44th Parl. 1st Sess.
February 15, 2023 02:00PM
- Feb/15/23 4:07:06 p.m.
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Mr. Speaker, I rise on behalf of the Conservative members of the Special Joint Committee on Medical Assistance in Dying to table, in both official languages, our dissenting report.
Conservatives completely reject the committee's endorsement of the Liberal government's new arbitrary deadline to expand MAID in cases of mental illness in one year. The evidence from experts, including leading psychiatrists, is clear. This radical expansion cannot be implemented safely, and there is no evidence to indicate that it will be any different a year from now.
We are also disappointed that the committee failed to undertake a meaningful study on the effectiveness and enforcement of existing safeguards, this at a time when there are multiple alarming reports of abuse, non-compliance and Canadians falling through the cracks under the Liberals' MAID regime.
Finally, we reject the committee's irresponsible recommendation to expand MAID for mature minors, especially having regard for significant knowledge gaps and a complete lack of consultation with impacted groups, including young Canadians.
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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, 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 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 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, 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, 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, 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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Mr. Speaker, I am rising today to speak to Bill C-39, which would delay, by one year, the Liberal government's goal of extending medically facilitated death to Canadians living with mental illness.
Extending medically facilitated death to vulnerable Canadians living with mental illness is unjust now and it will be unjust one year from now.
The government's MAID policy has been driven by radical groups. Their end goal is state-provided death on demand to anyone for any reason. These groups have almost constant and unfettered access to the Liberal government, and this is clear because this extreme expansion is backed by radicals within the Liberal government and Liberal-appointed radicals within the Senate.
At the MAID committee, one of this sort remarked that MAID should be available for babies. How far has our collective respect for dignity of the human person fallen that such a grisly statement could be made without rebuke? Many have said that we are at the end of a slippery slope, but it is clear that if the Liberals continue to take their marching orders from groups like this, they are nowhere near done.
By law, to be eligible for MAID, a person must have a grievous and irremediable medical condition that is incurable and in an advanced state of irreversible decline. That means that, to qualify, a MAID assessor must be satisfied that the person's condition will not get better. We know it is impossible to predict whether or not a person suffering from a mental illness will get better, so it is not possible to determine irremediability.
Dr. John Maher, a clinical psychiatrist and medical ethicist, said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”
MAID decisions in cases of mental disorders will be based on “hunches and guesswork that could be wildly inaccurate”, according to Dr. Mark Sinyor, a professor of psychiatry at the University of Toronto and a psychiatrist who specializes in the treatment of adults with complex mood and anxiety disorders. He also said that “they could be making an error 2% of the time or 95% of the time.”
The Liberal government is willing to say that Canadians with mental illness will not get better and then will end their lives, which could be wrong 95% of the time. Make no mistake, if the government goes ahead with its expansion of MAID for mental illness, people who would have gotten better will not get the chance, because they will be dead.
Right now, 6,000 people with the most severe forms of mental illness are waiting up to five years to get the specialized treatments they need to reduce symptoms, learn to cope and feel better. Instead of working to better those symptoms, to give people the help they need when they need it the most, the government is striving to offer them death.
When appearing before the Senate, Dr. John Maher said, “Clinical relationships are already being profoundly undermined. My patients are saying: ‘Why try to recover when MAID is coming, and I'm going to be able to choose death?’” He goes on to say, “Some of my patients keep asking for MAID while they're actually getting better but can't recognize that yet.”
We need to offer Canadians hope, and not death, when they are in the depths of despair. Under the Liberal government, a wave of hopelessness has spread to every corner of the country, and we are seeing people seeking and being approved for medically facilitated death because they are poor, because they cannot afford adequate care or housing. It has even gotten to the point that veterans have been offered death instead of treatment and support. We must ensure that the dignity of the human person is respected and considered as a foundational block for our society if it is to be a just society.
We have seen the respect for human life, and especially the lives of vulnerable Canadians, threatened by the current government's MAID regime, and that should be weighed against the standard of a society that is right and just, and that measures whether their actions and policies enhance or threaten the dignity inherent in every single person. This is not a dignity that was invented, imagined or assigned by a government, but it can be affirmed or denied.
What we are seeing in Canada is a government that is willing to offer death before it is willing to offer adequate care, access to timely treatment or even a life that is affordable to live. People are asking food banks to help them access death. It is an absolute disgrace that life in Canada has come to that.
That is why the preferential option for the vulnerable must be in mind as we make any decision in this place. Does this protect, or attack, the vulnerable? Does this enhance, or threaten, the dignity of the vulnerable? Does this lift up the vulnerable, or marginalize them further? These are the questions that have to be asked. When it comes to the Liberal government's MAID regime, I will say that it attacks and threatens the vulnerable, threatens their human dignity and marginalizes them further. How could it not, when death is the solution offered to the problems of the most vulnerable people among us?
