A national charity that educates health-care professionals about medical assistance in dying (MAID) has refused to provide its curriculum to a parliamentary committee studying whether Canada is ready to allow MAID for mental illness.
Canada is set to allow MAID for people whose sole condition is a mental illness in March 2027. The committee has until Oct. 2 to complete its report with recommendations to the government.
Prime Minister Mark Carney has said the committee’s report will inform whether the government allows MAID for mental illness in March.
On April 14, members of the parliamentary committee agreed to ask the Canadian Association of MAID Assessors and Providers (CAMAP) for its curriculum module about MAID and mental disorders. This curriculum is meant to teach health-care providers about how to conduct MAID assessments for people who have mental disorders as well as physical illnesses or disabilities.
CAMAP has not given the committee this curriculum — and says it has no plans to do so.
The module about MAID and mental disorders is a live online class, making it impossible to provide the committee with a copy of the curriculum, the association told Canadian Affairs in an email.
CAMAP does not intend to make its curriculum public, the association also said.
“CAMAP recognizes that there is significant public interest and ongoing discussion regarding MAID and mental disorders,” CAMAP’s email says.
“However, the purpose of the curriculum is not public advocacy or public education; rather, it exists to support health-care professionals in understanding and applying the existing legislative and clinical framework within their practice.”
The committee, which cannot compel the production of documents, will have to write its report without knowing exactly how health-care professionals are trained to assess the impact of mental disorders on MAID requests.
Denied requests
CAMAP is a national charity that educates health-care professionals about how to assess and provide MAID.
Since 2023, the association has provided a national course to teach Canadian health-care workers about MAID. It is the only such curriculum in Canada, and is accredited by the Canadian Nurses Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada.
Health Canada funded the creation of this curriculum and provides funding for health-care professionals to take it.
Medical professionals who want to assess patients for MAID or administer MAID are not required to take any specific training in MAID. But it is expected they will only provide services they have the skills to provide. More than 2,900 professionals have taken the CAMAP curriculum.
Some academics who helped create CAMAP’s curriculum have sharply criticized it, Canadian Affairs recently reported.
Three resigned from a working group that developed a curriculum module to assess how vulnerability can impact MAID requests. In interviews with Canadian Affairs, they raised concerns that the curriculum ignored how homelessness and loneliness could impact a person’s MAID request. They also expressed concern that the MAID curriculum discouraged health-care providers from challenging patients’ negative views about their disability.
The curriculum “presumes that disabled people’s lives are not just harder, but plausibly unlivable,” Catherine Frazee, an academic who resigned from the working group, wrote in an article published in an academic journal in April.
Instead of providing the parliamentary committee with the curriculum module about mental disorders, CAMAP sent the committee an outline of all the topics covered in each of the curriculum’s eight lessons.
In an email, CAMAP said it wanted to help the committee understand the context of the module on MAID and mental disorders.
“The context of how the education is delivered is crucial,” CAMAP wrote in its email.
“Non-medical persons may not comprehend what is being discussed and why, nor appreciate the clinical significance and implementation without extensive previous clinical education and experience.”
Committees cannot force individuals and organizations to produce requested materials, or discipline those who do not provide them.
CAMAP offered the parliamentary committee members the opportunity to take a facilitated curriculum session “so they could experience the curriculum in the context in which it is designed to be delivered,” CAMAP told Canadian Affairs.
“That invitation was not taken up.”
Autism, substance abuse included
Canadian Affairs obtained a copy of the curriculum outline CAMAP sent the committee, which CAMAP confirmed to be the proper document.
In its email to Canadian Affairs, CAMAP said that health-care professionals who complete the module about MAID and mental disorders will have “years of medical [or] nursing training.” But the document itself says medical and nursing students can take the course.
The document includes bullet point lists of topics covered in each of the curriculum’s modules.
There is no explanation given for what is included under each of these headings. For example, it does not list what the learning objectives for each module are, just that each module has learning objectives. It does not list what medications and supplies should be brought to a patient’s MAID administration, only that medication and supplies need to be brought.
The curriculum contains several case studies for discussion. These case studies are not stories of specific individuals, CAMAP said in an email. Instead, they reflect common themes or situations that MAID assessors and providers encounter.
The outline for the module on MAID and mental disorders says that the curriculum teaches health-care professionals how to do assessments for people who have major depressive disorder, personality disorders and psychosis.
It also includes teaching about assessments for people with autism and substance use disorders.
Some case studies are of individuals who have mental disorders as well as diseases like Parkinson’s or cancer. Another is one of a homeless individual who had alcohol use disorder and early cognitive decline.
“Understanding the interplay between physical disorders and mental disorders is important, and something that we do regularly — the module supports a better understanding of these relationships,” CAMAP said in an email.
Ongoing controversy
New data from the Angus Reid Institute suggests many Canadians do not know Canada is planning to allow MAID for the sole purpose of mental illness in March.
According to the polling firm, 56 per cent of Canadians said they did not know Canada was planning to allow MAID for mental illness next year.
Overall, 43 per cent of Canadians support allowing MAID for people whose sole condition is a mental illness and 39 per cent oppose it, the research found.
The data also show 74 per cent of Canadians think governments should be required to demonstrate a person has adequate housing, disability supports and income supports before they are offered MAID.
Late last month, 90 disability and mental health organizations sent an open letter to the prime minister, health minister and justice minister urging them to never allow MAID for mental illness.
Even if the Committee lacks the legal power to subpoena these materials (which surprises me), CAMAP’s position seems contemptuous of Parliament. Why shouldn’t the MPs doing this important work see taxpayer-funded materials that seem highly relevant to their task?
Keep documents like this secret, and you invite everyone to imagine the worst about what they contain.
I understand that MAID represents a huge shift in historical belief structures especially organized religious structures. It simply does not fit in to their mythology. I understand that this causes deep anxiety in some people who, rightfully, worry that it may be misused. Never the less, I am alarmed and concerned about the politicalization of this deeply personal life choice. To my knowledge there has never been this kind of scrutiny and potential interference over any other medical intervention. New treatment modalities are implemented in all aspects of health care all the time, trusting that our revered institutions such as the Canadian Nurses Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada have fully reviewed and revised them in order to protect the individuals affected. Why is this one so different? Because of our religious organizations? I believe that there was a separation of church and state in Canada. Does our government suddenly believe that they can better educate and train physicians than our health care organizations? To my knowledge they have never required the curriculum for medical or nursing training to be provided for scrutiny by the government before. Why do the politicians believe that they are somehow more capable than our esteemed medical organizations of assessing what each Canadian individual should choose for their personal situation than the person themselves? Who is more capable of deciding whether their life circumstances are livable or not than the individual living those circumstances every minute of every day? CAMAP rightfully points out that “Non-medical persons may not comprehend what is being discussed and why, nor appreciate the clinical significance and implementation without extensive previous clinical education and experience”. We all have our own personal beliefs and biases. I am concerned that these beliefs and biases are taking over the implementation of a comprehensive MAID option for individuals.