44th Parl. 1st Sess.
February 15, 2024 10:00AM
- Feb/15/24 3:57:19 p.m.
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Mr. Speaker, I thank my colleague for sharing. Really, only families who have gone through this actually understand the reality of the situation.
One of the frustrations we run into is that Nathan is an adult. The family is cut out. Family cannot tell the physician, if the physician does not want to listen, about what they are observing. They are only getting one side of the story, which is another problem.
If it was up to me, we would not be dealing with this three-year postponement. It would be otherwise. My view is that we can never write a protocol that covers all contingencies. We can never assure ourselves that a physician could not be persuaded to do whatever needs to be done. It is a decision that people will never recover from.
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- Feb/15/24 3:58:30 p.m.
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Mr. Speaker, I would first like to thank my colleague for his very touching testimony.
Quebec currently approves MAID for certain conditions, notably those for which death is foreseeable. There are certain circumstances in which, we know, it is acceptable.
In this case, we are talking about mental disorders and neurodegenerative diseases. I understand that, because of his family situation, this is a very sensitive topic for my colleague.
When it comes to mental disorders, there is no consensus among experts, and we have obviously agreed to push back the deadline for including the issue of mental disorders.
However, when it comes to neurodegenerative diseases, which are diseases of the central nervous system, which are incurable and some of which, like Alzheimer's, lead to certain death, is it not possible that these illnesses are similar to situations in which MAID is already acceptable? Quebec is working on this and, I should point out, there is a consensus within Quebec society.
Have we not correctly distinguished the question of mental disorders, which are not subject to consensus, from that of neurodegenerative diseases, which are currently being studied by Parliament?
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- Feb/15/24 3:59:54 p.m.
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Mr. Speaker, I do not live in a world of expertise. I live in a world of family experience.
The distinction between a mental illness and neurodegenerative disease is one that my colleague, who will be speaking next, would probably be able to answer much better than me.
I do think that members need to be cognizant of the transference from physical infirmities, pathologies and access to medical assistance in dying, to a diagnosed mental illness, pure and simple. There is a red line there. That is what we are dealing with today: what is on the other side of that red line.
I take his question as a good question. My colleague from Thunder Bay—Rainy River could maybe answer it much better than I.
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- Feb/15/24 4:00:58 p.m.
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Mr. Speaker, I also want to thank the member for sharing his personal family story with us. It takes a lot of courage to do that, and I really do appreciate it.
In part of his speech he also noted that his family is well resourced, with heroes in his family as well as with financial resources. It is fantastic, to be able to support a family member in this way. With that said, in my community of Vancouver East we have many family members who do not have those kinds of resources, so what I fear is that people might look at MAID as an option, and of course it is not an option. When we need to do is ensure that the proper resources are in place to support people through difficult times.
To that end, my question is this: For the government to consider all of these issues, how important is it to ensure that all families have access to resources to properly support them through difficult times?
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- Feb/15/24 4:02:10 p.m.
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Mr. Speaker, I was trying to make the point that we are a well-resourced family living in an affluent community with access to the best, and I am perfectly cognizant that thousands, and literally millions, of Canadians are not. In that case, they would not be able to explore all of the other options that well-resourced families can. I take the member's point entirely, and arguably, again, that is a good reason this should not be accessible for people with mental illness under the present circumstances.
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- Feb/15/24 4:03:00 p.m.
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Mr. Speaker, let me start by apologizing to the four or five people who might have listened to my last speech and who are here listening again today, because this is going to sound a little repetitive.
I certainly support the legislation, and I know there are a lot of people out there who are really worried about allowing MAID for mental illness. There are people who are worried about their friends. There are people who are worried about their parents. I am most sympathetic to people who are worried about their children. I have six children, and I know that they are going to, at some point in their life, go through difficult times. I would certainly be a little worried for them if we were to allow MAID for mental illness to be implemented with the current safeguards.
I know that there are also many psychiatrists who are worried about and/or oppose the legislation. In fact, the latest statistic I heard was from a survey that showed that about 75% of psychiatrists were against it. They are worried that their patients who would otherwise get better would instead resort to MAID.
