44th Parl. 1st Sess.
February 13, 2023 11:00AM
Mr. Speaker, I would like to begin by providing some background on Bill C-39, which is not rocket science, when it comes down to it. Then I would like to talk about the philosophical foundation for dying with dignity, as well as the context and whether or not medical assistance in dying should be extended to patients whose sole underlying medical condition is a mental disorder. I would also like to talk about mental illness generally in our societies and the experts' report before finally concluding my speech.
The context is rather simple. This is not about rehashing the entire debate. We are studying Bill C-39, which simply defers the provision in Bill C-7 that would have ended the two-year exclusion for mental disorders on March 17, 2023.
Following consultations, the government has decided to extend this exclusion clause for one year, which means that on March 17, 2024, mental disorders, or rather individuals whose sole underlying medical condition is a mental disorder, would be eligible for MAID, subject to the conditions, limits, guidelines, standards of practice, safeguards and precautionary principles outlined in the expert report.
Before voting, I invite all parliamentarians in the House to read the report of the expert panel. It contains precautionary principles that do not lend credence to last week's comments by, for example, the leader of the official opposition. It really puts into perspective the ideology underlying the comments by my colleague from St. Albert—Edmonton. Let me dive right into this matter.
Why is there such a delay? The reason is that we believe things should be done properly by the medical world. When a mental disorder is the sole basis for a request for MAID, how prepared are those working in this field across the country to ensure that MAID is adequately and safely delivered in light of the safeguards?
More providers and seasoned assessors will be needed. I should note that the experts did say that assessing whether a person with a mental disorder has the capacity to choose MAID is something they are already doing. Often a person may have cancer and also suffer from a mental disorder. It is not the sole underlying medical condition, and they still need to establish the person's capacity to decide for themselves. Again, in response to the oversimplification by my colleague from St. Albert—Edmonton, first a person needs to want MAID, and then they need to meet the criteria.
As far as mental disorders are concerned, to meet the criteria, this is not going to happen overnight or anytime soon. It is going to take decades before anyone can have access. It is going to take time for the whole range of necessary treatments and possible therapies to be tested without the condition that the person demonstrate that they cannot bear any more and that their pain cannot be relieved. That is a long way from people living in poverty, who are depressed and who might have access to medical assistance in dying. We are far from it.
That being said, what are we talking about? When we talk about medical assistance in dying, I know that everyone in the House wants to do the right thing. Everyone has the best of intentions and wants to look after the best interests of patients and people who are suffering. However, being compassionate does not square with undermining human dignity. Human dignity is grounded in the capacity for self-determination.
Those are the philosophical premises. The law grants any individual with a biomedical condition the right to self-determination. Nothing can be done without the patient's free and informed consent. To that end, the role of the state is not to decide what that patient, who is the one suffering, needs. Rather, the state must ensure the conditions needed for them to exercise free will, so that patients can make a free and informed decision.
Historically, it was difficult to fight medical paternalism. At one time, people who had reached the terminal phase of an incurable disease did not have the right to die. The right to die was acquired, and it was called palliative care. Life was artificially prolonged, and people died from clinical trials or new therapies rather than dying a peaceful death in palliative care. However, palliative care is not a substitute for medical assistance in dying.
I find it strange that my colleague thinks it is unacceptable to grant access to medical assistance in dying to someone whose soul is suffering, and that he even opposes any form of medical assistance in dying, even when people are at the end of their life. He is opposed. At some point, if people are opposed, they need to explain why.
Why does the law recognize people's right to bodily autonomy throughout their lifetime but take it away from them at the most intimate moment of their lives? The government or our neighbour is not the one dying, so on what basis is the government giving itself the authority to decide for us at the most intimate moment of our lives?
These are the ethical and philosophical grounds and principles behind our position. Just because someone has a mental disorder does not mean that they should also be subject to social discrimination and stigma. Even though mental illness is now considered to be an actual illness, mental health is still not on the same footing as physical health. Mental illness results in discrimination and stigma.
Should we be telling people who have to deal with such discrimination and stigma that they will also never be given the right to MAID, even if they have been suffering from a mental illness and have had schizophrenia, for example, for 25 or 30 years? On what grounds are we refusing them that right? That is the basis of the expert panel's report. Do we give that right to someone with a mental disorder who is suffering, who has tried everything, whose problems are far from over and who says that they cannot go on?
There are people out there who have an ache in their soul, and unfortunately, we lose them when they attempt suicide. It is really no better. We absolutely must fight against suicide because it is one decision that cannot be undone.
In the report, the experts set out several precautionary measures. They talk about structural vulnerabilities like poverty. On page 11 of the report, the experts state the following: “In the course of assessing a request for MAiD—regardless of the requester's diagnoses—a clinician must carefully consider whether the person's circumstances are a function of systemic inequality”, and, if so, this should be addressed.
