44th Parl. 1st Sess.
February 13, 2023 11:00AM
Madam Speaker, no, they have to invest in what gives people hope. There is no research. The experts and the special joint committee have done the research. This is window dressing. This is an arbitrary timeline for something that is dangerous. There is no proof. There is no science. They cannot say with certainty whether somebody with mental illness will or will not get better.
Absolutely, we need to invest. There was $4.5 billion promised by the Liberal government to invest in the Canada mental health transfers. Not one dime has been sent. What are the Liberals saying to people at home who are struggling? They are saying that they care about them, but they are not going to invest in access to treatment. They are going to invest in legislation that allows them to apply for MAID. It is wrong.
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Madam Speaker, my friend, the member for Peterborough—Kawartha, was absolutely right when she said that there is no science and no evidence to support this expansion. Indeed, the overwhelming evidence at the special joint committee, of which I am a co-vice-chair, was precisely the opposite.
The hon. member for Longueuil—Charles-LeMoyne asked the member about whether it is appropriate to extend the deadline to essentially get it right, but evidence before the committee from a leading psychiatrist was that the medical error rate on the question of irremediability could be anywhere from 2% to 95%. In the face of that, it would seem to me that there are no safeguards to get this right. The only thing to do to get it right would be to scrap this ill-conceived—
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- Feb/13/23 6:07:13 p.m.
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The hon. member for Peterborough—Kawartha.
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Madam Speaker, my hon. colleague has such a wealth of knowledge and facts on this legislation. Unlike the Liberals, he has done the due diligence. That is the reality. The facts speak for themselves.
At the special joint committee, there were numerous hours spent on this, and it was all done backward. Therefore, I absolutely agree with him and thank him so much for his intervention and his work on this file.
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Madam Speaker, I thank my colleague for her speech.
When we hear these stories, it is difficult to be indifferent to the situation. However, it is always ironic to hear the Conservatives say that they base their rational decisions on science, when we clearly know the relationship they have had with science in the past few years.
My colleague stated that there is no proof and no science. However, the people currently asking for this to be postponed, the people who produced the final report of the panel of experts, who made 19 recommendations, are experts who are members of professional associations. They clearly used scientific evidence. These are people with expertise.
Does my colleague not agree? Does she not recognize the expertise of those people? That is the fundamental question being asked in the House this evening.
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Madam Speaker, I think we are saying the same thing repeatedly here. The experts have weighed in and said that we cannot, with certainty, scientifically predict whether or not someone will or will not recover from a mental illness.
If the member wants to take that risk, and risk playing Russian roulette, I guess that is his answer, but the data is already there, which we have seen repeatedly.
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Madam Speaker, we have been here before, with the Liberals scrambling to meet a deadline, unable to get their act together. In this case, though, perhaps the delay will provide us with the opportunity to get things right, or at least, that is my hope.
The question that we need to ask here is not whether there should be a delay in when medical assistance in dying is extended to the mentally ill, but whether such an expansion is a wise move at all.
Seven years ago, I stood in the House and predicted that we would be here today. On May 5, 2016, I said:
It does not take much talent to predict that in the aftermath of this legislation there will be confusion.
However, if killing patients becomes an option, for whatever supposedly good reason, how long will it be before that reason becomes more flexible than rigid? What about those with no family who are a drain on hospital resources? Would it not be in the financial best interests of society to end their lives?
How are we going to prevent families from pressuring their aged ones, urging them to request death so that the next generation of the family will be financially better off? There are so many issues that are still unresolved. We are acting in haste, and it seems to be almost guaranteed that we will get it wrong....
We might not be discussing this issue if we were doing a better job as a nation in assisting those approaching the end of their natural life. Where is the commitment of the government to increase funding for palliative care, which was an election promise unfulfilled in budget 2016?
I did not, at that time, address the issue of so-called assistance in dying for those who are mentally ill. I confess that, at that time, it never occurred to me that such an idea would be considered.
We were talking about those whose deaths were not only foreseen but imminent. The idea of hastening natural death was put forward as something compassionate, to ease the pain of those suffering from terminal illness.
How quickly times have changed. What was once unthinkable is now being promoted as normal, which may explain why, in October of last year, a representative of the Quebec college of physicians suggested that MAID be extended to infants under the age of one with serious health conditions. These children are obviously too young to make such a decision themselves.
