44th Parl. 1st Sess.
February 12, 2024 11:00AM
Madam Speaker, when it comes to MAID, this government is not exactly a shining example of proactivity. After the Carter decision, it took a long time for the government to table a half-decent bill. Bill C‑14 was pretty worthless. It was a poor imitation of the Quebec legislation and was far from addressing the crux of the Carter decision.
That being said, the issue of proactivity is still relevant. Regarding MAID for people with mental health conditions, a three-year delay was unnecessary; one year would have been enough. The government has been aware of that for a year, since it is basing its decision to kick it down the road on the consensus recommendations of the Special Joint Committee on Medical Assistance in Dying.
Why has the government not done anything on advance requests for the past year? Why is it dragging its feet? Why is it not basing its decision to go ahead with this on the joint committee's key recommendation?
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- Feb/12/24 1:03:22 p.m.
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Madam Speaker, with all due respect to my colleague, who sits with me at the Standing Committee on Health, I invite him to reread the expert report. Honestly, when I heard him talking in his speech about people with mental disorders being put to death by the state, I thought that was utterly outrageous.
Recommendation 10 states, “The requester should be assessed by at least one assessor with expertise in the condition(s). In cases involving [mental disorders], the assessor with expertise in the condition should be a psychiatrist independent from the treating team/provider.” He talked about two doctors. There they are.
What is more, “Assessors with expertise in the person's condition(s) should review the diagnosis, and ensure the requester is aware of all reasonable options for treatment and has given them serious consideration.”
How can my colleague make such claims, when medical assistance in dying for mental illness has to be requested? Just because someone requests MAID does not mean they are eligible for it. Does he not trust the people who practice his profession?
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- Feb/12/24 1:20:09 p.m.
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Madam Speaker, it would have been good if my colleague could have sat with us on the Special Joint Committee on Medical Assistance in Dying. I think she is confusing two things. Just because a person requests MAID does not mean that they will be eligible to receive it, and all of the experts, whether they are in favour of MAID or not, have said that a suicidal state is reversible.
I am not sure what she was talking about, but it is important not to engage in fearmongering. No one who has just been taken into care will be given that option because, first of all, it is not an option that is offered to people. People have to make a request.
I would invite my colleague to read the panel's recommendations on that.
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Madam Speaker, let us try to calm down a bit.
In this debate, the government is basing itself on the Special Joint Committee on Medical Assistance in Dying for its amendment to Bill C‑62.
The Bloc Québécois would have liked to lend its support. The problem is that we believe that we should not indefinitely delay the possibility of medical assistance in dying for people with an irremediable mental disorder, when no psychiatrist worth their salt has been able to treat them or relieve their suffering. After 10, 20 or 30 years of suffering, the decision whether or not to request MAID should not lie with this person, who is supposed to determine whether the patient is eligible.
We asked for an amendment to the bill. Why take three years when, last year, we were told that it would take a year to make sure that MAID for people with mental disorders could be set up in a safe and appropriate manner? The main issue we have is that, in 2015, there was an election, but there was also the Carter decision. The government and this Parliament passed terrible legislation, similar to the one Quebec adopted a year earlier.
Quebec passed a law that only covers end-of-life cases, people who are terminally ill. I want to reiterate that, in the terminal phase of life, the process of dying has begun and is irreversible. People can be well taken care of in palliative care. Good palliative care, as described by Cicely Saunders at the time, is full, comprehensive, holistic support for people as they are dying. It involves adequately managing the person's pain and suffering, both physical and emotional, and supporting their family. All of this should be done in an environment that resembles a normal environment as much as possible. However, it is possible that, all of a sudden, in the midst of this process, the patient, who is slowly dying, will request MAID because, one day, they are feeling at peace and ready to let go. That is not a failure, in my opinion. It can be seen as successful palliative care. When my colleagues are about to depart this life, I hope that they will be calm and at peace. That is what I would wish for everyone.
So Quebec had taken those steps. Then in Parliament came the Carter decision, which stated that Ms. Carter was not at the end of her life, but she was suffering a great deal. It was therefore decided that depriving her of medical assistance in dying impinged on her right to life. Why? She was being forced to end her life prematurely, when the fact is that letting her decide what happened next would empower her. It was up to her to define when her suffering became intolerable.
It was a bad law. Bill C‑7 had to be introduced. When we began studying Bill C‑7, there was another factor that had to be considered; that was in 2021.
The Carter decision states that there cannot be an absolute prohibition on MAID simply because people belong to a particular group, one that is vulnerable. It must be assessed on a case-by-case basis.
The reality is that people can and do struggle with irremediable mental disorders. Irremediability is established through a rigorous process. During that process, practitioners must be certain that the person has never refused treatment that we know would have absolutely improved their situation.
There are indeed people whose mental disorders cause intolerable suffering, and psychiatry does not help them. If anyone here wants to claim otherwise, I would say that they lack intellectual integrity. Psychiatrists cannot cure everyone; it is impossible. That said, psychiatry is rife with medical paternalism.