Let me take a step back and look at the arguments coming from the other side. People are going to say, “Why not? Is it not a matter of personal autonomy? Is it not my body and my choice?”. This is not about the state's dictating to the individual what they can do with their own body. It does not criminalize trying to commit suicide or committing suicide. This is about what role, if any, the state should have in assisting people to commit suicide.
I am going to come back to the issue of whether MAID for mental illness is the same as assisting suicide.
The question of whether the state ought to take a role in assisting people in ending their lives is, I think, a little like the question of whether the state should try to prevent people from killing themselves. This is a topic I know something about, having worked a lot of years as an emergency room physician. In that role, my job, if somebody came before me and was suicidal, was to keep them in the hospital, even against their will, to prevent their suicide from happening.
Occasionally people would ask why I should I have that power, saying, “ Is it not my body, and my decision to make?” I think that there are two legitimate reasons for the state to try to prevent people from killing themselves. One is to protect someone from themself. When one is in the depths of depression, they cannot realize that things will get better; that is partly why someone is so depressed and wants to kill themself. The reality for most people is that they do in fact get better.
The other legitimate reason for the state's intervention is to protect the family. The person who commits suicide is dead. The rest of the family lives on and lives with the pain, but it is not only that; they are constantly haunted by whether the death was because of something they did or did not do.
Some people are going to say that, no, MAID for mental illness is not the same as assisted suicide, that we are talking about a small group of people who have intense, prolonged suffering and have tried every form of treatment but nothing has worked, and that it is cruel and unconstitutional to not allow those people access to MAID. I disagree. The Canadian law is far more permissive than, for example, the Dutch law. There is absolutely no requirement that all forms of treatment have been tried and been unsuccessful. Our law does not even require patients to have tried any treatment at all; it requires only that the patient have no other treatment that is acceptable to them. There are going to be people who refuse all forms of treatment altogether.
I know that there are people who support MAID for mental illness who will say that the safeguards are going to come from the medical profession, that they are going to require someone to have tried all forms of treatment beforehand. Unfortunately, I do not have the same sort of faith in the medical profession's doing that. Why do I not? If we look at what has happened with the MAID regime for people with physical illnesses, we see that there are a lot of MAID practitioners who are very zealous about its being all about one's personal autonomy and saying it is not for them to question someone's suffering, and who are quick to approve people.
Let me give some examples from the media. The Fifth Estate aired a program that said that a 23-year-old diabetic going blind in one eye was granted MAID. Another person, a 54-year-old man, had back problems, but his main problem seemed to be that he was worried about losing his housing and ending up on the street. He too was granted MAID.
CTV published a couple of relevant articles. A 51-year-old woman was actually granted and got MAID for multiple chemical sensitivities. Again, from CTV, a 31-year-old woman who seemed to use a wheelchair from time to time and had multiple environmental allergies, applied and was approved for MAID; again, however, her main problem seemed to be that she could not find suitable housing.
There are those who have such faith in my fellow doctors to come up with the system and all the safeguards, but I do not share the same sort of faith. I, as someone with a lot of children, realize it is inevitable that at times in their life they are going to go through a hard time, the breakup of a relationship or financial hard times. I am really worried that they would walk through the door of a zealous practitioner who will tell them it is all about personal autonomy and is their decision to make, because who is the doctor to question their suffering. There is not any requirement in the current legislation that the MAID practitioner talk to the family or the previous treating practitioner to find out whether in fact the depression was motivated by, for example, the breakup of a relationship.
I also want to talk about what I think is a really fundamental and perhaps fatal flaw in the current regime with allowing MAID for mental illness, which is the problem, the impossibility, of determining irremediability: Who is not actually going to get better? I have spoken previously about the inability of suicidal individuals to appreciate the fact that they are going to get better. Some people would ask whether there are people who are not going to get better, who are irremediable. That is in fact the requirement of the legislation. The problem is that doctors do not have a crystal ball. They are not really good at being able to determine who really is irremediable.
In fact, a recently published study looking at the ability of clinicians 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 of 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] assessments.
