44th Parl. 1st Sess.
February 13, 2024 10:00AM
Madam Speaker, my colleague is claiming that Bill C-14 resulted in good legislation with its reasonably foreseeable natural death criterion. However, that did not even address the Carter ruling, since Ms. Carter did not have a condition that made her terminally ill. The Supreme Court ordered Parliament to regulate situations like those of Ms. Carter and Ms. Taylor. Limiting medical assistance in dying to people who are terminally ill completely ignores people like Ms. Gladu and Mr. Truchon, who had to go to court to assert their constitutional right. People have had to go on hunger strikes to meet the reasonably foreseeable natural death criterion.
Is that what my colleague calls compassion?
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Madam Speaker, it is possible that my colleague misunderstood me. What I said in my speech was that I voted for Bill C-14 because it was a reasonable response to what had to be addressed, which was the Carter decision. The reasonable foreseeability of death was a problem clause, and I thought so at the time. I thought it was awkward and perhaps not the best way to put it, so it was not a shock to me that it ended up being challenged on that basis. I think my colleague may have been overestimating my enthusiasm for Bill C-14, but I did support it, because something had to be done.
However, this reckless expansion that came after the Senate amendments to Bill C-7 goes way beyond this. No court was calling upon Parliament or forcing Parliament to expand the eligibility of MAID to those whose sole underlying health condition is mental illness.
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Madam Speaker, the New Democrats actually also voted against what I thought was an ill-advised Senate amendment to Bill C-7. There is plenty of blame to be thrown around. I understand that. I have done more than my fair share this week against the Liberals, but the fact of the matter is that we are at a moment right now when time is critical. We have about a week and a half left, in terms of sitting weeks, until the March 17 deadline. It is imperative that this bill gets passed through the House this week, so that it can go to the Senate.
I am glad to hear the member's support for that measure, but I am curious as to why, when we had a vote on time management of this motion, which is programming the bill, the Conservatives voted against it, knowing that it could have actually jeopardized the time we had available to us this week to get Bill C-62 passed.
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Madam Speaker, there is no danger of Bill C-62's not passing this House. I think perhaps there has been some failure of the combined party leadership negotiations to come up with an arrangement that would have expedited this.
I am not concerned about the bill's not passing. The programming motion is there. I certainly never had any intention to deliberately delay the passage of this bill. That is not what any Conservative has attempted or is attempting to do.
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- Feb/13/24 7:41:34 p.m.
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Madam Speaker, let me start by saying that I am sharing my time with the member for Sarnia—Lambton, which, I have to say, is a little bizarre.
I support this legislation, a further three-year hold on allowing MAID for mental illness, and, in addition, imposing a requirement in two years' time to reform the MAID committee to re-examine this question.
I know there are a lot of people out there who are worried about MAID for mental illness. People are worried about their parents. People are worried about their siblings, and I can most appreciate that people are worried about their children. I have six kids and I, frankly, would be worried if we were to implement this legislation as is, because I do not think there are adequate safeguards. Everyone who is a parent realizes that our children will inevitably, at some time, go through difficult times.
I also know that there are many psychiatrists out there who are worried about this, and the majority of psychiatrists are against this. They are worried that their patients, who would otherwise probably get better, would instead resort to MAID. To all these people, I think their concerns are totally justified. I do not think there are adequate safeguards in place at the moment.
Let me step back a bit and look at the approach of those who are advocating for MAID for mental illness to start right now. For them, it is all about personal autonomy: “It is my body, my choice. Who are you to second-guess whether I want to live or not?” This is not the state dictating to people what to do with their own bodies. It is not criminalizing either suicide or attempted suicide. This is a question of what role, if any, the state should have in assisting people to commit suicide.
I am going to get back to the question: Is MAID for mental illness really the same as suicide? The question of whether the state should be assisting people in committing suicide is closely akin to the question of whether the state should help to prevent people from committing suicide. This is something that I have a bit of experience with, because for a lot of years, as an emergency room doctor, I would see people who were suicidal, and it would be my role, if I thought they were suicidal, to keep them in the hospital, even against their will. People would ask me why I should have this power. They would ask, “Is it not my right to decide what to do with my own body?”
