44th Parl. 1st Sess.
February 13, 2023 11:00AM
Mr. Speaker, as the member knows, for many years, in a substantial way, we have had legislation dealing with the issue. It stems from a Supreme Court decision. The member has made reference to that. There has been a great deal of dialogue over the last half a dozen years in regard to what we are actually debating today. We have a standing committee that has been overseeing it as of late. We have some deadlines. I think the legislation allows for more discussion by having the extension.
One of the things lost in the debate is the issue of situations where, because of the supports that are there when someone is looking for medical assistance in dying, they get some sort of treatment that ultimately takes them off the thought of having medical assistance in dying.
Could my colleague provide his thoughts on the medical professionals and others who are out there who are, in fact, providing a service that has been deemed by the Supreme Court as something that is necessary? How we define that is really what we are talking about.
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Mr. Speaker, there are doctors who see their role and have a role of helping people who are suffering from terrible sickness, an irremediable medical condition, to end their life without pain, and we have voted for that and we supported that. However, I have seen no consensus from the medical community that people who are depressed should be able to have assisted dying and no medical consensus that children should be able to. That consensus does not exist.
The only place that consensus exists is in the unelected, unaccountable Senate, and I would not take its advice on anything, yet the government did. The reason we have this legislation is because a bunch of unelected, unaccountable senators, people who flipped pancakes for the Liberal Party and Conservative Party fundraisers over the years, decided that if one is depressed they should be able to die. Not on my watch. Forget it.
So, yes, we have had a lot of talk, but we have had no review that Parliament was promised. This government did not do that job. It would rather listen to the Senate than actually do the hard work of reviewing this legislation and getting down to what is happening. Is it working or is it not? Why, in God's name, are we talking about expanding it when we have not addressed what we were committed to under the previous provisions of this legislation?
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Mr. Speaker, I wonder what the member's thoughts are on what is going to happen in the next year. We have had two years to develop guidelines, regulations and safeguards around MAID for those suffering a mental illness, and yet we have not developed a consensus at all. What we did was hear conflicting evidence and conflicting opinions at committee. Is the member confident that in the next 12 months we will actually come to a consensus, or are we going to be here a year from now seeking another extension?
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Mr. Speaker, that is an excellent question. We are debating until midnight tonight, for folks back home, because the government is scrambling to put this paper band-aid on the wound, and that wound is the failure to do due diligence. These are profound issues, and I do not know how that evidence is going to come down. I do not know where the guardrail should be. I do not know what the good reasons for use are and where it has been exploited. We need that evidence.
If the government waits until the 11th hour next year to either move forward or delay it again, we continue to fail. We have an obligation here. The statistics and numbers are concerning. We have to get to the bottom of it.
Again, I am not making a moral judgment on people who have used MAID. I have had very close friends use it. I can see its provision, and I support that, but I cannot go along with being told “Trust us, this thing is going to work” when we have not seen any evidence that this continual expansion is in the interest of individuals or society.
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Uqaqtittiji, there are real concerns from indigenous communities about MAID. I have heard from constituents of mine who have family in places like British Columbia who are vulnerable, have severe mental health disorders, and have love from their family, but are separated from their family. A mother is very concerned about her daughter. She heard from a friend that her daughter had applied for MAID and was being considered.
When I talk about MAID, I do not see it as an issue about suicide. Suicide is very different for indigenous communities. MAID is about dying with dignity. It is a privilege that most indigenous people do not have. It is more about how we can make sure that we are protecting indigenous people.
I wonder if the member has any ideas about what this government needs to do in the coming year to protect those most vulnerable communities, especially indigenous peoples who we need to make sure are not being taken advantage of.
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Mr. Speaker, I want to say that the whole plan we had developed as New Democrats, the national suicide prevention plan, came out of the groundbreaking work in Nunavut because of the understanding that statistics were important. Documentation and identifying the factors were key to being able to go in and bring down those numbers. We can dramatically decrease those kinds of deaths when we have actual facts.
That is what we have found, and I share my colleague's concern. We know that people from our region who end up in the city do not have the family supports. There is fundamental racism, and it has to be said, in the medical system. There are people who are coming in who are in distress, people who may be homeless, and they are not with their families and their loved ones. It concerns me that these decisions would be made without trying to find out where the family is. Where is the support?
If we do not have that, people will be using this, because they do not know what else to do when they are in distress. These are factors that have to be looked at, because vulnerable populations will be susceptible to this, and we have to find ways to support them. If they have the love and the support and they can get housing, in the vast majority of cases, they are going to be able to live much better lives.
