:
Mr. Speaker, it is an honour to rise today on the unceded lands of Tseshaht and Hupacasath on Vancouver Island in Nuu-chah-nulth territory to speak to Bill , which is calling for the extension of the temporary exclusion of eligibility for medical assistance in dying for persons suffering solely from a mental illness by three years, until March 17, 2027.
Clearly, without an intervention by Parliament, this expansion would come into effect on March 17, 2024, in just one month. New Democrats agree with the majority decision made by the Special Joint Committee on Medical Assistance in Dying, also known as the AMAD committee, which I will refer to it as in my speech. It reported that Canada is not adequately prepared to deliver medical assistance in dying to individuals whose sole underlying medical condition is a mental disorder.
The bill would allow more time to implement the necessary safeguards and address the capacity concerns that are expected to be the result of the expansion of medical assistance in dying for those with the sole underlying medical condition of a mental disorder. It would give medical practitioners more time to become familiar with available training and supports, while providing time for the public to become more aware of the robust safeguards and processes in place. I know this is a very sensitive and very personal matter to so many people around this country. Especially in my riding of Courtenay—Alberni, I have heard from many people about this.
We also need to ensure that we have the understanding and compassion to respect the right of an individual's choice of dignity when they have deep, prolonged and ongoing suffering. I will speak to that. Suffering from mental illness is extremely serious, and it is just as real as suffering from a physical illness. In our health care system, we clearly do not have parity when it comes to mental and physical health, and I will speak to that as well.
We must also affirm and protect the most vulnerable when we do any sort of decision-making on such a serious piece of legislation as expanding medical assistance in dying. This additional delay is necessary and needed right now to ensure that we have a health care system in place that can safely provide medical assistance in dying for those whose sole underlying medical condition is a mental disorder.
We know how we got here. The Liberal government made an ill-advised decision and did a complete 180° by accepting the Senate's amendment to Bill in the 43rd Parliament. That is what got us here. The government changed the law before any kind of comprehensive review had been conducted, and we have been trying to play catch-up ever since. I am going to speak about the important work that needs to be done, and I want us to be thoughtful in our approach to expanding medical assistance in dying.
As New Democrats, we take people's concerns and feedback very seriously. We are committed to helping find the best possible solution for Canadians in the policy of medical assistance in dying to ensure that it does what it was always intended to do. One of the biggest concerns New Democrats have with the expansion of medical assistance in dying is with the barriers that many Canadians face when they reach out for mental health treatment. Because of the Liberals, and the Conservatives before them, the chronic underfunding of our health care system has become even more apparent. It is now more than ever, as we see the disparity between mental and physical health and how people are taken care of.
We heard the promise to implement a new mental health transfer of $4.5 billion over five years, but he has still not done that. Even with the bilateral agreements, the Liberals are falling far short, and that would not even be enough. Everyone should be able to access mental health supports when they need it, but under the Liberal government, and that of the Conservatives before it, this has not been the reality. It is the same with all provinces and territories.
New Democrats wholeheartedly support the delay in expanding medical assistance in dying for those who have a mental disorder as the sole underlying condition, but the Liberal government needs to ensure that proper consultation happens between now and the expansion date, or it would need to be extended again. It needs to ensure that people will be protected while respecting their individual choice.
The Liberals cannot just delay the expansion either. They need to fund adequate supports and treatment options for people dealing with mental illness. Members have heard me say this repeatedly, but we need a pathway, a road map, to how we are going to achieve parity for mental and physical health and ensure people get the timely help they need when they need it.
Seven of the provinces and all three territories have said that they are not ready and have signed a joint letter to that effect, including my home province of British Columbia. That was signed by the ministers of health in those provinces and territories. They are calling for an indefinite pause on the expansion for individuals whose sole underlying medical condition is a mental disorder. That is what those ministers identified.
As New Democrats, we want to see a MAID regime where guardrails are in place to protect vulnerable populations while still allowing for personal bodily autonomy and end-of-life choices. We must make sure that people do not request medical assistance in dying because they do not have access to treatments, supports and services. This has to be absolute. The Liberals need to make sure everybody can access mental health supports. However, after nine years of carrying forward with the Conservative cuts to health care, this is where we are at right now right across the country. Help is out of reach for many people. This needs to change before medical assistance in dying can be expanded.
We know that the housing, toxic drug and mental health crises that are happening are not being addressed. I see that I do not have a lot of time left, but I want to ensure I outline that the AMAD committee heard from plenty of witnesses who cautioned the committee on expanding MAID in cases of persons suffering solely from a mental illness. I want to share what a couple of those experts had to say.
Professor Brian Mishara, who is with the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at Université du Québec à Montréal, said, “The expert panel report on MAID and mental illness states that there are no specific criteria for knowing that a mental illness is irremediable”, and that there is absolutely no “evidence that anyone can reliably determine if an individual suffering from a mental illness will not improve.” He warned us that “any attempt at identifying who should have access to MAID will make large numbers of mistakes, and people who would have experienced improvements in their symptoms and no longer wish to die will die by [medical assistance in dying].”
We heard from many experts. The CAMH raised similar concerns.
Because I see that I only have a couple of minutes left here, I want to talk a bit about the system and the lack of access. We are talking about a crisis going on from coast to coast to coast, according to a poll done just a year ago. The Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction released a report talking about postpandemic findings. It cited that 35% of respondents reported moderate to severe mental health concerns.
This is alarming. It should also be alarming to all parliamentarians that it found that fewer than one in three people with current mental health concerns accessed services. The report identified key barriers to accessing services as financial constraints and help not being readily available. We know that right now we are in a financial crisis, and I am sure those numbers have only gone up. It identified that one of the top stressors was between income and unemployment with mental health concerns.
We need to create a system of parity with mental and physical health. The government has not delivered when it comes to a plan, a road map, on how we achieve parity with physical and mental health. I hope in this budget, it is going to release funding on top of the bilateral agreements directly to community-based organizations as a COVID emergency recovery response because, post-COVID, we know some people are struggling financially, but the biggest concern right now and the biggest epidemic post-COVID is in mental health. I hope the government is hearing that.
I see that I have run out of time. I have a lot to say on this matter. I look forward to taking questions from my colleagues.
:
Mr. Speaker, I joined the latest edition of the Special Joint Committee on Medical Assistance in Dying, which was mandated to deal specifically with the question of the health system's readiness for an extension of MAID to cases of severe mental illness, out of a sense of duty as this is a deeply serious matter for Canadian society, one on which I received correspondence from a great many concerned constituents.
At first, I humbly questioned my qualifications to sit on the committee. I am not a psychiatrist. I am not a medical doctor. I do not have expertise or experience in this area. However, in a democracy, not all is left to the experts. The people, through their elected representatives, set legal parameters in areas of public interest by way of legislation and regulations. In fact, that is what has been happening since 2016 on the issue of MAID.
That said, it is important to carefully listen to and consult the experts out of respect for the authority of knowledge and experience. This is the opposite, I might add, of the new populism.
I agree with the committee's recommendation that we should indefinitely postpone MAID where the sole underlying condition is mental illness, also known as MD-SUMC. The central issue in MD-SUMC is irremediability; that is the question of whether there is the possibility that a person with severe mental illness can be cured of their terrible suffering, a suffering not different from physical suffering.