With respect to suicidal ideation, experts offer us another precautionary measure. It is not enough for a person to request MAID to have access to it.
The report states: “In any situation where suicidality is a concern, the clinician must adopt three complementary perspectives: consider a person's capacity to give informed consent or refusal of care, determine whether suicide prevention interventions—including involuntary ones—should be activated, and offer other types of interventions which may be helpful to the person”.
What is this claim about people who are depressed being able to request MAID? Members need to stop talking nonsense. That is not what the expert panel's report says. It says that incurability can be established over the course of several years. The patient must have exhausted all available therapies and treatments. However, that does not include overly aggressive therapy.
What does the member for St. Albert—Edmonton think should happen? When a person with a psychiatric disorder says that they reached their breaking point years ago, should psychiatric science insist that there is a treatment out there and that it is going to find it? That is what I mean by overly aggressive therapy.
Overly aggressive treatment may exist for all types of illness. Who gets to decide when it is too much? The Supreme Court and the Superior Court of Quebec have told us that it is up to the patient to decide. That is important, because the member for St. Albert—Edmonton keeps saying that we are cutting lives short, ending lives prematurely.
In reality, the opposite is true. Everyone wants to live as long as possible. People who are on what we call the second track, whose natural death is not reasonably foreseeable, want to live as long as possible. What they do not want is to be denied help when they reach their breaking point. If we do not give them access to MAID, they will find their own way to avoid ending up in that situation, because it is currently illegal for them, and they will end their lives prematurely. They will commit suicide.
The ruling that some contend should have been appealed to the Supreme Court states that there is an infringement on the right to life. The Conservatives' position infringes on the right to life because it forces people to end their lives prematurely rather than waiting for the moment of death, which sometimes is in one or two years. As proof, there is the case of Ms. Gladu. She did not go ahead with MAID, but she was relieved to know that she had that option. She did not commit suicide; she died naturally.
However, if her suffering became intolerable, she knew that she could access MAID because our compassionate and empathetic society would take care of her and ensure that she had a peaceful and dignified death. This meant that she could have the death that she did. Many people say that they choose to end their lives because they are not certain that they will be taken care of.
Is there anything more devastating than a suicide? That is a societal failure. We cannot be complacent about suicide attempts, about people feeling suicidal. In the health care system, mental illness, which is an illness like any other, absolutely must have all the necessary resources.
I just want to say a few words about the governments' ability to pay for the health care needs of the patients I am talking about, given the feds' post-pandemic offer. Governments have to deliver care to these people with irreversible illnesses, but they will not be getting money to do so. Over the next 10 years, they will barely be able to cover indexing on chronically insufficient funding. The federal government's share will go up from 22% to 24%. I hope government members are not too proud of that, especially considering that, during the third wave, people told us the system was in critical condition. The pandemic had destabilized it to the point that it would take 10 years to recover from the pandemic's side effects on patients without COVID. Right in the middle of the third wave, the Prime Minister said it would all be dealt with after the pandemic. We were told an agreement was imminent. I figured that they would come close to the $28 billion everyone expected, that they would give the governments of Quebec and the provinces the predictable funding they needed to rebuild their systems, take care of people over the next 10 years and finally recover from the pandemic.
I have heard the Conservatives say they will honour that small percentage. Of all the G7 countries, Canada still has the best borrowing capacity. If debt is unavoidable, what better justification for it than taking care of our people and restoring and rebuilding our health care systems?
I hear people say that individuals who have had an incurable mental disorder for years should not be given access to MAID on account of structural vulnerabilities. According to the expert report, however, two independent psychiatrists would have to be consulted. Not only would two independent psychiatrists be required, but we also have to consider recommendation 16. So far, I have been talking about recommendation 10, but my colleagues should hold on to their hats, because recommendation 16 states that, unlike for other kinds of MAID, when mental disorders are involved, there would be something called “prospective” oversight. This is different from retrospective oversight, as required by Quebec's commission on end-of-life care, which requires a justification every time MAID takes place. No, this does not happen after, but rather before, in real time.
This prospective oversight needs to be established in each jurisdiction, which is precisely what the delay will be used for. This additional safeguard needs to be established in controversial cases. According to the expert report, when an individual's capacity cannot be properly assessed, MAID is not provided, period. It is not complicated. There will be no slippery slope.
If there is a slippery slope, there is the Criminal Code, the courts, the police. Evil people do not belong in the health care system. They would be fired. If they do harm, they can be taken to court. To my knowledge, the provisions allow action to be taken.
My esteemed colleague seems to assume that everyone in health care is necessarily evil, which is absurd. The slippery slope is based solely on health care workers having evil intentions. However, to work in that field, people have to demonstrate skills proving the opposite. Consequently, all the precautionary measures and principles in this report are sufficient, in my opinion.
