Quite the opposite. CPA leadership’s “updated” Position Statement, released less than two weeks before the AGM, 20 months after the original Statement, 1 year after C7 Senate consultations began, and 8 months after C7 passed, remains deeply flawed, does not address any of the concerns raised by members regarding lack of evidence-based recommendations, and in some ways is worse than the initial 2020 Position Statement.

If anything the updated Statement emphasizes the need for these Member Proposals even more, as CPA leadership has made it clear they will not change their Position to include evidence-based guidance even after a year and a half of member concerns being raised.

No.

First, it is disingenuous to say you “do not take a position” while repeatedly claiming it is discrimination not to provide MAiD for mental illness, all while failing to issue a single evidence-based caution about known suicide risks to vulnerable and marginalized populations suffering from mental illness.

Second, as the articles below suggest, claiming to be “neutral” on this issue while failing to offer evidence-based guidance is not really being neutral, but oftentimes can serve as a “dogwhistle” indicating tacit support for expansion. CPA leadership knows full well that public and policy makers have taken the CPA Position as supporting MAiD for mental illness.

[click on links below to review articles]

“First, Take No Stand: On assisted suicide, the medical profession ducks behind “neutrality.””

“Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate”

Zero. CPA leadership did not engage members or experts for nearly two years prior to it’s sudden release, with no membership input, of the March 2020 Position Statement.

Despite concerns of membership communicated, individually and collectively, to the CPA Board, CEO and Chair repeatedly since release of the Position Statement, CPA leadership actively refused to entertain revision of the Statement. CPA Chair Forsythe responded to member concerns about lack of engagement by stating “the CPA does not intend to rescind a position statement on a matter that was always recognized as being controversial and unlikely to gain universal acceptance”, and to date CPA leadership has refused to even ask members whether they agree with the Position. If you are a CPA member, you know how much input you did (or did not) have into CPA leadership’s advocacy regarding MAiD for mental illness.

CPA leadership has continued to publicly claim that it has “engaged members on this issue since 2016, through surveys, a time-limited task force and symposia”. It is concerning CPA leadership continues to make such claims. In reality, after the previous time-limited task force was sunset in 2018 following delivery of its guidance document to the CPA board, there was zero membership engagement on this issue by CPA leadership for nearly two years. This was despite the fact that the September 2019 Truchon ruling flagged that the “reasonably foreseeable natural death” safeguard was soon going to be removed, with obvious implications for potential MAiD for sole mental illness requests.

Contrary to CPA leadership’s claims, there have been ongoing and increasing concerns voiced about lack of process and lack of evidence-based policy recommendations that CPA leadership has been contributing. Over 100 psychiatrists wrote to CPA leadership in 2020 requesting revisiting the CPA Position Statement to allow for a proper engagement process, including development of evidence-based recommendations to inform a Position Statement - these requests were rejected.

Throughout the consultation process on Bill C7, CPA leadership has somehow continued to claim to members that CPA has not taken a position on MAiD for sole mental illness, yet CPA leadership repeatedly presented in Senate consultations and testimony that the exclusion of MAiD for sole mental illness was “discriminatory”, “unconstitutional”, “inaccurate”, “stigmatizing”, “vague”, “arbitrary” and “overbroad”.

Despite concerns raised by members about the continued lack of evidence regarding ability to predict irremediability in mental illnesses wrt MAiD assessments, and the risk of discrimination due to premature death this posed especially to marginalized, racialized, or otherwise disadvantaged populations suffering from life distress, CPA leadership openly admitted issues of predicting mental illness irremediability were not considered in adopting its Position, yet maintained it would continue to hold its Position.

Despite extensive known evidence regarding mental illness related suicide risks, and concerns about potential risks to vulnerable populations being raised repeatedly by members, CPA leadership failed to even once raise concern about mental illness related suicide risk, or discuss suicide prevention, throughout these public consultations on mental illness and death (never once saying or writing the words “suicide”, “suicidal”, “suicidality”, “suicide risk”, “suicide prevention”, etc, nor presenting any evidence regarding risks of suicide in those with mental illness).

This would be like a respirologist association failing to once mention smoking as a risk factor during public consultations on lung disease.

By failing to provide key evidence-based input throughout the 2020-2021 MAiD consultation process, CPA neglected its duty as a professional association representing medical professionals to contribute known scientific evidence regarding potential risks to patients.

CPA leadership explicitly acknowledged abdicating its role of providing expert clinical evidence. When asked during Senate consultations “Do you [the CPA] agree with the other experts, including the Council of Canadian Academies, who say the knowledge is not certain about mental disorders, and we need more research about it? Does that call for precautions? Unless we have more information, should we prevent people suffering from mental disorders as the sole condition to access the second track to MAID as a matter of precaution?”, the 2020 CPA President Grainne Neilson responded “I guess that is a legislative decision”.

Despite formal requests being submitted by several members well before Notice of last year’s 2020 AGM and Agenda had even been sent to members, CPA leadership actively refused allowing submitted Member Proposals on MAiD appearing or being discussed on the 2020 AGM Agenda, and instead relied on obscure federal regulations to justify denying the submitted Proposals.