Under the law, for a person to be deemed eligible for MAID, the illness must be irremediable; grievous and irremediable. The problem when we move from somatic, that is physical, illness to psychiatric illness is that irremediability becomes more difficult to establish. In the case of psychiatric illness, an accurate prognosis is infinitely more difficult to produce.
Because of the difficulty, in cases of mental illness, of offering a reasonably certain prognosis, the determination of irremediability will necessarily have to be based on a retrospective view; that is on an assessment of the extent of a patient's past treatments and whether the patient exhausted all treatment possibilities in a quest to be relieved of their suffering. The problem is that the MAID assessors will most likely not have been involved in past treatments, which makes it difficult to ascertain the quality of those treatments. When it comes to establishing irremediability in cases of mental illness, evidence has shown accuracy is poor. It is less than 50%, a coin toss.
To quote Dr. Sonu Gaind, one of the experts who appeared before the committee, “Worldwide evidence shows we cannot predict irremediability in cases of mental illness, meaning that the primary safeguard underpinning MAID is already being bypassed, with evidence showing such predictions are wrong over half the time.”
It should be pointed out that under our MAID law, clinical certainty about irremediability is not actually required. Here it is important to highlight the distinction between legal irremediability and irremediability in clinical medicine.
In the MAID law, “grievous and irremediable” has a different meaning than in medicine. It is defined as incurability, “be in an advanced state of irreversible decline” and “enduring...physical or psychological suffering” that is intolerable to the person and cannot be relieved “under conditions the person considers acceptable.”
In law, therefore, it is not necessary to establish irremediability with a degree of clinical certainty. Rather, both patient and assessor must come to the shared understanding based, among other things, on the assessor's analysis of the history of past treatments. There is an element of subjectivity on the part of both patient and assessor. Naturally, the assessor will bring their own philosophical biases, values and ethics to this subjective equation.
As Dr. Gaind suggested to committee members, “Try those mental gymnastics on your constituents. Convince them it was okay that their loved ones with mental illness got MAID, not because of a clinical assessment based in medicine or science, but because of the ethics of the particular assessor.”
An important issue in determining eligibility for MD-SUMC is being able to separate suicidal ideation from a considered request for MAID. It bears keeping in mind that suicide attempts are not always rash and impulsive, the product of a panicked state. This, in some ways, is a stereotype. Psychiatrists will say that some suicides are not frenetic but carefully planned in advance.
Dr. Tarek Rajji, chair of the medical advisory committee at the Centre for Addiction and Mental Health, told the committee, “There is no clear way to separate suicidal ideation or a suicide plan from requests for MAID.”
To again quote, Dr. Gaind:
We cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests, with overlapping characteristics suggesting there may be no distinction to make.
In the Netherlands, an assessment by an independent physician is required for MAID, and in the case of psychiatric suffering, a third assessment by an independent psychiatrist, preferably one with specific expertise regarding the patient's disorder.
The problem with Canada's law, as it stands, is that there is no requirement for one of the assessors of MAID eligibility to be a psychiatrist, yet psychiatric issues are exceedingly complex. Often a patient has more than one illness. It is said that 71% to 79% of psychiatric patients who died through MAID in the Netherlands had more than one psychiatric disorder.
We humans are not self-directed, rational atoms exercising unencumbered clear-eyed autonomy. We are not as free as we think. We are born into families and communities, and influenced by the opportunities they offer, and alternatively, by the constraints they impose on us.
I sometimes wonder if we are not in the process of turning personal autonomy into ideology. I say “wonder” because as a liberal, I have not been bestowed the gift of absolutism that has blessed ideologues.
Requests for MAID can be influenced by, even driven by, extraneous factors like poverty and isolation, that is by psychosocial factors. According to Dr. Gaind, “those with mental illness...have higher rates of psychosocial suffering.”
This all means that MAID assessors will be wrong over half the time when predicting irremediability, will wrongly believe they are filtering out suicidality and still, instead, provide death to marginalized suicidal Canadians who could have improved.
Archibald Kaiser, Professor at the Schulich School of Law and Department of Psychiatry, Faculty of Medicine at Dalhousie University added that “The Supreme Court concluded in 1991 that people with mental illness have historically been the subjects of abuse, neglect and discrimination.”
Dr. Gaind further underscored that “Suffering is cumulative, and life suffering unfortunately fuels much of the suffering of those with mental illness, even more so for marginalized populations.”
There is, in fact, the possibility that gender-based marginalization can influence requests for MD-SUMC. We know that in countries that allow MAID for severe mental illness, the ratio of women to men who seek MD-SUMC is two to one.
For their part, indigenous representatives have expressed serious reservations about expanding MAID to include mental illness. According to Professor Kaiser:
In February 2021...many distinguished indigenous signatories wrote to Parliament that the consultation ... has not been adequate and “has not taken into account the existing health disparities...we face compared to non-Indigenous people.” They said, “our population is vulnerable to discrimination and coercion...and should be protected against unsolicited counsel.”
We know there is systemic racism in the health care system. Ask the family of Joyce Echaquan. How would systemic racism influence the rate of acceptance of MAID requests of indigenous and other racialized peoples? That is a pertinent question.
As Dr. Lisa Richardson, Strategic Lead, Centre for Wise Practices in Indigenous Health, Women's College Hospital, told a Senate committee on February 3, 2021:
In an environment where both systemic and interpersonal racism exists, I don’t trust that Indigenous people will be safe. I don’t trust that anti-Indigenous prejudice and bias will not affect the decision making and counselling about MAID for Indigenous people, no matter how much education is given.
Indigenous communities, many of which have felt the scourge of high suicide rates, especially among youth, may have concerns about possible contagion effects of MD-SUMC on suicidality.
Then, there is the basic question of the ability of the health care system in Canada, already stretched to the limit, to handle an expansion of MAID.
According to Dr. Eleanor Gittens of the Canadian Psychological Association, as a country we have not yet established parity between available physical and mental care. To quote her, “Care and treatment of mental illness are not covered by medicare, nor is it readily accessible.”
We do not really know how many people would request MD-SUMC, and thus whether we have enough qualified assessors. By some estimates, we would have well over 2,000 patients a year getting MD-SUMC with countless more requesting eligibility assessments. I know there is dispute around that number.
Just because there is a published Health Canada standard for MD-SUMC and a training module does not mean the system is ready. A building built on a soft foundation is not ready for occupancy, no matter the level of completion of its structure. There are today no safeguards preventing poverty, housing insecurity, loneliness, etc., that is psychosocial factors, from significantly fuelling MAID requests of those suffering from mental illness.
I will quote Dr. Rajji: “The standards document itself, the one developed by the expert panel, states that these are not clinical guidelines, and this is what is missing to ensure quality.” According, again, to Dr. Gaind, “it is a legal fiction that determinations of the eligibility of MAID are based on objective clinical judgment. In fact, I regularly witness practitioners' values influencing the interpretation of the current MAID eligibility criteria and safeguards.”
As per an article in the review Impact Ethics, “The few jurisdictions allowing MAiD for [sole] mental illness have safeguards Canada lacks, notably (unlike Canada) requirement of due care and no reasonable alternative, or treatment futility, prior to MAiD eligibility.”
