44th Parl. 1st Sess.
February 15, 2023 02:00PM
Madam Speaker, the member spoke about the charter and how every single piece of legislation is supposed to be complying with it. He mentioned that, at the justice committee, they did not have information about whether this particular piece of legislation was charter compliant. I want to give him the extra time to go over the matter just so the House can be well briefed on the current situation with Bill C-39.
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Madam Speaker, we do not have a charter statement and we should. It is my understanding that, even when a bill is revised, there should be a charter statement. With Bill C-7, we had an initial charter statement. It came back from the Senate, and there is no new charter statement. The charter statement we are left with is pre-amendment. That is a problem, and if we couple that with the lack of a charter statement in the House, we are left with a huge problem.
In my view, the law is to be followed and there should be a charter statement. We should be following that. I wish we had it. We should have it.
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Madam Speaker, we are here for what is really such a deeply personal and complex discussion on Bill C-39. I want to start by saying the discussion tonight is about Bill C-39, and it has been the discussion here for the last few nights. I say this because some time ago, and I believe it was in November, we had a one-night discussion in the House, a take-note debate on mental health, in which I participated. Frankly, there were very few participants in that debate. A number of colleagues were here for that.
However, the discussion tonight is not about mental health. It is about Bill C-39, the legislation before us, to delay the implementation of MAID as it pertains to mental illness by a year. The core of the crux is that there is a mental health literacy discussing this problem in the chamber, and perhaps even across the country.
I want to start by saying what mental health is and what it is not. Mental health is really, at its core, in the day-to-day for all Canadians and all of us in the House, who work really hard and have stress for ourselves and our constituents. We have been going through a really challenging time these last two plus years through COVID.
Mental health is the ability to navigate and recover from a challenging situation and to be able to move forward with a sense of self. It does not mean that when we are stressed, when we have anxiety or when we are facing a tough period where there may be ebbs and flows of depression, we are struggling from mental illness. That is mental health.
We really need to start the conversation there. Truthfully, for any human being, and I have two teenage daughters, day-to-day things are up and down. We are not meant to always be happy all the time. We are not always meant to be in a positive state of being. There are ebbs and flows to life, just as there are for every Canadian across this country. Having two teenage daughters, I am sure many colleagues in the House can relate.
The truth of the matter is that mental health is not the opposite of mental illness. When I talk about people being diagnosed with a mental illness, I mean people who are diagnosed by a physician, which means a psychiatrist, a medical professional who is familiar with the categorizations of diagnosis under the DSM-5.
There are individuals with mental illness who are treated for it who have good mental health. Can members imagine that? One can have good mental health while one struggles through mental illness. That is a reality for many, many individuals who deal with mental illness. About 15% to 20% are medically diagnosed with mental illness.
There is a mental health crisis for many Canadians in this country, with many social determinants, whether it be poverty, housing or inflation, that are impacting the mental health of many Canadians, but they are not struggling with mental illness. I really feel strongly that is where we need to start the discussion.
Bill C-39 is not about mental health. Bill C-39 is about mental illness and those who have struggled with mental illness who have been presented treatment after treatment, have tried everything imaginable to address their suffering, and have not found relief. They have not been able to find that ebb and flow of life many of us experience in mental health. We need to acknowledge that.
I heard a lot of disturbing statements in the House, such as this legislation being euthanasia or medical treatment by death. Shame on them for disparaging the DSM categorizations of medical professionals and using fast and loose language in the House on what is a profoundly serious categorization of suffering for individuals in this country.
Frankly, this is a hard issue. MAID is a hard issue for so many of us. It is so hard for us to know people we love may be suffering from a disorder or a terminal condition there is no relief from.
I want to move now into what Bill C-39 is, because we need to go over that.
Bill C-39 is asking for a year. It is asking for a year to pause on allowing for mental illness as the sole determinant for an individual requesting MAID, so that it can be reviewed and so that it can be put into place well. What do we mean by “well”? We have a health care crisis in this country. We have gone through two years of COVID. Doctors, nurses and health care practitioners are exhausted, and they need to be trained on this. They need to understand the DSM-5. They need to understand what the treatment protocols are for those who suffer with mental illness. We are not there yet. We want to ensure that the best practices are in place, and done with compassion and with a deep sensitivity for the individual suffering.