It was somewhat reassuring to hear the Minister of Employment, Workforce Development and Disability Inclusion say that she was shocked by the suggestion and found it unacceptable. It was less reassuring when the minister also said that she could not speak on behalf of the entire government on the issue, which means that I would not be surprised if, in the not-so-distant future, we are being asked to make yet another extension to the circumstances in which MAID is available.
According to the Centre for Addiction and Mental Health, Canada's largest mental health teaching hospital and one of the world's leading research centres in the mental health field, in any given year, one in five Canadians experience a mental illness. That, to put it mildly, is a significant number. Furthermore, by the time Canadians reach 40 years of age, one in two, which is half the population, have or have had a mental illness.
We need to recognize what that means for our country. Mental illness is a serious problem, but addressing it by making assisted suicide an option is not the way to proceed.
Speaking to the CBC, the minister of disability said that she frequently hears that some people with disabilities are seeking assisted death because they cannot find adequate housing or sufficient care, that they are choosing death because of a lack of social supports.
Is that not also the case for those suffering from mental illness? The Centre for Addiction and Mental Health tells us that about 4,000 Canadians commit suicide each year, an average of almost 11 a day, people of all ages and backgrounds. Those numbers are sobering.
In Ontario, 4% of adults and 14% of high school students report having seriously contemplated suicide in the past year. More than 75% of suicides involve men, but women attempt suicide three to four times more often. More than half of suicides involve people aged 45 or older.
In Alberta, each year, according to the University of Alberta, one in six people will seriously think about suicide. There are an average of 2,400 hospital stays and more than 6,000 emergency room visits annually for self-inflicted injuries, the result of suicide attempts. More than 500 Albertans will die by suicide each year. According to Alberta Health Services, in 2018, 7,254 Albertans visited the emergency department for suicide attempts. Three out of four suicide deaths are male, about 50% being middle-aged men aged 40 to 64.
After accidents, suicide is the second leading cause of death for people aged 15 to 24. Indigenous people, especially youth, die by suicide at rates much higher than non-indigenous people. First nations youth aged 15 to 24 die by suicide about six times more often than non-indigenous youth. Suicide rates for Inuit youth are about 24 times the national average. This is a national tragedy.
Experts tell us that mental and physical health are linked, which means that people with long-term physical health conditions such as chronic pain are much more likely to also experience mood disorders. In the same way, people suffering from mood disorders are at much higher risk of developing a long-term medical condition.
What does it say about Canada as a society and Canadians as people that our response to mental illness is now going to be focusing on killing people rather than appropriate medical treatment? If we were doing a better job of supporting those who are mentally ill, we might not be having this discussion today.
Many of those suffering from mental illness in its various forms will tell us that there are good days and bad days. On the bad days, when the dark cloud descends and it feels like it will never lift, death seems a pleasant option, but for most people, it does lift. As I said earlier, about half the population will experience some form of mental illness at some point in their lives. For most, it is something they can overcome.
Making suicide easier by calling it “medical assistance in dying” will, I am certain, mean that people with treatable mental illness will choose death. Some may do so because they are having a low period and do not see any hope for the future. For others, it may be a lack of medical and social support to help them deal with their illness.
Mental illness in Canada is estimated to cost about $50 billion annually when we include health care costs, loss of productivity and a reduction in health-related quality of life. That cost could be reduced if we were to invest more in mental health promotion and illness prevention programs, more support for early intervention aimed at children and families, and more emphasis on treatment for depression and anxiety disorders.
We need to pass this legislation, because there is a deadline approaching. Even more, though, we need to look at how we support those who are suffering from mental illness. Killing them should not be an option.
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Madam Speaker, in May 2019, every member of Parliament stood up and supported my motion, Motion No. 174, to establish a national suicide prevention action plan. There were a number of key steps that the government and members of all parties agreed to, including establishing national standards for training people involved in suicide prevention and making sure we were working with first nation, Métis and Inuit communities on establishing norms and proper funding, as well as the obligation to report to Parliament annually on preparations for and the implementation of the national action plan, including data.
That never happened. The government voted for it, and nothing happened. Yet, when the unelected, unaccountable Senate decided to throw in, at the last minute, a provision that would allow mental illness to be the sole reason to judge whether someone should be allowed to die or not, that was accepted without even a challenge, and now the government is scrambling at the last minute to prevent it from becoming law.
