44th Parl. 1st Sess.
February 15, 2023 02:00PM
Mr. Speaker, my colleague said that people should not be induced to turn to medical assistance in dying in moments of weakness. I do not know where he is getting that from, but I just want to say that the expert panel's report on mental disorder makes no mention of that. When it comes to socio-economic determinants, which my colleague raised, the experts say that they need to be taken into account but that they are not part of the criteria for having access to medical assistance in dying.
I am not sure what he is talking about, but one thing is certain. Members need to stop using scare tactics all the time. Basically, the Conservatives are against medical assistance in dying in every situation, not just in the case of mental disorder. Many of them are even opposed to it when a person is terminally ill and already dying.
I would like to say to my colleague that, if he knows of any cases where a person has been induced to seek medical assistance in dying, then he must report them. The Criminal Code would apply, the police would intervene and those people would be brought to justice.
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Mr. Speaker, I would say that it has been one of the challenges. We have heard of people calling Veterans Affairs looking for services and being recommended to consider MAID as an option. Therefore, I do not think it is reasonable to say that it does not happen, and this is the challenge when we do not have the proper safeguards.
As I said before, it is about safeguards, and our caucus varies across the board in terms of where we are at on this. I personally never supported MAID, but I understand that, in irremediable situations where there is pain and imminent death, there may be choices. However, I am very concerned that people who are down on their luck, having a hard time or concerned about being a burden to society could consider a permanent solution to a temporary problem.
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Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code with regard to medical assistance in dying, which was introduced by the Minister of Justice on February 2.
Through this bill, our government is seeking to extend the timeline that will expand eligibility for MAID where the sole underlying medical condition identified in support of the request is a mental disorder.
Our government is committed to ensuring that the MAID framework is prudent, well‑thought‑out and rigorous so that the assessment and provision of medical assistance in dying is safe. At this point, we believe that delaying the repeal of the exclusion is the best way to achieve these objectives.
It is crucial to strike a balance between promoting the autonomy of those seeking a dignified end and protecting the interests of those most vulnerable in our society. Our government believes that this is the right decision given the inherent complexities of MAID requests that are based only on a mental disorder.
My comments will focus on the current MAID framework, including eligibility criteria and existing Criminal Code protections, and on the broad range of opinions from the public, the medical establishment and other experts, in particular the organizations representing persons living with a mental health disorder.
At present, to be eligible for MAID, an individual must meet five criteria.
All applicants must be eligible for health services funded by the Government of Canada, be at least 18 years of age and capable of making informed decisions relating to their health, have a grievous and irremediable medical condition, have requested MAID voluntarily and not as a result of external pressure, and provide informed consent to receive MAID after being informed of available means to relieve their suffering.
As I just mentioned, one of the criteria is a grievous and irremediable medical condition, which means that the person must have a serious and incurable illness, disease or disability; that their medical situation is characterized by an advanced state of irreversible decline in capability; that their illness, disease or disability or advanced state of irreversible decline in their capability causes them to experience enduring intolerable physical or psychological suffering that cannot be relieved under conditions that the person considers acceptable.
In addition to these eligibility criteria, the Criminal Code also provides two sets of procedural safeguards that must be met before MAID can be provided. The first set of safeguards addresses situations where death is reasonably foreseeable, and the second, more stringent set applies to requests for MAID where death is not foreseeable.
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The safeguards for MAID requests where death is reasonably foreseeable include that the request must be made in writing and signed before an independent witness, as well as that the person must be informed that they may, at any time and in any manner, withdraw their request.
There are four additional safeguards when death is not reasonably foreseeable. This is because these MAID requests are more complex than when death is reasonably foreseeable. The four additional criteria are as follows.
A second physician or nurse practitioner must confirm in writing that the person meets the eligibility criteria. There must be at least 90 days between the first MAID assessment and the date on which MAID is administered. The person must be informed of alternative available means to alleviate their suffering, such as counselling services, mental health and disability support services, community services and palliative care, and offered consultations with relevant professionals who provide those services. Finally, both physicians or nurse practitioners must agree that the person has given serious consideration to those means.
If this bill is not passed, requests for medical assistance in dying where the sole underlying medical condition is mental health will become available on March 17, 2023.