For me, as a long-time medical doctor, it is absolutely mind-boggling that there are medical practitioners and psychiatrists who are not particularly bothered by the fact that they really cannot say whether the illness is irremediable, and would grant MAID. If we allow MAID for one such person who would actually get better, to me it would seem tantamount to the same sort of tragedy as the state's hanging someone who later turned out to be innocent. We in this place cannot let that happen.
Last, let me address the assertion of proponents of MAID who say that it is inevitable that the Supreme Court would find not allowing MAID for mental illness unconstitutional because it is allowed for physical illness. I think that, yes, there would be a finding that such a provision would violate section 15 or section 7, but as always, the question comes down to the section 1 analysis and whether the state's actions constitute a reasonable limitation as prescribed by law that “can be demonstrably justified in a free and democratic society.” I do not think the answer to that is clear. It is not just me; there was a letter written by 32 law professors who came to the same conclusion: it was not clear whether it would be found unconstitutional.
I am not going to say that we should never allow MAID for mental illness; in fact, I know personally of a case where this might have been the ethical thing to do, but I think we are a long way now from being in a situation where we should start to allow it. I would prefer the pause be indefinite, but so be it. We have what we have. Let us look at it in two years and see what has changed. I doubt very much will have changed.
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Mr. Speaker, as we debate here and keep hearing the words, which we are now getting used to, “medical assistance in dying”, in the context of Bill C-62, I wonder whether we can create something different, like “societal assistance in living”.
We desperately need things like a guaranteed livable income. We need better access to social supports, mental health provisions, addictions counselling and a panoply of things that would make us feel more confident that no one would opt for medical assistance in dying. If Canada, if we as neighbours and friends to the family of all Canadians, said that we are there for them and that they can count on something, a guarantee, social assistance in living, would the hon. member think that is a good idea?
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- Feb/15/24 4:13:02 p.m.
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Mr. Speaker, I absolutely support that. What a humane society does when someone who is suffering comes before it is that it tries to help them. Maybe that means better psychiatric care, but maybe it means addressing their socio-economic problems. Certainly I do not think that a humane society's first response to that person ought to be to offer them death. That is an absolute failure and a solution of an inhumane society. We ought to be helping people who are suffering, not ending their lives.
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Mr. Speaker, we have heard that a lot in this debate. We all want to be on the side of the angels. We all want to improve socio-economic conditions. The expert report does take structural vulnerabilities into account, and no assessor is authorized to grant a request for medical assistance in dying if there is any possibility that the request came about because of a structural vulnerability.
I paid close attention to my colleague's speech. Judging from the examples he gave, I gather he was in favour of Bill C‑14 for cases involving reasonably foreseeable death, but that he is against Bill C‑7 for people suffering from an incurable degenerative disease who are forced to cut their life short by suicide because their suffering has become intolerable. If Bill C‑7 is implemented, those people will be able to live until they reach the threshold of what they feel is tolerable.
Did I understand correctly that my colleague is against Bill C‑7 as it relates to degenerative diseases? I am curious, and I would like him to answer this question. He talked about it in his speech.
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- Feb/15/24 4:15:01 p.m.
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Mr. Speaker, I am not against MAID for physical illnesses. That is a totally different situation. The problem with MAID for mental illness is the inability to determine who is not going to get better. The unfortunate reality is that there are a lot of doctors who have a very cavalier attitude toward taking someone's life, and that there are people who could or would get better with a little time and with better treatment who would otherwise have their lives foreshortened by one of these zealous practitioners.
Certainly it is very different from, for example, the Carter situation, or someone who has ALS and is terminally ill with a neurodegenerative disease. That is a totally different story, and in those cases I certainly approve of MAID if that is what the person wants.
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- Feb/15/24 4:15:59 p.m.
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Mr. Speaker, I will pick up on the comment that my colleague just made, that essentially there are instances of zealous practitioners who may be going very far in terms of determining that someone is eligible when they should not be. Part of the problem with the euthanasia regime we have is that it allows doctor shopping. It allows somebody to find two doctors who may not be representative at all and may not be the attending physician, and asking them, “Would you sign this, please?” They may get approved even if they should not meet the criteria.