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Mr. Speaker, I want to thank the hon member for Timmins—James Bay for such a heartfelt and sincere exploration of how it has made all of us feel in this place. I remember feeling entirely conflicted on the vote on Bill C-7, because I could not see how we could deny advance directives for people who had a terminal diagnosis and were told they had to wait for the day of their MAID procedure, and be of sound mind and confirm.
We knew that people were actually choosing MAID procedures earlier than they needed to because of the failure to have advance directives in Bill, C-14. I know, as I did vote for Bill C-7, that I was approving something to come into place automatically by default that I thought was wrong, so I thank the hon. member.
Has the member ever explored the ideas of things like psilocybin? There are mental health illnesses where the psychiatry profession says there is no hope for a person, they are chronically depressed and nothing will ever lift them out of it. Does the hon member for Timmins—James Bay have any thoughts about what other medical procedures could assist in lifting people out of the deepest of despairs?
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Mr. Speaker, far be it from me to provide medical advice to anybody. I warn people back home to not ever take medical advice from a politician; that is not what we do, but I think what we look at in our job is to make sure people have access to housing. Our job is to make sure that, if people are on the streets, they can get mental health supports.
My brother is a subway driver, and he has seen the impacts of the pandemic and mental health crisis in real time in Toronto with the rising violence. We can talk all we want about getting tough on violence, but it is our job as politicians to put in place the supports. For people who are chronically depressed and people with mental illness, our job is to make sure there are places they can receive treatment. Then I think the vast majority of cases of what we are talking about and debating tonight would not be necessary, and it would be reserved for those who are suffering from illnesses, and they have a right to die in dignity.
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Mr. Speaker, it is an honour to rise this evening to speak on Bill C-39. Before I do, I want to let you know I will be splitting my time with the member for Saanich—Gulf Islands.
This legislation might be the simplest one I have had the chance to speak on in the House since being elected, but it is also one of the more serious and emotional ones. Simply put, it would allow for an extension for mental illness to be a condition for eligibility for medical assistance in dying.
I strongly support this delay for several reasons. The first is about concerns I heard about from so many neighbours of mine in Kitchener. In particular, I remember one conversation a group had in their backyard on a colder afternoon just last month. It was between Hannah, Peter and some friends of theirs, and they wanted to share with me specifically some of their serious concerns with medical assistance in dying being expanded further than it already had been.
I really appreciated them sharing their stories, concerns and recommendations. In my view, that was the best of how our democracy is supposed to function, which is for folks like myself who are sitting in legislatures like this one, who have a say in laws like this, to be hearing from neighbours about their concerns. In that conversation and in emails since, it has been almost been universal that folks in my community want to see at least a delay, if not more.
Second, I am supportive because we heard the concerns of experts across the country, such as doctors and health care professionals. On December 1, I really appreciated hearing from the Association of Chairs of Psychiatry in Canada, which includes the heads of the psychiatry departments of all 17 medical schools across the country, as they appealed for the governing party to delay what was then an expected expansion of MAID for those with mental illness.
The third reason I am supportive is because I believe we should spend more time closing the social safety net before we expand medical assistance in dying. I would put it to all colleagues here and ask why it is we are seeing a movement to expand medical assistance in dying much more quickly than we are seeing an expansion to the social safety net. I will give a few examples.
In my community, as colleagues well know as I have shared it many times, the unsheltered population has tripled in the last three years from just over 300 to over 1,000 people living rough. It is clear what is being done when it comes to the affordability of housing is not nearly enough, that we are going in the wrong direction and that more needs to be done.
As well, there are income supports, whether that is a guaranteed livable income for all or as many in this place, myself included, have pushed very hard for, a guaranteed income for those with disabilities across the country. Although we have made progress, and I am glad to see that Bill C-22 was passed in this House and is now in the Senate, the fact is it is yet to be funded. I would strongly encourage the governing party to fund the Canada disability benefit to get on with closing the social safety net with the urgency it deserves.
Next is mental health specifically. Just last week we saw a big announcement about health care, and yet absent from that announcement was dedicated mental health funding. It is all the more egregious when in the 2021 campaign the governing party ran that campaign on a commitment for a $4.5-billion Canada mental health transfer.
I hope there is no sleight of hand here, that with this new health care announcement we are not going to continue to see dedicated mental health funding. It is imperative that all parliamentarians in this place continue to apply pressure to ensure the Canada mental health transfer is in budget 2023. When I last asked the parliamentary secretary about it on Wednesday night, I did not get a clear answer, and it should concern all of us to not see dedicated mental health funding.
