President's Message

Medical Assistance in Dying: A complex topic worthy of careful assessment

Here at the CCA, we’re motivated by the knowledge that the assessments we undertake are important to the sponsors that request them, and to the public more broadly. For more than a decade, we’ve addressed topics such as climate change, medicines for children, oil sands, Canada’s science culture, marine safety, and STEM skills. We’re currently completing projects on regenerative medicine, the transportation needs of an aging population, and the state of science and technology and industrial research and development. Each one engages expert panels that wade into a river of knowledge, take stock of what’s there, and report their findings and conclusions.

On December 13, 2016, the CCA agreed to take on a new assessment from the Ministers of Health and Justice that promises to be one of our most important and challenging projects: medical assistance in dying (MAID). It will be unlike any other project we have undertaken to date ― unique in its size and scope and in its relevance to Canadians. MAID is now permitted in Canada, following the passage in June 2016 of Bill C-14. But three distinct areas were not included in the legislation: MAID for mature minors, advance requests for MAID, and MAID when mental illness is the sole underlying medical condition. These issues were identified as particularly complex and worthy of further study, prompting the federal government to seek independent reviews. The government turned to the CCA because we’re an independent, not-for-profit organization that convenes the best experts in their respective fields to assess the evidence on complex topics of public interest. Our rigorous process ensures quality and objectivity (for more on the CCA’s process, see our 2015/16 Annual Report).

And this is where it gets interesting. Who are the experts on this issue? To some extent, everyone is, insofar as people are best positioned to know their own views, values, and beliefs. So too are the many affected by MAID personally and professionally: clinicians who are asked to participate, hospitals and other facilities where the practice might occur, professional regulators, patients, families, and advocacy groups (there are also provincial perspectives to take into account, as Quebec approaches the issue somewhat differently than other provinces). We expect to have three strands of work going on at the same time, but integrated in a way to ensure that there is a coherent cross-cutting approach to the issues. And where a specific area of expertise is not present on a panel, we are committed to ensuring that we understand the issues by seeking input from those who may be affected by one of the three MAID sub-topics. 

What is the evidence? For many CCA assessments, the strategy is straightforward: to review the literature on a subject, bring experts together to deliberate on it, assess the breadth, depth, and quality of the evidence, and then report findings and conclusions. In the case of MAID and its sub-topics, however, there is a modest but not exhaustive amount of published empirical, social science, and related literature to review; there are a small number of jurisdictions where legislation exists; and there are also professional practice guidelines, codes of conduct, and other types of knowledge to consider. The panels will be assessing all of these and as much of the related “grey” literature as possible. We’re aware that we may need to wade even deeper into the river, to call for more evidence as needed and to make every effort to understand the implications for society.

We intend to name our panel members and chairs soon, and to convene the panels in early spring. We expect to release this assessment in late 2018, to meet the timetable established by Parliament. As always, we will share the results widely. Our hope is that our work will provide an objective and useful starting point for decision-makers, researchers, stakeholders, and all Canadians to engage on this topic.

More on the assessment process and continued updates on the project can be found here.

Eric M. Meslin, PhD, FCAHS
President and CEO
Council of Canadian Academies

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