:
Mr. Speaker, I am thankful for the opportunity to speak about Bill and the extremely important issue of medical assistance in dying, or MAID, and mental illness.
I think all members can agree that this is a highly complex, quite sensitive and emotional issue, that raises divergent and deeply held views from the medical community, experts and the public at large. The questions of whether, how and when to expand eligibility for MAID to persons whose sole underlying medical condition is a mental illness are difficult; they do not have easy answers.
The federal government believes that eligibility for MAID should be expanded to such persons. However, such an expansion should not be rushed and should not occur before the health care system is ready to safely provide MAID in all cases where it is requested on mental illness grounds. This is why we have introduced Bill , which proposes to extend the temporary mental illness exclusion by three years, until March 17, 2027. The bill also includes a provision requiring a parliamentary review prior to that date.
As members will recall, in 2015, the Supreme Court of Canada concluded in the Carter case that the Criminal Code’s absolute prohibition on physician-assisted death was unconstitutional. The Supreme Court held that physician-assisted dying must be permitted in some circumstances, namely, for competent adults who clearly consent to the termination of life and who have a grievous and irremediable medical condition. This decision led to the legalization of MAID in Canada one year later, in 2016, through Parliament’s enactment of former Bill . Our original MAID law limited eligibility for MAID to competent adults with an eligible medical condition whose natural death was reasonably foreseeable. Our MAID framework was added to the Criminal Code and was made up of a stringent set of eligibility criteria, as well as procedural safeguards to prevent error and abuse in the provision of MAID.
A few years later, the “reasonable foreseeability of natural death” eligibility criterion was challenged in Quebec; in 2019, it was declared to be unconstitutional by the Superior Court of Quebec in the Truchon decision. As this was a trial-level decision, it was only applicable in Quebec. Nevertheless, the Attorney General of Canada did not appeal the decision; instead, the federal government made the policy decision to expand eligibility for MAID. This led to Parliament’s enactment of former Bill in 2021, which expanded eligibility for MAID to persons whose natural death is not reasonably foreseeable. This resulted in the removal of the eligibility criterion that a person’s death be reasonably foreseeable and the creation of two sets of procedural safeguards for the lawful provision of MAID.
The first track of safeguards applies to persons whose natural death is reasonably foreseeable; the second, more robust, track applies to persons whose natural death is not reasonably foreseeable. This second set of safeguards was created in recognition of the fact that requests for MAID by persons who are not at end of life are more complex. This is why a minimum of 90 days must be taken to assess a person for eligibility for MAID when their natural death is not reasonably foreseeable. This is not a reflection period; it is a minimum assessment period. This safeguard aims to respond to the additional challenges and concerns that may arise in the context of MAID assessments for persons whose natural death is not reasonably foreseeable. This includes whether the person’s suffering is caused by factors other than their medical condition, as well as whether there are ways of addressing their suffering other than through MAID.
This second set of safeguards also requires that two practitioners be satisfied that the person meets all the eligibility criteria, and if neither of them has expertise in the medical condition causing the person suffering, one of them must consult with a practitioner who does. Involving a practitioner with the relevant expertise aims to ensure that all treatment options are identified and explored.
Practitioners are also required to inform the person of available counselling services, mental health and disability support services, community services and palliative care; to offer them consultations with the relevant professionals; and to ensure that the person has given serious consideration to such alternative means to alleviate their suffering. Although this does not require a person to undertake treatments that may be unacceptable to them, it requires that they fully explore and weigh the risks and benefits of available treatment options.
Former Bill , as originally introduced, permanently excluded eligibility for MAID on the basis of a mental illness alone. This was not because of the incorrect and harmful assumption that individuals who have a mental illness lack decision-making capacity or because of a failure to appreciate the severity of the suffering a mental illness can cause. Rather, this was done because of concerns about the inherent risks and complexities of permitting MAID for individuals who suffer solely from mental illness.
During its consideration of the bill, the Senate made an amendment that added a sunset provision that would repeal the mental illness exclusion 18 months later. The House of Commons accepted the amendment in principle, but changed the date of repeal to two years; in other words, the provision of MAID based on a mental illness alone was set to become lawful on March 17, 2023.
The decision to temporarily maintain the exclusion of eligibility was based on the recognition that additional study would be required to address the risks and complexities of permitting MAID in these circumstances. This is why the former bill also included a requirement for an independent expert review respecting recommended protocols, guidance and safeguards to apply to such requests for MAID.
Former Bill also required the creation of a joint parliamentary committee tasked with conducting a comprehensive review of the Criminal Code's MAID provisions and other MAID-related issues, including MAID and mental illness. The committee undertook this important work, and its interim report, which focused on MAID and mental illness, was tabled in June 2022. It urged the federal government to collaborate with regulators, professional associations, institutional committees and the provinces and territories to ensure that the recommendations of the expert panel were implemented in a timely manner.
The committee's second report was tabled in February 2023. The majority view expressed was that eligibility for MAID on the basis of a mental illness alone should be permitted. However, the final report also raised a key concern that more time was needed for standards to be developed and training to be undertaken before the law should permit a mental illness to ground a request for MAID. The federal government recognized the significant progress that had been made by the provinces and territories, stakeholders and the medical community in preparing for the expansion. However, it ultimately concluded more time was needed.
This is why we introduced Bill , and Parliament enacted it. It extended the exclusion by one year, until March 17, 2024. This extension aimed to provide additional time for the dissemination and uptake of key resources by the medical and nursing communities. We thought it essential to prepare for the safe assessment and provision of MAID in all cases where a mental illness grounds a request for MAID. The committee expressed support for the extension in its second report.
I want to take a moment to recognize the work that the federal government has done during this extension to support the fulfillment of some of the expert panel’s recommendations. For instance, we amended the regulations for the monitoring of MAID last year to ensure comprehensive data collection and reporting. Such changes allow for data collection related to race, indigenous identity and disability of persons requesting MAID. These changes came into force in January 2023, and the first set of data will be captured in Health Canada’s 2024 annual report on MAID.
Moreover, Health Canada convened an independent MAID practice standards task group to develop a practice standard for MAID. In March 2023, the model MAID practice standard and supporting documents that provide guidance to support complex MAID assessments were released. Finally, Health Canada supported the Canadian Association of MAiD Assessors and Providers in the development of a Canadian MAID curriculum, which was launched in September 2023.
In Canada, certain aspects of MAID fall under federal jurisdiction and others fall under provincial and territorial jurisdiction. The federal government is responsible for the criminal law aspect, whereas the provinces and territories are responsible for the implementation of MAID within their health care delivery systems. Impressive progress has been made in preparing for the expansion by the March 2024 deadline. However, the provinces and territories have all expressed that they are not yet ready. For this reason, we are proposing to extend the temporary mental illness exclusion for another three years, until March 17, 2027.
The extension would allow more time for the provinces and territories, and their partners, to prepare their health care systems by implementing regulatory guidance and developing additional resources for their medical and nurse practitioners. It would also provide more time for medical and nurse practitioners to become familiar with the available training and supports. Our ultimate goal is to help ensure that the necessary protections are in place to protect the interests of individuals who may seek MAID on the basis of a mental illness alone.
We believe that this issue should not be rushed. Eligibility for MAID should not be expanded until the health care system is ready to safely provide MAID in these complex circumstances. I urge all members to support the bill so our partners can get this right.
:
Madam Speaker, it should have never come to this. Had the government properly consulted with Canadians, this expansion of MAID would never have seen the light of day. Instead, what we now have is MAID in Canada, a triumph of ideology over common sense.
The Liberal government's recent decision to further delay, but not cancel, the expansion of MAID to the mentally ill reflects an unserious approach to this all-important life-and-death issue. MAID was originally designed for those whose physical illness was incurable and caused intolerable pain, and where death was reasonably foreseeable. However, the Liberals soon eliminated the requirement that death be reasonably foreseeable and then went far beyond that by quickly agreeing to a demand from the unelected Senate to expand assisted suicide to include those suffering from mental illness.
The government has signalled a willingness to go even further by including children in its deadly scheme. As we predicted back in 2016, when the introduced medically assisted death to Canadians, our country is now hurtling down a steep and slippery slope. Despite the accusations of fearmongering and exaggerating that have been levelled at us, history has proven that Conservative MPs were right. Over eight short years, our country has moved from banning assisted suicide to having the most permissive and dangerous regime in the world. The statistics are staggering. Last year, over 13,000 Canadian deaths were attributable to MAID, a 31% increase over the year before. That is without MAID being made available for mental illness.