In fact, it was because of this absence of sufficient supports for affordable housing, income supports and mental health care that I joined the CEO of the Canadian Mental Health Association of Waterloo Wellington to encourage the Minister of Justice to follow through on the delay that had been promised in December of last year. I am glad to see him follow through on that.
With my remaining time before I close, I just want to quickly mention the importance of quality journalism in this country and how it relates to this legislation.
I am glad to hear that all parties are supportive of Bill C-39, but I am not surprised to hear that, because of the work of Althia Raj and the Toronto Star. Specifically, back in November, as other members have shared, Ms. Raj spoke with the Minister of Justice. At the time, he said nothing could be done and that it would be a “challenge in the current Parliament” to delay the expansion of medical assistance in dying.
Ms. Raj then did something very reasonable. She reached out to all of the opposition parties, including the Green Party, and asked them if they would support what is now Bill C-39. Opposition parties responded, and days later, on December 11, Ms. Raj published an article sharing that all opposition parties were supportive. Then the question was put back to the Minister of Justice, and days later, on December 15, it was announced that this legislation would come before this House.
While there are many advocates and many campaigns that lead toward legislation such as this one, I think it is important that we call out and appreciate non-partisan journalists across the country doing important work to help bring to light the agreement that is sometimes there to move forward with important changes like the ones we are discussing, and to call out what might be certain rebuttals that may or may not be justified. In this case, they were not, and I appreciate Ms. Raj, as well as the medical professionals I mentioned earlier, like those from the Association of Chairs of Psychiatry in Canada, for their advocacy, which brought us to this point.
In closing, I applaud the governing party for introducing Bill C-39 and following through on the promise that was made back in December, and for listening to the need to slow down. I have no doubt that other parliamentarians across the country heard concerns similar to the ones I heard from Hannah, Peter and so many others. I also encourage the government to move more quickly on the social supports that are needed in my community and across the country.
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Mr. Speaker, I agree with my friend from Kitchener Centre that there is obviously a need to invest more heavily in mental health supports.
Looking at how medical assistance in dying has evolved in the last seven years, as well at the way that Bill C-7 brought forward the issue of mental health as a sole underlying condition and where we are at today, can my colleague reflect on whether we are moving at the right pace or moving too fast? I think what I heard from him is a suggestion that we are moving really fast, but we are moving based on the science that is available. In fact, the expert panel report suggested that we are in fact ready to move forward. Could he comment on the available science on this issue?
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Mr. Speaker, the Parliamentary Secretary to the Minister of Justice is a person and member in this place whom I really enjoy working with. He is focused on working together to get things done for people as opposed to parties, and I really appreciate that.
I think this question is an important one, but to answer it honestly, I have not yet seen the result of the special committee in place, which is meant to report back to Parliament on the research it has been doing. I think it is important to rely on committees of this House to share the research and work they have been doing. I am looking forward to reading what it comes out with. I hope that we will have time over the coming year to look at what it recommends and that the governing party will take the recommendations seriously, move forward on them and ensure that sufficient changes are put in place.
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Mr. Speaker, the bill, at this point, is necessary for us to ensure that we are protecting the most vulnerable. To me, and to many of us, as we are hearing, it speaks to a bigger issue: The government is leaving many behind.
I appreciate that my colleague spoke to the importance of closing the social safety net and spoke about the importance of disability supports, appropriate mental health supports, affordable housing and a guaranteed livable basic income. There are many components necessary for us to move forward to address the bigger issue.
I wonder if the member can share with us what he is hearing from constituents in his riding regarding what is most vital for us to move forward with so that those who are struggling the most have what they need to get through each day.
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Mr. Speaker, I thank the member for Nanaimo—Ladysmith because I know what a champion she has been in this place in pushing for people with disabilities to get the follow-through they have been promised and have advocated so strongly for over so many years. We could cut poverty by 40% in this country by providing a guaranteed income for every person with a disability, who are right now disproportionately living in legislated poverty. It is a national embarrassment, in my view, that we have not done more already.
Whether it is related to providing a guaranteed income for folks with disabilities and funding the Canada disability benefit or following through on the Canada mental health transfer, it is important for our democracy that political parties and leaders follow through on promises they have made. I am going to continue to push, alongside the member opposite and others in this place, in the lead-up to budget 2023 to see those important commitments followed through on.
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Mr. Speaker, I want to begin by thanking my colleague, the hon. member for Kitchener Centre, for such a thoughtful speech, one that anticipates much of what I want to say.
