44th Parl. 1st Sess.
February 15, 2023 02:00PM
Madam Speaker, I am proud to rise on behalf of my compassionate and caring residents of Renfrew—Nipissing—Pembroke. Like the majority of Canadians, my constituents strongly oppose state-sponsored suicide for those living with mental illness. That is why I will support the legislation to delay this from happening. This bill to delay providing assisted suicide is critical. It is a matter of life or death that this expansion be delayed.
Many Canadians are wondering, “How did we get here?” To describe this process as a slippery slope is to understate how greasy this rapid descent has been. How did we go from the Supreme Court reversing a precedent granting the right to die to those with incurable illnesses causing intolerable suffering and whose deaths are reasonably foreseeable to the point where the Quebec College of Physicians and Surgeons is advocating for the killing of newborn babies? How did we get here?
Obviously, first and foremost, the decision by the Supreme Court was to overturn the previous Supreme Court decisions and allow for a limited exception to the Criminal Code. The court found that the prohibition on assisted suicide is intended to protect vulnerable persons from being induced to die by suicide. The court ruled that the total ban on assisted suicide was overly broad because it also applied to non-vulnerable people and prevented them from receiving the assistance of a willing physician. The court said that it was up to Parliament to strike the right balance between Canadians suffering grievous and irremediable illness who want access to physician-assisted dying and those who may be put at risk by its legalization.
Then, Parliament debated legislation and Bill C-14 was passed in 2016. People whose deaths were reasonably foreseeable, meaning they were dying, and who were suffering intolerable pain could seek medical assistance. Despite widespread reservations, many Canadians view medical assistance in dying as compassionate.
Then, one judge said this was a violation of equality rights. The judge ruled that someone whose death was not reasonably foreseeable but who was suffering intolerable pain had the same right to assistance in dying. The progressive government did not appeal the case. It embraced the ruling and brought forth legislation to expand physician-assisted death to people who were not dying.
When that bill was before committee, the justice minister explained why physician-assisted suicide could not be expanded to include people whose sole condition was mental illness. The minister said there was no consensus. The bill then went to the Senate, where suddenly a secret consensus was discovered, unbeknownst to the medical community. The government flipped and flailed, and embraced this expansion to include mental illness.
The minister claimed the government would strike an expert panel to shape the necessary protocols to ensure that only the non-suicidal would be eligible for physician-assisted suicide. Last May, that expert panel returned with a protocol, albeit with two fewer members than when it started, after they resigned in protest. What did the expert panel have to say?
There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.
The expert panel, handpicked by the Liberal government, said it was impossible to make accurate predictions about future prognosis. Despite that admission, the Liberals still went ahead with recommending a protocol for allowing physician-assisted suicide for people whose sole condition is mental illness. The government claims it is listening to the experts, yet two of the experts on the panel resigned. They were prevented from providing a dissenting report. They are not the only experts speaking out.
I would encourage all my colleagues to get their hands on the article in the Globe and Mail, published last November, entitled “Canada will allow assisted dying for mental illness starting in March. Has there been enough time to get it right?”, written by Erin Anderssen. The article introduces readers to Dr. Madeline Li, a psychiatrist at Princess Margaret Cancer Centre. Many of my colleagues here may remember Dr. Li from her appearance before the Special Joint Committee on Medical Assistance in Dying. While the article touches on a number of the regressive aspects of expanding assisted suicide, I feel this passage is particularly relevant to our conversation:
But among the many experts who have lined up to express their objections to the direction and pace of Canada’s euthanasia laws, Dr. Li’s deserves particular attention. She led the creation of MAID protocols at the University Health Network, a group of Toronto-area hospitals that together form the largest health research group in the country. At the national association for MAID providers, she is the scientific lead currently developing the government-funded assisted-dying curriculum for doctors. She has administered assisted deaths directly to patients, and provided oversight to hundreds of cases as the MAID program lead at the UHN.
All that experience, she said in an interview, has made her personally opposed to expanding MAID for patients without a foreseeable death, especially those with mental illness. The debate among doctors has become too ideological, she said, and the current system doesn’t have enough safeguards to prevent unconscious bias from factoring into decisions.