MAID is now the fourth leading cause of death in the country. When compared to other jurisdictions where MAID is available, like California, Canada's assisted suicide deaths far exceed those of other jurisdictions. That should really concern us, as it reflects a reckless implementation of MAID. Imagine how many more thousands of deaths will be added every single year, should the Liberal plan to include the mentally disordered come into force.
Of increasing concern are the growing number of cases in which MAID has been improperly approved and administered outside of what the criminal law currently allows. Here are just a few of them: There is a Hamilton man who would rather die than struggle with poverty, as reported in the Hamilton Spectator Reporter; the Cape Breton woman who sought MAID over lengthy workers' compensation delays; the Ontario quadriplegic mother who applied for MAID over a lack of access to disability supports; the former paralympian who told MPs that the veterans affairs department offered her assisted death instead of help; and the Winnipeg woman who chose to die through MAID because of her futile struggle for home care.
There is the case of Donna Duncan from my own city of Abbotsford, who was euthanized because mental health support was not available when she needed it the most. Indeed, she received MAID without her daughters, Christie and Alicia, knowing about it until after the fact. They had no chance to say goodbye to their mother.
Then there is Kathrin Mentler, who lives with chronic depression and suicidality. Feeling particularly vulnerable, she went to Vancouver General Hospital looking for psychiatric help for feelings of hopelessness she could not shake. Instead, a clinician told her there would be a long wait to see a psychiatrist and that the health care system is broken. That was followed by a jarring question: “Have you considered MAID?”
There is the case of Sophia, who suffered from severe sensitivity to smoke and chemicals, triggering rashes, difficulty breathing and blinding headaches. She died by MAID after a frantic effort by friends, supporters and even her doctors to get her safe and affordable housing in Toronto. She begged officials for assistance in finding a home away from the smoke and chemicals wafting through her apartment. “The government sees me as expendable trash, a complainer, useless and a pain in the ass,” she said in a video filmed eight days before her death.
Canadians are dying unnecessarily and under circumstances that scream out for reconsideration of how far Canadians are prepared to go in euthanizing their fellow citizens. It has become stunningly clear how little the government consulted on MAID expansion. Mental health professionals are only now becoming aware of the government's plans to euthanize persons suffering from mental disorders.
Psychiatrists, psychologists, clinical counsellors and suicide prevention experts overwhelmingly oppose this expansion, and only recently has the government begun to consult with indigenous communities, our fellow Canadians who are at the greatest risk from an expansive application of MAID.
The provinces and territories, as has already been mentioned, have sent a joint letter to the government, saying that they are not ready for MAID expansion. Indeed, they have called not just for a delay but for an indefinite suspension of the government's plans. Ordinary Canadians, of course, have repeatedly said they do not favour expanding assisted suicide to include the mentally ill.
What is worse is that this expansion is taking place at a time when Canada faces compounding national crises in mental health, palliative care, opioid addiction, affordability and homelessness. The skyrocketing cost of living has only exacerbated these profound social challenges.
The government's reckless approach to MAID also flies in the face of Parliament's stated commitment to suicide prevention, including the recently activated 988 suicide helpline, which is thanks to my colleague from .
How can members claim to support suicide prevention efforts, when at the same time they are promoting state-facilitated suicide? Clearly, the government's contradictory approach has been one in which blind ideology has trumped common sense and reason. More troubling is that the message to our most vulnerable Canadians, the mentally disordered, the opioid addicted, the homeless and hungry, and the veterans, is that their government would rather euthanize them than provide them with the mental health and social supports they need to live productive, meaningful lives.
The utilitarian implications of the government's approach are deeply disturbing and profoundly wrong on so many levels. By any other definition, expanding MAID to include the most vulnerable is nihilism hiding behind the fig leaf of compassion.
In a briefing recently, Liberal government officials indicated that they are still hell-bent on expanding MAID to the mentally ill. It is just that their masters, namely the and his Liberal colleagues across the floor, do not want to face the voters' wrath for placing their corrosive ideology above the interests and welfare of the most vulnerable among us. That is why they, the Liberals, have kicked the ball down the road to avoid the political consequences.
We can and should do better. What is really required and what Canadians are demanding of the and his is that they put a full stop to this madness now. There being no national consensus on MAID expansion, completely rescinding this policy is the only reasonable and responsible thing to do.
:
Madam Speaker, we come here to debate the most serious of issues, and we are faced with one of those issues today.
I want to start by being very up front. I do not think that a pause is appropriate for the expansion of medical assistance in dying to those whose sole underlying medical condition is mental illness. There must be an abolition of the expansion to those who are most vulnerable and to those who are suffering.
We have heard that the Liberal government is pushing this off to avoid political consequences in the next election, and it is shameful. However, it does present an opportunity, because a Conservative government would not allow the expansion of doctor-assisted death to people for whom our country should be offering hope and help.
The concrete solutions that have been put forward by Conservative members have been heard in the House, including by my hon. colleague from with the 988 suicide prevention hotline, which he shamed the government into taking action on. While it took that shame for the Liberals to act, it does offer some help to those who desperately need it.
The hon. member for spoke just before I did. His Bill would have scrapped doctor-assisted death for those whose sole underlying medical condition was mental illness, but the government rejected that. With respect to the provinces and territories, which are constitutionally obligated to deliver on health care, the majority of their heads of government have had to call for the government to stop this reckless march forward.
While I will vote in favour of a pause, I cannot abide anyone believing that I am okay with this continuing three years from now.
This debate is following the Liberals' pulling the emergency brake on the reckless expansion of MAID just a year ago. Given the chance, there would be a wide expansion of MAID, and not just to those who are suffering from mental illness and addiction. This expansion of doctor-assisted suicide cannot be carried out safely or justly. It is difficult, if not impossible, to determine the irremediability of a mental disorder in individual cases, meaning we cannot say, with the certainty that is required in a matter that truly is life or death, whether a person suffering from mental illness will get better.
In appearing before the Special Joint Committee on Medical Assistance in Dying, on which I sat as a vice-chair, Dr. Jitender Sareen, a physician in the department of psychiatry at the University of Manitoba, testified, said:
We strongly recommend an extended pause on expanding MAID to include mental disorders as the sole underlying medical condition in Canada, because we're simply not ready. In our experience, people recover from long periods—“long” meaning decades—of suffering with depression, anxiety, schizophrenia and addictions with appropriate evidence-based treatments. We strongly believe that making MAID available for mental disorders will facilitate unnecessary deaths in Canada and negatively impact suicide prevention efforts. The clinical role is to instill hope, not to lead patients toward death.
Dr. Sareen went on to say:
Unlike physical conditions that drive MAID requests, we do not understand the biological basis of mental disorders and addictions, but we know that they can resolve over time. The real discrimination and lack of equity is not providing care for people with mental disorders and addictions.
I could not agree more with the doctor.
We have a moral obligation in our society to ensure that every person is treated with the inherent dignity and value with which they are created, everyone. They do not get that when we offer them death instead of help and hope, treatment and care.
Psychiatrists and even the so-called expert panel cannot know if someone is going to recover from mental illness, and this under a government where wait times for psychiatric treatment can be over half of a decade. If the government goes ahead with this, people who would have gotten better will not get the chance, because they will have been killed at the hand of the government.
Further, it is difficult for a clinician to distinguish between a rational request for medical assistance in dying where mental illness is the sole underlying medical condition and one motivated by suicidal ideation. On the question of suicidality, Dr. Sareen said:
...there is no clear operational definition differentiating between when someone is asking for MAID and when someone is asking for suicide when they're not dying. Internationally, this is the differentiation. If somebody is dying, then it can be considered MAID. When they're not dying, it is considered suicide.
On the same question, Dr. Tarek Rajji stated, “There is no clear way to separate suicidal ideation or a suicide plan from requests for MAID.”
With the line being blurred between suicidal ideation and so-called rational requests for medical assistance in dying, evidence from jurisdictions that have assisted suicide for mental disorders, both suicides and medically facilitated death go up.
We cannot move forward with this dangerous game that the government is playing, the plan of moving full steam ahead no matter what the cost. The minister said that the Liberals had the moral imperative to move ahead with an assisted suicide regime. Hopelessness and misery, that is their imperative. A moral imperative? It is immoral.
This is the same government that has degraded life in the country to the point where an entire generation of people is giving up hope. Two million Canadians are lined up at food banks a month and once former middle-class families are living in their cars. People are being offered MAID instead of a wheelchair, after serving our country and going to veterans affairs for help. People are being offered MAID at routine doctor appointments. People are seeking MAID because they cannot afford housing. People are seeking MAID because they cannot get the psychiatric care they need. This is blind ideology ahead of evidence. It is death on demand for any reason.
