Thank you, Mr. Chair.

Thank you for the invitation to speak. My name is Dr. Alisha Montes. I'm a clinical associate professor of pediatrics at Memorial University in St. John's, Newfoundland. I was also awarded a Rhodes Scholarship, and I completed my master's in bioethics and public health at Oxford University. My practice is comprised of children from birth up until age 18, and I have a special interest in developmental pediatrics. I am also a mother of three children.

Some words I would use to describe my own adolescence are tumultuous, stressful, hopeless and traumatic. I was an obese teenager who came from a broken and chaotic home. I was abused as a child and raised by a single mother who had PTSD. I was severely bullied as a teenager. I found it very difficult to function while at school and in my social circles. I had many years when I felt hopeless and wanted to die due to intolerable social and psychological suffering. But with a lot of support, encouragement, mentorship and appropriate access to medical care, I was able to overcome my struggles. I have been able to live a very full and meaningful life. If MAID was legalized, that may have been the end of my story. My future life was full of potential, and I am so grateful to be here today, speaking with you.

Studies show that the frontal lobe is not fully developed until early adulthood. The frontal lobe is very important for coordinating executive functions, including the balancing of risks and rewards and decision-making. This explains why adolescence is a highly vulnerable time for risk-taking behaviours.

In pediatrics we practice harm reduction, which is a public health strategy that was developed to reduce the negative effects of risky behaviours and to mitigate the risk of injury and prevent premature death in adolescents. I would argue that MAID for mature minors carries the highest amount of risk, as the consequence is death. It's irreversible. We need to ask ourselves if we should be legalizing this for mature minors when biology shows us that the ability to balance risks and rewards is one of the last areas of the brain to mature.

The Supreme Court of Canada recognizes that capacity for decision-making of children must take into account the child's mental, emotional, physical and developmental stage. The courts apply a sliding scale to capacity, meaning that decisions that carry grave consequences require more scrutiny. In some cases, a total prohibition is necessary to avoid future harms, such as with marijuana, alcohol, cigarettes and illicit drugs. I believe we have a duty to protect adolescents during this time of brain maturation. The legalization of MAID does the exact opposite of harm reduction. It exposes children to the very dangerous choice to end their lives prematurely and with the support of the Canadian government.

Based on my experience, giving adolescents the option to end their lives prematurely is not what they want or need, as the majority of their suffering is not because of their mental or physical conditions. It is due to social stigma, poverty, lack of access to resources and tumultuous home lives. Seventy-five percent of children with mental health disorders do not have access to specialized treatment. Here in Newfoundland, there's a one-year waiting list to see a child psychiatrist. We know that 70% of mental health disorders begin during childhood or adolescence. MAID is not the solution to these troubling statistics. We must spend our time and resources improving access to specialized care and listening to the voices of youth to ascertain how we can support them during this very difficult developmental period.

What kind of message does it send to suggest MAID when an adolescent is struggling through this difficult developmental time? Instead, we must believe in them. We must give them a reason to hope. We must delight in their individual talents, mentor them and teach them the important skills necessary to overcome their challenges and be resilient.

When adolescents want to end their lives, parents do everything they can to prevent them from committing suicide. I know this through my own clinical experience and as a mother. We know that the parental relationship is very important and integral to children's development. It even predicts such long-term health conditions as mental health wellness and the ability to cope and to maintain meaningful relationships. We need to carefully consider and study how this may negatively affect parental relationships and have the propensity to cause ripple effects through the family and cause trauma that may have lifelong negative effects.

Finally, the CCA report also noted that there is no robust evidence that captures the voices of the youth on this matter. It is troubling that the views of minors with disabilities, indigenous youth and those in the welfare system were not captured in the literature.

In medicine, we make decisions based on robust evidence. Why are we rushing to legalize this when there's a paucity of evidence and all of the integral voices have not been captured?

Thank you very much for your time.

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