Conservatives proposed in the last election platform that we should require MAID assessors to complete MAID assessor training to ensure full awareness of and compliance with the laws and best practices around MAID. Would the member be supportive of the proposal that we put forward to have specific MAID assessor training to try to have more consistency and less arbitrariness and fewer instances of people shopping around?
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- Feb/15/24 4:16:58 p.m.
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Mr. Speaker, I would approve of that. However, as a medical practitioner, I would not volunteer to become a MAID practitioner. If this position is going to be created, the only people who are going to take on the job are people who believe in MAID, believe that it is all about personal autonomy and believe that it is not for others to question a person's suffering. Whatever they are going to be taught, a lot of them are going to be the kind of people who do have a cavalier attitude toward taking life. Those of us who disagree with it are not going to accept the position to begin with.
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Mr. Speaker, I will be splitting my time with the member for Pitt Meadows—Maple Ridge.
Bill C-62, no. 2, suggests that we pause the expansion of medical assistance in dying, known as MAID, to people suffering from mental illness. The Liberals have shown time and again that they consistently pass legislation without the careful consideration needed for such significant changes to our society. This discussion is not just legislative; it is about how we value human life and the impact of the government's choices on all Canadians. In thinking about extending MAID to include mental illness, there is a need for a deep understanding of the complexities and uncertainties in diagnosing and predicting mental health outcomes.
Evidence to the Special Joint Committee on Medical Assistance in Dying showed a worrying truth: Clinicians often struggle to predict whether mental health conditions are irremediable, and they have a 50% chance of being wrong. This alarming fact points to a big problem with the proposed expansion; this is the chance of making permanent choices based on uncertain medical opinions. Mental health involves biological, psychological and social elements. Recovery is not always straightforward, and what seems irremediable at one point may improve with treatment.
Basing MAID on the idea that a mental illness cannot be cured shows a misunderstanding of the changing nature of mental health recovery. As the member for St. Albert—Edmonton put it, it is like flipping a coin on matters of life and death, a practice that is ethically troubling and goes against the idea of patient-focused care. Moreover, we cannot discuss MAID and mental illness without considering the wider issues of access to quality mental health care in Canada.
When people such as Canadian Paralympian and veteran Christine Gauthier are offered MAID from the government when simply requesting help with a wheelchair lift, it shows a worrying trend of suggesting MAID as a fix for systemic failures to providing proper care and support for those with disabilities and chronic conditions. This is not just one case. It reflects a larger problem, wherein essential services and supports are lacking; this drives people to consider MAID not because they want to but because they feel neglected by the Liberal government.
The risks of broadening MAID to include mental illness alone are complex, going beyond clinical doubts to wider social and ethical issues. It makes us question our dedication to mental health care, the value we place on lives touched by mental illness, and the kind of society we want to have. Do we face challenges with empathy, support and a commitment to better care, or do we settle for solutions that ignore the struggles Canadians face?
The Liberal government's approach to expanding MAID shows a wider trend of hasty law-making that leads to policies being introduced, then pulled back or changed after facing reality and public criticism. From errors in firearms legislation to heated debates on the carbon tax, the government often acts first and thinks later. This not only damages our law-making process but also lowers public trust in our ability to govern wisely and carefully.
The rush to include mental illness in MAID, without proper evidence or full discussions with mental health experts, ethicists and affected groups, shows a lack of regard for the careful and expert-led discussions that such a major policy change requires. The need to pause and rethink this expansion, via the bill, is an admission that the government's actions have been rash and poorly thought out.
This legislative step back, marked by two delays in implementation, is not just a minor issue; it is a clear sign of the dangers of choosing political speed over solid, evidence-based policy-making. It raises serious doubts about the government's commitment to responsible governance, which includes the need to fully explore, understand and foresee the effects of laws before they are passed. In this critical discussion on MAID, we must also consider the perspective of those directly affected by such policies. The voices of individuals and families living with mental illness must be central to our legislative process.
Their experiences and insights can provide invaluable guidance as we navigate the complexities of this issue. By engaging with these communities, we can ensure that our laws reflect the realities of those they impact most and uphold the principles of empathy and inclusion. Furthermore, the debate on MAID expansion underscores the need for comprehensive mental health services.