In thinking about it, I thought, well, the state has two legitimate interests in trying to prevent people from killing themselves. One is to protect people from themselves, because when they are in the depths of depression they do not realize that things will get better. That is partly why they are so depressed and why they want to kill themselves. However, the vast majority of people do get better.
The other legitimate reason for the state to intervene is to protect the loved ones. The person who dies is dead; they are not suffering any more pain. The people who continue to feel the pain are those who have lost their loved one. In addition, they often spend the rest of their lives thinking about whether this had anything to do with something they could or could not have done.
I know there are people who are going to say this is different: MAID for mental illness is different from assisting suicide, and the people they are talking about with respect to MAID for mental illness are people who are chronically, desperately ill, who have tried all forms of treatment and for whom nothing has been effective. They say that it is really cruel and unconstitutional not to help those people. I disagree.
First of all, the Canadian law, unlike the Dutch law, is very permissive as to who meets the requirements. There is absolutely no requirement that the person has tried all forms of therapy and they have failed. In fact, they do not have to have tried any form of treatment at all, because the legislation would require only that there are no other treatments acceptable to the patient. I know, from being a doctor, that people are going to refuse all treatment. They are going to refuse medications. I know those who support MAID for mental illness are going to say, “Okay, it is not in the legislation, but it is up to the medical profession, the doctors, to impose these requirements, like trying all forms of treatment, even if the law does not.”
I hate to say it, but as a doctor I do not have the same faith in my own medical profession, and the reason for that is that we ought to have learned from what has happened with MAID for other forms of physical disability. There are a lot of zealous MAID practitioners out there who absolutely believe that personal autonomy is paramount and do not think we ought to be questioning why somebody decides to take their own life.
Let me give some examples from the media. The Fifth Estate, a very good show, talked about a 23-year-old diabetic person who was losing sight in one eye, who applied for and was granted MAID. Another story was of a 54-year-old man with back problems, but his real problem seemed to be that he was afraid of losing his apartment and ending up on the street. He too applied for and was granted MAID.
CTV documented the story of a 51-year-old woman, who applied for and actually received MAID for multiple chemical sensitivities. Another story was of a 31-year-old woman approved for MAID for needing a wheelchair. I do not think she actually really needed it, but she usually used a wheelchair and had multiple environmental allergies. Again, her problem was mostly that she could not find adequate housing. Again, this person was approved for MAID.
To those who have such faith in the medical profession that they say we are going to create the safeguards, they are perhaps a little naive. I would sincerely worry if we were to implement this legislation with the safeguards in it right now. I have six children, and I know, almost inevitably, that life is such that they are going to go through difficult times, such as the breakup of a relationship or hard financial times. I would be worried they would see one of these zealous practitioners who believe in personal autonomy, who would say, “Who am I to question your suffering?”
Part of the problem is that the current legislation would not require the MAID practitioner to talk either to the family or to the treating doctor, so they are not going to find out that the depression was the result of the breakup of a relationship or the person's not taking their medication.
I also want to briefly talk about the problem with allowing MAID for mental illness and the question of irremediability. Part of the problem with allowing it for people who are depressed is the fact they cannot see that things are going to get better, but people are going to say that surely there are people out there who are not going to get better, which is the requirement of the legislation: One needs to have an irremediable illness.
The problem, though, is that doctors are not really good at predicting who is not going to get better, especially with respect to mental illness. With things like cancer, it is different.
A recently published study that looked at clinicians' ability to determine irremediability for treatment-resistant depression concluded, “Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard for irremediability cannot be met”.
Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of MAID assessment.
For me, as a long-time doctor, it is almost mind-boggling that there are practitioners out there, psychiatrists, who are not particularly bothered by the fact that they cannot be sure somebody's condition is irremediable. It would be absolutely terrible to take someone's life when they could actually get better.