I would like to ask my hon. colleague about the lost opportunities the government has had to lay a proper course for the protection of people to make sure that we are doing things in a humane way and not having to act in such an ad hoc, eleventh-hour response to a very badly thought-out provision thrown in by the unelected, non-accountable Senate.
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Madam Speaker, the member's question speaks to the spirit of my speech and what I was trying to address here, the last-minute actions and the non-action on the government side when it comes to addressing even election promises. It has been dragging for the last eight years, and there is no action happening to support the palliative care promise the government also made.
We are on the same page here, to call for a stop in dealing with last-minute legislation that comes in and does nothing but delay. It is toxic. This is a poison that we could ask Canadians to take at some point, but it is not acceptable. It is our responsibility, on our shoulders, to address this and deal with it as we are representatives of the Canadian population.
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Madam Speaker, in his speech, the member for Edmonton Manning spoke about the need for more mental health supports.
Last week, we had an announcement with respect to health care, but nothing with respect to dedicated mental health funding. I asked the parliamentary secretary about this last week, whether the governing party remains committed to a $4.5-billion Canada mental health transfer.
Could the member speak about whether he, too, is calling for the need for the Canada mental health transfer?
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Madam Speaker, it was in our platform during the last election to address this. Mental health is a health issue. The two can never be separated. The strategy has to be wide and wise to be able to address all the issues, because health care is at the front of everything we do in this country. It seems that the government is missing the point on that.
We call on the government to act wisely and to act in the best interests of all Canadians by seriously looking at the mental health issue that we are facing.
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Madam Speaker, we are living in a time when Canadians have lost trust in our institutions, whether it is the government, whether it is media, whether it is even the medical profession. We need to rebuild that trust. Canadians need to believe in their country and what it stands for. This bill that we are passing, hopefully, would just delay a very bad idea.
Could my colleague comment on why we really have to stop and re-evaluate? He said in his speech that he never even thought this would go to mental health. The original justice minister who put this forward was against it. Why do we have to rebuild this trust? Why is it so important that we speak out against this?
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Madam Speaker, this issue is for everybody, for every politician in Canada and in this Parliament, to work together on. There is no way this should be swept under the rug. We can delay the poison pill that we could give to Canadians—
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- Feb/13/23 6:24:22 p.m.
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Resuming debate, the hon. member for Provencher.
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Madam Speaker, I thank all my colleagues who have spoken so eloquently here these past many hours.
It will come as no surprise to my colleagues that I am opposed to medical assistance in dying and also opposed to any expansion thereof, but I will be voting in favour of Bill C-39, because what it would do is delay the imminent move the Liberal government wants to make, which is to extend MAID to those with mental illnesses.
When MAID first came to this House and was presented by the Liberal government, I was on the justice committee, and I, early on, warned this House that MAID was going to be a slippery slope, that “reasonably foreseeable” would not remain the standard by which MAID cases would be adjudicated, and that the legislation would also pose a serious threat to those with disabilities, the elderly, the poor and particularly those with mental health issues.
In August of last year, the Associated Press and the National Post both published reports on what has been happening in Canada's hospitals since the Liberal government introduced one of the most permissive assisted suicide regimes in the world. The results are alarming. In an interview, Tim Stainton, director of UBC's Canadian Institute for Inclusion and Citizenship and one of our leading experts on the subject, called MAID “the biggest existential threat to disabled people since the Nazis' program in Germany in the 1930s.”
A follow-up article in Forbes magazine written by journalist Gus Alexiou, who himself suffers from multiple sclerosis, states, “unfettered accessibility [to MAID] could...prove to be one of the most malignant forces the disability community [including those with mental disability or illness] has had to contend with since the 'mercy killings' of the Third Reich almost nine decades ago.”
This is because their reporting discovered that the people who are being targeted for MAID, and I do not think “targeted” is too wrong a word to use, are the most vulnerable Canadians: those who are disabled, seniors, those living in poverty and those with a mental illness.
