stressors or a dearth of appropriate clinical and community supports.
Background Statement
MAiD in Canada is based on the premise of having an irremediable medical condition. The CPA Position Statement on MAiD opines that “patients with a psychiatric illness….should have available the same options regarding MAiD as available to all patients”, yet it provides no guidance, standards or consideration of what irremediability means in the context of mental illness, including whether or not irremediability can even be prospectively identified in mental illnesses. The Statement has been criticized as being ambiguous and even dangerous in the current politicized debate, including in CPA’s own peer-reviewed scientific journal (https://bit.ly/3iskf9v ; https://bit.ly/3wd9R9w ). Members have decried the lack of evidence guiding MAiD policy formation through recent hearings on Bill C-7 (https://bit.ly/3iQQTBR ).
Despite knowing that MAiD is meant for irremediable conditions the CPA acknowledged in a June 11, 2020 email blast to members that the Statement was “never intended to….examine whether psychiatric conditions are irremediable and if so, how this should be assessed.” In other words, with its current Statement, the CPA has taken the position that patients with psychiatric illness “should have available the same options regarding MAiD” as patients with other medical illnesses, without any consideration of whether psychiatric conditions can be assessed as irremediable, and if so how.
Furthermore, while in response to criticism the CPA claimed in its June 11 email blast that the “statement supports…availability of, and access to, appropriate treatments, supports and services to ensure that MAiD is not requested as a means to escape social exclusion or a dearth of appropriate clinical and community support”, and that “in situations where mental illness is the sole underlying condition, access to MAiD should not be permitted until appropriate safeguards are in place”, none of this is included in the actual Position Statement.
For these reasons, Proposal 2 is being forwarded for member consideration with the aim of ensuring that any CPA public position explicitly highlights the importance of evidence based guidance on irremediability, and includes necessary and basic safeguards.
Note: There may be minor changes to text in the actual proposal at the 2021 CPA AGM