Lastly, let me address the assertion of some proponents of MAID that it is inevitable that if this was to go to the Supreme Court, it would find it to be unconstitutional, because it discriminates against people who have mental illness rather than physical illness. I do not think it is at all inevitable. Yes, a court would probably find this to be a violation of section 15 or section 7, but the real question, as in a lot of constitutional questions, is the section 1 analysis. Does it constitute a reasonable limitation “prescribed by law as can be demonstrably justified in a free and democratic society”?
I think that is highly questionable, but never mind my opinion. There was a letter written by 32 law professors to the relevant ministers a year ago, stating the same thing, which is that it was not clear this would be found unconstitutional.
I am not going to say I do not think we should ever allow MAID for mental illnesses. I, in fact, know someone to whom perhaps the only humane thing would have been to offer it. However, we are very far at the moment from being in a position in which I would be willing to advocate for MAID for mental illness.
Let us vote for this legislation. Let us re-examine it in two years' time.
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- Feb/13/24 7:51:16 p.m.
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Madam Speaker, I am encouraged by my colleague across the way's position on this particular issue and his knowledge as a medical practitioner, but for goodness' sake, it was a year ago we were dealing with this issue. The government controls the agenda; he is a member of the government caucus.
Why, instead of just punting this issue and kicking the ball down the road, did the government not put a fork in this with a piece of legislation that would stop us from having to deal with this for the foreseeable future? Did he advocate for that in his caucus? Why is Parliament going to have to deal with this again in a handful of years?
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- Feb/13/24 7:52:08 p.m.
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Madam Speaker, as the member knows, I am not free to discuss what I did or did not say in caucus. However, we did delay this for one year and a further three years. Obviously there are the considerations of what the Senate is going to do and what the courts are going to do. The issue will come back. Yes, I would have liked to have seen the pause be indefinite, but it is what it is. Let us go one step at a time, and I think in the end we are going to come to the right conclusion.
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- Feb/13/24 7:52:41 p.m.
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Madam Speaker, I have high regard for my colleague. We are both members of the Standing Committee on Health.
However, I am a bit shocked this evening. I say this quite honestly and without being condescending, but, if I were to return to teaching and present a speech to show how much sophistry there can be in one speech, I would take his. It is a perfect example.
On one hand, he says he knows what he is talking about because he is a doctor, and we should believe him. On the other hand, because he is a doctor, he tells us we should not trust doctors. Then who should we trust? He tells us he is a doctor, he knows what he is talking about, but he is concerned for his children. Then he gives examples of people feeling suicidal when we know full well, and it has been established beyond a shadow of a doubt, that suicidal states can be reversed.
What is he afraid of?
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- Feb/13/24 7:53:47 p.m.
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Madam Speaker, I thank my colleague from Montcalm, who sits with me on the Standing Committee on Health.
I am worried about something. I was a doctor and I still practise medicine, but now I am here in the legislature. We make the rules, and I think one of our responsibilities when we make rules is, like a doctor, to do no harm. If we implement this legislation, I am genuinely concerned that, although I know my colleague from Montcalm is a great individual, and I trust him, there are a lot of zealous MAID practitioners who are very cavalier in allowing MAID for various forms of illness. I do worry that my kids and the kids of my constituents are going to go through hard times and see one of these zealous practitioners, who will say, “Well, it is your decision to make."
It is our job to protect those people. That is why I am here.
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Madam Speaker, it has been reported in the media that some senators have been openly musing about blocking Bill C-62. Given that we are dealing with such a short timeline, I am just wondering whether my colleague has any thoughts about the unelected Senate's openly voicing blocking the democratic will of the House of Commons on such an important issue. What does he think the government should be doing to try to prevent that from happening when the bill makes its way to the red chamber?
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- Feb/13/24 7:55:29 p.m.
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Madam Speaker, I absolutely have comments on that. Sometimes court decisions deal with difficult ethical problems that involve balancing competing interests. They say these sorts of difficult decisions should be left to the elected representatives who are held accountable to the people, not left to the non-elected courts. That is absolutely right, and with respect to this issue, it ought to be us in the House, who are the elected people, who make the decisions, not the Senate.