What needs to be done now is to ensure that people get training. Not all Quebec psychiatrists have read the report. If they listen to interviews given by the member for St. Albert—Edmonton, they will wonder what is happening with their profession.
We must be able to see things realistically and proportionately, provide training, and ensure that we implement a law that will be both accessible and equitable throughout the country. We must avoid situations where an institution that does not want to provide MAID prevents someone from accessing it, if it is their choice and they meet all the criteria.
This is still a dangerous situation. It is happening in Quebec, and the college of physicians warned last week that, in a simple case of MAID for a terminal patient, some doctors did not want to refer the patient to another doctor who was willing to provide it.
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Mr. Speaker, it is an honour to stand to give my thoughts on Bill C-39. For those who are watching the debate today, this is the bill to amend the Criminal Code to delay, until March 17 of next year, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition is a mental illness.
It has to be stated very clearly, because of the timeline with which we are dealing, that if this bill is not passed, the original sunset clause that was put in place by the old Bill C-7 will come into effect on March 17, which is just over a month away. It is for that reason that I will support the bill and will work with all parties to get the bill passed quickly.
Today's conversation has to happen within the context of the mental health crisis in Canada. We know and have heard, and this is not just from members of Parliament, from many advocates and stakeholders that there is an extreme lack of funding and resources. Clearly, there absolutely must be parity between physical and mental health in funding.
The Minister of Mental Health and Addictions has stated in the House that Canadians should have access to timely evidence-based, culturally appropriate and trauma-informed mental health and substance use services to support their well-being. With that I agree wholeheartedly, but words are not enough. We need to see the requisite resources and funding to follow through those words.
We know that beyond the Canada mental health transfer many advocates have long been calling for legislation to enshrine in law parity between mental and physical health. I am very glad today that I am giving my speech beside the hon. member for Courtenay—Alberni, who is our mental health and addictions critic and who has himself tabled Motion No. 67, which calls on the government to develop that legislation and to urgently fulfill its promise to establish that Canada mental health transfer.
In my own riding of Cowichan—Malahat—Langford, many of my fellow citizens are going through extreme struggles with the opioid crisis. They are dealing with trauma. They are dealing with underlying mental health challenges that are simply not being addressed. That is an extreme gap and the cause of an extreme amount of shame for a country as wealthy as Canada to be still having these conversations about the resources that need to be brought to bear in communities like mine.
I have been a member in the House since 2015, so this is now my third Parliament. I have been here for the entirety of the legislative journey of medical assistance in dying. I can remember Bill C-14 and the sometimes difficult debates we had in the House. That legislation was in response to the Carter decision in the Supreme Court, which basically said that to deny people this right was contrary to our charter. It therefore gave the government a timeline to address it with the appropriate legislation.
What is not often talked about with Bill C-14 is that there was a legislative requirement in that act when it received royal assent. There was a five-year statutory review of medical assistance in dying. Unfortunately, that never occurred before the government went ahead in the previous Parliament and introduced Bill C-7, which established a second track for people whose death was not reasonably foreseeable.
The context of today's speech and C-39 is the fact that we have a story here of the government in several instances putting the cart before the horse. It not only introduced Bill C-7 before a statutory review occurred, which was a requirement of Bill C-14, but it then went ahead and accepted a Senate amendment to the bill that ran contrary to its own charter statement. It did that pretty massive expansion to the law without establishing a special joint committee that was a requirement of Bill C-7.
I am intimately familiar with what this process has been because I have not only been a member of the House since 2015, I have not only participated in debate on Bill C-14 and on Bill C-7, but I have also been a member of the special joint committee, both in the previous Parliament and in this Parliament.
The message all along has been that this kind of a review should have occurred before we were dealing with a timeline crunch. It became quite obvious during the special joint committee that too many Canadians, too many professionals in our country had apprehension about mental disorders as the sole underlying medical condition for being able to access medical assistance in dying as early as next month. Hence, we have Bill C-39.
I want to go back to the original charter statement that the government released as a part of Bill C-7. That includes a number of important statements as to why the government felt, originally, that mental disorders should be excluded from accessing MAID. It did say in that charter statement that the exclusion was not based on the assumption that individuals who suffered from mental illness lacked decision-making capacity. It also said that the exclusion was also not based on a failure to appreciate the severity of the suffering that mental illness could produce. Rather, it was based on the inherent risks and complexity that the availability of MAID would present to those individuals.
First, that charter statement identified that the evidence suggested that screening for decision-making capacity was particularly difficult. It could be subject to a high degree of error. Second, the statement identified that mental illness was generally less predictable than physical illness with respect to the course that the illness may take over time. Finally, it highlighted the experience that a few of the countries that permitted MAID, namely Belgium, the Netherlands and Luxembourg, for the sole underlying medical condition of mental illness had and some of the concerns relating to the increasing number of these cases and the wide range of mental illnesses in respect to which MAID could be provided.