Throughout this entire process, the government has tried to silence the voices of marginalized Canadians, especially those living with disabilities or mental illness, but it will not silence my voice here today. It will not silence the voices of Conservatives who stand here united in our opposition to expanding medically assisted death for mental illness.
Death is not an acceptable solution to mental illness and psychological suffering. Our health care system should help people. It should help them find the hope and resilience they need in order to live, and not facilitate their deaths. We continue to be, as we always have been, called to attend to the lives of the most vulnerable people and their preferential option in life. That is to listen to them, to include them, to support them, to lift them up, to help them and to love them, not to end their lives.
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Madam Speaker, I have three questions for the hon. member.
First, does she understand that someone who does not have the capacity to make a decision regarding MAID is ineligible for MAID?
Second, does she understand that in order for someone to be eligible for MAID, they must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services and palliative care, as well as being offered consultations with professionals who provide these services?
Third, is she aware that in order for someone to be eligible for MAID, they and the practitioners must have discussed reasonable and available means to relieve the person's suffering and agree that the person has seriously considered those means?
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Madam Speaker, I hope my hon. friend is aware of the simple fact that those who are suffering from mental illness, those who are in the darkest part of their life and whose government has abandoned them, do not have the capacity to choose MAID, because they are in desperate need of help that their government needs to provide. Those individuals need life and help over assisted dying.
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Madam Speaker, I did not speak today about individuals who are on artificial means and at the end of life. I did not speak about individuals who had living will directives. What I spoke about was the extension of MAID to those who are mentally incapable and the abdication of the government in providing the necessary supports to help those who are most vulnerable make the decision to continue a life in dignity.
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Madam Speaker, I thank my hon. colleague for his concern and compassion over the most vulnerable. The most pressing thing right now in order to make sure MAID is not extended to those with mental health issues is to make sure the Liberals live up to their promise of caring for those with mental health issues, and that is not through providing assisted dying.
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Madam Speaker, we have seen how slippery this slope has become with what I would call a botched expansion of MAID by the Liberal government.
A few short years ago, MAID was seen as a procedure that would be used in exceptional circumstances and that would require very strict criteria to be placed around it. Now MAID is being administered under increasingly questionable and concerning circumstances. The criteria has become looser and is wildly subjective, and many of the safeguards that once existed seem to have evaporated.
The recent scandal at Veterans Affairs around medical assistance in dying has revealed how bad the Liberals rushed and mismanaged it, and, I would say, how careless the expansion of MAID has become. Since Canada's inception, our men and women in the Canadian Armed Forces have fought and sacrificed to defend freedoms here at home and all around the world. Whether that be on the ground, in the air or at sea, they have done so with valour and distinction. In doing so, many of them endure physical, psychological or other injuries during their service.
There is nothing that we as Canadians can do to fully repay them for what they have done for Canada, but at the very least, it is incumbent upon us to remember and honour their sacrifices and ensure that when they transition out of service, they are fully supported and cared for as veterans. Sadly, under the Liberal government, Veterans Affairs Canada has fallen into disrepair. I have heard from many veterans that Veterans Affairs Canada feels more like an insurance company focused on reducing its financial liability and placing an unfair onus on veterans to have to prove their disabilities or illnesses over and over again.
I can think of a lot of examples, but one of the worst examples I can think of is a veteran I met who is in a wheelchair. He is missing both of his legs from his time serving our country, and every single year, he has to prove to Veterans Affairs that he is still missing his legs. Can anyone imagine what it must feel like for that veteran to prove every single year to Veterans Affairs that he is still missing his legs and is required to have a wheelchair because he served this country? That should never be the case.
I can think of another veteran who has been fighting Veterans Affairs Canada for years to have a wheelchair lift installed in her home. She is in a wheelchair because of her service, and she simply wants a wheelchair lift installed in her home. She has faced repeated delays and denials, and she still does not have the wheelchair lift she needs in order to access her home. She is forced to crawl across her driveway and up and down her stairs because of that. Is that what a veteran deserves after a life of service?
When I thought about the context there, I was that much more alarmed and disturbed when Global News broke a story last summer about an anonymous veteran who had been pressured to consider medical assistance in dying by Veterans Affairs Canada. We learned that the veteran had gone to Veterans Affairs Canada seeking help and support for injuries that he sustained while he was serving in our armed forces.
Initially, he was experiencing positive improvements in his mental and physical health. To him and his family, that must have been very promising. Then he got a call from a Veterans Affairs service agent who suggested that he consider medical assistance in dying.
The service agent brought the suggestion up repeatedly, even after the veteran asked her to stop. The service agent further asserted that she had helped another veteran successfully access medical assistance in dying and that the veteran had gone through with the procedure and was now deceased. In describing how she helped this veteran access medical assistance in dying, she concluded that it was preferable to traditional forms of suicide, like, as she said, “blowing [your] brains out all over the wall or driving [your] car into something.”
