(Ottawa) Leading experts involved in expanding Canada’s dying medical regimen to include people whose sole underlying illness is a mental disorder disagree on whether this reform should be postponed.
One expert says a delay would ease the 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 should start enrolling such patients starting March next year following a two-year phase-out provision incorporated into a 2021 update to the Medical Assistance in Dying (MAD) Act.
Despite a panel of experts finding the right safeguards are in place, the federal government announced last week that it intends to legislate to further delay reform. He didn’t say how long.
“Not everyone is ready,” Justice Secretary 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 to develop practice guidelines for cases of patients whose only underlying condition is a mental disorder.
She said she was pleased with the decision to delay expanding the law and that the delay will allow her and others to “properly implement” the guidelines.
“We only really started preparing recently,” she said, adding that the government only convened its expert group to develop the guidelines in the fall. “They set it up very quickly. This committee was convened just a few months ago to draw up a first draft. »
She said a draft directive was still undergoing peer review as of last week.
“We had everything to do 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 authorities for incorporation into regulations and then adopted into professional practice through medical schools.
“All of this had to be done before March, which would never have happened, estimates Mme Li. Now we have time for that. »
The psychiatrist said training modules to expand the law are still being developed.
She said a curriculum she’s helping to develop will teach doctors to consider the psychological factors that drive the desire to die and teach them how to assess at-risk patients in the face of medically-assisted death — and how to manage theirs Focus reflection on equity and diversity.
“We’ll probably get it ready for a soft start in the spring,” she said. It won’t be ready for an official launch until later this year or early next year at the earliest. »
Mme Li said once the program is ready, it must be shared with medical professionals across the country “so that there is some consistency and practice across the country.”
“It wouldn’t have been ready by March,” said Ms.me Li
Jocelyn Downie, a law professor and medical ethics expert at Dalhousie University, doesn’t think delaying is the right decision.
In her opinion, we shouldn’t wait until all clinicians in Canada are ready to provide medical care for the dying of people whose only existing condition is a mental health disorder to start reform.
“Clinicians who feel they are not ready to leave have a professional obligation not to participate in MAID,” says Downie.
When the MAID laws went into effect in 2016, she pointed out that not all clinicians were prepared. Protocols were still being developed. Medicines were still procured.
“Clinicians didn’t provide medical assistance when they died because they didn’t have everything they needed to do it,” she said. They didn’t need a term in the law to prevent that. Clinicians who were not trained did not provide medical assistance when 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 may have been ready for an expansion of the law in the spring, that technical briefings on standards of practice are already underway, and continuing education seminars with clinicians are already on the agenda.
“What happens is that people prepare, they also have hope, then we postpone the schedule because suddenly we are not ready on other parameters,” she argues.
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