Again, it really highlighted the fact that precaution was the necessary mode that was required before we embarked on this path. However, the government in its wisdom decided to accept a late stage Senate amendment to the bill after the House, full of its duly elected members, had given a final vote on Bill C-7. As a member at that time, I could not bring myself to accept that Senate amendment. Therefore, I ended up voting against the final version of Bill C-7 because of that.
It also needs to be said, when we are going over the history, that the special joint committee that was a requirement of Bill C-7 got a very late start. It was first brought into being just before the summer recess in 2021. We only had a few meetings before the summer of 2021 and we had the unnecessary election, launched solely at the request of the Prime Minister, in August of that year. This completely wiped out anything that was happening during the 43rd Parliament. That Parliament ceased to exist, and all of the committees that were a part of it did as well.
The new Parliament, the 44th, reconvened later that year, but it was not until around April or May of 2022 that serious discussions started coming together and we could actually get the special joint committee reformed. Again, we have to put that in the context of the impending deadline of March 17, 2023.
An incredible amount of time was wasted, not only from an unnecessary election but also from the delays of getting that committee up and running. We had to twice request an extension of our mandate from both houses of Parliament because the timelines we had been given were completely unrealistic, not only in hearing from as wide a range as possible of witnesses but also in producing a report that would reflect the gravity of the subject matter with which we were entrusted. That has to be highlighted in the debate today on Bill C-39.
I also think it is important because there have been a few narratives around this legislation. It is important to go back to understand what the Criminal Code actually says, and also to put that in the context of the definition of irremediability.
It is important that, in order to be eligible for medical assistance in dying, a person has to meet all of the following criteria: they have to make sure that they are in fact eligible for health services in the province they reside in, they have to be at least 18 years of age and capable of making decisions with respect to their own health, they have to have a grievous and irremediable medical condition, and they have to have made a voluntary request. All these conditions must be satisfied. A person must also give informed consent to receive medical assistance in dying, after having been informed of the means available to relieve their suffering, including palliative care.
Now we get to the definition of a grievous and irremediable medical condition as outlined in the Criminal Code. A person has to meet the following criteria for that definition: it has to be a serious and incurable illness, disease or disability; they have to be in an advanced state of irreversible decline in capability; and that illness, disease or disability, or that state of decline, has to be causing them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.
Those are the definitions in the Criminal Code, so despite the narratives we hear out there, those conditions must be met or the person administering MAID will have committed a crime. They will be in violation of the Criminal Code of Canada and will get the appropriate punishment as a result.
One of the difficulties is the fact that the term “irremediable” is not a medical or scientific term. It is a term that finds its definition within the Criminal Code. If we go to scientific or medical literature, it is a difficult term to define, and that, I think, is why we are seeing a lot of the apprehension around accessing MAID for mental disorders where the sole underlying medical condition is a mental disorder.
Some witnesses who appeared before our committee expressed the opinion that this should not be permitted, because there cannot be any certainty with respect to the incurability of a mental disorder. However, other witnesses told us that certainty is not required and that there are ways to consider irremediability, for example by looking at the years of treatment that people have had and whether any responses of the patient have actually been positive.
We also have to understand that the respect for personal autonomy in all of this is paramount, and it is has to be a treatment that is acceptable to the individual receiving it. They not only have to express informed consent, but it has to be something acceptable to them as a person.
I now want to talk a little about the special joint committee, which I have had the honour of being a member of, as I previously mentioned.
I think it is important to underline that our committee has struggled with the question of how to balance individual autonomy with protections for the vulnerable. We were tasked with looking at five themes through the passage of Bill C-7 and the motion that guided our work from both the House of Commons and the Senate: how we institute protections for persons with disabilities; the state of palliative care in Canada; advance requests; mature minors; and, of course, the subject of today, mental disorders as a sole underlying medical condition and their eligibility with respect to applying for medical assistance in dying.
Our final report is due to be tabled in the House this Friday, February 17. We wrapped up our committee meetings last week and finally approved a draft report. That draft report, as I speak, is going to translation services so that it can be ready for tabling here in the House, and so we will be able to meet the deadline that was given to us.
Before we did that work, we had others who did some important work ahead of us. We had the expert panel that was established. They also wrestled with major concerns, such as incurability, irreversibility, capacity and suicidality, and of course the intersection between structural vulnerability, mental disorder and medical assistance in dying.
That panel report, an important precursor to our work as a special joint committee, did state that assessors in medical assistance in dying should be able to establish incurability and irreversibility with reference to treatment attempts made; the impacts of those treatments; and the severity of the illness, disease or disability. The incurability of a mental disorder cannot be established in the absence of extensive attempts at interventions with therapeutic aims.