After learning about those accusations, the Conservatives demanded that the Minister of Veterans Affairs and his officials come before the Standing Committee on Veterans Affairs and answer for those appalling accusations. The minister came to the committee about this disturbing incident and indicated that it was, in his claim, isolated to one employee and was not indicative of a pattern of behaviour or a systemic issue. In fact, between the minister and his officials, they described the incident as isolated six different times. However, later in that very same meeting, they admitted that there was a second case involving the same employee.
That did not quite seem right either, so we asked the minister and his officials to come back to the committee, and the very night before the minister came back to testify that second time, another anonymous veteran came forward. He told the Operation Tango Romeo Trauma Recovery podcast that he too had been offered medical assistance in dying by Veterans Affairs Canada and that he too had felt pressured. This employee told the veteran, in the veteran's recollection, that they could help end his suffering because they had helped someone else end their suffering.
The next day at the veterans affairs committee, the minister confirmed that he was now aware of four cases involving one employee, but those did not include the allegations that were made the evening before on the Operation Tango Romeo podcast. Now we are talking about a situation where, after being told it was an isolated incident, we are aware of five different instances of this happening with two different Veterans Affairs employees at minimum. When we called on the Minister of Veterans Affairs to fire the employee who was involved in this, he refused to answer the questions, only saying instead that this employee was no longer in direct contact with veterans.
However, it got worse from there. Another veteran, Christine Gauthier, came to testify before the veterans affairs committee on something completely unrelated, but she revealed that she too had been offered medical assistance in dying. She was simply trying to get some help for her home to have a lift installed. Then, unprompted, a suggestion was made by another Veterans Affairs employee that if her pain was so unbearable, MAID was something she could consider as an option. In private conversations since then, I have learned of at least a couple of other veterans who have been offered MAID, so that makes about eight veterans and about four different employees, at minimum, whom we are aware of.
This whole thing has gone down a very bizarre trail, and we get repeated denials. The minister came out at one point and said, after he had admitted there were four cases, that Veterans Affairs has never offered this. Then, the very next day, he told us they fired the employee who was involved in the four cases. It is a story that no one on that side of the House can seem to get straight, and it is really concerning. Those are the kinds of inconsistencies that we are seeing.
When veterans go to Veterans Affairs Canada looking for help, support and assistance, whether with physical injuries or mental injuries, they should feel comfortable and safe when they are dealing with Veterans Affairs. There should be a level of trust there. However, instead of being offered help with things they need to help them live their lives, they are being told that maybe it would be better if they just went off and died. That is a pretty sad situation. Veterans are being betrayed by the very people and institutions they are supposed to be able to trust, and that creates further damage. That creates what is called sanctuary trauma, and that can further isolate veterans and further prevent them from wanting to get the help they need.
I hope a long, hard look at this is taken in the next year. If the Liberal government cannot even stop its own employees from pushing MAID on veterans, how can it assure Canadians that the necessary safeguards can be put in place to protect vulnerable people from being pressured into accessing medical assistance in dying?
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Madam Speaker, perhaps my intervention will be more of a comment than a question, but I am happy to hear the member's thoughts on it.
Let us be absolutely clear on what happened with this one particular individual. There was a case worker in Veterans Affairs who should never have been giving any kind of advice regarding MAID. They were certainly not qualified to do that, and that individual no longer works for Veterans Affairs. That is the reality of the situation. Pertaining to medical advice, that should only ever come from an individual's physician and the medical experts who are qualified to do that.
Let us be clear that this was an isolated incident. The individual no longer works for Veterans Affairs. It is very clear what has happened with this individual and the fact is that they are no longer employed by Veterans Affairs.
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Madam Speaker, I note there are a number of inconsistencies in what my colleague is saying about MAID for people with a mental health issue as the sole underlying condition. The expert panel reported on MAID and has made a number of recommendations. I know the extension we are seeking today is about ensuring that all of our systems can be in place, so I am wondering if my friend could reflect on what the expert panel has said in clearly outlining what is required and the safeguards in place for MAID to be extended to those with a mental health issue as the sole underlying condition.
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Madam Speaker, on behalf of my constituents, the ones I have noted on the record and the many others I have spoken to, I will say that they are not so much interested in what the expert panel had to say. They simply do not want the extension to happen, and I do not mean a delay. If the government is looking for a pat on the back and a reward for a good deed, as the Yiddish proverb goes, it is not going to happen right away.
For my constituents, I think the starting point is that there is a lack of trust, because they read stories of people who have accessed MAID and who had a condition that did not fit the description given in law. Because there are different provinces applying it in different ways and physicians have applied it in a fairly subjective way, there is a very low level of trust from constituents in my riding.
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