Depression, anxiety, schizophrenia, personality disorders and addictions will all become justifications for death under the Liberal government if this plan is allowed to be carried forward. A new generation of addicts will have been created, by normalizing and legalizing opioids that are being peddled to our children. The MAID regime seems like it will become the government's plan for addictions. Rather than offering treatment and a chance to get better to people who are suffering, they are being offered death.
There is hope yet, if we pass this bill, that we could stop the expansion of MAID to people who are suffering. We can make a commitment, as the representatives of Canadians, to deliver on the health, help, hope and treatment that Canadians deserve, that every human person deserves. Dignity, respect, hope and life, that is what we are going to have to vote to protect.
I am proud to stand and vote in support of life.
:
Madam Speaker, I will start with an assertion whose veracity will become clear. With Bill , the cowardly Liberal government brought forth a mouse.
If we are talking about Bill C‑62 today, it is because Bill created the Special Joint Committee on Medical Assistance in Dying when it passed. The committee's mandate was to review the medical assistance in dying legislation, in particular as regards the issue of advance requests. Because we knew that the problem was more difficult in cases of mental illness, the government set up an expert panel to help MPs do their job. The panel was to issue a report to the special joint committee.
The expert panel was indeed set up. The problem is that, instead of putting everything in place following the adoption of Bill C‑7, the government decided to call an election in 2021. That delayed the process.
Immediately after the useless election, we would have expected the special joint committee to sit but, no, we had to wait. They took their sweet time. The committee was finally convened, but it had a huge mandate. Its mandate was so huge that Bill on mental illness had to be introduced, delaying the committee's recommendation.
Since February 2023, the committee has been very clear on the issue of advance requests. In fact, that was its most widely held recommendation. During the entire debate on Bill C‑62 in the House, the government said that we needed to be cautious and proceed slowly. That is fine, but when caution involves making patients suffer, I cannot agree. I think we need to be diligent.
The government took its sweet time. Here we are in 2024, and it introduced legislation seeking to postpone the issue of mental illness. Fine, but what is happening with the main recommendation the committee made in February 2023? The government knew very well that Quebec was laying the groundwork on the issue of advance requests. It knew very well that Quebec would bring in its own law. Instead of taking inspiration from that and seeing what measures could be included in the regulation accompanying Canada's MAID legislation, it did nothing.
I have stood in the House many times to ask the Minister of Justice and the Minister of Health why the government did nothing. Why does the bill not include a component on advance requests, which should have been prepared over the past year? After all, the government introduced legislation enacting the special joint committee's February 2023 recommendation on mental illness. On the issue of advance requests, however, it did nothing, despite the majority recommendation.
Yesterday, I got my answer. The demonstrated in front of the whole committee that he was unfamiliar with the Quebec law, yet he rises in the House and says he has enormous respect for Quebec's process. The Liberals do not even know what they are talking about. The minister told me that the issue of advance requests is more difficult than the issue of mental illness because, for example, there might be family quarrels at the patient's bedside.
I realized that the minister had not read section 29.6 of the Quebec law, which stipulates that, as soon as patient is diagnosed, they can appoint a third party. The third party will not determine when the person can access medical assistance in dying, but will advocate for their wishes, which will be included in the advance request, or the person's criteria.
People in my riding have told me that, when they become incontinent and can no longer control their bowels, when they have reached the point where they no longer have any appetite and it becomes a chore for their caregivers to feed them, although they are well compensated for their troubles, when they are no longer able to recognize their friends and family members and when they can no longer maintain relationships, they would like to have access to medical assistance in dying. The third party in whom they have placed their trust will then ask the care team—because patients are indeed cared for by entire teams—to evaluate whether they are meeting the criteria, if they are there yet.
If people make advance requests, it is because they want to avoid shortening their life. They want to live as long as possible. We could be good to them and take care of them until they cross their tolerance threshold.
The minister does not even know what I am talking about right now. Do members think it is normal that people say they respect Quebec, that they have great admiration for Quebec's progress on this issue, but that they do not even know what is in Quebec's law?
It is no surprise that they come out with a bill like Bill C‑62, that does not address this at all. Then they have the gall to say that Quebec has made good progress, but that not all Canadians are ready for that, so they have to wait and watch their patients suffer. Quebec is not the only province that supports advance requests. According to an Ipsos survey, 85% of Canadians from coast to coast support advance requests.
The Conservatives claim that they want to do good, they want to take care of Canada's most vulnerable. I, too, want to take care of the most vulnerable, but who is more vulnerable than a patient who is about to cross their tolerance threshold, who is suffering and who is being told no by the government?
Some claim that there could be abuses, as if the Criminal Code did not provide for punishment of abuses. They seem to believe the medical system to be inherently evil. I heard my Conservative colleague earlier. Listening to the Conservatives, one would think everyone working in the health system wants vulnerable people euthanized. I heard another Conservative member say there is an opioid crisis, there are people in the streets, and we are going to euthanize them. That is absolutely false. It is really far-fetched. That kind of rhetoric is meant to scare people; it amounts to spreading misinformation on a crucial topic.
When we care, we do not infringe on individual autonomy. The role of the state is not to decide matters so personal as how someone wishes to cross their threshold of tolerance. It is not to tell patients what is right for them. It is to provide the conditions so they can make a free and informed choice.
:
Madam Speaker, as always, it is a great honour to rise in this House, as I have done many times over the past 20 years. I mention the 20-year mark because I have always been a great political optimist, a great believer in Canada and a believer in our fundamental goodness when it comes to working things out.
However, we are in a very dark time for democracy. We see the rise of disinformation and social conflicts in all aspects of life. On the international stage, we see the uncertainty coming out of Putin's aggression and the mass killing of innocent people in Palestine. I do not feel that the House of Commons is rising to what Canadians expect us to be. Too often, we are dealing with very profound issues through glib press releases or slogans and bumper sticker politics.
Every now and then we are confronted with legislation that forces us to go deeper, and this is certainly such a moment. There is nothing more profound in the human community than birth and death. How we address the rights of people as they are dying, as well as the supports that need to be in place, not only defines who we are as a society but also goes right down to who we are as families, as neighbours, as spouses, as parents and as children.
We are in a very unfortunate moment in terms of the failure to put the guardrails in place to protect people at this most profound moment. The issue of MAID is very personal, and it is of societal importance that we get this right.
I have certainly struggled with this issue. I wanted to make sure that what we did was done for the benefit of all, in the best interest of the human community, considering the right not only of the individual but also of the people who love them to be part of something special.
I am coming up on the anniversary of my sister Kathleen's passing. Nobody blew through our family more like a summer storm than Kathleen, and I have never seen anybody suffer greater pain. She was fearless right until the very end. Kathleen was always wanting one more gathering, song or story. She would never have accepted MAID, because her will to live was so powerful even as she knew she was not going to live.
I am not saying that her death was any more profound than anyone else's. How she went was her choice, as well as our choice. My mother said the rosary; I sang Danny Boy. That is how we do things in our family. We had one of those great Celtic wakes afterward. There were people there who had never even met my sister, but they all told stories about her. That is the way we do things in the Celtic tradition.
I have also had friends, who had cancers they could not beat, phone me to say goodbye. MAID allowed them the opportunity to choose, with their family and their community, a dignified way to go. I respect that. It is a very profound choice.
When Parliament was confronted with the need, because of the Supreme Court ruling, to put a regime in place, we did so and then said that there would be a review. We needed a review because we were going to a place we had never been to as a society. The review would happen after we saw how MAID was working. Was it working as it was supposed to? Were there abuses? Were the rigours that Parliament said had to be put in place not paid attention to?
Then we had the Quebec Superior Court decision, the Truchon decision. I felt at that time that it was the obligation of the federal government to appeal. I am not going to argue the merits of the Truchon decision, but the obligation of the federal government was to make sure that, if we were to apply this at the national level, we had really done all the due diligence. That was not done.
The Liberals moved a change to MAID before the review that was supposed to happen. Suddenly, things were already changing from what we had agreed on. Then it went to our colleagues in the Senate. I will never say much that is positive about the Senate, but today I will certainly say how dismal and appalling the attitudes of the senators were.