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Madam Speaker, here we are again at the eleventh hour. The government has waited on something that it has to put in place; otherwise, on March 17, people whose only condition is a mental illness will be able to apply for medical assistance in dying.
The Liberals are not virgins in the parliamentary process. They understand very well that, typically, for a bill to go through three readings in the House and through committee meetings, and then go to the red chamber, where a similar number of readings and committee meetings take place, takes about 18 months. If there is goodwill among all parties and we agree, it may be six months. It is ludicrous to me that less than two months before the deadline, the government put forward this legislation. It is really putting a gun to the head of opposition members, because if we decide not to pass the bill, on March 17 people who suffer only from a mental illness will be able to receive medical assistance in dying.
I have a lot of compassion for people suffering from mental illness. In many cases, they have suicidal thoughts and are not full of hope for the future, so it is easy for them to say in despair that there is no way out. However, a lot of people get better and go on to live full lives. They are not in a place where they can really take that decision.
It is not the first time the government has waited until the last minute. I remember when the medical assistance in dying legislation in Bill C-14 was introduced, there was a lot of pressure for us to get along and pass the bill. I would have more confidence if it were not for the fact that the government continually brings forward legislation that is unconstitutional. Then it goes through the courts to the Supreme Court and, like Bill C-69, is declared unconstitutional. The bill for the welfare of indigenous children was also declared unconstitutional. It is our job to give due process to bills and to make sure they are a good idea, rather than just rubber-stamping them and passing them along.
I do not want to have the consequence that people who are mentally ill would receive MAID if we do not pass this legislation in time, but we have no guarantee that the Senate is not going to delay the bill. There was a question for the member who gave the last speech about how the Senate may choose to block the bill. That would delay it even further and we would not make the timeline. It is not a sure thing that the bill is going to get across the line.
We have to look back to the Carter decision. We spent a lot of time talking about what the response would be, and it was the court's order that the criteria be an irremediable condition with imminent death. That is the path we started on. I was very concerned at the time because every recommendation from the special committee that studied this said that without good-quality palliative care, one really does not have a choice.
At that point in time, I found out that only 30% of Canadians had access to palliative care. That is what prompted me to bring forward my private member's bill to get consistent access to palliative care for all Canadians. That bill unanimously passed in the House. Since then, we have doubled access, from 30% to almost 60%, which is a great thing, but there is more to go. If people do not have good-quality palliative care, they really do not have a real choice.
The government needs to refocus itself. I saw in the report that after five years of progress on palliative care, there are still identified gaps. The government needs to pursue that with passion and aggressiveness because that is the answer. If people have good-quality palliative care, they do not choose medical assistance in dying, and that applies everywhere. I met today with some of the representatives from palliative care, and they informed me that when people go to hospice, nine out of 10 of them are asking for medical assistance in dying, but very few of them actually take advantage of it once they experience palliative care.
Why are nine out of 10 of them asking for medical assistance in dying? It is because the doctors are recommending it, and I do not have any confidence that the safeguards that were supposed to be in place are actually being adhered to. A doctor from the Liberal Party who spoke before me cited five examples that he is aware of where clearly people did not meet the conditions but were given medical assistance in dying.
Canada is on a very slippery slope. If we look at the history of countries that have implemented medical assistance in dying, the Netherlands was sort of at the forefront, and it took a while for it to experience a rise in the percentage of people who were dying from medical assistance in dying. However, last year in Canada, 4% of people who died did so by medical assistance in dying. We set a world record. We are top of the charts on killing people with medical assistance in dying.
I think this is absolutely the wrong direction, so to broaden medical assistance in dying to include people who are mentally ill is absolutely ill-informed, at the very least. I would say, without being insensitive, that people who are mentally ill are actually able to kill themselves. Sadly, in their despair, many of them are taking their lives every day. They do not need the government to enable them.
The Conservatives warned the government, when this ill-advised amendment came from the Senate, that this would happen. Instead of realizing the mistake and backing off, the Liberal government is kicking the can down the road for another three years, where the next government will deal with it, instead of recognizing that this is not a good idea.