This means that someone who has not had access to adequate care would not be eligible for MAID. Therefore, MAID could never be used as a substitute for good psychiatric care. I think that is an important thing we have to realize. There will be safeguards in place, not only with the Criminal Code, but also, we hope, with the standards of practice.
For patients who are considering this, we want to make sure that there has been a long track record of attempts to deal with their illnesses. At the same time, we have heard very clearly that there are many Canadians and many professionals who feel that additional time is needed to make sure we get this right.
One of the witnesses before our special joint committee was the chair of the Government of Quebec's Select Committee on the Evolution of the Act respecting end-of-life care. She explained that Quebec had decided that MAID for mental disorders as a sole underlying medical condition should not be permitted at this time because of the challenges of determining irremediability, as well as the lack of social consensus. Another level of government, this time the Province of Quebec, is also underlining the concerns that many members of Parliament are expressing here today.
I mentioned the final report that will be tabled in the House, but our committee did release an interim report. That interim report was specifically on this subject matter. I will read from our conclusion. It states:
We must have standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight in place for the case of [medical assistance in dying for mental disorders as the sole underlying medical condition]. This task will require the efforts and collaboration of regulators, professional associations, institutional committees and all levels of governments and these actors need to be engaged and supported in this important work.
Although some work is already underway to implement the recommendations of the Expert panel, there is concern that more remains to be done to ensure that all necessary steps have been taken to be ready by the March 2023 deadline...
Again, in our interim report, our special joint committee was already, at that time, expressing concern with the upcoming deadline, and I think it is a smart move that we are moving ahead with Bill C-39. If we back that up with the testimony we heard at committee, we had a number of different witnesses who clearly expressed that they had troubles with this deadline and that those standards of practice were not yet ready.
It needs to be underlined again that, if Bill C-39 is not passed, the original sunset clause of March 17 will come into effect. My vote for this bill is occurring because of that very fact. This is aside from the broader conversation we need to have about medical assistance in dying in general. It is support for a bill that is going to extend the deadline by one year so we can make sure that we get these standards of practice right, so we have the necessary time to engage with the broader community.
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Madam Speaker, it is important to outline what we are talking about here today: Bill C-39. Currently, due to Bill C-7, the Criminal Code explicitly states that, when it comes to MAID, mental illness is not to be considered an illness, disease or disability. However, when Liberals passed Bill C-7 two years ago, it had a sunset clause, and this is an important clarification. That means an important guardrail protecting those with mental illness from being eligible to seek MAID during times of depression or other crisis would expire two years after that bill passed, which means it is set to expire next month.
Now the Liberals, having heard the outcry from across the country, from the medical community and those serving the folks with mental illness, have introduced Bill C-39. This is a last-minute attempt to save face by extending the prohibition on MAID for mental illness for one more year. That is not good enough.
Conservatives have been united in our opposition to expanding the Liberal government’s medical assistance in dying regime to Canadians with the sole underlying condition of mental illness. We do not believe that medical assistance in dying is an acceptable solution to mental illness and psychological suffering. Our health care system should help people find hope when they need to live and not assist in their deaths.
Allowing MAID for people with mental illnesses such as depression blurs the line between suicide assistance and suicide prevention. Experts have been clear that expanding eligibility for medical assistance in dying to Canadians living with mental illness cannot be done safely. It is impossible to determine the irremediability of an individual case of mental illness.
For example, Dr. Sonu Gaind, who is the physician chair of the MAID team at the Humber River Hospital in Toronto, where he is chief of psychiatry, states, “I know that some assessors think they can make those predictions of irremediability in mental illness, and some assessors think they can separate what we consider traditional suicidality from what’s fuelling psychiatric MAID requests. And on both counts they’re wrong. The evidence shows that.”
Andrew Lawton, Canadian columnist and journalist, wrote a harrowing personal article two years ago, stating:
If Bill C-7 were the law of the land a decade ago, I’d probably be dead....
In 2010, I nearly succeeded in committing suicide. My battle with depression was worsening, and I was losing. Miraculously, I pulled through: I count my lack of success in that attempt as my happiest failure, for which I’m grateful to God’s intervention and a team of dedicated healthcare practitioners.
It’s saddening to think that under different circumstances, these practitioners could have been the ones killing me rather than saving me....
Bill C-7 undermines years of attention and billions of dollars of funding to bolster mental illness treatments and supports, including, ironically, suicide prevention and awareness campaigns and programs.
This bill kills hope and reinforces the flawed belief afflicting those with mental illness, that life is not worth living and that one’s circumstances cannot improve.
Every time I have risen to speak on these bills, that has been my emphasis as well: Life is worth living. Every life has dignity and value. We need to be far better as a nation at communicating that to those who need to hear it the most.
Two years ago my friend Lia shared her story with Canadians. She said, “I was 15 when I first tried to kill myself and I attempted suicide seven times in the years that followed...I’m speaking about my mental health struggles because I’m scared that doctors could soon be able to end the lives of people suffering with mental illness - people like me. To be honest, if medically assisted suicide had been available when I was in university, I would have used it to end my suffering as soon as I could.”