Stan Kutcher, whom I had to sit with on the special committee, showed disrespect and arrogance. Senators, who are not elected, who have no accountability, who do not have to go back to their communities when they are dealing with a suicide crisis like I and other people have to, said that they wanted an arbitrary date to extend MAID to people suffering from mental illness and depression. That was an extraordinarily outrageous and poorly thought out overreach, and it was the job of the Parliament of Canada to simply say, no. All the other provisions of MAID would have stayed in place, but that did not happen. What happened was the Liberals agreed, and then it dawned on them that we were going down a very dangerous road and things had not been thought out.
There is my colleague from , whom I have sat with on many committees. We probably disagree on a lot in politics, but we share the same integrity of coming to the House to do the right thing, bringing what we can bring to bear. He brought forward legislation to deal with this provision, and it was voted down. Therefore, we are now some 30 days from a profound change in legislation that would change Canada forever, and we are scrambling on a question of life, death and body autonomy. This is not how we should be dealing with these issues.
I used the words “body autonomy”, because it is one of the profound human rights, the right to control one's body and the right to make a decision, but it is not an absolute right. There are societal factors that go into that right. When people are deeply depressed, when they are suffering mental illness and feel alone, their body autonomy has been compromised as has their ability to make decisions.
It is really important for us to always remember that nobody dies alone. They may die in grief. They may die in isolation. They may die in the blackest hole of their personal pain, but the impacts of that death affect family, neighbours and people beyond what the poor person who suffered that dark moment could ever understand. If people have ever sat down and worked with people whose loved ones were lost to suicide, they want to say, again and again, “If only they had known how much they were loved.”
In the northern communities I work in, children as young as 10 years old are giving up and killing themselves. What kind of nation sits back and lets children give up hope at age 10?
I would have thought that when we had those kinds of suicide crises at Cross Lake, Attawapiskat, Pikangikum, and Wapekeka, and we cannot even mention how many of those communities have suffered, that there would have been a national consensus to look at what we needed to put in place, but that did not happen.
When I sat on that special committee and heard some of the medical experts say that they were really pleased that the Liberal government had put in place all the steps necessary to help this through, it made me think that we were putting resources in place to push ahead the ability of people, who are severely depressed, to make a decision to die without getting a second opinion from their loved ones, their families or their spouses, even. The government would do that, but it would not put in place the broader supports we need for mental illness.
This is not a whataboutism issue; this is about the crisis we are facing, with 4,000 suicide deaths a year. The mental health crisis is extreme. In 2016, I brought forward the national palliative care strategy, because it is not applied fairly across the country. When we cannot die in dignity, it is a terrible thing.
We have talked with doctors and nurses across the country about the palliative care approach. The federal government agreed and said it would put a strategy in place, that it would work with the provinces and territories, yet nothing was done. In 2019, I brought Motion No. 174 on a national suicide prevention plan, which was based on the incredible work that was done in Nunavut. We know that Quebec put a suicide prevention plan in place and cut the suicide rate by 50%.
Once one starts to map it out, these factors are not difficult to find, the patterns of where those suicide clusters form, with respect to areas of age and economic crisis. That was part of what the suicide action plan would be. Parliament would provide the resources so we could to start to map out where these crises occurred and put the mental health services in place.
We need to be doing that as a Parliament instead of scrambling at the eleventh hour to come up with a fix, a temporary fix, another temporary fix on a temporary fix, on a decision that was put forward by a non-elected, unaccountable Senate, which had no backing, no credibility and no support, other than the fact that a couple of arrogant senators, who have never been elected and have no accountability, decided that Parliament would go along with this, and the government put up with that.
It was an absolute failure of public policy, to unelected senators like Pamela Wallin and Stan Kutcher dictate health policy for people in crisis. We would never allow that for anything else, yet here we are, 30 days from the deadline.
We have had letters telling us not to do this. Seven out of 10 provinces say to not do this. We had the medical community saying that it had no way to even properly assess and not do this. We have had really profound, thoughtful witnesses come forward to talk about the complexities of the issues of mental illness. Who is one to say whether it is irredeemable? Who is one to say that this suffering is so bad that it warrants death, when there are options?
We also have the issue of people in increasingly desperate situations, who feel alone. It tells us who we are as a society when we say that it is really too bad that one is homeless. It is really too bad that one is suffering the nightmare of addiction. It is really too bad that there are young people in a northern indigenous community and they have never, ever been able to get proper medical attention. However, if they want to die, we will set up a process.
MAID was not meant for that. MAID was meant to deal with people who could make the choice, an informed adult choice as they suffered pain that would not go away, with their loved ones and their families.
I remember when my good friend Liz from Vancouver Island called me. We were good friends. She used to drive me around Vancouver Island in this old Jaguar with wood panelling that she got for $4,000. I kept saying, “Liz, if this car breaks down on the mountains, I'm not going to have to get out to push it to the other side am I?”
Liz played blues music for me in the car. She talked about the Catholic saints and about queer politics. She was her own person, and she smoked. As she was dying, she called me and said that this was the moment, that she was taking the moment because this was the last one she may have to make that decision. It was a very profound way to go. MAID is for that.
MAID is not for people who feel they have no hope, without a back-up, without a robust, multidisciplinary team to walk the issues through with them. It is not something they can make a second choice.
I think of Dr. Valorie Masuda, a palliative care physician, who said to the committee:
If this special joint committee on MAID recommends proceeding with allowing access to MAID for chronic mental conditions, I would recommend that there be a robust, multidisciplinary review process involving physicians, psychiatrists, social workers and ethicists involved in a patient's MAID application, and that there be a transparent review of MAID cases shared between health authorities and provincial and federal oversight so that we ensure we are not treating social problems with euthanasia.
Imagine if someone with mental illness and depression were able to get a multidisciplinary team of physicians, psychiatrists, social workers and ethicists, we would not have a mental health crisis. Those people are not there. Those teams are not there.
The government made a commitment to transfer $4.5 billion for mental health to the provinces to deal with the crisis that is unfolding before us, but it has not done that.
Therefore, again, we are in a situation where we are being asked to vote. The bill that the Liberals have brought forward is gutless, because it will punt this down the road for three years, and we will be back at it in three years.
We had punted it down the road for a year over the fundamental failure of the former attorney general who simply let it pass. However, the Senate made a completely unreasonable, undemocratic and unwise pronouncement that overrode the work of the democratically-elected House, a House whose members, as dismal as we are sometimes, dumbed-down, sloganeering and fighting over the stupidest things, have to go back to our constituents and talk to them. We have had to go the funerals of people who have died from suicide because of depression. We bring that experience into the House.
We can disagree on the extent of MAID, we can disagree on many things, but we have a democratic right and a duty to do the right thing here. The Senate has no democratic accountability to anyone. Therefore, the fact that we are having to pick up the pieces from its arrogance and the failure of the Liberal government to hold it to account is concerning. We need to reflect on that. I would urge the members in the other chamber to not play games with this.
On March 17, the deadline changes, the law of Canada changes, and the amount of people who could die without proper support would change. It would change forever the legal framework of Canada. My message to those unelected senators is not to play games with the work we are doing. We are picking up the pieces. We are trying to fix the damage they did, and we need to do so this, because a bigger principle is at stake, the stake of human dignity in a country.
We have to also extend this conversation to our ongoing failure as a nation on mental health; our ongoing failure to offer young people a better future; and our ongoing failure to recognize that if the weakest people in our society are allowed to kill themselves because there is no hope, then we have failed, and we are failing.
I would like to think that we can come together across party lines to say that there has to be guardrails that protect the autonomy of the individual, and also places individuals who are in mental crisis and depression within the context of their family, their loved ones and their society. When one dies alone and in darkness, the effects are felt for years and years after.
Going into some communities after a suicide crisis is like walking into shockwaves of grief that play out for years and years to come, and it takes so much work to come back from that for a community, for a family. Here we are as a society making that decision. Therefore, let us do this right and let us do this with respect for the people who expect us to do the right thing.
:
Madam Speaker, I will be sharing my time with the member for .
I am pleased to have the opportunity to speak in the House today in support of Bill , the bill that proposes to extend the temporary exclusion of mental illness as an eligible condition for medical assistance in dying by three years, until March 17, 2027. I will speak today about the importance of a delay before lifting this exclusion to provide more time for the provinces, territories and their health care partners to prepare for this critical juncture in the evolution of medical assistance in dying, which we refer to as MAID in Canada.
The legal framework for MAID is set out in the federal Criminal Code. However, it is the provinces and territories who have the responsibility for health care delivery, including MAID implementation. We have been working in close collaboration with the provinces and territories to support the safe implementation of MAID since before the original legislation permitting MAID was enacted in the Criminal Code in 2016. This is an important relationship built on the mutual goal of ensuring quality health care for the people of Canada.