In Canada, a patient would be able to qualify for MD-SUMC even if they refuse treatment. Often a psychiatric patient will refuse additional treatment owing to treatment fatigue. While treatment fatigue has been studied in the context of HIV and type 1 diabetes, with the goal of developing strategies to help overcome it, treatment fatigue has not yet received attention in psychiatry. A better understanding of treatment fatigue could lead to alternatives to MAID, such as palliative or recovery-oriented treatments.
I respect the Senate. I value the Senate. Senators bring more than just sober second thought; they bring expertise in fields crucial to good public policy making, but senators are not elected. They are not the voice of the people. It was never the government's intention to extend MAID to those suffering from mental illness.
The government was running out of runway to meet the court-imposed deadline in the Truchon decision for amending the law to remove the requirement that death be foreseeable to qualify for MAID. It could not afford a back-and-forth game of procedural ping-pong with the Senate over its last-minute amendment to remove the mental illness exclusion from Bill . It had to accept the Senate's amendment to get the bill across the finish line.
In my view, we are not ready for MD-SUMC. We cannot ascertain irremediability with any acceptable degree of certainty and objectivity. We cannot sufficiently distinguish an unfettered request for MAID on the grounds of mental illness from suicidal ideation. We are not able to separate out psychosocial factors that might drive MD-SUMC. We have not properly consulted racialized communities to take account of their views, concerns and fears, notably those of indigenous communities, and we have not built proper safeguards into the law.
We do not require the involvement of a psychiatrist in assessment nor require that a person have reasonably exhausted available treatments before making a request for MD-SUMC. The few other jurisdictions that allow MD-SUMC have this requirement.
We have not studied and understood treatment fatigue such that we can develop strategies that can possibly lead a patient to other non-lethal treatment options, and finally, we have allowed an unelected body, the Senate, to drive this agenda.
:
Madam Speaker, I will be sharing my time with my colleague from .
Once again, I rise in the House to speak about a sensitive topic, one that is fundamental in our lives, and that is medical assistance in dying. Personally, I am in favour of medical assistance in dying. I am not here to defend my personal opinions. I am here as a legislator who has to consider all the data that support giving the green light, under certain conditions, to medical assistance in dying or, conversely, the red light urging us to not go forward.
I believe this is in no way a partisan issue. People can be on the left, they can be on the right, they can be sovereignists, or they can be federalists; that is not the point. It is a matter of how we, as human beings, feel about this issue. Regardless of where we come from or where we are on the political spectrum, we are first and foremost human beings. On that basis, we must make a choice for people who need medical assistance in dying, and we must make sure this is done right, within the proper rules.
We are dealing with this situation because the debate began here, at the federal level, in 2015. However, in Quebec, the debate began long before that. It just so happens that I have participated, both at the provincial and federal levels, in the early stages of this legislation that we are discussing today.
I would remind hon. members that the first province to have legislated on this issue did not do so overnight, quite the opposite. Only after six years of serious, thorough, scientific and medical debates and hearings did the Quebec government and the National Assembly vote for a law that would be the first step in medically assisted dying. I would like to emphasize the importance of that process. It was done over six years, under three different governments, under three different premiers. That proves this is not a partisan issue. As much as possible, we should always take this approach.
I will always remember, during the final debate on the adoption of the first steps toward medical assistance in dying in Quebec, how one of the members was very much against the bill. I can see him now, rising in the National Assembly and telling members not to vote for it. He felt so strongly on the issue and was so against the bill that he was red in the face. Once he sat down and the speech was over, I applauded him. I did not applaud him because I agreed with him. I applauded him because we live in a democracy that allows him to express an opinion that differs from my own. That is the beauty of democracy. Despite the fact that the majority of his party and his government were about to vote in favour of the bill, he was against it, and he had the opportunity to say so with all of the passion that drove him. That is how we should debate medical assistance in dying.
Let us not forget that this debate started at the federal level because of the Carter decision. Without going into detail, I will remind members that happened in 2015, which was an election year. Using his good judgment, the head of the Canadian government at the time did not move forward immediately because we were on the verge of an election campaign. At the risk of repeating myself for the umpteenth time today, this is not a partisan issue, while an election campaign by definition is the epitome of political partisanship. That is fine, that is what an election campaign is. That is why the prime minister and head of the Government of Canada at the time, the Right Hon. Stephen Harper, showed good judgment and decided to hold the debate after the election campaign.
Canadians made their voice heard. They elected a new government. There was then a debate on the subject. That is when the first steps toward this bill on medical assistance in dying were taken. Some may have noticed that the bill, like all other bills, was not perfect. Nevertheless, it did lead to certain specific situations.
Personally, I was for medical assistance in dying, but I did not vote in favour of the bill because I found it was poorly drafted. I remember the Hon. David Lametti who, at the time, was not the minister of justice. As we know, he became minister of justice later on. The removed him from that office, and he decided to serve elsewhere. I remember that Mr. Lametti said that he would vote against the bill because he found that it did not go far enough. The bill was passed, but other things happened, and today we find ourselves having a debate on mental health.
I would remind members that I am in favour of medical assistance in dying as long as the rules are well defined. I will give the example of Quebec. Actually, I am going to talk about Quebec's experience, because an example is something that should be followed. Instead, let us take inspiration from the experience of Quebec, which held a political debate on the issue of medical assistance in dying for six years before passing its first bill on the subject.
With regard to MAID for people with mental illness, after holding hearings and consultations and thoroughly analyzing the issue, the Quebec National Assembly and the Government of Quebec decided not to move forward with MAID for people whose only underlying medical condition is a mental disorder. They felt that there was no consensus on this issue and that there was no scientific consensus. Some people were in favour of it, while others were against it.
That is where we are at right now. That is why I think that we need to be careful as long as there is no strong scientific consensus. Personally, I am in favour of medical assistance in dying, but I think that it must be administered to those who want it within a very clear legal framework. In this case, the framework does not go far enough.
I have a colleague from Nova Scotia, the member for , who is a physician. I listened carefully to what he had to say yesterday because he knows what he is talking about when it comes to his profession. He practised medicine for over a quarter of a century and continues to practise to this day. He cared for thousands of people in his community.
He talked about the hardest parts of his practice. One example he shared involved a person showing up in the middle of a suicide crisis on a Saturday night and needing treatment. That is not a broken arm, it is not a growing cancer, it is not trying to get a pebble out of someone's eye. It is much more complicated than that, and it cannot be resolved immediately.
That is why his perspective was so valuable.
[English]
He said he is ready to challenge anybody who is not in that kind of a situation and whether they would be comfortable with that.
[Translation]
He said that, in his practice, he had always found these situations very difficult, and that he needed time to recover from that kind of meeting. Anyone who has spoken to doctors dealing with patients who have suicidal feelings will confirm it. Mental health problems are difficult to identify and to treat. I would again remind members of Quebec's experience. After thoroughly examining this issue, Quebec decided not to go forward with medical assistance in dying for people struggling with psychiatric illnesses.
The issue of medical assistance in dying can never be separated from the issue of palliative care. Palliative care is an essential part of our health care system; we should always be thinking of doing more, because, unfortunately, we will never do enough in that area.
Without going into my life story, I can say that, two years ago, I had a particularly challenging year, given that both my parents died. I remember May 2022, when my mother spent the last days of her life in the hospital. She was in a wing where people were receiving palliative care, one after another. Then there were rooms with people who had requested medical assistance in dying. For the last 15 days of my mother’s rich life, I was with her in the hospital and met people who had requested MAID. They all did so in full knowledge of the facts and with the support, assistance, guidance, and, above all, the presence of their families, in the same way that we were with my mother in the last days of her life.