That being said, what we wanted was for the government, whose Bill C‑62 is based on the work of the Special Joint Committee on Medical Assistance in Dying, to plan ahead for when it might have to introduce Bill C‑62 and include another key recommendation of the special joint committee in the bill. That recommendation was presented a year ago and was the subject of a consensus. One Conservative member even joined the majority. There is a consensus in favour of advance requests.
Why was that not included in the bill? It should have been anticipated. The government knew that the date would have to be pushed back. It had a year to introduce a measure in the House that would have also covered people suffering from dementia and Alzheimer's. Why did the government not do that? We asked the government why it was not doing so when it had the chance. Quebec drafted its own legislation. It is structured, rigorous and unanimously supported in Quebec.
An Ipsos poll shows that 85% of the Canadian population supports advance requests. In British Columbia, 84% supports advance requests. In Alberta, it is 84%; in Saskatchewan and Manitoba, it is 81%; in Ontario, it is 84%, in Quebec, it is 87%; in Atlantic Canada, it is 81%. I could go on. There are other figures. They vary. The results are based on a sample of 3,500 people. That is not nothing. When will the government take action? Why has it not heard this request? Why has it not spoken with Quebec, who has worked on this issue? Why did it not hear the unanimous will of the National Assembly, just last week? Why is it afraid of its own shadow? Why do the Liberals lack courage so?
The last time they lacked courage, we ended up with Bill C‑14. What is the problem with Bill C‑14? The real problem with Bill C‑14 is not a legal problem. The problem is for a patient who is suffering, who, to satisfy the reasonably foreseeable natural death criterion, has to go on a hunger strike. We have seen that. The problem is for people who, like Ms. Gladu and Mr. Truchon, have to fight for their constitutional rights in court. When I say there is a lack of courage, that is what I mean.
My only viewpoint is the viewpoint of patients who are suffering. The only thing I am standing for here is the suffering patients' right to self-determination. Patients had to fight an uphill battle against medical paternalism when it comes to MAID.
As I mentioned last week, there was a time when the palliative care that is so dear to the heart of my Conservative friends and that I personally consider to be very important was called passive euthanasia. Doctors obstinately used aggressive life-support measures because their duty was to save their patients. As we know, every doctor thought that they could save every patient back then. It was actually doctors suffering from cancer who started to assert their right to refuse treatment. Today, cessation and refusal of treatment are part of what are considered to be good medical practices.
Why are we not studying the bill today? The government is imposing a gag order. We will not be overly critical of this decision. I understand that this has to be done before March 17. We are not getting too worked up about this, but still, we have not consented and will not consent to this. Why not? It is because we wanted a bill that was based on the recommendations from the Special Joint Committee on Medical Assistance in Dying. I want answers from the government in that regard.
Why the delay in expanding medical assistance in dying to people with mental health issues? We did what the committee asked. Bill C‑62 even provides for the Special Joint Committee on Medical Assistance in Dying to reconvene in order to determine whether the groundwork has been laid. That is what we are doing. We basically took the recommendation and inserted it into the bill. Then, there is the issue of advance requests. There is a consensus on that across the country, but the government lacks the courage of its convictions.
The Liberals are afraid of demagoguery because there has been a lot of it on this issue. They are lumping everything together. However, at some point, they need to be consistent in their approach. The Liberals are well aware that the state's role is not to decide for the patient what is best for them when it comes to a decision as personal as one's own death. The state or the patient's neighbour is not the one who is going to die. The state's role is to determine the proper conditions and ensure that they are put in place so that patients can make a free and informed choice. If people are worried about abuse or the slippery slope when it comes to advance requests, then they should look at Quebec's law, which is a model to follow.
The government could have easily inserted elements of the Quebec law into its regulations. It is all well and good to say that the law is a little vague, but the amendment we are making to the medical assistance in dying legislation, expanding section 241 of the Criminal Code, is followed by a procedure, regulations on enforcing regulations. That is where the various safeguards are put in place.
There are standards of practice when it comes to mental disorders. A year ago, a committee began looking at standards of practice, and they will be sent to the regulatory bodies in each province, namely the colleges of physicians. Once we have clear guidelines and standards of practice and the criteria I was talking about earlier are met, someone in a suicidal crisis will not have access to medical assistance in dying.
It bears repeating, because I am hearing a lot of confusion over this. A suicidal person is not eligible for medical assistance in dying, even if they suffer from a mental disorder and are in suicidal crisis, and even if they have recently been admitted to care and diagnosed. I have often asked psychiatrists if they thought that giving access to medical assistance in dying to people with mental disorders could also provide an opportunity for prevention. Some people commit suicide and no one sees it coming. No one knows those individuals today, no physician took them on.
For example, knowing that MAID is an option, a person might come forward because they are suffering and want to exercise that option. Well, that person would not qualify. However, they would then be taken care of and get the treatment they need, since suicidal ideation is reversible. There is no question about that. However, it is not about those patients. When we asked the chair of the expert panel, psychiatrist Mona Gupta, how many patients in her practice would have been eligible, she told us of two or three patients over her entire practice. Still, these are people who are suffering.