This is Lia's call to parliamentarians: “I don’t need someone to tell me how to die, I need someone to tell me to stay.”
The House should be writing laws that instill the value of life and that there is no question this is what we value. Laws need to encourage people to stay rather than seek to end their lives.
Dr. John Maher is an Ontario psychiatrist and editor-in-chief of the Journal of Ethics in Mental Health. Dr. Maher has highlighted that the wait times for mental health treatment in Ontario programs are up to five years long, and that one of his patients recently told him that he would like assisted suicide because he believed that nobody loved him.
Dr. Maher also rejects assisted suicide as a solution for mental illness by stating the following:
You're assisting someone in the completion of their suicide. The doctor is the sanitized gun...I'm not at all disagreeing that there are people who have an irremediable illness. What I defy you or any other person in the universe to prove to me is that it's this person in front of you.
The suicide prevention community has also pointed out the harsh reality for costs. Shawn Krausert, the executive director of the Canadian Association for Suicide Prevention, testified at committee and said the following:
Ending the life of someone with complex mental health problems is simpler and likely much less expensive than offering outstanding ongoing care. This creates a perverse incentive for the health system to encourage the use of MAID at the expense of providing adequate resources to patients, and that outcome is unacceptable.
Most Canadians do not support expanding MAID to those with mental illness as the only underlying condition. Today, a survey was published in which a mere 30% of Canadians support MAID for those who have a mental illness.
I can assure members that, among my constituents, that number is far lower. The vast majority of my constituents want the federal government to focus on helping people live well and to invest in palliative care and suicide prevention instead of assisted suicide.
Some of the petitions I have tabled here over the years were sent to me by constituents who have recognized that suicide is the leading cause of death for Canadians between the ages of 10 and 19. They are specifically calling on the government to protect Canadians struggling with mental illness by facilitating treatment and recovery, not death.
I agree with my constituents, and the majority of Canadians, that the government should withdraw this bill entirely and table a bill that permanently removes the extension and expansion of assisted suicide for mental illness when it is an underlying condition.
I want to end with some words from my friend Lia. She says:
I want to say right now, to whoever might need to hear this: death doesn’t have to be the answer. It takes work. It takes time. It takes others. And it's complicated. But there is hope...I’m sharing my story because I’m not the only one who has more to live for. There are people in your life who do too. As someone who struggles with mental illness, I don’t need someone to tell me how to die. I need someone to tell me to stay.
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Mr. Speaker, I rise to talk about this issue tonight, because for me it is deeply personal. As someone who has suffered with depression and mental health issues at various times in my life, including a severe depressive period for which I was seeking treatment, I think the expansion of medically assisted death to those with mental health conditions is incredibly troubling. The fact that this is where we are, almost a month away from when this would be available to Canadians suffering with mental health issues, is a catastrophic failure of the government to properly deal with this issue. I am so unbelievably disappointed that the Liberals are rushing through legislation now to try to delay the implementation of this because they did not do any of the hard work that was necessary in order to get this right. The problem is that there is so much evidence out there on how they could have gotten it right, yet they chose not to.
I want to talk a bit about an article that was written on December 15, 2022, by Dr. Karandeep Gaind, a professor of psychiatry at the University of Toronto and the chair of his hospital's MAID team. If anyone has not done it, they should read this article, because it outlines and summarizes the incredible challenges with this issue and how the government has failed in examining it.
I am going to start here: “[E]vidence shows it is impossible to predict that a mental illness will not improve in any individual.” He goes on to say, “Yet expansion activists mistakenly believe they can make such predictions.” Research, which he cites, “tells us their chance of being right amounts to chance or less, with precision modelling showing only 47 per cent of [irremediable medical condition] predictions end up being correct”.
This means that 47% of the time when a doctor says a person's mental health will not improve, they are wrong. This evidence was readily available to the government at any time, yet we find ourselves having to push through legislation to delay it at the last minute.
He goes on to say this: “[W]hen expanded to those seeking death for mental illness, evidence shows MAID becomes indistinguishable from suicide.” We should remember that this is a psychiatrist talking. He says, “We cannot differentiate those seeking psychiatric euthanasia from suicidal individuals who resume fulfilling lives after being provided suicide prevention, rather than facilitated death.”
Let that sink in for a minute. This is a psychiatrist who teaches at the University of Toronto and is the chair of his hospital's MAID team. These are the things he is saying. He has been saying them for a very long time, and the Liberals still could not get this right.
He then talks about the federally appointed panel:
The government-appointed federal panel...was responsible for providing safeguards, standards and guidelines for how to implement MAID for mental illness. Instead, the panel recommended that no further legislative safeguards be required before providing death for mental illness, and did not provide any specific standards for the length, type or number of treatments that should be tried before providing MAID. Its report even suggested society had made an “ethical choice” that MAID should be provided even if suicide and MAID were the same.