Both the expert panel on MAID and mental illness and the Special Joint Committee on Medical Assistance in Dying emphasized the importance of clear practice standards and consistent implementation of guidelines across the country, training for physicians and nurse practitioners, and case review and oversight to support best practices and trust in the appropriate application of the law.
Provincial and territorial governments and their stakeholders, such as health care professional organizations, regulatory bodies and practitioners, have been actively planning for eligibility for MAID for persons whose sole medical condition is a mental illness. As has been recognized across the board, critical progress has been made in this regard. However, the provinces and territories face different challenges within their jurisdictions and are at varying stages of work in implementing these key elements and consequently their readiness for the lifting of the exclusion.
For example, a model practice standard for MAID was developed by an independent task force group made up of clinical, regulatory and legal experts as a resource for physician and nursing regulatory authorities to adopt or adapt in their development or ongoing revision of MAID standards. In addition to the model standard, the task group also released a companion document entitled “Advice to the Profession”.
Practice standards are developed and adopted by regulatory bodies responsible for ensuring that specific groups of health professionals operate within the highest standard of clinical practice and medical ethics. While some provincial and territorial regulatory bodies have successfully implemented MAID practice standards into their guidance documents for clinicians, others are still in the process of reviewing and updating their existing standards. To support the safe implementation of the MAID framework, health Canada supported the development of a nationally accredited bilingual MAID curriculum to support a standardized approach to care across the country. The Canadian Association of MAiD Assessors and Providers has created and is now delivering a training program that has been recognized and accredited by the appropriate professional bodies.
The MAID curriculum includes a series of training modules to advise and support clinicians in assessing persons who request MAID, including those with mental illness and complex chronic conditions, or who are impacted by structural vulnerability, as well as help with the practical application of the MAID legislative framework. The curriculum will help achieve a safe and consistent approach to care across Canada and ensure access to high-quality MAID training for health practitioners. So far, more than 1,100 clinicians have registered for the training, which is impressive given the curriculum was just launched in August 2023. This is only a portion of the workforce. More time would allow additional physicians and nurse practitioners to register and participate in the training, and to internalize these learnings and put them into professional practice.
Now let me turn to case review and oversight of MAID. In Canada there is a process of self-regulation within the medical and nursing professions. The provincial and territorial regulatory bodies, which I spoke of earlier, have a mandate to protect the public for all health care, and MAID is no exception. In addition to the presence of health professional regulatory bodies, several provinces have implemented formal oversight mechanisms specific to MAID. For example, in Ontario, the Chief Coroner reviews every MAID provision, as does Quebec’s end-of-life commission. Both of these bodies have strict policies regarding the timing and type of information to be reported by clinicians, and the Quebec commission issues annual reports.
While the provinces with formal MAID oversight processes represent over 90% of all MAID provisions in Canada, other provinces do not have formal MAID quality assurance and oversight processes in place to complement existing complaint-based oversight processes undertaken by professional regulatory bodies. Work is being planned to explore case review and oversight models, and best practices, through a federal-provincial-territorial working group, with a view to supporting consistency across jurisdictions.
All provinces and territories were united in their request to delay the lifting of the exclusion in order to have more time to prepare their clinicians and health care systems to manage requests where mental illness is the sole underlying condition, and to put the necessary supports in place. Provincial and territorial governments must ensure not only that practitioners are trained to provide MAID safely but also that the necessary supports are available to clinicians and their patients through the assessment process.
Both the expert panel and the special joint committee on MAID emphasized the importance of interdisciplinary engagement and the knowledge of available resources and treatments. Experts and practitioner communities have also expressed the need for support mechanisms to be in place for providers undertaking assessments and persons who request MAID, irrespective of their eligibility.
While some jurisdictions have robust coordination services to manage requests and provide ancillary services, other jurisdictions take a decentralized approach, which can result in less coordination across services and disciplines. The availability of necessary support services for both practitioners and patients is also variable, depending on the region. For example, we have heard about the challenges of accessing health care services generally in rural and remote areas of the country. Additional time would allow more work to be done to support patients and clinicians involved in MAID.
The Liberal government is committed to supporting and protecting Canadians with a mental illness who may be vulnerable, while respecting personal autonomy and choice. The provinces and territories are ultimately responsible for the organization and delivery of MAID and supporting health services. Given their responsibility for how MAID is delivered, moving forward before provinces and territories are ready would not be the responsible course of action.
We believe that the extension of three years proposed in Bill would provide the time necessary to work on these important elements for the safe and consistent application of MAID for persons suffering solely from a mental illness.
:
Madam Speaker, Canadians would be forgiven for thinking they have seen this movie before, because they have. It was only last year that we debated Bill , which provided an extension of the coming into force of this dangerous legislation. Now we are debating Bill , which was introduced two weeks ago thanks to consistent pressure from Conservatives, advocates, experts, organizations and individuals from across the country who want to help individuals live with mental illness, not help them end their lives.
How did we get here? We got here because we have a , a and a government that have ignored the science, the legal experts, the courts and the pleas of the most vulnerable. They have ignored Canadians. They have plowed ahead with legislation to expand medical assistance in dying to Canadians who deserve help, Canadians who are suffering from mental illness.
I do not need to tell the House about some of the shocking headlines we have seen over the last year. Veterans suffering with PTSD are being told by employees of Veterans Affairs that they could consider MAID. Individuals without housing are considering MAID for economic reasons. Individuals, as we heard at our justice committee when we studied Bill , who did not wish to have MAID were consistently pressured to considered it.
On this side of the aisle, Conservatives have chosen the path of hope rather than harm, and we will continue to do so, but across the way, just this week, we heard a government minister say it is not a matter of if this expansion takes place; it is a matter of when.
I mentioned ignoring the law. When we were at the justice committee studying Bill , we consistently heard the government say that we have to do this because the courts told us we have to. Nothing could be further from the truth. First of all, there was a court decision, which the government did not appeal. That decision in no way directed the full expansion of accessibility to MAID to those suffering from mental illness. In fact, it was not in the original legislation.
What happened with Bill , which we studied at justice committee, in no way, shape or form involved expansion of MAID to those suffering from mental illness. However, when the bill got to the unelected Senate, it was amended to include this provision, which we had not even studied. The minister at the time assured us his bill was charter-compliant. The previous justice minister was at committee.
I am holding today a letter signed by 32 leading experts on the law, professors from faculties of law around the country. The letter says, “We disagree as law professors that providing access to MAID for persons whose sole underlying medical condition is mental illness,” which is what we are talking about today, “is constitutionally required, and that Carter...created or confirmed a constitutional right to suicide, as [the Minister of Justice] has repeatedly stated. Our Supreme Court has never confirmed that there is a broad constitutional right to obtain help with suicide via health-care provider ending-of-life.”
Those are powerful words. If I had time, I would read the names of the 32 professors who signed the letter. People would recognize many of them. They would certainly recognize the different universities they represent.
With the letter in hand, I said to the minister of justice, “Minister, you have come here saying that, constitutionally, you have to do this, but these 32 experts are saying you do not. Who is right, you or these experts?". The minister said, “I'm right.”
That is the attitude we have seen consistently with the government as it has plowed ahead in spite of the evidence, in spite of the concerns and in spite of the pleas from disability groups, mental health experts and psychiatrists.
I have a brief from the Society of Canadian Psychiatry, which makes a number of conclusions. I do not have time to read them all, but I want to touch on a couple of the conclusions:
At this time, it is impossible to predict in any legitimate way that mental illness in individual cases is irremediable. A significant number of individuals receiving MAID for sole mental illness would have improved and recovered.
This is a finding of the Society of Canadian Psychiatry. I have already spoken about this a bit, but even they can see this. They go on to say:
The political process leading to the planned expansion of MAID for mental illness has not followed a robust and fulsome process, has not reflected the range of opinions and evidence-based concerns on the issue, and has been selectively guided by expansion activists.
If that does not send a shiver down one's spine, I do not know what would. When we are talking about Canadians at their most vulnerable place, they should be able to count on us. How many of us participate in, for example, Bell Let's Talk Day every year? We say to people, if they are suffering with mental illness, to reach out, that we are here to help and that they should talk to someone they trust and access mental health support. Now, in spite of all this, we have psychiatrists saying the government is moving in the wrong direction.
I turn to their recommendations:
The Board of the Society of Canadian Psychiatry recommends that the planned 2024 MAID for mental illness expansion be paused—
It's not for a year, not for three years and not for five years, but:
—indefinitely, without qualification and presupposition that such implementation can safely be introduced at any arbitrary pre-determined date.