I will now briefly discuss some of the concerns that we have heard regarding the upcoming expansion. In their May 2022 submission to the Special Joint Committee on MAID, the Centre for Addiction and Mental Health expressed that “Before eligibility is extended, there must be thoughtful and inclusive discussions to develop consensus definitions of irremediableness and suicidality.” We believe that the extra year will allow for the necessary consideration of these important topics.
In addition, in November, the Canadian Psychiatric Association issued a statement in favour of delaying the repeal of the exclusion from medical assistance in dying in cases where a person's sole underlying medical condition is a mental illness. The CPA is of the opinion that more time is needed to improve education on suicide prevention and access to mental health and addiction services; to develop an expert-approved definition of the irremediability of different mental disorders; and to develop approaches and procedures to help clinicians distinguish between suicide and access to medical assistance in dying.
In December, the Canadian Association for Suicide Prevention also issued some observations in support of the delay. It would like more research to be done into the prognosis of mental disorders in order to draw conclusions on the irremediability of any mental disorder, which is a legal requirement within our MAID framework.
Many of these concerns were raised during the hearings of the Special Joint Committee on MAID, which was established to undertake a review of the Criminal Code MAID provisions and other related topics, including mental illness. The committee’s final report was released this week. One of the reasons for the extension is so that the government can seriously consider the recommendations of this committee.
The government believes that extending the exclusion of mental illnesses is necessary to ensure that MAID is provided appropriately in all circumstances where a mental illness is the sole medical condition for requesting MAID.
I hope that all members will join me in supporting this bill.
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Mr. Speaker, when members had the special joint committee, they had a great deal of consultation with many different stakeholders. A lot of evidence was provided. Earlier today, the Chair presented the report. It is worth recognizing that a majority of the political parties inside this House seem to support Bill C-39.
Can the member comment on whether the extensive discussions and dialogue that have occurred have in fact improved our system? Could she add value to anything I have said?
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Mr. Speaker, I thank my colleague for his question and comments. As he said, the report was tabled this afternoon.
During discussions at the Special Joint Committee on MAID, we heard from a wide range of partners, associations and people who had concerns. The discussions led us to make the decision to extend the delay for those whose sole medical condition is a mental illness. That way, we will have time to set things up properly and ensure that doctors and nurse practitioners are ready to provide MAID under these conditions. Things must be done properly to respect autonomy and freedom of choice.
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Mr. Speaker, I would like to know if my colleague believes that one year will be enough time for the government to ensure that this bill is as perfect as possible.
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Mr. Speaker, I thank my colleague for this important question. There have been discussions on this issue. Should expanding MAID to people with mental disorders be delayed by six months, nine months or twelve months?
With guidance from the Minister of Justice and his team, and keeping in mind what we have heard, we do believe that one year will be sufficient, especially since the expert panel is already developing an accreditation program and standards of practice.
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Mr. Speaker, I thank my colleague for her speech. I would like to know more about her perception of what the Conservative members are doing, since they seem to be fearmongering. It could even be described as spreading misinformation.
The Conservatives are suggesting that anyone with a mental health issue could request and be eligible for medical assistance in dying.
I wonder if my colleague could explain why this rhetoric is false. I would also like her to tell us what she thinks of the approach that the official opposition is taking.
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Mr. Speaker, I sincerely thank my colleague for his question. I condemn this practice of spreading disinformation. It leads Canadians to believe things that are simply not true.
I talked in my speech about all the safeguards that are in place to provide MAID to people whose only medical condition is a mental health disorder.
This must be done under controlled conditions, after these individuals have accessed services and after a determination has been made by physicians or nurses. We all know that the process is well regulated and that rules must be followed.
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Mr. Speaker, it is an honour to stand today to speak on behalf of the constituents of Moose Jaw—Lake Centre—Lanigan, a riding I am very proud to represent. If the Speaker will permit me just a bit of latitude, I have not had the opportunity before now to remember former colleague and member of Parliament Ray Boughen.
Ray was a dedicated public servant, but his earliest calling was as an educator. He was a long-time teacher and principal before being elected as mayor of Moose Jaw for two terms, from 1994 to 2000. He went on to serve as a trustee on the Prairie South School Division from 2000 to 2008 before entering federal politics. He served two terms as member of Parliament for Palliser before retiring in 2015.
