Canada is not ready to expand medical assistance in dying for people with a mental disorder, leaving psychiatrists across the country “incredibly concerned” about patients needing better access to care, including for addiction services, says a group representing the specialists across the country.
The Association of Chairs of Psychiatry in Canada, which includes heads of psychiatry departments at all 17 medical schools, issued a statement Thursday calling for a delay to the change set to be implemented in mid-March.
Lack of public education on suicide prevention as well as an agreed-upon definition of irremediability, or at what point someone will not be able to recover, are also important, unresolved issues, the statement says.
“As a collective organization, we recognize that a lot of work is being done in Canada on this issue,” Dr. Valerie Taylor, who heads the group, said in the statement.
“Further time is required to increase awareness of this change and establish guidelines and standards to which clinicians, patients and the public can turn for more education and information,” said Taylor, who is also chair of the psychiatry department at the University of Calgary.
A statement from the office of federal Health Minister Jean-Yves Duclos says Canada is committed to implementing MAID for those with a mental disorder by keeping their safety and security at the forefront.
“We will continue to listen to the experts, including those at the front lines and those with lived experience, and collaborate with our provincial and territorial counterparts to ensure that a strong framework is in place to guide MAID assessors and providers before MAID becomes available to those for whom mental disorders are the sole underlying condition.”
The office did not say whether the implementation expected on March 17 would be delayed.
Dr. Jitender Sareen, head of the psychiatry department at the University of Manitoba, said many controversial issues were discussed at the group’s annual meeting in October regarding which patients with a mental disorder could be eligible for MAID, seven years after the practice was legalized in Canada for those with a physical ailment.
“If a person wants MAID solely for mental health conditions, we don’t have the clear standards around definitions of who’s eligible. How many assessments and what kinds of assessment would they actually need?” he said.
Sareen also called for training for health providers doing the assessments to begin sooner than its expected rollout next fall. Psychiatrists want clarity on what could be a request for suicide compared with MAID, leaving them to determine a path toward treatment or providing euthanasia, he added.
“There is still controversy around that between providers. Some people believe suicide is impulsive and self-destructive. But that’s not necessarily the case. People can have thoughts about suicide without a mental health condition, an active condition like depression or schizophrenia.”
Patients in rural communities may lack access to mental health care, and those struggling with addiction who have little to no access to harm-reduction services like supervised injection sites could also be left suffering until they try to seek MAID as a way out, said Sareen, who specializes in addiction services.
“We’re in the middle of an opioid epidemic. And we’re in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are the highest ever,” he said.
“As a group of department heads in the country who are responsible for medical education both for psychiatrists and residents, we’re saying, ‘Look, let’s put things aside as far as whether we agree with this law change or not.’ We’re just concerned we’re not ready for March.”
The federal parliamentary committee reviewing the law to expand MAID to those with a mental disorder issued an interim report in June and is expected to publish a final report in October. However, it has been delayed until February.
The final report of an expert panel was released in May with 19 recommendations, including training for doctors and nurse practitioners assessing MAID requests to address topics like the impact of race, socioeconomic status and cultural sensitivity.
The report also said the expansion of MAID raises additional challenges involving those who are elderly, have neurodevelopmental or intellectual disabilities and people who are in prison, where the prevalence of mental disorders is high compared with the general population.
The panel relied on evidence from Belgium and the Netherlands, which it said have the most extensive set of safeguards, protocols and guidance overall.
Dr. Derryck Smith, a psychiatrist in Vancouver and a past board member of Dying With Dignity, said that while there is no doubt that MAID is a divisive topic among his peers across Canada, he believes there’s a need to wait for the special parliamentary committee’s final report “before we try to slow the process down.”
Smith said lack of access to care for mental health is no different than that for physical ailments so any delay in implementing the new law is a basis for discrimination.
“The healthcare system is crumbling around us but that’s a different matter altogether,” he said. “What concerns me as well is what is so special about psychiatric illness. Why are we putting stigma around psychiatric illness?”
The Canadian Mental Health Association said it is focused on ensuring Canadians have access to universal mental health care with supports that are fully integrated into the public system and available for free.
“This includes recognizing the social determinants that are prerequisites for good mental health by providing housing and income and food supports that help keeps people well, safe and out of poverty, and which create conditions that may mitigate requests for MAID,” it said in a statement.
This report by The Canadian Press was first published Dec. 1, 2022.
This story was produced with financial assistance from the Canadian Medical Association.
Racism: Examining Injustices of Canadian Society
As the Canadian government works to create a more inclusive and just society, racism remains an issue that needs to be addressed. Racial discrimination, both conscious and unconscious, continues to be a problem throughout the country, resulting in the exclusion and marginalization of certain groups. Let’s look at why racism is still prevalent in Canada and what can be done to combat it.
The Root Causes of Racism in Canada
Racism is a systemic and deeply rooted problem in Canada that has been perpetuated through laws, policies, and practices for centuries. Every day, Canadians are confronted with the effects of racism in their lives, whether it’s seen in the workplace, at school, or even within our own homes. In order to understand how racism has become so pervasive in our society and what we can do to combat it, we must first examine its root causes.