Their story begins with Alan from B.C., who suffered from severe depression. He was administered MAID shortly after being taken to the hospital for a psychotic episode. His family begged the doctors not to kill him, as he had been involuntarily admitted and was in the throes of a psychotic episode when he demanded MAID. The family's pleas were ignored, and Alan was dead shortly thereafter. As Dr. Mark Komrad, a psychologist at John Hopkins Hospital, accurately predicted, our law “will provide, not prevent, suicide for some psychiatric patients.” Alan's death was not a reasonably foreseeable death. He was killed because he had a mental health condition.
Then, there was a disturbing incident where a Veterans Affairs agent casually offered MAID to a veteran with PTSD and a traumatic brain injury, something they had no business doing. To its credit, the government dealt with that employee, and I commend it for that, as I commend it for taking this pause on MAID expansion. I was in government, and I know how hard it is to walk back on things. It takes courage to do that, so I am glad the government has seen fit to do so. However, it turns out this one veteran incident was not an isolated incident; it was one of six incidents, that we know of, where it was suggested that veterans should consider assisted death.
Moreover, let us be clear about what we are talking about, because as I listened to the justice minister and read some of what has been put into print, it does not sound like he is convinced that those with mental illness should not receive MAID. It just sounds like he was not ready to go.
CBC, on February 2 of this year, quoted him as saying:
COVID slowed everything down. To be honest, we could have gone forward with the original date, but we want to be sure, we want to be safe, we want everyone to be on the same page.
We want, in particular, those health practitioners, those faculties of medicine, colleges who had some concerns to have the time to internalize what is happening.
Let me read that sentence again: “We want, in particular, those health practitioners, those faculties of medicine, colleges who had some concerns to have time to internalize what is happening.” That does not sound like an about-face to me. It sounds like the minister and the government still have every intention of moving forward with this.
According the National Post, a 2021 report by the UN “warned that Canada's liberalization of euthanasia posed a dire threats to its elderly and [infirm] populations.” That threat certainly includes those suffering with mental illness. The report said, “There is a grave concern that, if assisted dying is made available for all persons with a health condition or impairment [including mental health]...a social assumption might follow...that it is better to be dead than to live with a disability.” Given what we have seen to date, that certainly appears to be the case.
Just a little less than a year ago, last February, I received an email from a constituent. She is not my constituent but a constituent of a Liberal member of Parliament. It was sent to several MPs. I would like to read it into the record. It comes from a woman by the name of Melissa, and this is what she said:
...I was the farthest thing from a being a productive member of society. 15 years ago I was struggling really badly. I had entered into my second year of grade 10, which was due to a mental health diagnosis. I was diagnosed with PTSD, a personality disorder, major depression, and I had anxiety and was on a bunch of antipsychotics. I was in and out of crisis stabilization units, psych wards and a couple years later I got kicked out [of] a safe home for youth. I got kicked out of school and home because I was overdosing on the prescription medication and was self mutilating. I was a lost cause and didn't want [to] live and suicide was the only way out from all this pain......or so I thought.
She continued:
...it would have made me a prime candidate for MAiD, since my condition was nearly impossible to overcome apart from a miracle. I was a burden on my family, the medical system, the education system, and on top of it had chronic stomach issues and back pain which I would frequent the hospitals for. If I had an open door to access MAiD, that would have been something I would have seriously considered and would not be here to tell you about my story.
There are so many young teens that, like myself grow up in broken homes and get stuck in hopelessness and despair, and there are others who have everything they could ever want, yet still suffer from issues affecting their mental and physical health. Not everyone overcomes and it gets carried into their adult life, which makes them eligible for Medical Assistance in Dying.
She went on to say:
When you make the choice to go through with MAiD you no longer have an opportunity to go back and reconsider your decision. I know people suffer, and life can be tough and there are moments that seem unbearable. But there is Hope!!!! I've been there before. I suffered for over 10 years, I started on antidepressants by the age of 12, and by [the] middle of high school I had lost my mind and just wanted to end it.
Yet taking life is a very serious matter. I met Jesus who became my hope, I know that the name of Jesus has been frequently misrepresented but, the Jesus I met truly takes away needless pain and suffering.
Then she addressed her Liberal member of Parliament and asked him to reconsider his support for this particular bill.
Sadly, this is happening in Canada at the same time as we are facing a growing and serious health care crisis that has been exacerbated by years of COVID, restrictions and delays. Millions of Canadians are unable to access primary care, and wait times for doctors, appointments, surgeries, mental health support and emergency room visits are among the longest in the developed world.