What are we led to believe when a government will not listen to legal experts when it comes to the criminal law and will not listen to psychiatrists when it comes to mental illness? It begs the question of who it is listening to and why.
This is the second time, and Conservatives have warned all along that there would be a dangerous, slippery slope. Canada has leapt ahead of all other nations. Some nations were ahead of the curve on this compared to Canada. Now they look at us and ask what happened that we would even be discussing providing assisted death to someone who comes to Veterans Affairs or to one of the number of hospitals across our country, looking for help, and instead is offered medical assistance in dying.
I want to set the record straight that the Liberal government has not, in any way, been bound by the courts to expand MAID to those whose sole underlying condition is mental illness. This was a path it chose to take. We need to take this time to reflect on that path, to turn back and to give people hope.
We all know individuals who have been touched by mental illness in the health care system. We know the wait times can be extraordinary for people to get help. We also know the government has contributed to those wait times. After eight years, people are suffering.
I would urge members to support this bill and then to look at ways to provide support for those suffering with mental illness, not to offer them assistance in death.
I move:
That the question be now put.
:
Madam Speaker, I am glad to be joining debate on Bill . Off the top, I will mention that I will be voting for it. Like the shadow minister for justice on the Conservative side said, this is about protecting the vulnerable. Though the federal government has dropped the ball in this latest iteration of its legislation, these three years, I hope, will be taken to basically fix the mistakes that were made all the way back to Bill . I want to talk a little about what brought us to this moment, and then refer to some constituents of mine who have emailed me over the last few months on the issue of assisted suicide.
I will also mention that I am sharing my time with the member for . I am sure he will add more to this debate.
To go back to the beginning, not too far to the beginning because I could get into Genesis, the Carter decision is what kicked off multiple debates that I have now been a part of. I have now seen this debate go from Bill to Bill to Bill , and the attempts by my hon. colleague from , who, I think, tried to do right by vulnerable Canadians all across Canada to make sure that we would not see an expansion of the MAID provisions to those who are still suffering with mental health conditions.
The great thing about Hansard is that I was able to go all the way back and review what I had said on Bill . I spent quite a bit of time complaining that the reasonably foreseeable clause would be knocked down by a court. It was knocked down by a court in the Truchon decision, because all our deaths are reasonably foreseeable; that is what living is all about. At the time, I had said that all of us who are born are born with one foot in our grave. One is assured one will die; one does not know just what it is, but it is reasonably foreseeable. I am just repeating it now. I know that it is morbid, but it is the truth. A lot of what we are dealing with here are issues of life and death and how one's death will happen. Therefore, at the time, this reasonably foreseeable clause would get knocked down, and it was knocked down in the Truchon decision.
My issues, just generally, are that, in a perfect world, this would not be necessary because people would not suffer. However, because this world is not perfect, people do suffer. People suffer in deep and different ways. Members know that I had a disabled daughter who passed away a few years ago. Had she lived longer, and I know at least one little girl in Calgary who has lived much longer with the same conditions my daughter had, she would be one of those vulnerable Canadians who would be facing the possibility that her physician, her specialist, might push for and might offer MAID.
I say “offer MAID”, but it seems so weird to say “offer MAID”, to offer something that I do not consider to be a medical service and to rush one's death sooner. Although we all die, as I said many Parliaments ago, the act of dying is not one that one does alone; it is done as a family, as a group of friends and with those loved ones around.
It is not something that happens in solitude. There are others who will miss one when one is gone. I know that it is difficult in a moment of suffering and a moment of great pain, or chronic pain, to believe it, to know it. A lot of the emails, the correspondence and the meetings I have had were with people who are worried about the assisted suicide MAID provisions, which the government has ineffectually dealt with through successive pieces of legislation. I think it was a grave error not to appeal the Truchon decision. I really do. I think it was a mistake. I said it to constituents at the time.
I have a Yiddish proverb, because I always do. They are great proverbs, and everybody should live by them and should know more of them. I just wish I could pronounce them in Yiddish: The truth never dies, but it is made to live as a beggar. This legislation is a beggar. This legislation should have been a permanent fix to the issues.
I think that Conservatives have suggested, both in committee and outside of committee, what some of those fixes would be. Although I disagree with an acronym, I will use RFND, reasonably foreseeable natural death. It should be limited to those who are terminally ill, where their death is foreseeable within the next six months, where there is a prognosis from a medical professional saying that one will indeed pass away.
For those most terrible conditions, I am thinking of a lot of cancers. My grandfather passed away from brain cancer in Canada, which brought my family to Canada. His death was very much reasonably foreseeable when it was terminal. There are others who have mental health conditions, which are caused by a physical condition. The mental health condition alone should not be the reason to seek assisted suicide.
Different Conservatives have mentioned, and I very much agree with this, that patients should be the ones requesting it. These are all things the government could have legislated into law. These are things that experts have said, and I want to read some of what the experts said in different committees.
Professor Trudo Lemmens and Mary Shariff persuasively rebutted a bunch of arguments that were made in Truchon. They noted again that reasonably foreseeable natural death applied to “all” persons, “not only to persons with disabilities”. “The judge in Truchon failed to appreciate how such a restriction reflects a constitutional duty to protect the equal value of the lives of all Canadians.”
I have read the Carter decision twice now. As many in the House know, this is something I take pride in saying that I am not a lawyer. I am not burdened with a legal education. I know the member for is disappointed and that the member for will be disappointed too, so I come to this as a layperson. Even the Carter decision did not say he had a right to die. It goes back to this idea, like I have said, that all of our deaths are reasonably foreseeable. It will happen; it is unavoidable in life.
These two experts said that the judge in Truchon made a mistake. This concept, this expertise, was then repeated in observations made by 72 disability rights organizations that penned a letter to the then justice minister. They said that reasonably foreseeable natural deaths are the ones where there is terminal illness that is coming up very quickly, and that this idea is an equalizing effect, guaranteeing a common thread among persons accessing MAID, assisted suicide, namely that they are dying within a very short time window. That is how I think this legislation should work. I am not saying there should be no MAID.
The Carter decision stands as a Supreme Court decision in Canada, so there has to be a provision of it in a method. It should be rare and should be restricted to the very few people for whom it was originally intended. I feel that Bill to Bill to the situation we are in today do not address that. That is why we have this legislation that is a beggar. It is not in the original form that it should be. The truth lies in abiding by what Carter decided.
Another one reads, “From a disability rights perspective, there is a grave concern that, if assisted dying is made available...regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.” That is a terrible message to send to persons with disabilities. I am thinking of my daughter, had she lived. That would have been a terrible message to send to her.
All three of my living kids have a chronic kidney condition. My boys will likely need a kidney transplants. What a terrible thing to tell them, that they are a burden on the medical situation and that maybe they should seek faster death. Is that what specialists are going to tell them when they are adults? I will not be in the room, but they will be in the room. Will that be pushed onto them? For those who are on dialysis, it is hard on their bodies to go three to four days a week to get dialysis in a hospital setting. I am not speaking of peritoneal dialysis that can be done in the home.
There have been lots of experts. The member for explained a lot of what has been said on the issue. The government keeps erring in the wrong direction with more expansive legislation to allow more people to access something that was not the original intention of Carter. We should abide by Carter, as I mentioned before.
I have had constituents write to me. I just want to make sure that I read some of their thoughts into the record. Leanna wrote, “Please Halt the expansion of MAID to include those facing mental illness.” Catherine wrote, “As a parent who has seen my own children experience mental health challenges while in their teen years and early twenties, I am writing to express my deep concern about people with mental illness alone becoming eligible for medical assistance in dying. The move towards this will put countless vulnerable people at risk.”
Joe, in my riding, is a regular writer. I respond to most of his emails. I will send this to Joe just to make sure he knows I read his emails. His second and third points read, “By offering MAID for mental illness governments may put less money into treating mental illness.... Canadians may wish for MAID because of despair. They have not have been offered treatment for their mental illness.”
Cameron talked about a friend of his who is a nurse working in a mental health unit in Calgary. Mental health for him is all about seeing the intrinsic value of every human being, as celebrating the person not for what they contribute but for the beauty of their existence. He feels that once we stop seeing the dignity of one person, we will doubt our own worth and validity.
I know my time is running short, so I will not belabour this. I have heard comments from some members of the House who have tried to impugn a person's faith, religion or philosophical affiliations with whatever beliefs; although, all of us come to the House with our different beliefs. Some of them are sacred. Some of them are secular. It really does not matter where they come from, but all of us try to ascribe value to life, what that life is and what autonomy should be like.