Can doctors—a mostly healthy, privileged group of people living in a society that routinely stigmatizes people with disabilities—objectively judge what makes life worth living? Dr. Li says she once watched a doctor use an actuarial chart to calculate that an older woman seeking MAID after a fall had, on average, three years left to live; he approved her for MAID, over the objections of three other physicians. “What if it had been six?” she asked. “How many years is enough?”
Dr. Li worries that since many psychiatrists won’t participate in MAID, there will be “an echo chamber of a few assessors who will all practice in the same way,” leaning hard toward patient autonomy. Already, she argues, MAID assessments are too often focused on whether a patient is eligible for an assisted death, rather than exploring why a patient wants to die in the first place.
The federal expert panel recommended that decisions should be made on a case-by-case basis, with the doctor and patient reaching a shared understanding. But while the law requires that patients must give “serious consideration” to clinically recommended treatments to relieve their suffering, they can refuse those treatments if they don’t deem them “acceptable.”
For instance, Dr. Li described the case of patient in his 30s, who asked for an assisted death, even though multiple doctors said his cancer was curable. Two assessors approved him for MAID. Faced with his adamant refusal to get treatment, and his progressing condition, Dr. Li said she helped him die “against her better judgment.” If MAID didn’t exist as an option, she believes he would have gotten treatment, and still be alive.
The government and its hand-picked experts assure us they can devise protocols rigorous enough to prevent vulnerable people from receiving assisted suicide. The expert panel says that despite it being impossible for doctors to predict a future prognosis of mental illness, Canadians should trust the opinion of doctors in making a determination of intolerable mental suffering, yet Dr. Li, against her better judgment, went ahead with assisting in the death of a man in his 30s who had a treatable cancer.
Unlike cancer, where we can have an objective test to determine a prognosis, we are supposed to just trust the opinion of doctors. Dr. Li was of the opinion the young man's death was not foreseeable. His condition was treatable, yet she assisted in his suicide. She is opposed to expanding this. How reluctant will physicians who support assisted suicide be when assessing people with mental illness?
Finally, while Dr. Li feels the debate has become too ideological, Canadians following the debate in this House might be confused. We have seen social Conservatives, small “L” liberals and socialists all raising serious concerns. We all seem to have the same goal of the maximum amount of compassion and care, while protecting the vulnerable.
I imagine there are about three million Canadians who grow angry hearing the Minister of Justice centre this debate on balancing the protection of vulnerable Canadians while preserving individual autonomy. On this issue, the minister seems to be more concerned with the autonomy of individuals to make their own medical determinations, while less concerned with the impact on vulnerable people.
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Madam Speaker, I invite my colleague to read the expert report, which clearly states that, when treatment exists, people are not automatically eligible for medical assistance in dying just because the treatment is hard to get.
That is the shortcut the Conservatives have been taking since the start of this debate. Just because a person with depression asks for MAID does not necessarily mean they will get it. Just because someone somewhere is considering MAID because they are depressed does not mean they will have access to it. That is what they do not understand. There are assessors, providers, professionals whose job is to provide care for people whose condition is reversible. Is anyone here going to suggest that depression is irreversible?
Our colleagues talked about the experiences of people who attempted suicide. In every case, the condition was reversible. In fact, some Conservative members even talked about their own experience. They are here to tell the tale. We have to see things clearly. There are 16 key recommendations that are worth reading. I invite them to read the report.
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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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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, that was a powerful speech and it gives me great hope. We will probably come out of this on two different sides, in different parts of our lives, but I can tell that the member is a good dad and a good person.
For the people watching at home or watching this clip on Facebook later on, even the intervention from my colleague from the NDP gives me great hope. This is not finished. This is not done. We have an opportunity here because there are good people in all parties. I think that this year, this opportunity, gives us, hopefully, some time to reflect on what is important and hear stories like the ones we just heard, that including mental diseases and conditions in MAID is wrong. It shall not be in our society that people seeking help for depression could possibly be turned to medically assisted suicide.