To comply with federal regulations, this year CPA leadership was unable to legally block similar Member Proposals (Proposals 1 and 2) on MAiD submitted months ago, through June and July, for the 2021 November AGM. Proposal A above regarding censure was not submitted until August, the last day before CPA leadership would have again been able to deny hearing any submitted Proposal. At that time in August, despite prior requests from members to confirm that their previously submitted Proposals (from 6+ weeks earlier) on MAiD would be heard, CPA leadership still had not confirmed or responded to members that it would allow those MAiD Proposals on the 2021 AGM.

Beyond process concerns, the actions of CPA leadership have impacted emerging national policy while failing to raise evidence-based concerns of risk of premature death related to vulnerable patients. As the national professional psychiatric association, input from the CPA can be influential in shaping policy, and CPA leadership has an obligation to ensure input is responsible and evidence-based.

CPA leadership’s failure to even once raise evidence-based concerns about mental illness related suicide risk, while arguing that the exclusion of MAiD for mental illness was “discriminatory”, “stigmatizing” and “unconstitutional”, naturally led to policy makers’ and public perceptions that CPA supported committing to and agreed with providing MAiD for sole mental illness (https://bit.ly/3zAf90R).

Bill C7, which initially excluded MAiD for sole mental illness when first drafted in February 2020, was subsequently amended in February 2021 and passed in March 2021, with the “sunset clause” committing to provide MAiD for sole mental illness by March 2023. No medication or treatment would normally ever be introduced in this way, by committing to implementation prior to having essential evidence supporting implementation.

To illustrate potential positive impact on emerging policies, contrast the 2016 process with the 2020 one.

In 2016 as initial MAiD laws were being developed, while both Drs. Gaind and McGregor (the past CPA presidents who jointly raised concerns about CPA’s 2020 Position in their Open Letter) were still on the CPA Board (Dr. Gaind as president, Dr. McGregor as B.C. Board member), CPA informed the federal Ministers of Health and of Justice that “There is no established standard of care in Canada, or as far as CPA is aware of in the world, for defining the threshold when typical psychiatric conditions should be considered irremediable”.

Prior to CPA’s input in 2016, media reports indicated that MAiD for sole mental illness would be allowed in pending 2016 legislation; immediately after CPA’s input the subsequently released legislation Bill C-14 recognized that issues regarding MAiD and mental illness needed to be studied further prior to deciding or committing to allow MAiD for mental illness.

The “sunset clause” does not provide time to review whether it will be responsible to provide MAiD for mental illness by 2023, it mandates that we must provide MAiD for mental illness by 2023.

Existing evidence of psychiatric euthanasia in Benelux countries already shows risks posed to marginalized patients, and expert reviews have repeatedly found lack of evidence in being able to predict irremediability of mental illnesses. A sunset clause cannot command non-existent evidence to appear.

The CMHA and disability advocacy groups strongly opposed the sunset clause, yet CPA leadership raised no concerns or objections to it.

From the only study seeking psychiatrists’ opinions on the issue to date psychiatrists overwhelmingly disagree with the “sunset clause”. Ontario psychiatrists in the 2021 OMA Section on Psychiatry survey opposed the sunset clause by a 3:1 ratio, with 68% believing there should be further review to determine whether MAiD for mental illness should be permitted prior to committing to provide it in 2023, compared to only 23% thinking further review was not needed; and an even stronger ratio of five psychiatrists strongly agreeing such further review was needed prior to making this commitment for each psychiatrist strongly disagreeing.

We **STILL* don’t know. It has now been almost two weeks and CPA leadership has refused to respond, in fact has not even acknowledged, repeat member requests to clarify what the process will be regarding the Proposals. Questions CPA has refused to answer thus far in the past two weeks about the AGM, that is less than two days away, include:

Will the submitters of Proposals, and/or members, have the opportunity to speak to or have discussion about the Proposals?

How will voting be done on the Proposals, and what percentage of vote is required for Proposals to pass?

Will Board members recuse themselves from Proposal A (or 3, as it appears in the , which clearly represents a personal conflict of interest for each Board member?

This site will be updated once CPA responds with the requested information.

Given the repeated actions of CPA leadership to fail to properly engage, and at times actively block, member input on this important issue over the past 1 1/2 year, and the impact of CPA Positions on public policy and the risks they are bringing to vulnerable patients, it is important membership send a clear message to CPA leadership that their processes to date on this issue are unbefitting leadership of a member association.

Remarkably, even after 20 months of criticism about the lack of evidence-based guidance and the lack of any cautions about suicide risk to marginalized patients with mental illness, even in its Nov Position Update CPA leadership refused to address any of these concerns.

While it is unfortunate members and the association are in this position, a censure was deliberately chosen rather than other harsher actions enforceable at an AGM - censure sends a message but does not prevent any from continuing with their roles; the Proposal specifically focusses on the 2020-2021 period during which the repeat lack of engagement occurred; and the entire 2020-2021 CPA leadership, which in the end is responsible for CPA actions, is identified as a group.

There will be some natural turnover at the 2021 AGM, and it is important that new 2021-2022 leadership moving forward is aware that membership supports it in improving flawed past processes and ensuring membership is properly engaged on complex policy issues like MAiD.

While unpleasant and unfortunate, given the ongoing issues over the past year and a half, a censure importantly articulates in a measured way that past processes were flawed, while allowing for future improvements (rather than implicitly accepting and condoning, and not correcting, a concerning pattern of behaviour).