This psychiatrist is summarizing what the government panel found. To me, it is absolutely and truly shocking.
He goes on to say, “I am not a conscientious objector.” There are many who are. There are members in this place who conscientiously object to medically assisted death. I am not one of them. I think it can be appropriate in certain circumstances, and Dr. Gaind is in that group as well. He says, “However it is clear to me that Canada’s planned expansion of MAID to mental illness is based on ignorance—if not outright disregard—of fundamental suicide prevention principles.”
Let that sink in. Again, I go back to who is saying this. This is not me saying this, not a parliamentarian saying it who does not have experience in mental health. This is a psychiatrist at the University of Toronto and the chair of the hospital's MAID team. He finishes, “It appears to ignore what drives the most marginalized people to consider death as an alternative to life suffering.”
This again is the incredible challenge. We have heard all the reports about people thinking they should now get MAID as a result of mental health issues. I cannot believe that we let it get this far, that we do not have rules in place and that we have to go forward and put this off.
The government had so much time to get this right and it could not. It did not even come close. This to me is just a symptom of how the government does things without thinking them through, without thinking of the consequences. What is going to happen if we do not get this bill passed by March 17? Then it is open and available. How is this legislation just being introduced now to push it back? The government knew ages ago that it was not going to meet this deadline. It knew ages ago that it did not have safeguards in place, and yet here we are now. I find that breathtaking.
The doctor's final comments in the article, I think, we should all listen to. They read:
Postponing the March 2023 expansion of euthanasia for mental illness is the only responsible course. Canadians and mental health organizations recognized this and called for it, with the Canadian Association for Suicide Prevention and over 200 individual psychiatrists so far signing a petition to this effect, and the academic chairs of the departments of psychiatry across Canada joining this call for delay.
That article was written in December and here we are now dealing with this legislation. It is a catastrophic failure by the government and the minister responsible for this. Let us hope it is not a catastrophic failure for Canadians.
Someone who is dealing with a mental health issue needs help. Let us be clear. I went through a period in my life where I did not want to continue to live. It was a deeply dark, terrible period of time.
The government is moving forward with this legislation with absolutely no safeguards in place to protect people who are in that terrible place. Eminent psychiatrists have been banging the clarion bell on this for ages and the government did nothing until the last minute. Now it is saying we have to put it off.
I can tell colleagues that I have absolutely no faith that the government is going to get it right. As the quotation I cited in the article stated, the panel got it wrong. I do not know if there has been any ministerial direction to make sure it gets it right. What I can say is this. On this side of the House, we are going to stand up for people with mental health issues. We are going to protect them and not let the government just throw them under the bus.
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Mr. Speaker, I am thankful for the opportunity this evening to speak to Bill C-39.
At the outset, I believe it is important, first of all, that my constituents know that this bill is not a complicated one. It does not propose anything new to Canada’s euthanasia laws, nor does it propose to appeal laws that are currently in place. This is a simple bill that delays the expansion of medical assistance in dying to those living with mental illness by 12 months, one year. On those grounds, Conservatives support its swift passage, but only as a temporary solution.
However, this bill is what happens when a government moves too fast, too aggressively, and fails to take into account the pleas of experts and everyday Canadians living with mental illness and family members living with them. These Canadians include our family members, our friends, our neighbours and our co-workers. They live with mental illness that, to them, should not be a death sentence. They see the provision of MAID for their illness as yet another step along the road to devaluing life in this country. They know it is not going to accomplish anything to end stigma around mental illness, and they know that it puts vulnerable Canadians from all walks of life with illness seen and unseen at risk.
That is why this bill is little comfort to me and to Canadians at large. The extension of assisted death to mental illness must not just be delayed; it must be scrapped completely.
Assisted death has been a highly emotional issue since this place first considered its legalization in 2016. It was the first bill that I debated in this House. Debate has been passionate due to our personal experiences, personal beliefs and convictions on what constitutes dignity in end-of-life decisions. However, today’s debate takes on an even greater heaviness in that respect.
Statistics indicate that one in two Canadians by age 40 has or has had a mental illness. The chances are even greater for young people, and among those who have answered surveys on the topic, respondents report that they would be three times less likely to disclose a mental illness than a physical one, like cancer. The numbers are grim but paint a realistic picture of mental health as it relates to all Canadians. It is universal. No one is immune to life’s difficulties, whether in the short or the long term. That is precisely why stakeholders are asking the government to show true compassion by reconsidering an expansion of MAID to those with wounds that are largely unseen.