We have not done enough in the year since Bill C-7 passed to know with any degree of certainty that we have lived up to our obligations when passing that act to fully study what it would mean to extend medical assistance in dying to those who are dealing with deep suffering that comes from a mental health issue, not from a medical diagnosis of traditional medicines, such as ALS, cancer or the other cases that moved us forward on this trajectory.
I want to briefly canvass what brought us here and the way in which the Parliament of Canada and the Supreme Court of Canada have dealt with medical assistance in dying, and I want to suggest, in closing, that when one looks to the Supreme Court of Canada for guidance, I do not believe we can say that the Supreme Court of Canada's guidance takes us to the availability of MAID in cases of deep mental health distress.
Going way back, as the member of Parliament for Saanich—Gulf Islands, I want to reflect on one of the champions, heroes or, as one might even say, martyrs on the issue of access to medical assistance in dying. I speak of Sue Rodriguez. She lived in North Saanich, in the electoral district that I am honoured to represent. She had ALS. She famously said, “[W]hose body is this? Who owns my life?” She went all the way to the Supreme Court of Canada back in 1993 in an effort to get access to the alleviation of suffering from a disease that would kill her. This was not in doubt. However, the Supreme Court of Canada, in 1993, denied her request.
As others have mentioned in this place over the last couple of days of discussion, a colleague and friend of many of ours and a dear friend of mine, Svend Robinson, stayed with Sue Rodriguez when a doctor assisted her illegally, and she took her own life, with the doctor's assistance, in probably the first public case of medical assistance in dying in Canada.
The courts took a long time to change, and that decision in 1993 was not changed until 2015 in the Carter case. In the Carter case, the Supreme Court of Canada found, taking a different view, that the charter rights in section 7 to life, liberty and security of the person were violated by not allowing a person to make such a decision and to have access to medical assistance in dying. The Carter case changed things by putting squarely to the Parliament of Canada that it had to deal with this.
I will quote from the Carter case. The Supreme Court of Canada said, “competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering”. That was the basis for creating legal access to medical assistance in dying.
When Bill C-14 went through, I tried so hard to put forward amendments saying we have to allow advance directives. It was not right not to allow them for someone who knows they are terminally ill and are facing incredible suffering. It is their choice and they should be able to access medical assistance in dying with an advance directive. However, back when Bill C-14 went through, this was rejected. My amendments were rejected in the House as well. Similar amendments were then passed in the Senate, and we all recall it came back here without those amendments having been accepted.
Bill C-7 repaired that but opened the door to something entirely different. I do think it is entirely different to say that when people are suffering incredibly and intolerably due to a deep, chronic and unsolvable mental health condition, they should also have access to medical assistance in dying.
I will go back and say what the political promises were when we started down this road. I first want to address the medical conditions.
When Bill C-14 was first debated, a lot of members in this place were asking about palliative care: Would people choose medical assistance in dying if they had the option for palliative care? We heard many promises from the government benches that we would see increased funding for palliative care. That has not happened. That is one thing that concerns me greatly.
We have also heard, since we passed Bill C-7, that there would be more supports for mental health. That has not happened either.
What would we do if we were serious about making sure that every Canadian could exercise, fully, their rights, under section 7 of the charter, to life, liberty and security of the person?
At least, one would know that the health care system should be working well. I am pleased to see that the premiers accepted the federal offer today. I hope that the federal government will defend our public health care system with every ounce of its energy and make sure that the deals with the provinces are specific and tied to outcomes and results.
However, our health care system is in trouble. I was just talking to an incredible indigenous woman. I will not say her name; it was a private conversation. She is Cree. She lost a dear friend recently because that Cree dear friend could not get access to medical care in time to diagnose and treat her cancer. She leaves two small children behind.
The health care system in the country is not equal, any more than the litany of deeply racist and distressing conditions in which the system works against justice for indigenous peoples. We all know it. In the context of the health care system, how can we not know it?
In terms of mental health care supports, we know even more deeply that the suicide rates among youth in this country are a huge source of concern. We know that mental health issues have been worsened among our youth, through the pandemic, through isolation, through all kinds of things, through being preyed on by social media.
We know that our schools, universities and post-graduate programs are failing young people because they cannot get the mental health supports that they need when they need them. They need help to avoid addictions and to kick addictions. Our young people need so much help and we are failing them.
Opening up MAID is not a solution to solvable mental health care issues where we are just falling down on the job because we are not providing the mental health supports that we have promised over the years.
What would we do if we wanted to be serious about section 7 rights? We would bring in a guaranteed livable income, to ensure that no Canadian is living in poverty, poverty being the number one social determinant of ill health, in terms of physical health and mental health. We would address poverty and end it through guaranteed livable income.