Doctors are saying that 50% of the time they cannot even identify whether somebody's condition, when they suffer from mental illness, is irremediable. If that is the case, then half of the time, they are going to kill someone who might have gotten better. This is a totally bad idea. The government should stand up, say it realizes the mistake it has made and that it should have introduced legislation to eliminate that mistake. However, that is not where we are today. Today, here we are: If we do not make a decision and pass the bill in a hurry, people with mental illness are going to start dying from MAID on March 17.
I would say that there is a lot scope creep that has been suggested. Where do we stop? There has been a suggestion that if we approve those with mental illness, maybe minors should be added, or maybe the option of advance directive should be added. It looks like the solution to all of these things is death. We hear that homeless people are requesting medical assistance in dying. We hear that veterans are being advised to take medical assistance in dying. This is just scope creep and broadening who is dying in this way, without having proper controls in place. I do not think that is acceptable.
One of the things that has been totally ignored is the conscience rights of doctors. The federal government will always say it did not preclude that in its bill, but the fact is that provinces are forcing medical doctors and nurses to participate, even if it is against their religion and their conscience rights, and the federal government has done nothing to correct that situation. That is a problem.
The other thing I would say is that in the creep that is happening, they have created an express lane for the disabled. It is disgusting to the disabled community and disgusting to me that they would say that if someone is disabled, they should go to the front of the line. For the vulnerable, the mentally ill and the disabled, we need to protect those people; we need to stand up for their rights and know that we can give them hope.
I do not agree with the way this was brought forward. I think the government should have appealed the Truchon decision. When Quebec decided this needed to happen, the government should have said no, that it had thought about it, studied it and spent a long time on it. It should have said it was going to appeal that decision, because what it brought in at the beginning was at least better than the scope creep we are seeing now.
I have talked about the many examples of things that are not good with the legislation. Obviously, I do not want to see anymore people die. I will definitely work with the government to see the legislation pass as speedily as possible, and I encourage it to use the same leverage it used on Bill C-234 to help its Liberal-appointed senators do what it wants. I hope it does the same on this bill and that it receives speedy passage, and that we do not have people with mental illness being killed by the government.
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- Feb/13/24 8:06:17 p.m.
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It being 8:06 p.m., pursuant to order made earlier today, it is my duty to interrupt the proceedings and put forthwith every question necessary to dispose of Motion No. 34 under Government Business, which is now before the House.
The question is on the amendment.
May I dispense?
Some hon. members: No.
[Chair read text of amendment to House]
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- Feb/13/24 8:08:54 p.m.
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Mr. Speaker, we request a recorded division.
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- Feb/13/24 8:08:54 p.m.
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If a member participating in person wishes that the amendment be carried or carried on division, or if a member of a recognized party participating in person wishes to request a recorded division, I invite them to rise and indicate it to the Chair.
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- Feb/13/24 8:08:59 p.m.
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- Feb/13/24 8:52:03 p.m.
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I declare the amendment lost.
The next question is on the main motion.
If a member participating in person wishes that the motion be carried or carried on division, or if a member of a recognized party participating in person wishes to request a recorded division, I would invite them to rise and indicate it to the Chair.
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- Feb/13/24 8:52:40 p.m.
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Mr. Speaker, I request a recorded division.
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- Feb/13/24 9:04:13 p.m.
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I declare the motion carried.
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Mr. Speaker, I am pleased to have the opportunity to rise in the House this evening in support of Bill C-62.
I will note, in particular, the government's commitment to respecting people's autonomy and personal choices, while supporting and protecting Canadians living with mental illness who may be vulnerable. I will also talk about the major investments that our government has made to improve access to mental health services for all Canadians.
We recognize that mental illness can cause suffering that is on par with suffering that results from a physical illness. That is not up for debate. We also know that persons with a mental illness are capable of making decisions with respect to their own health, unless individualized assessment suggests this capacity is lacking.
However, while we respect the autonomy of those who choose MAID in response to severe and irremediable suffering, we have an equally important responsibility to protect Canadians who may be vulnerable, including those suffering from mental illness or who are in crisis. That is why federal legislation provides rigorous safeguards and criteria that must be applied to all MAID assessments.