Racism is embedded into Canadian society largely due to the historical legacy of colonialism. Through colonization, Europeans sought power and control over other nations while systematically stripping them of their culture and identity.
This resulted in a system of dominance and privilege that was heavily skewed toward white people while creating oppressive conditions for Indigenous peoples and people of colour.
As a result, many societal systems have been built on this foundation of inequality—from education to employment to housing—which has only served to further entrench racism into our society.
Discrimination is another major factor that contributes to racism in Canada. Systemic discrimination occurs when certain groups are disproportionately denied access to resources or opportunities because of their identity or perceived differences.
For example, people who are racialized often face systemic discrimination when it comes to employment; according to Statistics Canada, unemployment rates for racialized individuals were more than double those for non-racialized individuals as recently as 2018.
Similarly, Indigenous women experience higher levels of poverty than any other group in Canada due to systemic discrimination that prevents them from accessing education and employment opportunities.
Finally, institutional prejudice plays a significant role in perpetuating racism in Canada. Institutional prejudice refers to the biases that exist within institutions such as schools or workplaces which favour certain groups over others based on race or ethnicity.
These biases may be subtle or overt, but they have powerful consequences; research shows that students who identified as visible minorities are more likely to get suspended from their school than their white peers due to implicit biases held by teachers and administrators against these students’ racial backgrounds.
Similarly, workers who are racialized may be passed over for promotions despite being better qualified than their white counterparts due to underlying prejudices against them.
How Racism Impacts People
Racism can have significant impacts on individuals’ mental health, education outcomes, employment opportunities, access to resources such as healthcare services, and overall quality of life.
For example, studies have found that racial bias affects hiring decisions even when employers are unaware of their own biases. Additionally, people from minority backgrounds often experience discrimination when trying to access housing or healthcare services due to implicit biases held by service providers or institutions.
These experiences of exclusion can lead to feelings of frustration and helplessness among those impacted by racism.
What Can Be Done?
In order for us as a society to address the impacts of racism on individuals and communities across Canada, there must be an acknowledgement that racism exists and an openness towards taking actionable steps towards addressing it.
To do so effectively requires collaboration between different levels of government as well as with organizations advocating for social justice initiatives such as anti-racism campaigns.
Efforts should also include educational initiatives aimed at increasing awareness about systemic forms of racism as well as providing tools for individuals looking to challenge discriminatory behaviour within their own circles or workplaces.
Racism is still pervasive in Canada despite the efforts taken by many individuals and organizations towards creating a more equitable society free from discrimination based on race or ethnicity.
In order to address this issue effectively, we need widespread collaboration between different levels of government along with education initiatives aimed at increasing awareness around systemic forms of racism while also providing individuals with tools necessary for challenging discrimination where they see it occurring.
With everyone working together, we can create a brighter future free from bigotry and prejudice for all Canadians, regardless of their background or identity.
Is Canada in a recession? StatCan’s early estimates are saying not yet
Early indicators from Statistics Canada on show the country’s economy is slowing but might not be in recession territory yet.
The agency released new gross domestic product (GDP) data on Tuesday, showing the economy grew at a rate of 0.1 per cent in November.
Early indications show that the country’s GDP was essentially unchanged for December.
Overall, StatCan said advance information suggests a 1.6 per cent annualized increase in GDP for the fourth quarter of the year and annual growth of 3.8 per cent in 2022.
Economic growth is expected to slow in response to higher interest rates, with many economists anticipating a mild recession this year. A recession is traditionally defined as two consecutive quarters of negative GDP growth.
“Overall, today’s data show that the Canadian economy continues to cool, but not as yet shift into reverse, in the face of rising interest rates,” said CIBC Senior Economist Andrew Grantham in a note to clients Tuesday.
The Bank of Canada has raised its key interest rate eight consecutive times since March, bringing it to 4.5 per cent, the highest it’s been since 2007.
After hiking interest rates last week, the central bank signalled it would take a pause to assess how higher interest rates are affecting inflation and the economy.
In November, growth in real domestic product was driven by the public sector, transportation and warehousing and finance and insurance.
Meanwhile, construction, retail and accommodation and food services contracted.
— with files from the Canadian Press
St-Onge urges provinces to accelerate efforts to make sports safer for athletes
Sports Minister Pascale St-Onge says ending abuse in sports will require complaints processes that include provincial-level athletes, not just national ones.
St-Onge and provincial sports ministers will meet during the Canada Games in mid-February where their agenda will include the ongoing effort to address widespread allegations of physical, sexual and emotional abuse in sports.
She says she asked the provincial ministers at an August meeting to look at joining the new federal sport integrity process or creating their own.
The national sports integrity commissioner can only investigate allegations of abuse from athletes at the national level.
But St-Onge says the vast majority of athletes aren’t in that category and only Quebec has its own sports integrity office capable of receiving and investigating complaints.
The national sport integrity office officially began its work last June and has since received 48 complaints from athletes.
This report by The Canadian Press was first published Jan. 31, 2023.
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