44th Parl. 1st Sess.
October 5, 2023 10:00AM
Mr. Speaker, I am going to address the subject of Bill C‑314; that goes without saying. However, I feel especially compelled to condemn the excessive and inappropriate nature of this initiative from the hon. member for Abbotsford. His bill is being tabled in reaction to an important, sensitive social issue, namely medical assistance in dying.
The fact that my colleague from Abbotsford wants to amend the Criminal Code to include the notion that mental disorders should not be considered grievous and irremediable medical conditions for access to medical assistance in dying is a proposal that does not even need to be made. Mental illness is an extremely complex issue, even a controversial one in medical circles. There are many reasons for that. To begin with, it would be imprudent and dangerous to rush the process of providing access to medical assistance in dying when the sole underlying medical condition is a mental disorder. However, that is not what is happening right now. The Criminal Code will be revised in due course, if necessary. On this point, experts feel that the current provisions of the Criminal Code are adequate to allow for further work on medical assistance in dying.
What I want to speak out against today is what I see as the official opposition's blatant politicization of this issue. Everything looks normal, or almost, when one reads Bill C-314 objectively, but it is the whole message surrounding the introduction of this bill in the House that I want to condemn. I would like to be able to say that some members just do not understand, but I cannot even use that explanation as an excuse for their behaviour.
Although I agree that being unable to afford a home and dealing with inflation and rising grocery prices are not pleasant experiences, associating them with medical assistance in dying for mental disorders is the worst kind of populism. This just shows an appalling ignorance of the many realities experienced by people living with with mental illness or just plain ignorance in general. This is a position of contempt toward people who are working on many fronts to lead a somewhat normal life, despite the suffering caused by their mental condition. With Bill C-314, the Conservatives are putting on their agenda generalizations and falsehoods that they think will win them votes, and I do not see anything good about that.
This debate is a societal debate. When the official opposition claims that the work that will be done next spring is to allow Canadians who are “losing hope”, the phrase used by the leader of the official opposition, to access medical assistance in dying, I think that is completely irresponsible. There is a difference between a request and the acceptance of the request. That is the first thing the member should take into consideration. Just because a request is made does not mean it will automatically be accepted. I want to come back to the fact that the Conservatives are driven by purely vote-seeking motivations and that these statements are false. At press conferences, they tell Canadians that the intention is to provide medical assistance in dying to people whose only condition is depression or other mental health problems. Come on. Depression is reversible. Suicidal ideation is also reversible. They need to stop for a minute and think. In my opinion, it is completely irresponsible to say such things. However, it gets worse. In March, the leader of the official opposition went so far as to include the following generalizations in his preamble:
Those going to The Mississauga Food Bank [are] seeking help with medical assistance in dying, not because they are sick but because they are hungry...
Here is another quote:
...1.5 million are eating at food banks, and some are asking for help with medical assistance in dying because they cannot afford to eat, heat or house themselves.
Honestly, my colleagues cannot be serious. There are plenty of other passages from Hansard I could quote. In any case, if the Conservatives seriously believe that not being able to afford a house or dealing with the challenge of finding a place to live during post-secondary studies are two factors that lead people to want to end their lives, then I would say that things are an absolute mess.
We expect the official opposition to put an end to its demagoguery and simplistic approach, and instead take a more collegial approach where real discussion can take place and where all opinions can be expressed to allow a full understanding of what is at stake. The Bloc Québécois believes that the strategies and messages coming from the official opposition on such an important and sensitive issue do nothing to advance everyone's understanding of the issue.
The subject we are studying deserves serious consideration. We have a duty to Quebeckers and Canadians, and it is certainly not to tell them a bunch of nonsense, as the opposition leader did last March in the quotes I cited earlier. Medical assistance in dying is not a form of treatment for people with depression or suicidal ideation. It is the last resort, after decades of care, interventions and numerous therapies have all failed, when suffering is never-ending and the disease is incurable. I cannot emphasize that enough.
We believe that suffering is not exclusive to people who have a degenerative disease or who are at the end of their life. There is no need to rush this work, since the outcome has not yet been decided, contrary to what the Conservatives would have everyone believe with their message and their populist election strategy.
In its report, the Expert Panel on MAID and Mental Illness made 19 recommendations and proposed more stringent safeguards. For example, in recommendation 10, the panel proposed that a psychiatrist independent from the treating team and an independent assessor be consulted. Recommendation 16 involves the implementation of prospective oversight. There are other recommendations.
Under no circumstances would the Bloc Québécois condone providing access to medical assistance in dying in this medical context without the following: a thorough analysis of the practices and standards being considered; discussion with civil society groups, patients' rights representatives, professional associations and other stakeholders; a clear interpretation of the criteria regarding incurability, irreversibility and enduring and intolerable suffering; and the establishment of all of the safeguards and legal processes related to the ability to consent.
Members can count on the member for Montcalm, the Bloc Québécois critic on this file, to do a very thorough job.
I invite all members of Parliament, especially the members of the official opposition who might be tempted to repeat their dangerous generalizations and falsehoods, to read all of the recommendations. There are recommendations that have to do with the assessment process. The Criminal Code requires consultation with a specialist, and the key recommendation is for that specialist to be a psychiatrist. There is also the prospective oversight that I was talking about earlier.
The recommendations relating to implementation fall into three categories: consultation, training and data collection. Simply put, in order to access medical assistance in dying when a mental disorder is the sole underlying condition, there must be a significant history of treatment and therapy. Nothing is taken lightly.