It is about the individual. Many of us in the House have beliefs, which may be religious beliefs or personal beliefs, about how they feel about MAID in general or how they feel about MAID in relation to this particular categorization of mental illness. At the end of the day, it is about the individual. It is not about us. It is about them. We need to remember who is at the core of this legislation and why it has been put forward, and the compassion and time that have been put in by medical experts. One can present me with one panel or another panel. At the heart of this is human suffering. I would not wish on anyone in the House to know what it is to have a loved one who suffers from mental illness, because I did.
I had a 15-year-old nephew who suffered from mental illness. Every treatment was offered to him, every treatment, and he refused. I lost my nephew to suicide, not because we did not have hope, not because there were no resources, not because we did not try, but because everything that was put on the table, and trust me, I am a fierce mama, did not help him. I have to live with that loss, and the grief of that loss, of his choice. He did not make his choice in a medically assisted format. He chose suicide. We need to understand the difference.
Why do I share this? I share it because this is a personal issue. I also have a dear friend who had ALS. She suffered for years, but we put into place protocols for her so that when she knew it was enough, we would be by her side in her choice. There were friends who did not show up for her choice. There were many of us who debated about her choice, that it was gut-wrenching. Each step of the way, we had check-ins with her, even when she could only communicate through her eyelids. Was she sure that this was what she wanted? Was she ready? It was heartbreaking to leave that room that day, but it was her choice.
At the core of this, as hard as it is for members of this House to understand, it is about the individual. We have an obligation to provide every guardrail to every professional framework that is caring and compassionate, and that is why we need time to build it and set it out.
At the end of the day, these are professionals. This is mental illness. To the degree that individuals are suffering at that level, one should never have to watch individuals suffer to that degree.
Even if they go and ask for it from their psychiatrist, even if they are contemplating this, that is the beginning of the process. It is not an automatic decision. Then, their entire history of treatment needs to be reviewed, every protocol questioned. Every stone needs to be turned and reviewed by another professional. This is not even sober second thought, as we would have in the Senate. This is sober after sober after sober, three times, four times, five times, until every check has been done with the individual who is truly suffering.
I want to get out of the speak of professionals and all of that because at the core of this is the human being who is suffering. We need to know our language and be clear about that.
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Madam Speaker, I agree with my hon. colleague's very thoughtful speech, except there is one thing that still concerns me. I will paraphrase, because I was not taking notes as she spoke, but it was something like “once a patient who is suffering has tried everything”. My concern is that as long as we block access to psilocybin, as one example, or other therapies and treatments that could make a difference, I do not think we have tried everything.
That is why I am very relieved we have another year, and I hope my hon. colleague would agree that we need to use that year well, including accelerating research into other promising therapies.
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Madam Speaker, the member for Saanich—Gulf Islands and I talk about many things with such thoughtfulness and care.
I can only speak at the moment to the current available treatments that are out there. I know some of the treatments that the member mentioned are in great debate and great discussion at this time. The point is why we are asking for time. We are asking for time for exactly that reason, so that we understand the depth of the treatments and the options, to make sure that we are not missing anything before we allow this to go forward.
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Uqaqtittiji, I had the wonderful privilege of welcoming the member for York Centre to my community in Iqaluit and we had a wonderful time there.
I want to ask the member a specific question about the “Final Report of the Expert Panel on MAiD and Mental Illness”, from May 2022, because I really appreciated the refocus on mental illnesses. In that report, “mental illness” is said to be for those who are “lack[ing] a standard clinical definition”. My concern is that there are a lot of first nations, Métis and Inuit who might not fit into this professional model. This panel recognized it as well and, in recommendation 14, said that there need to be consultations with first nations, Métis and Inuit on creating practice standards.
I wonder if the member could share her thoughts on that.
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Madam Speaker, my hon. colleague from Nunavut always reminds us how important it is to make sure that in all of our consultations, no matter what the issue is, whether it is climate change, indigenous early learning, or mental health and health care in indigenous communities, the indigenous lens on health care must be included.
Communities handle the care of their loved ones differently. There are diagnostic tools that are available from many different backgrounds and communities that weigh in on such decisions that we make as a country. I would welcome the member sharing her thoughts with me on what we should be considering in that discussion.
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Madam Speaker, there is one thing from the other side that I find confusing. They can correct me if they wish, but they seem to be saying that if in fact a year from now we allow mental illness as a sole reason for medically assisted death, those people would not be suicidal. By the very definition of medically assisted suicide, or MAID, that person is suicidal.