I believe this is a blessing, that we have one year to hopefully convince enough of my colleagues, in all parties, that we need to not just pause this but scrap the idea that we could potentially solve one's mental health problems by providing suicide.
We talk about why we are here and why we are having so much trouble with mental health. I think mental health and addictions, if we talk to different specialists, go hand in hand. I believe we are on a very dangerous course right now with the explosion of mental health issues and the acceptance of hard drugs in our country.
We have an epidemic of overdoses happening right now. That is not medically assisted suicide. That is drugs-assisted suicide. This is not to say that there is an analogy to it, but it is wrong. We should not be allowing this in our society.
We have to do more. We have to do more for mental health in Canada. This is a serious subject. I do not want to get partisan, but our health care system was garbage before the pandemic. It was underfunded and it was on life support before the pandemic. We went through the pandemic and we put our population through so many pressure points that no doubt we were going to have a spike in the abuse of drugs and mental health issues.
The health care system, before the pandemic, was on life support. We kind of muddled our way through it, and here we are today. Other than the announcement a week ago, we have not had an increased health transfer to the provinces, which provide the health care these patients need. They need proper mental health supports, not the MAID 1-800 number.
I am very frustrated with where we are as a society, that this is what the case is, that we cannot get help in this country. It is broken. We cannot find a doctor. We cannot get treatment. We cannot get addiction beds: “Come back in 18 months and we might have a spot for you.” How is that treatment?
I have heard people say that the health care professionals will have check boxes and forms and it has to go through a secondary step and it is going to get signed off on by another professional. Who has time for that? We cannot even find family doctors to see patients for common colds, but we are going to have all these health care professionals who are going to go through all these applications and somehow weed out the ones that should not be there. It is just not going to happen.
It is frustrating that we are here tonight debating this. There is no court in Canada that said that we need to expand MAID for people suffering from mental health issues. Not a single court ruling said to blow this wide open and offer it to anyone who is having issues.
We need to spend this year to think about the ramifications of this.
We heard the member talk about his 40-year-old son. This is the part that gets me. I am a relatively new dad. My two boys are not 40, but nine and seven, and they are going to have challenges as teenagers. We all had challenges as teenagers. We all know teenagers who had challenges, and hopefully not too many of us know teenagers who took their lives. Life is hard sometimes. Teenagers have pressure where it seems like the whole world is on them, and they make that choice. We cannot stop what young adults do.
I worry about my two kids, who are going to go through the same things that everyone in this chamber has gone through: the pressures of being an adolescent, or as was said in here, a mature minor. They are not mature minors; they are teenagers who are going to have tough days. I had tough days.
I do not want my two boys to think that just because they are depressed and having a tough go of it, or maybe having more serious mental health concerns, they can just access MAID and be done. That is the wrong approach for Canada. I will do whatever I can in the next 12 months to convince enough members of this chamber that this bill needs to be—
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Madam Speaker, we are talking about mental illness, mental distress and depression as being reasons why it may be permissible to ask for assistance in dying. I look at this and say that we have come a long way. Our laws were based on some court rulings surrounding people who wanted to die because they had lost their ability to control their bodies. They had ALS; they had no control over their bodies at all. They could not actually go through the act of committing suicide, but they maintained razor-sharp consciousness and a strong will. Sue Rodriguez is one example.
We should not go from that to somebody who is essentially having a failure of will. That is what depression is, being unable to formulate plans to carry on and instead saying there is an easy way out. This seems to me to be fundamentally dangerous, to be almost leading people on. It seems to me this is an obvious underlying problem.
I am glad to have a year to slow down this progress in the wrong direction. Quite frankly, I think we should be very much looking at some entirely different direction. The idea that the courts are somehow going to impose on Canada in the situation of depressed people, people who are struggling because of circumstances that are hard in their lives, is that “life is hard; death is easy”. It is absolutely outrageous to say, “This is it. The kingdom of death is upon us; that is just dandy".
I guess I am asking my colleague to offer some commentary on this national abdication of will that seems to be, at best, coming a year from the present.
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