In closing, we have to consider our capacity to pay for the health needs of the patients in question. We have to provide care to these people with irreversible illnesses. As a compassionate and empathetic society, we must take care of patients who meet the eligibility criteria for medical assistance in dying and provide them with a gentle and dignified death. Let us allow this work to continue early next spring without polarization or disinformation.
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Mr. Speaker, I would first like to pay my respects to my colleague, whose personal accounts were very moving. Our hearts go out to Anton's family.
As we know, Bill C-314 amends the Criminal Code to provide that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying. The Bloc Québécois supports access to medical assistance in dying when a mental disorder is the sole underlying medical condition. We agree with the expert panel that the safeguards currently in place in the Criminal Code are sufficient. We think the exclusion should be maintained for one more year in order to give health care professionals a chance to develop standards of practice for cases of medical assistance in dying related to mental illness and to become familiar with those standards.
I would remind the House that the Bloc Québécois's position on medical assistance in dying has always been to uphold the consensus in Quebec, which came about following five years of consultations, specifically that medical assistance in dying is a right. Everyone has the right to die with dignity, of their own free will and with as little suffering as possible.
The Bloc Québécois is of the opinion that it is wrong to draw false analogies between the different problems in society and the specific issue of access to medical assistance in dying when a mental disorder is the sole underlying medical condition. We are of the opinion that it is possible to defend the right to self-determination, which is what medical assistance in dying is, while contributing to improving our health care systems, especially our mental health services. On that note, the Bloc Québécois would remind the House that the government has not substantially increased health transfers. That is affecting the system.
I would like remind the House that, in this debate, it is not a matter of offering people euthanasia as an answer to society's ills, contrary to what the Conservatives are saying. It is frankly irresponsible to suggest that the government's actions are causing people to become depressed and that the government's solution is to offer them medical assistance in dying.
It is also important to remember that the Conservative leader spread disinformation by failing to mention the context, when he stated in his communications that the government decriminalized dangerous drugs. The context is that Ottawa authorized a three-year pilot project in British Columbia to decriminalize the possession of small quantities of drugs. It is a pilot project based on practices used in Portugal with the explicit goal of curbing the overdose epidemic that is happening in British Columbia. The hope is that this pilot project will set a course to help Canadians and Quebeckers with addictions.
What is more, it is misleading to say that the governments will be providing medical assistance in dying in less than a year. That suggests that people will have their request for medical assistance in dying approved in less than a year, when that is not at all the case. As the experts on the Special Joint Committee on Medical Assistance in Dying pointed out, it will take at least a decade, maybe several decades, before a person can get medical assistance in dying for a mental disorder. It will have to be established that decades of therapy using multiple approaches have done nothing to treat the patient's mental health condition. In short, that is the complete opposite of what is being said by the Conservative leader, who is suggesting that a temporary depression is sufficient grounds to access medical assistance in dying.
In the Truchon and Gladu ruling, the courts had determined that the criteria were too restrictive, hence the evolution of this legislation. At the end of a press conference, a journalist asked the Conservative leader if he was prepared to use the notwithstanding clause to block access to medical assistance in dying. The Conservative leader skilfully dodged the question by mentioning that it is not currently before the courts. The Bloc Québécois is curious to hear what his colleagues think of this.
It should also be noted that the expert panel did not recommend deferring the exclusion measure. This is a request by professional associations. Although the expert report is entitled “Final Report of the Expert Panel on MAiD and Mental Illness”, the experts recommend changing the terminology to “mental disorder” because “mental illness” does not have a standardized definition. The panel finds that its recommendations on safeguards, protocols and directives should apply to all clinical situations in which several or all of these important concerns are present, namely incurability, irreversibility and capacity. The expert panel considers that the safeguards currently included in the Criminal Code are adequate for cases of medical assistance in dying when a mental disorder is the sole underlying medical condition.
As my colleague from Repentigny said earlier, the panel made 19 recommendations to proceed with requests for medical assistance in dying when a mental disorder is the sole underlying medical condition. They fall into five broad categories: the development of practice standards for medical assistance in dying; the interpretation of the term “grievous and irremediable medical condition”; vulnerabilities; the assessment process; and implementation.
Briefly, the panel recommends that practice standards be developed and shared with professional associations so they can adapt and adopt them. It should be noted that the government set up a task group to address this and that these practice standards were published in early 2023.
When it comes to interpreting the expression “grievous and irremediable medical condition”, the criteria of incurability, irreversibility and enduring and intolerable suffering, which are currently contained in the Criminal Code, must be duly established. They must be appropriately interpreted in applications for MAID when a mental disorder is the sole underlying medical condition. Although the expert panel acknowledges that it is impossible to establish fixed rules surrounding treatments, their duration, number and variations, they must nonetheless be part of the considerations for accessing medical assistance in dying. Simply put, for someone to have access to MAID when a mental disorder is the sole underlying medical condition, that person must have a significant history of treatments and therapies.
With regard to vulnerability, this involves ensuring that applicants have access to sufficient resources—housing, pain management, community support—so that their choice to access medical assistance in dying is not based on an adverse social circumstances. Again, the Bloc Québécois reiterates that increasing health transfers and funding the construction of social housing must be permanent priorities for the federal government.
As for the recommendations regarding the assessment process, the key recommendation is that the Criminal Code requirement, in this case consulting a specialist, involve a psychiatrist.
Finally, the recommendations for implementation can be broken down into three areas: consultation with stakeholders, training, and data collection for monitoring purposes.
As my hon. colleague and friend, the Bloc Québécois member for Repentigny, explained, this is a serious subject. We must set partisanship aside and work with the expert panels.
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