If we now allow mental illness as a sole reason for MAID, are we not making suicide easier?
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Madam Speaker, this is exactly the reason why mental health literacy is so important, because those who suffer with mental illness are not necessarily, by default, suicidal. I would be more than happy to educate the member on the determinants of that.
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Madam Speaker, I am pleased to speak to Bill C-39 this evening. As a legislator and member of Parliament for Lévis—Lotbinière since 2006, I have been told about, and sometimes even witnessed, some very difficult situations involving people or families in distress.
On May 3, 2016, in the House, I allowed myself the privilege of expressing the thoughts sent to me at the time by several of my constituents during the sensitive debate on MAID. It is a topic that leaves no one indifferent.
I want to emphasize that, regardless of their political allegiance or their position on this issue, all parliamentarians are once again demonstrating courage by taking part in this debate, which is difficult for all of us.
The Supreme Court gave members of Parliament the daunting task and responsibility of setting the foundations of a law. This forced us to do some soul-searching about the purpose of our lives and the lives of the citizens we represent. We were aware that the law as a whole would not be perfect, that it would merely be acceptable, given all the changes it made to our way of seeing life and living in the future.
It is always a great privilege for me and a sign of undeniable trust when people share heartfelt confidences with me, especially when they deal with matters of life and death. The expansion of MAID to people with mental health disorders definitely falls into that category. I see parents, grandparents, brothers, sisters and friends worried about the expansion of the MAID legislation. When we stop and think about it, obviously we all want to keep our loved ones with us as long as possible.
Surprisingly, however, many of the discussions I have had with my constituents have revealed another very important issue that can cause mental health problems. I am talking about how the Liberals have trivialized the consequences of cannabis use, even though they knew the extent of the consequences when legalization was studied in committee. Several studies confirmed that use in adolescence would cause mental health challenges for those who already had a genetic predisposition.
We were promised that a lot of money would be invested in programs for people grappling with that addiction, as well as mental health services. Unfortunately, given the challenges that already exist across Canada in terms of access to regular health care, we suspected that specialized mental health care would be inaccessible and insufficient for Canadians. Therein lies the rub. One can easily imagine what will happen when hard drugs are legalized in Canada, again by the Liberal legacy that is destroying the Canada we once knew.
I would like to share that I will soon be a grandfather for a sixth time. I am obviously very happy, but I am also very concerned about our Canada, which has been deteriorating by the day since 2015. Canada is deeply broken, and millions of Canadians are suffering because of the erosion of their sense of security and quality of life.
I would like to use the time that I have to speak to Bill C-39 as an opportunity for honest reflection. As members no doubt know, humans need to give meaning to their lives to fully appreciate all the good things life has to offer. It is human nature to seize the best opportunities we get to enjoy life. However, what do we do when the government takes away those opportunities by implementing policies that go against our well-being and we lose faith and hope in the future?
Is it right for us, in the near future or the next few years, to allow people with mental health challenges to put an end to their lives, when they might have a better quality of life if we were to give them ways to fix what is going wrong and more resources so that they could find balance in their everyday lives?
I think the public is aware that nothing is working anymore and that we are living the opposite of what we are used to in so many aspects of our lives.
In spite of that, we must not see the future as inevitable. There are always solutions, and, as fragile as life may be, we have the privilege of sharing love and friendship. We can strengthen our bonds and help one another.
Our society is constantly changing. It shapes our fundamental, cultural, religious and spiritual values when it comes to life and the end of life. What was personally unacceptable yesterday may change tomorrow. We need to respect one another here, because we all have a say in this Parliament. That being said, the end-of-life choice that is acceptable to the individual is based on their convictions, their beliefs, their physical health and perhaps, ultimately, their mental health.
We have to be careful about that fourth point, mental health, because when it comes to care and scientific advances, we are still making progress. Who knows if we will find drugs that open up new possibilities for people who currently do not see any solutions?
We are faced with the same question we had to answer when the initial law was drafted in 2016: How can we ensure that this will not get out of control? It will be difficult to include safeguards in the law that will cover all of the very different cases of people with mental health issues.