That is how we must look at the issue. Respecting the choices of individuals, insofar as the guidelines have been well established. That is true both for people who wish to receive medical assistance in dying and for those who wish to receive palliative care.
:
Madam Speaker, it is always a privilege to rise on behalf of the residents of Kelowna—Lake Country.
We are confronted with a decision of profound significance: the proposed delayed expansion of medical assistance in dying to include individuals suffering solely from mental illness. The delay should be supported, and I will note at the same time that as the shadow minister for employment, future workforce development and disability inclusion, I am compelled to express my opposition to the expansion altogether.
I want to draw attention to the recent findings of the report of the committee on MAID presented on January 30, 2024. The committee's report aligns with the long-standing concerns Conservatives have been voicing. It advocates pausing the expansion of assisted suicide to include those afflicted with mental illness. MAID is an irreversible outcome. The expansion, if unchecked, could tragically lead to the loss of lives that might have been saved through treatment and support. This is why we should not even be debating a delay but looking to abandon this piece of legislation.
The Liberals continue to ignore mental health experts, advocates and opposition parties, and have not completely abandoned the concept of MAID for those with the sole underlying condition of mental illness. In 2023, the government introduced eleventh-hour legislation to put a temporary pause on expanding assisted suicide to those suffering with mental illness. This came only after significant backlash from experts across Canada who called on the government to delay the expansion of MAID. The government is not listening to people speaking out and saying they want it abandoned altogether.
If the Liberal government moves ahead with the radical expansion of MAID to include those whose sole underlying condition is mental illness, it could lead to irreversible results. In 2023, the heads of psychiatry at all of Canada’s 17 medical schools called for a delay to the federal government’s MAID legislation that would have expanded eligibility to persons suffering solely from a mental illness. Many stated that it is impossible to determine that an individual’s mental illness will never respond to treatment.
As the shadow minister responsible for persons with disabilities, I have also found widespread opposition to the expansion of MAID to persons with mental illness among advocates for persons with disabilities. More than 50 disability and human rights organizations, including several from my home province of British Columbia, wrote a joint letter to then minister of justice and to federal party leaders in December 2022, to express their total opposition to the MAID expansion. They cited discrimination, lack of supports and concerns for protecting vulnerable people.
Many people have come out again, still opposing the Liberal government's legislation and lack of empathy, adding weight to the argument against the expansion and making it permanent for anyone suffering from mental illness. Disability and human rights organizations are clear that delaying the legislation is simply not good enough; we must completely halt the expansion of MAID for mental illness.
My argument against expansion for MAID for those whose sole underlying condition is mental illness is rooted not only in expert opinion, as I have outlined. As I address the chamber today, I carry with me the voices of residents from Kelowna—Lake Country living with disabilities and mental illness who have reached out to me, having serious concerns about this. A striking example is a letter I received from a young woman in my community who fears the human impacts of this type of legislation. Her journey through the darkness of suicidal thoughts and battle with mental illness is an important reminder of what is at stake. She fears that availability of MAID might have led her down an irreversible path. This is a sobering testament to the potential dangers of this type of law. Her personal story is not just one of struggle but is also a clarion call for our society to be a source of support and hope.
Just recently, a resident of Kelowna shared a distressing experience that deeply resonates with the gravity of our current dilemma. He told me that he sat with a friend who opted for MAID recently. He expressed that if we allow the expansion to persons with the sole underlying condition of mental illness, those people might not always be capable of making such grave decisions, and we risk opening a door to irreversible consequences. This story is a stark reminder of the weighty responsibility we bear. This is a call to action, urging us to rethink and reassess, and to prioritize the well-being and dignity of Canadians in our health care and mental health policies.
When battling mental health issues for years, many people often feel on the brink of giving up. The cost of living is so bad that people cannot even afford to live, but what they need is support and understanding, not an easy exit offered by the government. A policy to expand MAID to those whose sole underlying condition is mental illness is a betrayal.
The commitment to help people was evident in Conservative private member’s bill, Bill , which sought to amend the Criminal Code to provide that a mental illness is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying. The bill was voted down, unfortunately, in October 2023, with 150 MPs voting in favour and 167 against. This shows that the Liberal government just wants to delay the issue until after the next election.
After eight years of the Liberal government, many people are increasingly struggling with a rapidly deteriorating quality of life. Many local residents in Kelowna—Lake Country and Canadians across the country have to deal with the immense stress of not knowing how they will pay to house themselves or put food on the table every month. This is heightened by economic stresses and escalating mental health challenges. At such a time, expanding MAID to include mental illness as the sole condition is not only ill-advised but also literally life-ending.
We have already seen concerning examples of not helping people with mental anguish who reach out, such as Veterans Affairs Canada's confirming that unprompted suggestions of MAID were offered by a Veterans Affairs caseworker to several veterans as a resolution for concerns such as PTSD. In addition, there has been testimony at the human resources committee by disabled persons considering MAID due to lack of living affordability, and reports of food banks being asked by clients for details on applying for MAID. These examples highlight the risk of MAID becoming a misguided solution for individuals in desperate need of compassion and support.
With such a climate of anxiety, mental health challenges and increasing rates of addiction across the country, expanding MAID to include mental illness as the sole underlying condition could be a tragic course. I believe we should be focusing our efforts on improving affordability and quality of life, and on compassionately helping people. It should not be easier to get MAID than to access mental health and addiction supports.
I, alongside my Conservative colleagues, will continue to stand with the many experts, doctors and persons with disabilities who oppose MAID expansion where mental illness is the sole underlying condition. They are expressing inherent risks and concerns related to protecting those who may be struggling and to protecting the most vulnerable. The proposed policy expansion of MAID for those with mental illness as the sole condition sends a troubling message that the government is willing to give up on some of the most vulnerable citizens. It is an admission of defeat, suggesting that we as a society are retreating from our moral obligation to provide comprehensive and compassionate care to those battling mental health challenges.
Instead of passing legislation like my common-sense private member’s bill, Bill , the end the revolving door act, which aims to provide mental health assessments and addiction treatment and recovery in federal penitentiaries, policies like the expansion of MAID to those with mental illness are really an irreversible path. We need to ensure that we support mental health systems and long-term solutions.
As members of Parliament, we should not choose the easy path over the right one. This is not the Canada we aspire to be: a nation that prides itself on compassion and support. Our duty is not just to legislate but also to protect, support and give hope to Canadians, particularly the most vulnerable among us. It is a duty we must uphold with the utmost seriousness and commitment.
:
Madam Speaker, I think it is my assistant calling me, telling me it is time to speak. She is very efficient.
As I was saying, the bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID, on the basis of mental illness alone would remain prohibited until March 17, 2027. In my remarks today, I will be addressing some of the concerns that have been expressed about allowing MAID for mental illness and the importance of ensuring that our health care system is ready before legalizing this practice.
As members know, Bill temporarily excluded MAID for mental illness until March 2023. Parliament extended the exclusion for an additional year after organizations such as the Association of Chairs of Psychiatry in Canada and the Centre for Addiction and Mental Health expressed a need for additional time. The Special Joint Committee on Medical Assistance in Dying, or AMAD, also supported the extension.
