December 12, 2018

Medical Assistance in Dying

The Expert Panel on Medical Assistance in Dying

Summary

In December 2016, the CCA was asked by then Minister of Health Jane Philpott and Minister of Justice and Attorney General of Canada Jody Wilson-Raybould to undertake independent reviews related to medical assistance in dying (MAID). Specifically, the CCA was tasked with examining three particularly complex types of requests for MAID that were identified for further review and study in the legislation passed by Parliament in 2016: requests by mature minors, advance requests, and requests where a mental disorder is the sole underlying medical condition.

On December 12, 2018 the CCA released the three final reports of the Expert Panel, one on each type of request: The State of Knowledge on Medical Assistance in Dying for Mature Minors; The State of Knowledge on Advance Requests for Medical Assistance in Dying; and The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder is the Sole Underlying Medical Condition.

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The Question

What is the available evidence on, and how does it inform our understanding of, medical assistance in dying (MAID) in the case of mature minors, advance requests, and where mental illness[*] is the sole underlying medical condition, given the clinical, legal, cultural, ethical, and historical context in Canada?

*MAID legislation and the charge use the term mental illness. However, the Working Group chose to use the term mental disorder to be consistent with current clinical and legal practice.

Overview

The Expert Panel undertook an evidence-based assessment of the state of knowledge surrounding three topics areas: MAID for mature minors, advance requests for MAID, and MAID where a mental disorder is the sole underlying medical condition.

The three final reports gather and interpret, with the sensitivity required of the subject, the available evidence, and they explore the societal, clinical, legal, and practical implications and issues associated with both permitting and prohibiting MAID in the three topic areas. They reflect a broad range of knowledge, experience, and perspective from relevant healthcare professions, diverse academic disciplines, advocacy groups, and from jurisdictions where MAID is permitted. The reports also reflect a particular moment in Canada’s history, in the breadth and availability of evidence, and in the evolution of thinking and practice related to MAID. They do not make policy recommendations and are intended to provide evidence to inform decision-making processes as well as to inform the ongoing national dialogue on MAID in Canada.

The Expert Panel

The CCA brought together a multidisciplinary Expert Panel of 43 individuals with expertise, knowledge and leadership experience in a range of disciplines including law, medicine, nursing, bioethics, social sciences, and health sciences, among others.

The Panel was chaired by the Honourable Marie Deschamps, C.C., Ad. E., Former Justice of the Supreme Court of Canada and Adjunct Professor at McGill University and Université de Sherbrooke. In order to effectively address the three types of requests, the Expert Panel was divided into three Working Groups, each with a Chair:

  • Working Group Chair for Mature Minors: Dr. Dawn Davies, Associate Professor, Department of Pediatrics, University of Ottawa; Palliative Care Physician, Roger Neilson House/CHEO
  • Working Group Chair for Advance Requests: Dr. Jennifer Gibson, Sun Life Financial Chair in Bioethics and Director, University of Toronto Joint Centre for Bioethics
  • Working Group Chair on Mental Disorders as the Sole Underlying Medical Condition: Dr. Kwame McKenzie, CEO Wellesley Institute; Professor of Psychiatry, University of Toronto; Medical Director of Health Equity, Centre for Addiction and Mental Health

Expert Panel

The Expert Panel on Medical Assistance in Dying