Ray was instrumental in the early stages of my political career. Under his recommendation, or probably dare, I served as city councillor and later as mayor of Moose Jaw. My heartfelt condolences go out to his wife Sandra, his daughter Patti, his son Ryan, all his family and friends, the students who have been left behind and the people who know him.
Once again we are here debating an issue the Liberals have waited until the last minute to address. They have had years to work on this, and only now, as their polling numbers decline and their deadline approaches, are they finally listening to experts and putting the brakes on allowing medically assisted death for those suffering from mental illness.
This is a government of press releases and talking points. Quite honestly, the government has been forcing the issue without public consultation, and now there is a realization it does not have the support of the public. People have grave questions and concerns, and we are seeing that in almost every article we read in the news.
Instead of opening Pandora's box and seeking proper consultation before introducing policies like MAID, the Liberals have again been forced to backtrack. They have ignored experts, relying instead on their own ideology. This is a government that is out of touch with the everyday Canadian and will do absolutely everything to ignore good policy and common sense.
When experts come along with information that does not align with the Prime Minister's carefully drafted talking points, they are ignored, like the experts from the Association of Chairs of Psychiatry in Canada, who in December told the government that Canada was not ready to expand MAID to those suffering from mental illness.
If the government were serious about helping and treating people, it would work to ensure that access to qualified psychiatrists was easier to obtain than offering MAID. The government opened Pandora's box, and now we are seeing the results impacting our veterans community and have heard troubling testimony at my committee.
There are now multiple instances of the Department of Veterans Affairs discussing the topic of medical assistance in death with Canadian veterans. We heard one particularly troubling account of a veteran, who said he was “in a good place”, being told MAID was an option. He was told by a caseworker that they have done it before and they can do it for him. This is unacceptable. This is a conversation that should only be held between a patient and a doctor.
Now it has become so bad that the minister has been forced to refer one case to the RCMP. He now thinks the issue is done with. The truth is that there is a much deeper issue at play here, and many others have come forward since the minister has dismissed this.
Veterans who served our country and who now need their country are being betrayed by the government. Regardless of one's thoughts on MAID, when the law was passed, it was stated that any discussion of it had to be between a patient and a doctor. If the government's own departments cannot grasp this simple fact, how can we trust them to develop guidelines for mental health and the mental health industry?
This is beside the fact that wait times for veterans in Canada to receive treatment are skyrocketing, with many waiting almost a year. It can be even longer if someone is a francophone or a female veteran. Meanwhile, the wait time to obtain MAID is currently just 90 days.
After eight years of the Liberal government, everything is broken. Canadian veterans need help, and veterans needing help are seeing wait times skyrocket, not decline. There are veterans who are homeless and on the streets, and the Liberal government has withheld funding for veterans who are desperately in need.
Veterans took an oath to serve their country. They were ready to die for their country. Veterans with PTSD need help. They are not ready to be systematically eliminated by the government.
I mentioned something earlier about opening Pandora's box. Medical assistance in dying cannot be undone. I grew up in a single-parent home, and my mother suffered from postpartum depression. She had tough days, and there were days when she did not want to leave her bed. As a young child, I witnessed this, but every night has its morning, and there were people there for her. Whether it was family, friends or the local church, people gathered round. They were there to help.
Many people call this hope, and hope comes in different forms. To offer MAID, we take away that hope. Let us not take away hope for people who want help. Let us show compassion and care.
I ask this House, “What is the most valuable commodity in Canada?” Many will say it is minerals, some will say fertile grounds and some will say our abundant and clean energy. I would argue that it is the people of this great country.
The people of this country are the most valuable commodity we have. The potential of our country lies in its people. Let us not devalue a person who is in need of help because they are suffering from mental health issues, suffering from PTSD, suffering from depression or suffering from anxiety. These are the people who need hope.
I am not prepared to give up on people who need our help, because people did not give up on my mother. I am motivated by first-hand experience, and because I have a vested interest in the next generation, this is important to me. When I started out in politics to serve my community, I asked myself these four questions, which I will ask my colleagues here. What kind of kids do we want living in our communities? What kind of community produces that kind of kid? What kind of leadership produces that kind of community? What kind of people provide that leadership?
I believe in hope, and I want to send the right message to the people of Canada: They are valued; they mean something. I also want to send the right message to the next generation, an important message: Times may get tough, but there is hope.