At the outset of my remarks, I want to emphasize that the government recognizes that mental suffering may be as severe as physical suffering. We know that not all individuals with a mental illness lack decision-making capacity. The extension of the temporary exclusion of eligibility for MAID is not based on these stigmatizing stereotypes.
I also want to announce my profound sympathy for anyone in Canada who is intolerably suffering because of a health disorder. My thoughts are with them.
While the federal government believes that MAID eligibility should be expanded to those whose sole condition is a mental illness, this process cannot be rushed. Over the past year, important progress has been made to prepare for the expansion, but provinces and territories are at varying stages of readiness. The federal government has listened to its partners and introduced this bill as a direct response to their concerns.
A cautious, deliberate and rigorous framework is essential to ensure the safe provision of MAID where a mental illness grounds a request for MAID. Debate about the parameters of the MAID regime has been taking place since before the Supreme Court of Canada's 2015 decision in Carter, in which it held that the absolute prohibition on physician-assisted dying was unconstitutional. This is a sign of a healthy democracy.
Most recently, the Special Joint Committee on MAID witnessed the diversity of views and expertise first-hand. Some witnesses who testified, such as Dr. Trudo Lemmens, chair in health law and policy at the University of Toronto, expressed concerns about permitting MAID where the sole underlying condition is a mental illness. Others, including the members of the Canadian Association of MAID Assessors and Providers, thought the country was ready for the current March 17, 2024 deadline.
Still others supported expanding MAID for mental illness, or accepted that it would become legal but recommended a delay. This recommendation came from Dr. Jitender Sareen of the University of Manitoba on behalf of eight chairs of psychiatry departments in Canada. The chairs of psychiatry outlined several reasons, including concerns about a need for further safeguards and accepted definitions of irremediability in mental disorders, before moving forward.
I would like to acknowledge the important contributions that have been made on this topic. While not everyone agrees, it is clear that we all care deeply about the well-being of those seeking MAID and the protection of the vulnerable.
Let me now get into some of the specific concerns that have been raised. Members will recall that certain eligibility criteria need to be met to qualify for MAID. This includes having a grievous and irremediable medical condition, which requires that a person be in an advanced state of irreversible decline.
Some doctors, such as Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre, have said it is impossible to predict which patients with a mental illness will get better; in other words, we cannot determine whether their illness is irremediable. However, other experts, including members of the expert panel on MAID and mental illness, suggest that the evolution of the illness and the response to past interventions can be used to assess irremediability, as is done with some physical conditions such as chronic pain.
Concerns have also been raised, by Dr. Sareen and others, that it is too difficult to distinguish between suicidality and a rational request for MAID when the request is based on a mental illness alone, because suicidality may be a symptom of the mental illness itself. Dr. Stefanie Green acknowledged that this can be complicated, but testified before the MAID committee that clinicians have a duty to assess every patient for suicidality. It is something that doctors do regularly in clinical practice. In addition, MAID assessments may involve suicide prevention efforts where warranted.
Another concern expressed by Dr. Tarek Rajji, the chair of the medical advisory committee at the Centre for Addiction and Mental Health, is that there was no consensus within the medical community about whether MAID should be available for persons whose sole underlying medical condition is a mental illness. However, others, including Dr. Green, note that the lack of consensus in the medical community is not unique to MAID.
A last concern that I want to address is that individuals are requesting MAID due to a structural and systemic vulnerability, such as lack of income and social supports. I want to be clear that the law requires that the suffering be due to illness, disease or disability, not poverty or unmet needs.
Our government is confident that the existing safeguards will ensure that only those who meet the eligibility criteria receive MAID. We are also determined to invest in social programs that can alleviate non-medical suffering and bolster social supports. Our MAID framework contains two sets of safeguards, one for requests where natural death is reasonably foreseeable and the other, more robust set for requests where natural death is not reasonably foreseeable.
The second set of safeguards would apply to cases where a mental illness is the basis of a MAID request. These include a requirement for a doctor or nurse practitioner with expertise in the condition to be involved in the assessment, a longer assessment period of 90 days, a requirement that the patient has been informed of the means available to relieve their suffering and has been offered consultations with relevant professionals, and a requirement that both assessors and patient agree that the patient has given serious consideration to the reasonable and available means of relieving their suffering.
In addition to these stringent safeguards, there is other guidance for doctors, nurse practitioners and regulators, including a model practice standard. Implementation of robust regulatory guidance and additional resources is ongoing, as is uptake of the nationally accredited bilingual MAID curriculum.
We are confident that, with more time, we can achieve readiness to ensure the safe provision of MAID in circumstances in which a mental illness grounds the request for MAID. We have made important strides, but work remains to be done to prepare health care systems and for more doctors and nurse practitioners to benefit from the available training and supports.
Our government thinks that three years is enough time to complete this work, so that our health care system is prepared when MAID for mental illness is permitted. In addition, we are proposing to add a requirement for a parliamentary review by a joint committee of both Houses of Parliament, to start within two years of this bill's receiving royal assent.
The committee will have six months to submit a report, including a statement of any recommended Criminal Code changes. This review will inform government action and ensure that they move forward only once the Canadian health care systems are ready.
With the March 17, 2024 deadline fast approaching, I urge everyone to work together to see that this bill is adopted before that date.
:
Madam Speaker, I appreciate the opportunity to speak to this. Having been in this place for all the debates we have had, I have been trying to figure out the best way to explain to Canadians, if there is an argument here, why it is not between Liberals and Conservatives, or between Greens and NDP and Conservatives and the Bloc. It has actually been, from the very beginning, a struggle for Parliament to actually deal with an issue we have been kicking down the road for too long.
I mentioned earlier in debate, as the member for Saanich—Gulf Islands, the quiet and extraordinary courage of a single woman, Sue Rodriguez, who took her irremediable medical condition of suffering all the way to the Supreme Court of Canada and was denied the opportunity for what is generally called death with dignity. She had the procedure illegally. Those who were with her at the time would have been subject to criminal penalty as well, including my friend Svend Robinson, who at the time was member of Parliament in a different party from a different place.
It was a very fraught time, and the issue of medical assistance in dying kept coming back to me from constituents who were heartbroken that their parents or loved ones had to go through suffering. Quite often people would say to me they would not let a family pet go through this kind of suffering so why do we allow our moms and our dads to go through this when there is no prospect they are going to recover.
This finally went back to the Supreme Court of Canada for a different decision that came out of the Carter case. The Carter case, back in 2015, said that refusing to allow someone the legal option to seek medical assistance from their doctor in a situation where their illness is terminal is really a violation of section 7 charter rights. I only mention this because that was also with a deadline. We have to take action on this; we cannot just leave the matter. The Supreme Court of Canada has said that this provision of the Criminal Code is actually a charter violation. That means one cannot let it just sit there anymore.
It would take too much time, and my colleagues will be relieved to know I will not go through this chapter and verse, but it is a tough, tough issue for parliamentarians. At the time, as we started debating the first iteration of allowing for death with dignity, in Bill , our first Minister of Justice to deal with this was the very honourable Jody Wilson-Raybould. She had to struggle with this. Our Minister of Health at the time, also very honourable, Jane Philpott, was struggling with this.
