Dr Laurence Normand-Rivest: Let us offer healing to the suffering

Presentation at the EPC Press Conference on October 7 in support of Bill C-218

Dr Laurence Normand-Rivest

My name is Laurence Normand-Rivest and I have been a family doctor for 13 years in Montreal, caring mainly for geriatric patients in clinic, long term facilities and providing palliative care at home for patients at the end of life. I also work 15 hours per week at the walk-in of my clinic where I meet patients of all ages and backgrounds.

I support Bill 218 to undo Bill C-39 coming into effect on March 17th 2027 that would allow those suffering solely from psychiatric illnesses to ask for MAID.

We should ask ourselves if homicide is an adequate answer to suicidal ideation. Have Canadians become lobbyists of suicide?

In 2016, Bill C14 defined MAID as assisted suicide provided by a doctor to a patient suffering from a terminal and grievous and irremediable condition in the context of a relationship between the patient and his doctor. Many safeguards have been removed since the introduction of the law, especially the initial delay of reflection of 10 days removed in 2021 with the introduction of Bill C7, which allows a patient in shock because of bad news to ask to be killed immediately. Bill C7 also expanded MAID for the people suffering from a serious illness when death is not foreseeable. With Bill C-39, patients wouldn’t need to have any physical illness to ask for assisted suicide.

Les idées suicidaires sont un symptôme de la dépression. Statistiques Canada estime que plus d’un Canadien sur 10 souffrira d’un épisode de dépression majeure dans sa vie. Des centaines de patients m’ont consultée au sans rendez-vous à cause de symptômes dépressifs. Je leur dis qu’ils peuvent prendre des rendez-vous de suivi avec moi et que je ne les lâcherai pas tant qu’ils ne seront pas guéris. La période initiale de détresse et d’idéation suicidaire, pouvant parfois durer des mois voire des années, est réversible pour la plupart des patients. J’ai même un patient qui avait été déclaré inapte au travail pour dépression chronique qui après dix ans, est redevenu assez fonctionnel pour réintégrer le travail qu’il aimait tant. Il est très réducteur de notre part de juger qu’une condition psychologique est irrémédiable, et plusieurs comorbidités physiques, comme des douleurs chroniques, nécessitent l’attention de plusieurs médecins spécialistes et de professionnels, ainsi que l’aide de ressources communautaires, avant de permettre au patient de sortir des bas-fonds de sa dépression.

English translation: 

(Suicidal thoughts are a symptom of depression. Statistics Canada estimates that more than one in ten Canadians will experience an episode of major depression in their lifetime. Hundreds of patients have consulted me at the walk-in clinic due to depressive symptoms. I tell them they can schedule follow-up appointments with me and that I will not abandon them until they have recovered. For most patients, the initial period of distress and suicidal ideation—which can sometimes last for months or even years—is reversible. I even have a patient who had been declared unfit for work due to chronic depression but, after ten years, became functional enough to return to the job he loved so much. It is overly simplistic to deem a psychological condition irreversible; furthermore, various physical comorbidities—such as chronic pain—require the attention of multiple medical specialists and professionals, as well as support from community resources, to help the patient emerge from the depths of depression.)

In 2023, Health Canada published the norms of practice of MAID, stating that patients should be informed of all the therapeutical options available to alleviate suffering. If the patients qualify for it, Health Canada stated that they should be informed of the possibility of MAID.

Why have we placed assisted suicide at the same level as healthcare? Have we designed suicide as a remedy to patients because of our incapacity to provide proper care to all? Roger Foley, a 51 year old man suffering from cerebellar ataxia hospitalized in London since 2016, has been offered MAID several times because our healthcare system couldn’t provide the homecare he was asking for.

I am very concerned for our patients who are psychologically in distress and wondering to whom they will turn to. We know that access to healthcare is often very difficult, especially for the most vulnerable, who are isolated, and prone to despair. AP News reported that patients have qualified for euthanasia because of isolation, poverty and obesity. In Montreal, I have heard of colleagues in my department administering MAID to a homecare patient who had chronic mobility issues but no grievous or irremediable condition, because he had asked for it a few days before Christmas in order not to be alone. Can MAID be a solution to the plague of loneliness? Have we thought of the despair of those suffering the loss of the deceased? How many victims will there be of our culture of death?

J’ai été responsable du service d’hébergement dans le CIUSSS Centre-Sud de Montréal pendant quelques années, et j’ai travaillé dans 8 CHSLD dans les CIUSSS du Sud et du Nord de Montréal, dont 2 unités où un grand nombre de patients souffrent de maladies psychiatriques chroniques. J’ai aussi parmi ma clientèle âgée au bureau et à domicile plusieurs patients souffrant de schizophrénie, de trouble bipolaire réfractaire ou de dépression chronique, dont plusieurs personnes invalides. Parmi eux, nombreux sont ceux qui trouvent une grande joie dans la simplicité du quotidien, et qui sont eux-mêmes des soignants par leur empathie qui apporte tant de consolation pour les personnes qu’ils rencontrent. La vulnérabilité ouvre le cœur à la souffrance de l’autre et nous permet d’y faire face.

English Translation: 

(I was in charge of the residential care department at the CIUSSS Centre-Sud de Montréal for several years and worked in eight long-term care facilities (CHSLDs) across the CIUSSS networks of southern and northern Montreal, including two units housing large numbers of patients with chronic psychiatric conditions. My caseload—both in the clinic and during home visits—also includes many elderly patients suffering from schizophrenia, treatment-resistant bipolar disorder, or chronic depression, including several individuals living with disabilities. Many of them find great joy in the simplicity of everyday life and act as caregivers themselves through an empathy that brings profound comfort to the people they meet. Vulnerability opens the heart to the suffering of others and enables us to face it.)

We know that suicidal thoughts are symptoms of an underlying depressed mood and that depression can be treated. Let us offer healing to the suffering, be present and faithful in our support, and not eliminate them.