To those members, I note that I did abstain from one vote that was specifically on advance directives because I have a constituent, Jim, who communicated with me over email that he and his spouse saw the experience of his mother, who passed away from Alzheimer's, and how terrible it was. In situations like that, it is incumbent upon the government to find a way to meet the requirements of the original Carter decision so that Jim and his spouse, when that time comes, can have their wishes met.
:
Mr. Speaker, I rise today to speak to Bill which seeks to delay the expansion of medically assisted death to individuals whose sole condition is a mental illness until March 2027.
Yesterday, in anticipation of these remarks, I sent an email to about 10,000 constituents, and I heard back from 95 of them on the subject we are debating today, medical assistance in dying, or MAID. I heard from parents who have lost children, as well as those who have suffered from depression and were able to overcome their illness with treatment.
The majority of respondents agreed with the position I am about to outline, but there were some who did not. Many of those who disagreed with my stance came from Mission—Matsqui—Fraser Canyon's very large and diverse Dutch community. Given its history in, and our connections to, the Netherlands, people in the Dutch community have a deep understanding of this issue. I appreciated hearing their thoughtful comments.
Among those who disagreed, the most common concerns raised were about access and advance requests for those suffering from dementia. Concerns were also raised about the challenges many Canadians face in accessing mental health supports and treatment, which can leave some feeling hopeless. In fact, it nearly brought me to tears, hearing from constituents who asked, “How dare you try to take away the right for me to access MAID when I am suffering from mental illness?” They did not see a pathway out for the circumstances in their life. That is a horrible position to be in.
One thing, however, was unanimous: Our health care system is failing to meet the needs of Canadians suffering from mental health challenges. This must be addressed. I am grateful to everyone who took the time to share their thoughts and concerns in a compassionate and respectful way.
Almost a year ago, I stood before my colleagues in this House and expressed my concerns about the Liberal government's decision to extend medically assisted death to individuals suffering solely from mental illness. I highlighted the stark contradiction between our efforts to promote mental health awareness and services and those to offer death as an option to those struggling with mental health challenges.
Mental health affects every family in our country, and it pains me to see the government contemplating the provision of death as an option to individuals who are at their lowest point. I shared the heartbreaking story of a member of my community of Abbotsford, who received medically assisted death without her daughters being informed, despite her documented mental health condition. Regrettably, such stories are becoming too common under our existing MAID regime.
Retired corporal Christine Gauthier, who represented Canada at the Paralympic Games, testified before the Special Joint Committee on Medical Assistance in Dying that she had tried for five years to get a wheelchair ramp installed in her home through Veterans Affairs Canada. Instead, she was offered MAID by a VAC caseworker. A week before her testimony, the confirmed that at least four other veterans had been offered MAID as well.
Now, after eight years of the Liberal government and with the cost of living soaring, some Canadians are seeking MAID in fear of homelessness. Most recently, a member of my community from the Family Support Institute of BC raised deep concerns about the expansion of MAID. They stated that, even with the current restrictions, our most vulnerable populations are gaining access to MAID without adequate precautions, social services, expertise, professional supports and wraparound social networks to consistently represent their interests and voices.
Despite our repeated calls to protect the most vulnerable, I believe the Liberal government has failed to act responsibly on this point.
Around this time last year, instead of cancelling the expansion of MAID for mental illness, the Liberals introduced last-minute legislation to impose a temporary one-year pause. Now, a year later, I am here again to see that the government wants to add another pause of three years to the mental illness expansion, delaying it until March 2027.
This past fall, the Liberals had an opportunity to get rid of this expansion altogether. In February, my colleague, the hon. member for tabled Bill , which would have cancelled the expansion of MAID to those with mental illness as the sole condition. When the bill came up for a second reading vote in October, most Liberals, along with the Bloc Québécois, defeated it.
The government is seemingly only choosing to delay the expansion again after the significant backlash it has received from mental health experts, doctors and advocates across Canada. It seems that the government wants to recklessly push aside this issue instead of listening to what Canadians and, indeed, our mental health professionals want.
For many years we have heard about the fast expansion of assisted suicide in Europe. Now, Canada has infamously become a global leader with its progressive euthanasia policy. The Netherlands was the first country in the world to legalize euthanasia, and it took the country over 14 years to reach 4% of the total population's death from assisted suicide. Other countries with similar policies, such as Switzerland and Belgium, have not even reached the 4% mark. Canada's MAID regime has only been around for six years and has outpaced these countries with euthanasia, accounting for 4% of total deaths in 2022. Health Canada reported that 13,241 Canadians received assisted suicide just in the past year. That is more than a 30% increase from 2021 deaths.
Belgium allows euthanasia to children of any age. Most recently, the Netherlands expanded its euthanasia policies to include terminally ill children. The Liberals have met with the largest pro-MAID lobbying group, Dying with Dignity, many times. This group is advocating for assisted suicide to be expanded to mature minors. If the government continues to take us down this slippery slope, will it lead us to a path that expands euthanasia to all children? Youth in this country are already falling through the cracks, with suicide being the second leading cause of death for youth and young adults. How can youth struggling with mental illness even think of having a better future if they become eligible for MAID and it is normalized? The Liberals, in my opinion, are inadvertently creating a culture of death.
Delaying the expansion of MAID for mental illness is not enough. The government must immediately and permanently halt the expansion of MAID to those with mental illness. The reports from the committee echo what Conservatives have been advocating for years, which is that expanding assisted suicide to those suffering from mental illness will lead to the premature death of individuals who could have recovered with proper support and treatment.
The government is taking an ideological stance, and it is not listening to the experts working in the field. Last year, the country's largest psychiatric teaching hospital, the Centre for Addiction and Mental Health, said that it is not ready for this expansion and emphasized the need for more mental health resources.
The chief of the psychiatry department at Sunnybrook Health Sciences Centre in Toronto, Dr. Sonu Gaind, has said that it is irresponsible for us to provide “death to someone who isn't dying before we ensure that they've had access and opportunity for standard and best care to try to help alleviate their suffering.”
We cannot overlook the inherent dignity and value of human life, especially when individuals are at their most vulnerable. It is our duty as lawmakers to prioritize the well-being and protection of everyone in Canada, particularly those facing mental health challenges.
As the member of Parliament for Mission—Matsqui—Fraser Canyon, I believe in upholding the principles of compassion and support for those struggling with mental illness. Yes, I also acknowledge that we need to do a lot more; efforts to date have not been sufficient, whether in terms of the government response or the societal response.
Delaying the expansion of MAID for mental illness is not the solution; it merely postpones the inevitable reckoning of the profound ethical and moral implications of such legislation and the broader implications we are faced with here today. Those struggling with their mental health deserve support and treatment, not death. We know that recovery is possible when treatments are more readily available.
:
Mr. Speaker, I will be sharing my time today with the member for .
I am very pleased to have the opportunity to speak in this House today in support of Bill , particularly after listening to some of the debate this morning and hearing some of the language used in this House today.
For example, the member for , throughout his speech today continually used the words “the mentally disorded” I believe in reference to people who are suffering from mental illness. A little later in the day, we then heard from the member for , who continually referred to people as “addicts” throughout his speech.
In this House, we are leaders. Our words are important and we should not be furthering the stigmatization of people who suffer mental illness. I would caution my colleagues across the way to be careful in their language and to please not further marginalize people who are already suffering.
I will turn back to Bill . As the and the have emphasized, the government believes an extension of three years is necessary to provide individual clinicians as well as provinces and territories the time they need to prepare for this change.
I also believe a three-year extension of the period of ineligibility to receive MAID on the basis of a mental illness alone is necessary. Although significant progress has been made, more time is needed to ensure the safe assessment and provision of MAID in these circumstances. I have heard from psychiatrists in my riding of Hamilton Mountain who have said these very things. They need more time to get the system ready.
My remarks today will focus on the progress that has been made in preparing the health care system, and also what more needs to be done.
In 2021, as required by former Bill , an expert panel examined the issue of permitting MAID where the sole underlying condition is a mental illness. It concluded that the existing legal framework of eligibility criteria and safeguards is sufficient, providing that MAID assessors apply the existing framework appropriately with guidance, through the development of MAID practice standards and specialized training.
Our government understood the importance of the panel's findings. To that end, we have been working in collaboration with the provinces and territories and other health care partners to implement consistent standards across the country and support a highly trained workforce to undertake these complex assessments.