Since it was expanded, MAID has seen a dramatic upswing, exacerbated by COVID-19 and the inability of too many Canadians to access timely and proper health care, including a lack of mental health supports. In fact, in an Angus Reid survey that just came out today, 55% of Canadians are worried that the expansion of MAID will become a substitute for social services.
An ER doctor recently told my office that prior to COVID, mental health cases accounted for one in every seven ER visits. Post-COVID and post-restrictions, that number is one in three. According research in the National Post, 2020 saw a 17% increase in MAID deaths over 2019 that disproportionately involved the elderly. I see no reason why we will not see an even more significant jump if MAID legislation is permanently expanded to include mental illness.
I recognize there are many for whom every day is a struggle and for whom mental health and physical health issues are debilitating. I will not begin to pretend that I know what it is like, and I want to be sensitive to that, but I believe that every human life, whatever the contents and challenges of that life may be, holds an innate and sacred dignity. Only God can give life and only God should be able to take life. It is my deeply held conviction that from conception to natural death, life is a precious gift.
It is the role of government to seek the best for all its citizens. We must adopt policies that embrace that gift, policies that uphold life and reinforce the value of every citizen. As Pope Francis put it during his recent Canadian tour, “We need to learn how to listen to the pain...of patients who, in place of affection, are administered death.”
We need to be there for the elderly, the infirm, the disabled. We need to be there for those who are suffering from mental illness, not offering the needle—
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Madam Speaker, in light of this important bill, there is a need to push it to a place where the government and members of this House have an opportunity to hear more. We need to ensure that those who are desperate, in need and seeking the kind of support that mental health supports can provide them actually have those resources and can get them without seeking MAID. I support the member in his call for that.
However, I also support the need to ensure that those who are furthest behind and need support get that support through the mental health transfer or other means, like a guaranteed livable basic income. That is an important piece to this.
Can the member elaborate on the need to ensure that we support those who are living in poverty with real tools and solutions so they can live with dignity?
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Madam Speaker, absolutely we need to support individuals. We know that in the recent health care proposal from the federal government to the premiers of the provinces, there was no mention of mental health care support. That is very unfortunate. The Liberals had a wonderful opportunity to expand on and incorporate it into the funding they were providing to the territories and provinces and they chose not to do that.
In addition, with respect to providing supports for folks suffering from a mental health crisis, we know that the cost of living has become a huge burden for individuals and has intensified their feelings of hopelessness and exasperation. Under the Liberal government, we have seen the cost of living increase significantly, and we are going to see it increase more with its proposals for additional taxes.
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Madam Speaker, I listened with great interest to the last answer, and I have a question on it. We have heard in many speeches today by the opposition that it is all about supporting people, yet every time our government has provided supports, whether it was the one-time income support or assistance for housing, the members opposite have voted against those initiatives. I am not certain how they can have it both ways by suggesting that we need to be there for people in their time of need.
Why do opposition members continue to vote against the initiatives put forward by the government that are helping the very people they are referencing in their speeches today?
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Madam Speaker, in the opening part of his speech, my colleague said that he would be voting in favour of extending the deadline by another year. Is he optimistic that in that one year the government will be able to develop regulations, safeguards and guidelines to assist the medical profession in the responsible application of medical assistance in dying?
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Madam Speaker, there is something very broken in Canada today. I could talk about inflation being at 40-year highs. I could talk about interest rate hikes in the last 12 months that are doubling the average mortgage payments and making residential rental rates out of reach for many workers in Canadian cities that need workers. I could talk about the housing affordability crisis and I could talk about crime. We have talked about these things.
We are now learning in recent polls that two-thirds of Canadians feel that Canada is in fact broken. One of the pillars of our society they feel is broken is our health care system. Canadians used to be proud of our universal, world-class, leading-edge health care system. Now people wait for hours for emergency care and months for specialist appointments.
This does not line up with the view that we as Canadians have of ourselves as a prosperous nation. There is indeed something broken, and nowhere is this more evident than in our mental health care arena.
We are in the midst of a serious opioid crisis right across this country, and certainly in British Columbia, my home province. Decriminalization, safe supply and anti-stigma campaigns have had, at best, very little positive effect. At worst, they have contributed to the skyrocketing number of opioid deaths in the last eight years. Clearly, what the government has been doing has not been working.