I think it is wise to make the right choices for Canadians' safety and for future generations. Once again, time will tell whether this change in direction was a good one. All parliamentarians in the House and the Senate will make a significant contribution to this debate. We must all bring a rational and moral tenor to this bill as we align it with Canadian values and thinking in a way that respects all of our Canadian communities. We will live with the future changes that will come from this law. We have to ensure that it will be interpreted in accordance with our guidelines, because the consequences will be irreversible.
I am pleased that we are giving ourselves some time to address this delicate subject in order to protect vulnerable people and not to do something irreparable to people who are precious and who have the potential to live a better life with dignity.
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Madam Speaker, I thank my colleague for his speech. He is right, there are service gaps. People with mental health issues may be unable to access what services there are. This is a huge problem. The government has not put any resources into it.
This evening, we learned that, when people seek access to psilocybin, a therapy that makes a difference for them, the government and Health Canada are not responding to those requests in due time.
Here is my question for my colleague. Why does the government seem unwilling to take mental health issues as seriously as they deserve to be taken?
Why is the government dragging its feet on approval for a therapy like psilocybin? Why is it so slow to follow its own guide on the importance of authorizing this kind of treatment?
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Madam Speaker, that is a very important question. Canada is facing huge challenges right now with respect to mental health. We should double down on this and make mental illness a priority, because it is affecting hundreds of thousands of Canadians.
There are plenty of ways to add more resources to our health care system. The government could speed up the approval process for certain drugs. We can all be more open to new ways of thinking, working and living in society that would alleviate this problem. Let us hope the government will see it and show a little leadership on things like that.
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Madam Speaker, I largely agreed with the hon. member's speech, except for when he started blaming everything on the Prime Minister. Other than that, I thought he made a good and thoughtful speech.
Has the hon. member had any interaction with the health care system in Quebec? Has he made any observations with respect to how it deals with the mental health care that is given in Quebec for the patients who might well be accessing this particular MAID service?
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Madam Speaker, I find my colleague's questions very interesting.
In Quebec, once a patient enters the system and has access to psychiatrists and health care, the results are relatively good. However, the unfortunate part is that there are not nearly enough staff, people and psychiatrists for the number of cases that exist.
Wait times to access this type of service can be six months, even a year or a year and a half, depending on the severity of the case. This unfortunately means that there are some people who, while waiting for treatment, may commit an irreparable act and leave this earth.
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Madam Speaker, I just align with one of my colleagues, the hon. member for New Westminster—Burnaby, in relation to doing everything we can for those who may be suffering before it gets to the point of an application for medical assistance in dying.
Earlier today, for example, one of our colleagues gathered folks who were suffering from immense pain and living day by day, not knowing what to do. That pain contributes to their overwhelming feeling of despair, which then leads them to apply for something like medical assistance in dying. In fact, the government could put in place regulations to support these folks before they get to that place. They could ensure psilocybin, a treatment that they are calling for; they have already established a right to have access to this treatment. Would the member speak to the importance of ensuring that we do everything we can to support these folks, including providing medicine that they desperately need?
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Madam Speaker, I thank my colleague for his very interesting question.
Yes, if there is an opportunity to speed up the approval of certain medications here in Canada to help people with mental health issues, let us do it as quickly as possible.
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Madam Speaker, I understand I am the last member to speak on this debate. I doubt, however, that I will be the last word on this. I am not. I see that I am neither the last speaker nor the last word then.
I have been kind of reluctant, frankly, to engage in this debate because I do not consider myself to be an expert. I have not participated in committee hearings, and I have not had the benefit of listening to the expert witnesses. Therefore, the only thing that I bring to this particular debate is 25 years in and around the mental health system in the eastern part of the GTA. This is due to the fact that my son, technically my stepson, has schizophrenia.
The schizophrenia started to manifest itself when he was about 15 years of age; he is now about 40. As a family, we have been able to make some observations about the current state of the mental health care system in our neighbourhood. We are a well-resourced family; we have been able to access the best that there is on offer in and around the city of Toronto.
Our son has spent some weeks at the Whitby Psychiatric Hospital east of Toronto, one of the best that Ontario has to offer. He has also spent some time at the CAMH in downtown Toronto, which is possibly the leading health care facility in this particular area of health care. He has also spent time at our local Scarborough Health Network; this is a good health network, but my observation is that it is just absolutely overwhelmed.