For example, we supported the development of a model practice standard for MAID by individuals with clinical, regulatory and legal expertise. A model practice standard for MAID was released in March 2023 and has been adopted, or is in the process of being adopted, by most regulators across the country as a basis for assessment for clinical decision-making. The standard also provides guidance for MAID clinicians as they navigate more complex MAID requests.
We also supported the development of the first national, fully accredited bilingual MAID curriculum, which was launched in August 2023. The curriculum consists of seven training modules addressing various topics related to the assessment and provision of MAID, including how to do a MAID assessment, how to assess capacity and vulnerability, how to manage complex chronic situations and how to assess requests involving a mental illness. Over 1,100 clinicians have registered for the curriculum since August of last year.
This progress is the result of leadership and collaboration among health system partners, including federal, provincial and territorial governments, health professional organizations, regulatory bodies, clinicians and organizations like the Canadian Association of MAID Assessors and Providers. This collaboration and progress will continue to make improvements in approaches to safety and quality in assessments and provisions of MAID.
In terms of the future, I want to briefly speak to the Regulations for the Monitoring of Medical Assistance in Dying, which outline the reporting requirements relating to MAID requests. These regulations came into force in November 2018, but were recently revised to facilitate enhanced data collection and reporting on MAID activity. Most notably, the regulations now allow for the collection of data based on race, indigenous identity and the self-reported presence of a disability, where a person consents to provide this information.
The revised regulations came into force on January 1, 2023, and information on MAID activity in 2023 will be released in Health Canada’s annual MAID report this year, in 2024. This information will provide valuable insight into who is requesting and receiving MAID, including those under track 2, whose natural death is not reasonably foreseeable.
Despite all this work, we have heard that the provinces and territories are at various stages of readiness for the lifting of the exclusion of eligibility and that they need more time to prepare their health care systems.
I know that the suffering caused by a mental illness can be just as severe as that caused by a physical illness, but I strongly believe that this extension is necessary to ensure that MAID can be safely assessed and provided on the basis of a mental illness alone. This extension does not question the capacity of people with mental illness to make health care decisions. It is about giving the health care system more time to adopt or implement some of these key resources to ensure that MAID practitioners are properly equipped to assess these complex requests, and that the provinces and territories have the necessary mechanisms in place to support them.
For example, both the expert panel that I referred to earlier and the special joint committee on MAID have emphasized the importance of case review and oversight of MAID, both to educate practitioners and to support accountability and public trust in the law. While the majority of cases of MAID, 90%, take place in provinces with formal oversight processes, other provinces do not have formal MAID case review and oversight processes in place beyond those already undertaken by professional regulatory bodies.
Work is being planned to explore best practices through a federal-provincial-territorial working group, with a view to encouraging more consistent and robust mechanisms across the country.
The expert panel and the special joint committee also identified engagement with indigenous partners as a priority. The Government of Canada has launched a two-year engagement process on MAID to hear the perspectives of first nations, Inuit and Métis, including urban indigenous people, indigenous people living off-reserve with or without status, indigenous people living with disabilities, and two-spirit, LGBTQQIA+ and gender-diverse indigenous people.
The proposed extension under Bill would provide the necessary time to have these discussions with indigenous partners. It is an essential process to appropriately inform implementation as well as guidance and training material for clinicians to support enhanced integration of cultural safety in MAID practices.
Health Canada will provide its first official update to Parliament on this work in March 2024, just next month.
In conclusion, the Government of Canada remains committed to ensuring that laws reflect the needs of people in Canada, protect those who may be vulnerable, and support autonomy and freedom of choice. While we have made significant progress in the study of MAID and mental illness, and in the development and dissemination of key resources, we are not yet ready. We need to act prudently and not rush this change without the necessary resources in place.
This decision is not an easy one, but I want to assure the House that we will continue to work collaboratively with our partners to improve the mental health of Canadians.
I thank all members for the opportunity to speak today as we debate this important bill.
:
Mr. Speaker, I am rising for the second time this week to speak to this issue. As I said at the beginning of my speech at second reading, I was so interested in this issue that I offered to sit on the Special Joint Committee on Medical Assistance in Dying when it dealt with the question of mental illness. I felt it was my duty to take part in a debate that is so important for our society. This is a crucial and extremely complex social debate. As a legislator, I wanted to learn more about this hot-button public policy issue that is so important to my constituents. Many of them have written to me about this.
I attended much of the debate on the issue this week, and I was very impressed by the tone. It is true that emotions can sometimes get the better of us, but that is to be expected when we are debating such a crucial matter, a matter of life and death. I must say that I was impressed that the debate was conducted in a respectful manner. That is impressive, and we should adopt that same tone when we discuss the many other issues addressed here in the House.
I heard arguments that I do not want to call fallacious, because that is a pejorative term and I do not want to criticize anyone, but let us just say that I heard a few contradictions during certain speeches.
First, someone claimed that we could have simply amended Bill to include advance requests. I do not think we are ready to make a hasty amendment to open the door to something as complex—if not more—as medical assistance in dying, namely, medical assistance in dying for persons with a mental illness. It took much effort, much debate, much discussion and several committee meetings for us to be able to talk about medical assistance in dying for patients with a mental illness.
Moreover, the idea that we can move an amendment in committee is wrong, because such an amendment would certainly be ruled out of order, since the scope of the bill is not that broad. The bill deals with a specific question, namely, medical assistance in dying for persons with a mental illness.
People claim we are taking too much time to debate this issue, that it has already been three years and that we should end the debate. We are not talking about policies like affordability or the need to build housing as quickly as possible. We are talking about something very serious. We really are going beyond the more practical issues, and I think it will take the time it takes because there is no consensus among the experts. If there is no consensus, we cannot force the issue, suddenly demand consensus and insist we move forward because time is running out. The issue of how long it will take to reach a good conclusion is unfortunately not a problem for me.
As I was saying, this is not simply a technical medical issue, it is a moral and ethical issue for society, certainly.
The matter of caution was also raised. Some claim that the government is too cautious, too timid, on this issue, that it is not acting as quickly as people would like, that it has not addressed the issue fast enough or lacks political will. It does in fact lack political will because there are too many uncertainties. In this case, it is not a bad thing to lack political will in order to forge ahead as soon as possible.
However, on this idea of being too cautious, I would say that this is true even for the Bloc Québécois, because it has accepted the framework we have established. For the moment, we are not implementing this framework. Nevertheless, under the framework, not everyone who requests medical assistance in dying on the grounds of a mental illness will receive it. We are talking about a mere 5% acceptance rate. Even if we went ahead, we would do so with a lot of caution, given the 95% of people who would request medical assistance in dying on those grounds.
We should then not talk as if caution were not an issue. Caution is an issue, even if we agree to move forward. I would like to ask my colleagues who keep disparaging the government for its caution whether it would be too cautious to require that, in these cases, a psychiatrist be involved in assessing the person's request. Right now, it is not necessary for a psychiatrist to be involved in the assessment. In the Netherlands, where medical assistance in dying is legal, a psychiatrist must give an opinion on the request. There is caution built into the process, but it is not unreasonable. I would say that my colleagues in the Bloc Québécois agree that some caution is required.
There is also talk about freedom. Some say that this is a matter of freedom, as if they were talking about absolute freedom. It is not a matter of absolute freedom, because 95% of those requesting medical assistance in dying would not have access to it on the grounds of a mental illness. We need to make things clear and add nuance to this debate to avoid giving the impression we are talking about absolute concepts.
Then they bring up the issue of the Quebec nation. I listened carefully to my friend, the hon. member from , with whom I enjoyed working on election reform. He is a seasoned parliamentarian who makes excellent speeches in the House. He said that there were many nations in Canada. Indeed, there is the Quebec nation, but there are also indigenous nations. There are indigenous nations within the Quebec nation as well. What I understand is that indigenous nations are not too keen to move this issue forward at this time. They say that they have not been consulted enough. They have concerns about the systemic racism that exists in health care systems across the country. Among other things, they are afraid that not enough thought will be put into processing the requests.
We should not focus too much on the idea of community when it comes to medical assistance in dying. When people get to that point, when they are on their death bed, I do not think they dwell too much on the community. Each person is a soul facing infinity alone. That is why we should not talk too much about nations when we are discussing medical assistance in dying. It is not a matter of being part of a community. I agree that it is a matter of individual rights. That is where it gets complicated, because we do not want people to suffer.
However, we do not want people to do things that have not been assessed with the utmost caution, because it is a matter of life and death.
I will stop here and await my colleagues' questions.