We would do more, as I mentioned, for the end-of-life issues and access to palliative care. There is such a thing as having a good death. We do not like talking about death in our society. We are all supposed to be young and preferably sexy forever. Let us face it: people get old and it is a lovely experience. It is a good thing to be healthy in old age and enjoy it right up to the moment when whatever one thinks is going to happen to oneself happens: meet one's makers or feed the worms, whatever. A good death is a good thing.
Medical assistance in dying does give people that option of a good death, surrounded by family, feeling loved. I am very supportive of the work that we have done in Bill C-14 and half of what we did in Bill C-7, but where are the mental health supports?
Again, to the point that the hon. member for Timmins—James Bay made, I totally agree. I say yes to housing, to supports and to ending poverty.
However, I do think that we have to explore and open up. In the next year, let us get serious at looking at non-traditional therapies for people dealing with what appears to be irremediable depression. Do psychedelics make a difference? I am not going to prescribe. As the hon. member for Timmins—James Bay said, do not take health advice from politicians.
However, the evidence is coming in on using such products as psilocybin to actually trigger something that results not just in a bit less suffering and mental health conditions. There are certainly papers out there that are peer-reviewed and very interesting, that one can cure depression. I certainly would not want to turn my back on a potential cure and then embrace medical assistance in dying for people who could be cured.
Neither do I want to turn my back on people who are suffering and who are saying that we are making them wait another year and asking why we are doing that. These are not easy issues but these issues, life and death issues, are at the heart of the sacred and they are at the heart of our work in Parliament.
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Mr. Speaker, we have had a number of speakers make reference to the issue of mental health and this member, the leader of the Green Party, also referred to palliative care. The greatest contribution that Ottawa can do in regard to the areas of mental health, health in general, palliative care and hospice care is provide the financial resources and then use the Canada Health Act and raise the profile of the issue itself. We can put a checkmark on all three of those with respect to the last five or six years of this government. At the end of the day, we do need to see more working together with provinces and indigenous communities, in terms of continuously raising the profile of the issue to make sure the resources are being properly allocated.
When she reflects on the legislation and the special joint committee that is out there, is there something specific that the leader of the Green Party would filter out or like to see?
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Mr. Speaker, to my hon. colleague and parliamentary secretary's first set of comments, absolutely I am looking to the federal government to defend public single-payer universal health care as under the Canada Health Act. I am looking at threats to that system. For as much as people say we have to do it because things are bad right now, that is the work that has never stopped to undermine our public health care system in Canada by the forces for privatization, and they must be resisted.
I would throw one door open here. Before deciding that this is up to a group of experts, please let us get a reference to the Supreme Court of Canada to ask whether extending MAID to mental health conditions falls within the Supreme Court of Canada's understanding of the ruling in Carter.
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Mr. Speaker, I want to thank my colleague for talking about some opportunities and she also cited broken promises when it came to palliative care. As members know, I was here last Monday and the Monday before and would have been here tonight on Adjournment Proceedings, to drag the government here to talk about mental health, but it was disrupted so I am back.
I asked the minister about mental health just last week. She cited:
Through the proposed bilateral agreements on the shared health priorities, we are working with the provinces and territories to integrate mental health and substance use as a full and equal part of our universal health care system.
However, when it comes to the reality on the ground, the Liberals have still not delivered on their promised mental health transfer of $4.5 billion. Even the agreements that they signed with the provinces today do not assure that.
Does my colleague agree that we need, enshrined in the legislation, parity between mental and physical health to have a proper conversation in this House about expanding medical assistance in dying for those whose sole identified underlying medical condition is a mental illness?
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Mr. Speaker, this is one of my favourite recommendations from medical doctors around mental health. Because the hon. member for Courtenay—Alberni is from such a beautiful place in the world, I do not know if he knows that Dr. Melissa Lem prescribes visiting national parks to get out into nature.
To answer the member's question simply, yes, I agree with parity.
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Mr. Speaker, I would like to thank my friend from Saanich—Gulf Islands regarding her relationship with Sue Rodriguez and the first battle toward medical assistance in dying that took place decades ago, which has brought us here.
The expert panel that was convened reported in the summer and outlined a number of different areas in which the systems are ready. As a government, we have heard from a number of different parties about the need for an extension. I wonder if my friend could advise what specific issue she has with the expert panel report with respect to medical assistance in dying, in respect of mental health as the sole underlying condition.
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Mr. Speaker, yes, there is an expert panel looking at the medical and mental health conditions, but I think we have skipped a step in making sure what we are doing remains constitutional.
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