When people talk about the fact that the resources are not there—the resources in terms of someone to assess capacity, for an independent psychiatrist to look at a case—I would point out that right now, the decision-making capacity of a person struggling with a mental disorder, but who has cancer, for example, is verified. Psychiatrists are currently assessing the decision-making capacity of people with a mental disorder and a comorbidity. Depending on their condition, practitioners are able to determine the decision-making capacity of these people who have a mental disorder.
The Supreme Court was clear: Not allowing these people to access MAID creates stigma. Not only does it stigmatize them, it discriminates against them. Why infantilize and weaponize people who have a mental disorder and who, in their entire existence, have not found treatment that can alleviate their suffering?
I rather like having discussions and debating with my Conservative colleagues. They have a sense of conviction, but there are some Conservatives who use scare tactics and conflate everything. It is not enough to repeat some 20 times that someone came to say that irremediability is hard to address. Everyone agrees. Even the expert panel starts with that. They did not hide that fact. In fact, they say that because irremediability is hard to establish there must be safeguards and precautionary principles put in place.
I therefore move the following amendment:
That the motion be amended in subparagraph (b)(ii):
(a) by adding after the words “be deemed referred to a committee of the whole,” the words “that an instruction be deemed to have been given to the committee granting it the power to expand the scope of the bill so as to take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care,”;
(b) by replacing the words “deemed reported without amendment” with the following: “deemed reported with the following amendments:
That the bill be amended by adding the following new section 241.21 to the Criminal Code:
New section 241.21
Medical assistance in dying eligibility criteria for advance requests
“241.21 The government of a province may establish a medical assistance in dying framework for advance requests from persons who have an illness that could deprive them of the capacity to consent to care, in accordance with the laws of that province.””; and
(c) by replacing the words “deemed concurred in at report stage” with the following: “deemed concurred in at report stage, as amended”.
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- Feb/12/24 1:45:26 p.m.
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Madam Speaker, perhaps the interpretation was not accurate, because what I said is that the suicidal state is reversible and that all experts agree on this, whether they are for or against expanding medical assistance in dying to cover mental disorders. It is reversible. People need to stop fearmongering.
I was also saying that if we expand MAID to cover things like mental disorders, it could have a preventive effect. Some people who have suicidal ideation today are going to commit suicide, and they will never have received treatment in the system. Sometimes no one sees it coming.
I am not saying that my colleague's quote does not exist. I am saying that some people suffering today will commit suicide and no one will see it coming. I am more thorough than that. He knows that very well. He does not have to insult me to ask me questions.
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- Feb/12/24 1:47:38 p.m.
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Madam Speaker, that is precisely why I am saying that the government lacks courage. Faced with the political rhetoric machine, the government thinks it is better to backtrack, knowing full well that, by postponing this until 2027, it is quite possible that the same government will not be deciding what to do about mental disorders. What it could do is extend it for a year, and if we are still not ready in a year, nothing would stop us from taking another year. Putting this off until 2027 right now essentially leaves the ball in the Conservative demagogues' court.
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- Feb/12/24 1:49:25 p.m.
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Madam Speaker, I have already answered my colleague's question.
What I told him and I will say it again is that the Special Joint Committee on Medical Assistance in Dying sat for too little time. I would have liked to be able to question the people who wrote that letter to get them to support my position, which is that decisions cannot be forever.
He is telling me that the NDP, which is a progressive party, believes that mental disorders are totally related to our ability to meet demand, when no matter how good the treatment a person receives is, they may still experience a mental disorder that will be irremediable.
Instead of putting it off indefinitely, why not work on it over the next year? That is the Bloc Québécois's position. It is a matter of hearing from those people to see what their arguments are based on, knowing that this cannot be postponed indefinitely.
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- Feb/12/24 1:51:34 p.m.
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Madam Speaker, since 2015, every time we have addressed medical assistance in dying in the House, it has been blocked by the Conservatives.
I understand that my colleague is not happy about it. He tells me that everyone has a right to their own opinion. The Conservatives' opinion is very much based on the views of religious right-wing voters.
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- Feb/12/24 1:52:44 p.m.
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Madam Speaker, I would like to talk about how the work is organized.
In Quebec City, parliamentary committees are rigorously organized. Witnesses are not invited for just five minutes of speeches with three or four other panellists at a meeting where sometimes there are not even any questions because the witnesses are of no interest to the party in question. Expert witnesses appear at these hearings, and each witness gets 50 minutes. It is altogether different.
Here in Ottawa, the methodology is inadequate and we are not doing a good job. This needs to be fixed.
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- Feb/12/24 1:54:13 p.m.
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Madam Speaker, I am not so sure about the wording of that question.
It is up to the patient to make the request, but it is not the patient who ultimately decides. The decision is made by the assessors, the treatment team as well as a psychiatrist who is independent of the treatment team and independent of the person who will carry out the procedure. There will also be prospective oversight, not retrospective oversight.
There are enough guidelines for us to make an informed decision in this matter.
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