The previous speaker talked about access in the order of 12 to 18 months. This has been our experience as well, even though we have supported him as a family. As I said, we are well resourced, and his mother, in particular, is fierce in her protection of him.
We started to notice his erratic behaviour when he was around 15. For three or four years, we really did not know what it was, in spite of taking him to various health care experts. When he went off to university, he had his first diagnosed psychotic break. If members know anything about schizophrenia, they know that when one is recovering from that psychotic break, one never regains everything. Over the years, he had a number of psychotic breaks, and each time, he did not fully come back.
The observation is that when one is around 40 years of age, that is as good as it is going to get. One neither gets any worse nor certainly any better. He fills the definition of somebody who has an irremediable condition. It is medically diagnosed, and he has had episodes where we had the police there and things of that nature. Fortunately, as I said, his mother is a fierce advocate for him, and we have been able to stabilize his housing. He is well housed and well fed, which has not always been the case. However, at this period of his life, he is stable.
Over the course of these 25 years, we have made some observations of the system. The first observation is that it is overwhelmed. If the general health care system in Ontario is at its maximum stretching point, the health care system is always stretched beyond that point. I will not say it is broken, but it certainly is stretched.
This is not a condemnation of the people or the personnel who are in the system. They are good-hearted, overworked and exhausted. It is the patients who suffer. I do not have a great deal of faith, based on my observations, that one year from now somehow we will have a better system than we have today. My guess is that it will be closer to generations.
One of my hon. colleagues from the NDP raised the issue of poverty, homelessness and all the other issues that people face. Again, it has been our observation that we as a family have been able to shield him from a lot of things that mental health patients face on a daily basis, such as how they are going to eat, where they are going to sleep, all that sort of stuff.
Therefore, from time to time, it appears that ending one's life is an attractive alternative. I fear that, primarily for those people who are not well resourced and not well shielded from the vagaries of life, who have no job, no relationships and a limited appreciation of their own reality, it would be an attractive alternative to end their life, and that will be made available to them and, I dare say, available a little too readily at times.
These are observations we have made over 25 years. We have made them in the context of a family trying to support someone who would fall within the specific categories that are delineated in the legislation. We frankly have no real faith that this might not be an alternative for our son. That would be tragic for us all because it would not be a death in isolation.
I would also make the observation that we are long on talk in this place and short on resources. We talk about fixing the system. We talk about making resources available. One can pretty well go back through the speeches in Hansard for the last year or two years or five years or 10 years, and each incident of legislation comes with a promise of resources. I wish that were true, but it is not. In our observation, it is only getting more challenging.
In some respects, this legislation is a way out of doing what we need to do to facilitate the health care challenges of our most vulnerable citizens. While I will, with colleagues, support this legislation, I frankly do not think things will change in a year. It may be that they will change in 10 years. I think this is the kind of timeline and horizon that we would be realistically looking at in order to deal with people who would fall within the specific delineated categories as set out in this legislation.
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Uqaqtittiji, I would like to thank the member for his thoughtful intervention. This is indeed a difficult debate because we are talking about something that is inevitable for all of us. The difference is ending suffering and how some people have the privilege to die with dignity while others have no choice but to feel like ending their lives through suicide.
This is a very difficult question or debate. We want to talk about ensuring practice standards that meet everyone's needs, so mental health issues are addressed and people with mental illnesses also get the help they need. Given his experience with someone with mental illness, could the member talk about how this kind of discussion needs to be opened up in the next year?
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Madam Speaker, I thank the member for an excellent question that centres on the issue of practice standards.
I have no doubt that, particularly where I live in the east part of Toronto, we have the highest-quality practice standards. However, there can be the highest standards and most qualified people in the nation, but if they are overwhelmed by virtue of people being in the system because of the circumstances in which they live, no amount of practice standards will get them out of that.
My focus would be on relieving the suffering by helping those people so that they do not find themselves contemplating this alternative.
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Madam Speaker, I am not really posing a question. I just have a comment.
My friend from Scarborough—Guildwood is a dear friend and someone I have looked up to for many years. I want to thank him for sharing his very personal experience with us. I know it is something that he has shared on a number of occasions and in a very public way. I think it is important that we all understand that we have people in our lives who are deeply impacted by mental health issues.
As government moves forward on this, that is always something the minister, as well as the government, will continuously evaluate and undertake. I really do want to thank him for sharing his very wise comments with us today.
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