I will be voting in favour of the bill, but I hope the government reconsiders its position on MAID.
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Mr. Speaker, it is most unfortunate that the hon. member decided to take such a partisan tack in his remarks for something that is as complex, sensitive and deeply personal as medical assistance in dying.
He started by saying the Liberals have waited until the last minute. I guess he is unaware that the Carter decision suspended the implementation of the decision for a period of time while the Conservatives were in power, and they abjectly, repeatedly and continually refused to bring in amendments to the Criminal Code that were called for by the court. An election ended up intervening, and the Liberals were left to deal with that.
The member serves on the veterans affairs committee and indicated that at the veterans affairs committee, we heard that a Veterans Affairs employee said to a veteran that they had done this for someone else and they could do it for that veteran. I can tell members that I am on the Veterans Affairs committee and that is not true. That testimony never came before the committee. That was put to the committee by the Conservatives based on something that was uncorroborated and not presented to the committee. It is most unfortunate.
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Mr. Speaker, what is unfortunate is that we are actually dealing with this in the veterans committee. These are veterans who served our country and were willing to put their lives on the line. These are veterans who served with honour and who care about the fabric of this nation.
Whether they have served in Croatia, like my cousin has, or whether they have served in Afghanistan or in some other theatre of operation, they come back and they find it difficult to integrate into society.
Instead of keeping them out of society, we need to integrate them into society. Being offered MAID as the first option is unacceptable, in my opinion.
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Mr. Speaker, I do not know where my colleague got the idea that MAID is the first option offered to veterans.
Morally speaking, it is equally unacceptable to exploit veterans for ideological reasons, which is exactly what my colleague is doing.
If people are offering MAID to veterans who are known to have a reversible condition, they should be reported to the police, taken to court, and put in jail, period.
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Mr. Speaker, I would point out that it is unacceptable. That should not be the first option for a veteran when they are looking for help. We heard the testimony of a serving veteran who contacted Veterans Affairs saying that he wanted some help. He wanted to reach out before he got out of the military and that option was offered to him. That is unacceptable for someone who is serving in the military at this point.
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Mr. Speaker, we need to be very careful about language, when I hear my colleague saying that MAID just takes hope away. I had good friends who suffered, who faced death and who had horrific pain. They made a choice, and they died with their loving family around them.
That is one thing, and I respect that. I do not have any right to tell them that they had no choice to do that.
The issue before us is whether we should expand this, with now over 10,000 cases a year undergoing MAID, and include mental illness and depression. I think that is a step way too far. It is irresponsible that this comes at the 11th hour, almost the 12th hour, to be debated in the House.
It goes back to the fundamental failure. We were told, when MAID was brought in, that there would be a review by Parliament to make sure that it was being used in a fair and applicable manner that met what we were all told were going to be the conditions. That does not seem to be the case.
Why are we debating putting this off for another year? We should be voting to say, no, this is not what MAID was intended for. It should not be used in conditions of depression, mental illness, PTSD or any of those other extensions that the unelected and unaccountable Senate thinks it should be.
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Mr. Speaker, my hon. colleague and I agree on a great deal. My disappointment and my first-hand account of what I have seen in Veterans Affairs is disappointing, because the push-back has been from veterans with PTSD who want hope and who want to live.
I appreciate the question that has been brought forward.
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Mr. Speaker, in regard to what the last speaker said, I believe, whether it is today or the other evening, that the Conservative Party has been politicizing what is very much a personal issue. Are they bringing in vets?
I had the privilege and honour of serving in the Canadian Armed Forces. I marched with World War I and World War II veterans in a parade. After the parade of remembrance, we went to a legion where there were all sorts of discussions. One got an appreciation of the sacrifices that were made and the types of horrors they had to endure.
To use veterans in a manipulative way to try to give the impression that the Liberal government, let alone any member of this House, would support that any civil servant recommend to a veteran that they apply for MAID is absolutely ridiculous and uncalled for. It is a politicization that cannot be justified. If there is a civil servant working for Veterans Affairs, any civil servant, it is something we take very seriously. They should not be communicating with the public, especially not with veterans, knowing what veterans, not exclusively, often have to go through.