It occurred to me as the debate went on that what we had in Canada on this issue was essentially a professional dispute. The lawyers in Canada wanted to make sure that the charter was respected. The doctors in Canada said they did not want to be asked to figure out what “irremediable” meant and were not exactly ready for that. Therefore, subsequent revisions kept happening because, after all, in our first attempt to get medical assistance in dying right, we did not allow for advance directives. Therefore, we had subsequent court cases where people who had terminal cancer could not access MAID because they decided they better ask for it now, which was maybe months before death would occur naturally and months before a doctor could say, “Okay, you're ready now. Nod.” One had to be able to physically sign; the day of, one had to confirm one's procedure.
Again, I better not go back through all of this, but essentially the professional views of doctors pleading with parliamentarians outweighed the lawyers dealing with parliamentarians to say that we were probably still going to have charter violations, but it is better that we listen to the doctors and that they are ready. All of this ended up taking us back to fixing medical assistance in dying again to try to make it more humane, to try to respond to the concerns of Canadians from coast to coast that they wanted to be able to access an advance directive in a situation that fit the MAID template. This brought us to Bill .
To some of the comments that were made in this place earlier today, the government and Parliament were under a deadline that was court imposed, not politically imposed, to oblige ourselves, as parliamentarians, to meet what the Supreme Court of Canada said the charter required us to do. We had a very tight timeline, and then the Senate did something I do not think anyone in the House expected.
Again, we had a professional dispute going on here. Doctors were saying they were not ready to extend this to people whose sole irremediable condition is mental illness. Public health professionals in addiction and mental health were saying they were not ready. However, with strong pressure and strong professional advice from the psychiatric community, the Senate decided we should extend MAID to those with an underlying condition that is only, and I do not say “only” as if it is a marginal or trivial matter, a crushingly painful and life-ending threat from mental illness.
We are walking this fine line. The line is even finer when we start realizing who is more likely to not be able to access mental health supports; they are the marginalized and the poor. Who is more likely to not be able to imagine continuing on in life with a crushing mental illness? It is again the marginalized communities. The disability community spoke with a loud voice saying not to extend MAID as they were worried enough that it was a slippery slope when Bill first came in, and now Bill .
Here we are again with a court-imposed deadline. Let us be clear to Canadians watching today. Certainly, the provinces and many doctors and mental health professionals have spoken with one voice. If we do not act quickly to pass this legislation and if the Senate does not act quickly to get it to royal assent come March 17, then as a matter of reality, we are up against March 17, and medical assistance in dying would become available to people where mental illness is the sole underlying condition.
Is it irremediable? We are told by the experts that no one really knows how to answer that question. Yes, some of the psychiatric community says the safeguards are there and if three psychiatrists say that it is irremediable, then that is enough. However, we are all asking where the mental health supports are, particularly for those who are marginalized. Where is the access?
This is one that particularly perturbs me. I have had many people come to me from a community that has experience with using psilocybin, conventionally known as magic mushrooms, as a way to alleviate a mental health condition, which might otherwise be irremediable, with remarkable results. We know that Health Canada is currently accelerating trials on psilocybin. It strikes me as beyond a catch-22 that the authorities would say to those people and to their doctors, who think psilocybin could help them, when the alternative is that they are more likely to commit suicide, or if we do not act by March 17, they will have access to legal medical assistance in dying, and it would be too dangerous to let them try psilocybin, but the alternative is death. It seems to me that any medical risks from psilocybin pale in comparison to the irreversible reality of death. How can we let this happen? We cannot.
I think we need to discuss another thing in this place, which is societal assistance in living. We know what medical assistance in dying looks like, but what does societal assistance in living look like? It means ending poverty and bringing in a guaranteed livable income for all. It means access to mental health services in this country. It means a compassionate and caring approach that says to every Canadian, whether in the disability community, the indigenous communities or the youth who are struggling with addictions, that we hear them and will not fail them. That means, no matter how members feel about it, we have to pass this legislation expeditiously.
:
Madam Speaker, the decisions made in this place have a direct impact on the lives of Canadians. That impact can be no greater than when it is a matter of life or death, and this is exactly the case with this piece of legislation. As members of Parliament, we have a duty to serve in the best interests of Canadians; this duty must extend to the protection of the most vulnerable in society.
I should note that I will be splitting my time with the member for .
The expansion of medically assisted death to those suffering from mental illness is dangerous and, simply, reckless. It is inevitable that the expansion of MAID to those suffering solely from a mental illness would result in the deaths of Canadians who could have gotten better. This is not to say that those with mental illness should be left alone to suffer. Recovery is possible, and we cannot give up on these individuals and their loved ones. Canadians suffering from mental illness need and deserve support and treatment. They may feel that their situation is hopeless, but the antidote is hope, not death. They deserve government policy and a health care system that are compassionate and responsive to their needs. Where there are gaps or shortfalls in our care system, we should prioritize working alongside our provincial partners to address them. That, not expanding MAID, should be the priority.
The Special Joint Committee on Medical Assistance in Dying heard loud and clear from the mental health experts and advocates that the planned expansion of MAID was dangerous. The current Liberal government has already had to introduce eleventh-hour legislation to delay the expansion of MAID by one year from the date that it had arbitrarily set. We find ourselves, ironically, now in the same position as we were in last year. Bill , once again, would only offer a temporary delay in the expansion of MAID to persons suffering from mental illness. The risks and dangers that exist today would continue to exist in three years. However, the Liberal government is intent on its expansion.
It is truly frightening to see that the Liberal government wants to continue to expand the access to MAID, despite clear concerns about safeguards of vulnerable people. The Liberals' careless approach was already evident when the Liberal government decided not to appeal the Truchon ruling and, instead, introduced legislation that went much further than the ruling had required.
What we have seen repeatedly from the current Liberal government is the willingness to offer MAID to more and more Canadians, without prioritizing supports or treatment. This continues to be the case with those in the end stages of life. Through pain management and psychological, emotional and practical supports, palliative and hospice care provides relief from pain, stress and symptoms of serious illness. Palliative care has proven to improve the quality of life not only for the patient but also for their family. However, access to this is not universal here in Canada.
The government's own report on the state of palliative care in Canada, released this past December, confirms that access to palliative care is indeed not universal. We do not have the necessary safeguards in place to protect vulnerable Canadians when access to MAID is more universal than access to palliative care is. When Canadians suffering from serious illness do not have access to appropriate care, they can be left feeling hopeless. Personal autonomy is not increased when a person feels as though they have no other choice.
When the current Liberal government removed the “reasonably foreseeable death” clause from the MAID framework, it opened up to persons with disabilities who are not close to death. Disability advocates raised alarm bells with this decision, and the news stories that have emerged in recent years have underscored the risks and the danger in that decision. Reports showing that poverty, not pain, is driving Canadians with disabilities to consider assisted death are truly heartbreaking.
For persons with disabilities, the pressures of the cost of living crisis are compounded. Their basic living costs are generally much more significant. As the prices go up on everything, their costs are even greater. It is unacceptable that there are persons with disabilities turning to MAID because of their cost of living situation.
This NDP-Liberal government's inflationary spending and taxes are fuelling the affordability crisis in this country, and what is even more shameful is that, despite the pain and suffering it is causing Canadians, there has been no course correction for this costly coalition. It has continued to mismanage tax dollars. It is intent on quadrupling the carbon tax, which is increasing the cost of just about everything.
Let us not forget that not a single disability payment has gone out to those who want it and have been asking for it. Bill was sped through the parliamentary process, but those who are desperate for financial assistance are still waiting.