The government must prioritize the enhancement of mental health care infrastructure, ensuring that all Canadians have access to the support and treatment they require. By strengthening our mental health care system, we can address the root causes of despair and hopelessness that lead individuals to consider MAID, thereby affirming our commitment to life and well-being.
This moment also calls for a re-evaluation of our societal values and the role of government in safeguarding the dignity of every citizen. As policymakers, we have a duty to foster a culture that values every life, provides hope through support and resources, and respects the autonomy of individuals while carefully considering the ethical implications of life-ending interventions. This approach would not only address the immediate concerns surrounding MAID but would also contribute to a more compassionate and just society.
As we think about what this pause means, we must consider the lessons learned and push for a more thoughtful, consultative and evidence-based approach to making laws. The stakes are too high, and the chance for unintended harm too great, to accept anything less. In MAID's case, where ethics, law and personal choice intersect delicately, our responsibility to be extremely careful and considerate cannot be overstated.
The proposal for a pause on MAID's expansion clearly shows that the Liberal government's policy-making has been quick and poorly thought out. While this pause is needed, it points to a bigger issue of governance, where major legislative changes are made without enough foresight, discussion or understanding of the deep ethical implications. This pause reminds us of the dangers of enacting laws that deeply affect Canadians' lives and well-being, especially the most vulnerable. It shows the current Liberal government's failure to engage in a careful, evidence-based legislative process, preferring instead policies that match ideological aims rather than the complex realities of issues such as MAID and mental health.
This should be more than a brief stop; it should be a crucial time to rethink how policies, especially those about life and death, are made and applied. It questions the government's commitment to maintaining the highest standards of care, empathy and respect for all Canadians' dignity. We must demand greater legislative care and ethical responsibility from the government.
The discussion on MAID and mental illness needs a comprehensive approach that puts individuals' well-being and rights ahead of quick political gains.
It is time for a move towards more responsible governance, where policies are made with great care, are based on wide consultation, and reflect our collective values and ethical standards. Sadly, the current Liberal government seems to lack concern for any of these values.
The way forward should be marked by a dedication to thorough research, wide involvement and a deep respect for life's sanctity. Only by such a comprehensive approach can we ensure our legislative actions truly serve all Canadians, embodying the justice, empathy and respect that define our nation.
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- Feb/15/24 4:27:11 p.m.
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The member for Mirabel on a point of order.
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- Feb/15/24 4:27:20 p.m.
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Mr. Speaker, we are debating an extremely important issue and it does not seem as though we have quorum.
I would like to request a count, please.
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- Feb/15/24 4:27:26 p.m.
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Okay. We will count the members.
And the count having been taken:
The Deputy Speaker: It is okay. We have quorum.
The hon. member for London—Fanshawe.
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- Feb/15/24 4:28:42 p.m.
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Mr. Speaker, I have to admit that this has been one of my big things. Even when I was a mayor, I talked about the mental health of Canadians.
We can solve a lot of societal problems if we have a better handle on mental health. In order to do that, we have to fund appropriately and properly. One of the big challenges, when we start looking at mental health, is that it is probably going to take at least a 20-year period before we start seeing some real benefits to society. Unfortunately, governments are only elected every four years; therefore, they are not willing to put in the real money that is needed. They often use a band-aid approach.
We need to start looking at a long-range plan to enhance and assist our mental health in Canada.
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- Feb/15/24 4:29:34 p.m.
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Mr. Speaker, we often hear the argument that investments must be made in mental health to prevent mental illness and severe mental disorders.
I did not hear his leader say that he was going to put more on the table in terms of health transfers. Will the Conservatives propose a substantial increase in health transfers?
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- Feb/15/24 4:30:11 p.m.
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Mr. Speaker, there is a big misconception in this House about the opposition. We are not going to come forward and start laying out our plan for the next election, as to everything we are going to do.
Believe it or not, the Liberals would steal everything we are proposing. That is why, I have to admit, we are not going to lay everything out.
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- Feb/15/24 4:30:41 p.m.
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Mr. Speaker, if I understand this correctly, from what I just heard, the most important thing for this member is political opportunity and gain, not to advance the best interests of Canadians.
I have news for that member. He was not elected to come here and spend—
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