The experts who made up the expert panel on MAID and mental illness were of the opinion that the existing legal safeguards provide an adequate structure for assessing cases where a mental disorder is the sole underlying medical condition, provided those safeguards are interpreted correctly and applied appropriately. In its final report, the group made 19 recommendations, including the development of model MAID practice standards and training for clinicians.
Our government has made significant progress, in collaboration with the provinces and territories and other health care stakeholders, to implement the recommendations of the expert panel and to prepare for the expansion of MAID eligibility. However, the provinces and territories have expressed concerns regarding the current March 2024 timeline and are asking for more time.
The Special Joint Committee on Medical Assistance in Dying also recognized the progress made in preparing for the expansion of eligibility for MAID. However, as noted in the committee's recent report, it is recommended that additional time be provided to ensure that eligibility for medical assistance in dying can be safely assessed for individuals whose sole medical condition is a mental illness.
The three-year extension we are proposing in this bill will allow more time for the adoption and integration of the necessary resources, such as the model MAID practice standards and the training program recommended by the expert panel. This will ensure that MAID assessments for people with complex conditions, such as people suffering solely from mental illness, are conducted with the appropriate level of rigour.
I believe that any Canadian who is suffering grievously and wishes to consider MAID as an end-of-life option should be free to do so. I also think that, in parallel with the implementation of MAID for those who are assessed and deemed eligible, we also need to commit to improving our mental health care system.
As such, it is important for all Canadians who are struggling with mental illness and/or thoughts of suicide to have timely access to critical mental health resources. As parliamentary secretary, I am pleased to speak about our ongoing and future investments as well as progress being made on key interventions to support the needs of Canadians with regard to mental health and substance use care.
Budget 2023 confirmed the government's commitment to invest more than $200 billion over 10 years starting in 2023-24 to improve Canadians' health care. Of that amount, $25 billion will go to the provinces and territories through adapted bilateral agreements that will focus on four key pillars, including improving access to mental health services and addictions-related services. Other key investment include $598 million for a mental health and well-being strategy with distinction-based funding for indigenous communities, and $350 million for the substance use and addictions program since 2020.
Thanks to the mental health promotion innovation fund, the Public Health Agency of Canada is investing $4.9 million a year in community-based programs for mental health promotion focused on reducing systemic obstacles.
I am also very proud to recall that we have recently taken an important step to provide suicide prevention support for people who need it, when they need it most. Canada's new three-digit suicide crisis helpline, 988, launched on November 30, 2023. It is available to call or text, in English and in French, 24 hours a day and seven days a week across Canada. An experienced network of partners, as trained responders, are ready to answer 988 calls and texts. Responders provide support and compassion without judgment. They are here to help callers and texters explore ways to keep themselves safe when things are overwhelming.
We understand that the past few years have been hard and that many people have been struggling to cope. There is still a lot more to do, and we are committed to continuing to work with our partners to address Canadians' needs in the areas of mental health and substance use. In the future, we remain determined to improve access to mental health care services and to help those with substance use issues.
To that end, the Minister of Mental Health and Addictions and I met with a wide range of partners and stakeholders, including the provincial and territorial ministers responsible for mental health and addiction, to discuss their priorities and needs. This commitment will ensure that mental health and substance use services and programs are based on core expertise.
We have been listening to Canadians with lived and living experiences, to health care professionals on the front lines and to experts to make evidence-based investments and interventions to support timely access to mental health care needs. However, we recognize that no matter what treatments and services are available, sometimes they are not able to relieve intolerable suffering in a manner acceptable to an individual. That is when MAID may be an option for individuals who make a request and who are deemed eligible by two independent medical practitioners.
Ultimately, we are committed to respecting the personal autonomy of each and every Canadian, while protecting the interests of those who may need more care. The three-year extension we are proposing will enable us to do all we can to train and support clinicians who will assess complex cases, including those in which mental illness is the sole medical condition. In the meantime, we will continue to invest in resources and support for mental health and substance use problems.
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