The affordability crisis is continuing to surge across the country, and it is further putting persons with disabilities in a vulnerable position. Medically assisted death should not be more readily available to persons with disabilities than the supports and accommodations they need to live a full, healthy and dignified life.
Repeated reports that Canadians are being offered medically assisted death without first requesting it is also very alarming. It suggests that safeguards have not been put in place to ensure that vulnerable people are not being pressured or coerced into seeking medically assisted death. No person should feel that the health care system, the infrastructure that is meant to provide care and support, sees no value in their lives.
There are serious concerns with the existing MAID framework and the framework's ability to protect the most vulnerable in our communities. These are concerns that are not being addressed by the Liberal government and that ultimately should be the priority of the government on an issue such as medically assisted death. When the risks and concerns that exist with the current framework are already proven to be warranted, we should certainly heed the clear warnings against its expansion.
Experts have said that it is impossible to predict in any legitimate way that mental illness is irremediable. This means that individuals suffering solely from mental illness can recover and can improve. Their mental health state is not destitute nor without hope. If medical assistance in dying is offered to persons suffering solely from mental illness, it is inevitable that vulnerable Canadians will die who could have gotten better.
Experts have also made it clear that it is difficult for clinicians to distinguish between a rational MAID request and one motivated by suicidal thoughts. Persons with mental illness are already disproportionately affected by suicide and suicidal ideation. To extend access to medically assisted death to this group of individuals contradicts and undermines suicide prevention efforts. Every single person's life has value and purpose. It is not acceptable to have government policies in place that devalue the life of a person, and the Liberal government's intention to expand access to MAID fails individuals suffering from mental illness in this country.
Whether it happens in March of this year or in three years, the expansion of MAID will still be dangerous and reckless. The delayed expansion of MAID will ultimately still fail vulnerable Canadians. Bill does not go far enough to protect those suffering with mental illness. The must immediately and permanently halt the expansion of medical assistance in dying to persons with mental illness. We cannot give up on an individual who is suffering. They deserve support and treatment, not death.
Common-sense Conservatives know that recovery is possible for persons suffering from mental illness. We do not support policies that abandon people when they are in their most vulnerable state. Death is not a treatment for suffering. We will stand with them and their loved ones. Above all else, when we consider medically assisted death, we must be gripped by a resolve to protect the most vulnerable because, in matters of life and death, there is simply no room for error.
:
Madam Speaker, before I give my speech on this very important topic, I would like to quickly comment on the horrific incident we faced in southern Manitoba over the weekend with the tragic loss of life of two young women and three children. As a father, it is tough to fathom the loss of a child and the impacts it would have on that family's loved ones and friends. It would impact everyone in their lives and, frankly, the broader community.
My heart goes out to those of Carman and the surrounding area, and to the friends, families and loved ones of the victims of this horrific incident. It is devastating news for a small community like that, where folks know their neighbours and look out for each other, so I pray for strength during a very dark and incredibly difficult time for our community.
To the issue at hand, we are more than a month away from the Liberal government implementing medical assistance in dying for those who suffer from a mental illness. I believe this is heartless, reckless and immoral. Every Canadian has worth, and I, for one, will never give up on those who need help.
Never have I seen a government mismanage an issue as critical as this, and while it may be unpleasant for my Liberal colleagues to hear, I believe they must be held to account. Due to the incredibly serious nature of this issue, there is a lot to be answered for. How could the let this happen and let it get to this point? How could the government be so irresponsible and negligent?
From day one, our Conservative team in Parliament has been sounding the alarm bell, but we were ignored, and we now find ourselves in an emergency. I believe it is ludicrous that it took the outcry of countless medical professionals to get the Liberals to reverse course on this matter. Witness after witness testified to the Special Joint Committee on Medical Assistance in Dying about the dangers of pressing ahead with this plan.
Why did the accept the last-minute amendments put forward by the Senate that dramatically changed the legislative framework for MAID? There was no parliamentary study. There was no consultation with experts or affected groups and no evidence that MAID for mental illness could be implemented safely and appropriately. When the Liberals' original bill, Bill , was put before MPs, at no time did it contain any language about creating a pathway for MAID for those with mental illnesses. In fact, it explicitly ruled that out in its entirety.
The original proposed amendment to the Criminal Code specified that “persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying”. The then said, “there is no consensus among experts on whether and how to proceed with MAID on the basis of mental illness alone.” The minister then did a 180° and became a proponent of this disastrous course. Due to his actions, and the 's rubber-stamping of the those Senate amendments, we are where we are today.
This is now the second time the Liberals have had to delay the implementation of their reckless legislation. There will never be a consensus from mental health experts that the government should implement MAID for those who are suffering from a mental illness, and if the Liberals will not listen to me, I implore them to listen to their own expert panel on MAID and mental illness, when it said it is implausible to determine whether a mental disorder is incurable.
The panel's report said, “There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.” That was echoed by the heads of psychiatry departments of all 17 medical schools, who called on the Liberals to stop this plan from being implemented on March 17.
I completely agree with these experts, but not only should we pause this law from being implemented, we need to permanently end it once and for all. Let me be perfectly clear. Instead of delaying, the government needs to introduce a bill to ensure that it never happens.
When I ran to become a member of Parliament, this was a key plank of my platform. I pledged to do everything I could to stop the Liberals from ever implementing this dangerous idea, and the sad reality is that the —
:
Madam Speaker, as I said, the sad reality is that the only wants to delay this implementation. Even the Liberal in charge of mental health said last week that her government was not debating if but when this law should proceed. My answer is never. It should under no circumstances proceed.
Instead of being in a position where the Liberals keep introducing legislation to postpone this terrible policy, it will take a new Conservative government to resolve this issue once and for all.
I want to remind all MPs in the House that we could have dealt with this issue not too long ago. My Conservative colleague, the member for , introduced a private member's bill that would have stopped this from ever happening. Almost everything we are discussing today would have been dealt with by that bill. Sure enough, the and almost every Liberal MP voted against it.
As for my colleagues, who seem unconcerned about the expansion of MAID, let me try to persuade them otherwise. There is no reasonable way to establish a legal framework to identify which mental illnesses are incurable. Every person is different and every circumstance is unique. There are variables such as people's economic situation, their support system and where they live that have an impact.
Unfortunately, in rural Canada, access to mental health and addictions services are often abysmal. If people are fortunate enough to live in a community that does have access to mental health services, there is a good chance they will have a lengthy wait time ahead of them. If people make the very difficult decision to seek help and go looking for it, I am embarrassed to say that it can take days, if not weeks, for them to get that help.
It is understandable how people with a mental illness, who have lost all hope, can think this way because they cannot access the treatment and support they need. We all know someone in our lives who has struggled. We also know that this does not define the person. Due to the stigma slowly receding, more and more people are finally seeking the help they need.
The other good news is that mental health research and advances have come a long way in helping treat those with a mental illness. Sometimes it can take years of treatment, even a lifetime's worth, but with the right supports and help, people can regain control of their lives. I am raising this because, in accordance with the law, there is a prerequisite that someone must suffer from a grievous and incurable medical condition to be eligible for MAID.
On the first part, there is no doubt that people suffering from mental illness are in a grievous condition at times. If they cannot get the help they need, it can quickly get out of control. As to the second part, it is no wonder why people think their mental illness is incurable. If they cannot access mental health supports, services and treatments, it must feel like they will never get better.