The Canadian Mental Health Association points to socio-demographic factors beyond age, education and income levels as driving forces behind a request for MAID. Racism, poverty, homelessness and gender-based violence have harmful effects on mental health and symptoms of mental illness. Over these past couple of years, we can tell too that isolation, persecution for one's beliefs and hopelessness impact our mental health.
The Ontario Hospital Association is clear that these complex issues must be addressed through appropriate legal safeguards, coupled with societal supports, before assisted death expansion is considered. On the other hand, I believe that we must consider the realities of mental health in Canada among certain groups close to my heart and why expansion must never be entertained.
This summer, Canadians were shocked to learn that a Canadian Armed Forces veteran struggling with PTSD and a brain injury was repeatedly advised of MAID as a solution to his suffering by a Veterans Affairs Canada employee. The veteran had never inquired about MAID, but even after asking the VAC employee to stop pressuring him over and over again, the employee persisted. We know that veterans face a greater risk of suicide compared to the average population. It is truly frightening to know that instead of facilitating the most appropriate care available, this public servant chose to repeatedly suggest MAID as a solution to suffering. This frightens me to know, and I wonder how often this kind of advice has led to tragic consequences.
Debbie Lowther of VETS Canada said that it is like planting a seed within someone who is already struggling with their mental health or may even be contemplating suicide. No matter how isolated the Veterans Affairs issue may be purported to be, and I do not believe it is, it is clearly a result of the government’s attempts to muddy the waters on suicide. It did a lot to draw Canadians’ attention to the normalization of assisted death in this country and just how rapidly it is becoming a “fix-all” solution, not just for end-of-life issues but for treatable illnesses among vulnerable people. When accessing an assisted death takes less time than accessing disability benefits for our veterans, we are completely failing them. Sadly, veterans are not alone in this respect.
Some Ontarians, for example, face multi-year wait times for special mental health care. That is years of living with mental health issues when they could be receiving treatment. Why are they not? We need to ask ourselves that question. Disability advocates have been crystal clear with this government for years that Canadians do not have access to all the supports that they need and deserve and are even available.
In a piece in the Hill Times this past week, Spencer van Vloten of BC Disability is correct when he states that, “too much time is spent considering who should die, rather than how to help people live.” He goes on to note all-time highs in wait times, nearly 30 weeks, for those seeking mental health treatment.
To paraphrase one disability rights advocate, “those living with treatable illnesses likely would not put MAID anywhere near the top of their list if they had unimpeded access to support and treatment.”
Indigenous Canadians also face an increased risk of preventable harm as MAID becomes more accessible. Tyler White, CEO of Siksika Health Services noted that, “Indigenous elders work hard to tell young people that suicide should not be an option, and the medical assistance in dying (MAID) bill [Bill C-7 in this case] says the opposite.”
Many indigenous Canadians can speak to negative experiences with the health care system, including procedures that were done against their will. It is my belief that an assisted death regime, with ever-expanding boundaries and ever-diminishing safeguards, will not help to heal mistrust. It will only worsen it for our indigenous people, our veterans and those with disabilities.
It comes down to this simple fact: The same majority of Canadians who desire empowerment in their end-of-life decisions want Parliament to carefully weigh the risks of MAID for those living with mental health issues, such as depression. Sixty-nine percent fear that depressed individuals could see MAID as a means to escape dealing with the underlying causes of their condition. The experts say they can, over time, deal with those conditions.
The slippery slope does exist, and it exists nowhere near to the effect that it is happening in Canada and spinning out of control. We have to apply the brakes here. We are not only listening to those who will personally be affected by these laws, but we also need to take lessons. I know this government says, “We take no lesson”. Well, do not take them from us then, take them from jurisdictions with a long-standing MAID regime for mental illness.
In Belgium and the Netherlands, MAID laws once limited to mentally competent, terminally ill adults now include adults and children with mental deficiencies, severely disabled individuals, and those with treatable psychiatric conditions such as anorexia and depression. Between 2012 and 2017, the Netherlands alone saw a 600% increase in euthanasia which was sought to address psychiatric conditions; conditions that the experts say cannot be determined to be irremediable.
So, this government has made a choice. This minister has claimed that this is only a pause. It cannot claim as a government that it stands as a champion for mental health treatment while simultaneously cheapening the value of that treatment and, indeed, human life itself.
The minister claims that MAID expansion can be done safely, but experts have been clear that expanding eligibility of medical assistance in dying to Canadians living with mental illness cannot be done safely. It is impossible to determine irremediability in individual cases of mental illness. This expansion will only blur the lines further between suicide assistance and suicide prevention.
Canadians cannot trust this Liberal and NDP government to protect the lives of our most vulnerable, including those who are simply asking for a hand in the seasons of need. Every action they have used for MAID since 2015 has achieved the opposite.
So, let us not further stigmatize those with mental illness by placing euthanasia ahead of other solutions. We need to reject a culture of death on demand and instead let us make Canada a champion for suicide prevention at all stages of life.
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