It is in this environment that we are now, as parliamentarians, talking about whether MAID, medical assistance in dying, should be made available to those whose only underlying health condition is a mental illness. Indeed, there is something broken.
There was a time when those suffering a mental illness got the help they needed. I want to note an editorial that ran in last weekend's Vancouver Sun by editorial writer Douglas Todd. He writes often but not often about himself or his family. This is a very personal story.
When Mr. Todd was a young man, his father Harold, a World War II vet, was diagnosed with schizophrenia. He spent many stable years in metro Vancouver's Riverview Hospital, where he received three meals a day, where he was kept safe and where nurses administered and monitored his medications. He was stable. Riverview was not perfect but it kept Harold off the streets.
Harold died 23 years ago, according to the story, right around the time that the provincial government started taking the view that hospitals and boarding houses for the mentally ill were inhumane and paternalistic, and that patients with mental illness should not be out of sight, out of mind, but should be allowed to live in a community. These facilities have been largely wound down and replaced with nothing, which has led to disaster.
The younger Todd noted that last year alone, 2,272 British Columbia residents died of toxic street drugs. He says this: “If my dad had not had stable housing, he would have been vulnerable to such a fate.” That is where mental health is in Canada in 2023.
That brings me now to the question of recovery and the incurability of mental health issues. A number of my colleagues have spoken about that.
A member of my community shared with me a chilling story of how her daughter struggled with her mental health years ago. Through a proverbial turn of events, she happened upon a hospital during a serious bout of suicidality. My constituent is confident that if her daughter had been offered MAID in the hospital that day, she would have agreed to it. Instead, she found hope for a better tomorrow and access to real support. She has now recovered and is living a full life as a wife, mother and member of our community.
This question of possible recovery is one that experts disagree on. What constitutes irremediability for mental illness? When is a mental illness incurable and how do we discern that? Our special joint parliamentary committee on MAID looked into these very troubling questions. One witness shared that he likely would have chosen MAID in his darkest days but now has a rich life with successful medication and therapy.
Dr. Vrakas gave the opinion that for people struggling with mental illness, offering MAID to them is a “clear signal of disengagement from mental illness”.
Dr. Sareen from the Association of Chairs of Psychiatry said in December 2022 to the committee that, “We're in the middle of an opioid epidemic. And we're in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are the highest ever.”
We cannot pretend that patients have a free choice between MAID and treatment when treatment is simply not accessible.
However, no consensus has been reached about such pivotal questions as: can this person be cured? There is a huge risk in assuming that they cannot. The reality is, providing MAID to a person suffering from mental illness is an irreversible reaction to a condition that we do not know is incurable.
Dr. Maher summed this up perfectly in his testimony to the committee when said, “The rallying cry is autonomy at all costs, but the inescapable cost is people dying who would get better. What number of mistaken guesses is acceptable to you?”
Dr. Mishara added that he has personally known countless people who have “convincingly explained that they wanted to die to end their suffering and are now thankful to be alive. If you proceed to allow MAID for persons with a mental illness, how many people who would later have been happy to be alive are you willing to allow to die?”
There are, of course, experts on the other side of the debate who assure us that we can discern between people who apply for MAID and people who suffer from suicidal ideation; experts who believe that, when a person is depressed and can see no brighter future, we should not try to change their mind by offering care, medication and therapy.
However, I am confident that this lack of consensus alone should be enough to definitively say no, that expanding MAID to those whose only underlying condition is mental health is not a responsible public policy choice. Instead, let us fix our health care system. Let us see this government deliver on its forgotten promise to fund mental health. Let us open or reopen our assisted living homes for people suffering from mental illness. Let us take care of our mentally ill people. Let us give hope for a better tomorrow and the support needed to live through today.
The very narrow question that we are addressing today is whether we will vote in favour of a bill that would extend the deadline. The government has a two-year deadline. That time has come and gone. I think March 17 is the deadline, which will soon be upon us. Do we give ourselves another year to develop the guidelines, regulations and safeguards to make sure that MAID for mentally ill patients is administered in as responsible a manner as possible?
To be honest, I am torn on this. I voted against MAID in the first place, but like my colleague, I will be voting in favour of this, because I am optimistic that we can at least come up with regulations that will put safeguards in place to manage this very troubling public policy question.
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