The Liberals love to talk about compassion, so as I wrap up my comments, let me tell the House the compassionate thing to do.
First, we need to permanently suspend, not delay, MAID for those whose sole underlying condition is mental illness.
Second, we need to better our services for those who are most vulnerable in our society. Unfortunately, the Liberal government has yet to deliver on its campaign promise of implementing a mental health transfer for the provinces. Instead of improving access to mental health services, all people are hearing is that the government is making it easier for them to choose death.
Finally, we need the Liberals to understand that there is a cost-of-living crisis. Far too often, we have seen them ignore the needs of struggling Canadians. There have even been instances of people coming forward to say that they feel MAID is their only choice because they cannot afford to live any more.
In St. Catharines, a man said that he wanted to start the process of applying for MAID, not because he wants to die but because social supports are failing him and he fears he may have no other choice. The CEO of the Mississauga food bank has said that people are coming into her facility asking not for food but for help to end their lives, not because they are sick but because they cannot afford to eat.
I will proudly continue to fight for the most vulnerable in our society and for common sense. Today, that means we are calling for the suspension of MAID for those suffering with mental illness.
:
Madam Speaker, members of the Conservative Party might not like what I have to say, but it is the truth, and sometimes the truth hurts. If we go back to the original debates in May, we would find a great deal more compassion being expressed on the floor of the House of Commons, on all sides. Whether they were Liberals, Conservatives, New Democrats or any others, members demonstrated very clearly the difficulty of what Parliament had to do in bringing in MAID to respect the Supreme Court of Canada decision. Today during the debate, we witnessed the standing on a point of order on something completely irrelevant to the debate, to attempt to table a document. Why did he? He just could not wait until question period, I guess, which begins after statements by members that start in about 15 or 20 minutes.
We should listen to what some of the Conservative speeches have been about. Some Conservatives, the last couple in particular, have stood in their places and given a false impression that the legislation would be like suicide on demand. The member for said that today someone feeling depressed due to mental health issues could go to a doctor and book an appointment to commit suicide, with the government's support, on Friday. Members of the Conservative Party are spreading misinformation on such a sensitive issue. These are very difficult things that Canadians have to deal with every day.
Yesterday the member for referred to 12,000 or 13,000 people being killed in a very ad lib fashion, implying that the legislation just allows people to be killed. From my perspective, the decision to access MAID is not easy; it is a very difficult one. Family members and individuals are experiencing some very difficult times in dealing with a real-life situation. Conservatives, yesterday and today, are virtually making a mockery of it and spreading misinformation on such an important issue. What happened to the compassion of 2015-16 and even 2017? At that time, there seemed to be a sense in the chamber that, yes, at times there are going to be disagreements if members feel very passionate about an issue, as they should, but there was also a much higher sense of co-operation as members shared the experiences they were being told about by their constituents.
The member for said that people are going to food banks and are thinking of committing suicide because of the cost of living. There are a number of things that come to my mind that speak to the manner in which individuals across the way make those types of stupid statements. That is, quite frankly, what they are; they are not legitimate contributions, such as discussion about supports and services would be, to the debate on such an important issue that the House is having to address.
In the debates taking place in 2015-16, we heard a great deal about issues like hospice and palliative care. We wanted to ensure that MAID legislation would not in any way be utilized as a direct result of not having proper services and systems in place to provide assurances to those individuals who were feeling so compelled to actually access MAID. Those are the types of things that I think really contributed a great deal back then.
Today, in contrast, Conservatives will say, “What about the $4.5 billion that the Liberal Party made a commitment to?” Members are right in that there was a substantial commitment by the government to deal with the issue of mental health, and the commitment was significant: several billions of dollars over five years. It is one of the reasons that the health care agreements we have put into place, which were highlighted last year, of just under $200 billion over 10 years, are to support health care not only today but also in future generations that will benefit by that sort of investment. Furthermore, the is working with provinces, coming up with agreements that deal with things like mental health and services. We recognize how important it is to ensure that these services are being supported.
Unlike a number of members from the Conservative Party, and I do not want to label them all, at least not at this point, this is a government that has continued to work with, in particular, provincial jurisdictions and other stakeholders in different forums in order to provide assurances that the people who are accessing MAID are, in fact, being informed in a very tangible way of the types of services available. In no way whatsoever is it as simple as their just saying, “I want this and I will get it”, and then two days later receiving it. We can look at the amount of public attention and debate that has taken place on issues such as palliative and hospice care since the MAID introduction, which I believe have been greatly enhanced.
I would like to think that provinces, which are ultimately responsible for the public administration of health care services, have taken note and understand that they too have a responsibility because they are the ones delivering the services that Canadians expect. The federal government has recognized that by supporting things such as the encouragement of long-term care standards and by providing substantial finances to ensure that provinces are better able to meet the demands on health care services. With respect to what I said earlier in regard to mental health, there are serious commitments that we continue to live up to and work on with other jurisdictions.
I have confidence, as I indicated yesterday, in the health care professionals, the social workers and the other individuals who have the expertise and confidence in the individual who feels that MAID might be the avenue for them to pursue. There is a great deal of effort put into every situation, and I have confidence in the system.
Members can correct me if I am wrong, but I cannot recall one province or premier in Canada that has clearly said that MAID is not working. The provinces are asking for the three-year extension in one aspect of MAID: where mental health is the sole reason for the request. The issue of the sole underlying medical condition being a mental illness was added to the original MAID legislation, then brought in as a form of legislation and allowed a period for provinces and jurisdictions to have time to get what is necessary in place so Canadians could be served.
We then found that the provinces required more time. There were a number of provincial governments not saying to get rid of MAID, but rather saying that they needed more time for the implementation of that aspect of it. That is in essence why we have the legislation that we have before us today.
However, if we listen to members of the Conservative Party, we will find that they give no indication of supporting Bill . It will be interesting to see how they actually vote. Logically, I would think they would vote in favour of the bill. If they do not vote in favour of Bill C-62, and, for whatever reasons, the legislation were not to pass, ultimately the criterion of sole underlying medical condition of mental illness would take effect on March 17 of this year. Therefore, it is important that members, no matter what side of the debate they happen to be on, would be in favour of the legislation because it is a direct response to what is being asked of the Government of Canada by our partners that are ultimately responsible for administering the legislation.
Members opposite will often try to say that it is up to the government. It is important to highlight what I mentioned at the very beginning: The reason we have MAID legislation today is that in 2015, the Carter decision by the Supreme Court in essence said we had to bring it in. There was no choice, if, of course, we respect the Charter of Rights and Freedoms. I will repeat what I said yesterday: There was a great deal of consultation, literally hundreds of hours of different types of meetings, including standing committees, chamber debate, outside meetings in ridings, canvassing and petitions. Even though there were all sorts of mechanisms to provide input, at the end of the day, I believe that the legislation met a threshold to, in good part, deal with the concerns of the Supreme Court of Canada and to respect the Charter of Rights.
That was followed by a decision in appeal court in Quebec giving us another obligation to improve the legislation and that is exactly what we did.
We continue today to look for ways to improve the legislation. I believe it is a reflection of the Canadian Charter of Rights and Freedoms. If members of the Conservative caucus are saying that they do not support the MAID legislation, then I would question whether they actually support the Canadian Charter of Rights and Freedoms.
I would further add that the 's general attitude—