The member referenced the idea that the Prime Minister is not listening. I reflect on debates on Bill C-14, which was brought in back in 2016. The member for Charlottetown referenced the Supreme Court of Canada's decision. It obligates the House of Commons and all members of Parliament to deal with medical assistance in dying. There is no choice. We are a nation that operates with respect to the Supreme of Court of Canada, the rule of law, and that obligation for us to deal with it.
Let us look at the debates we had then, in contrast to what we heard the other day in the speech before mine. In 2016, members debated the then-Bill C-14 with a great deal of passion, and people expressed personal opinions in a very real way. I cannot recall the same sort of partisanship. In the debate the other night, the member said the Prime Minister was not listening to what groups were doing and he was forcing this bill through. We have a minority government. The government and the Prime Minister cannot force anything through, unless there is at least a buy-in by a majority of the members who sit in the House. How can the Prime Minister force something through?
What I hear from the other side is that mental health and depression will somehow qualify someone to be able to apply for MAID. That is not the case. Do the members know the difference between a medical illness, where someone works for years with a psychiatrist and is diagnosed as mentally ill, versus someone with a mental health issue?
Just because someone is depressed one day, or individuals might have some mental health issues, does not mean they are mentally ill as prescribed by a psychiatrist who individuals work with over months, if not years.
If someone wakes up today and they are not feeling good, and maybe there has been some depression over the last number of weeks and months, that does not mean they go to the hospital or somewhere and then they are told they can apply for MAID. That is not the way it works.
If one listened to the Conservatives, one would think it is like MAID on-demand, and it is not. Trying to give that false impression is doing a disservice to the debate, because they are not understanding the issue of what is being advocated for.
If someone has a serious depression issue because of a layoff, a marital breakdown or a death in the family, it does not mean they can apply for MAID. If their depression is that severe in a relatively short period of time and they apply for MAID, then they will find other supports they can get in touch with.
I would argue that there is another side of this debate we are not looking at. There are individuals who are wondering about MAID and are thinking about making contact as a direct result of knowing it is there, even though they would not be eligible to apply. We are talking about not months, but years, of working with a psychiatrist, where there is no remedy. After that, it still has to go through another process. We are talking about a very small percentage.
If the Conservatives want to talk about mental health in general, I am game for that. Regarding mental health, let us take a look at the agreement we just signed. It is over $196 billion. That will be millions of dollars going toward issues like mental health.
For the first time, there was a program, the Wellness Together Canada portal, which led to a direct service to Canadians dealing with mental health. It was put in by the Liberal government. Over two million people have been served through that portal. All of them have dealt with some form of mental health issue. Out of those people, there might be zero who would qualify to apply for MAID. It may be a very minuscule percentage, if any, of those who went through that portal. However, we would not think about that if we listened to the Conservative Party.
The Liberal government has raised the issue of mental health virtually from day one. During the pandemic, we put a program in place and we invested millions of dollars to provide support for people who are enduring mental health-related issues.
There is a difference between what we are talking about with MAID and the bigger picture of mental health in Canada. We know that. We have invested in it. We are talking about billions of dollars.
If we reflect on their debates, the Conservatives were even taking extra caution by having the extension. That is why all members in the House are standing up and saying they will vote in favour of it, because it is an extension.
The government is working with stakeholders and other members of the House, not just Liberal MPs, to ensure that we get it right. We have not drawn the same conclusion that the Conservative Party of Canada has. We recognize the issue of mental illness and what is coming from our courts.
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Mr. Speaker, if anyone is politicizing this issue, it is the government. The intention of Conservative Party members is to ensure the safeguards needed to make sure these types of bills do not come through the House of Commons without any regard to the safety and lives of Canadians.
I would ask the hon. member to name at least half a dozen safeguards that he believes would ensure that the dignity, health and safety of Canadians would be well regarded in the bill.
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Mr. Speaker, if I were to review the other night's, and today's, Hansard, I could very easily identify a half-dozen or more Conservative MPs who stood in their places trying to give the false impression that if someone is depressed, they can actually apply for MAID. How irresponsible is that?
There are many issues the member has raised. In terms of the half-dozen safeguards, we just had a joint committee report tabled today that will provide the answers the member has requested and many more.
I warn that it might go against what the Conservative spin notes say in the back room of the Conservative Party, because it has been very well thought out. It has been supported by a majority of people in the House.
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