Lisa Burback

Dear CPSA colleagues, I know that you are constrained by the current Federal governmental regulations and policies, and the following is not aimed at any of you who are doing your best. I also respect my colleagues who are supportive of MAID, despite my fervent disagreement with the concept. However, I want to stand in solidarity with other physicians who are raising concern about MAID. I agree with them that it is completely unfathomable that people with mental disorders associated with emotional dysregulation and suicidal ideation (e.g. severe depression, personality disorders, trauma-related disorders, etc) are being allowed to undergo MAID without a) the requirement of a psychiatric evaluation, b) exhausting potentially effective treatments, and c) creating a better system so people can access needed supports and treatments. I have already been told by multiple patients with limited access to such supports and treatments that they will apply for MAID if they can't find appropriate psychosocial supports. A few pertinent examples of frustrating system issues include a) I cannot access publicly funded ketamine for treatment resistant depression within AHS, despite being a psychiatrist employed within the system (but I can refer to private clinics that are not covered and my patients cannot afford), b) the clinically recommended treatments for PTSD (which is frequently associated with suicidality and depression) are not practically available in our publicly funded system (e.g., CPT, EMDR, PE), and b) homelessness and food/housing insecurity is at an all time high. I do appreciate the standard for conscientious objection. The only issue I have is following wording, with respect to MAID, as I don't think it applies: "These expectations accommodate the rights of objecting physicians to the greatest extent possible, while ensuring that patients’ access to healthcare is not impeded." The Merriam Webster dictionary defines healthcare as "efforts made to maintain, restore, or promote someone's physical, mental, or emotional well-being". While MAID is a health system service, I don't think it applies as healthcare. It is NOT a treatment for an illness; it is purposely facilitating death in someone who would not ordinarily die. MAID stands for Medical Assistance in Dying. The original intent for MAID was to reduce suffering of those who are in the process of dying (e.g. terminal cancer). Now it has expanded to mental illnesses where the person would NOT die, nor do we know if they would have recovered in the future. We are not "assisting" death anymore. We are being asked to participate in something very different. Further, we cannot accurately predict whether someone will recover from a mental illness. I have personally observed recoveries that others would not have predicted. I have worked with many patients with longstanding treatment resistant illnesses and chronic suicidal ideation. I see unacceptable risk for vulnerable people to fall through the cracks. I also see improvements to mental health treatment on the horizon. Why are we fighting against "discrimination" based on diagnosis (ie. disallowing mental illnesses as a reason for MAID) but we are not fighting against the discrimination that has occurred for decades related to mental illnesses (funding and resources for appropriate access to evidence based mental health care treatments). I agree wholeheartedly with my colleagues Dr. Hamza Riaz and Sheila Wang and others who see the enormous problems with MAID for mental illness. Respectfully, Lisa Burback, MD

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