Hon. Donald Neil Plett (Leader of the Opposition): Honourable senators, to mimic Senator Manning, I rise today to bring you chapter 3 of “Myla Plett’s Curling Adventures.”

Our story last left off with Myla and Team Plett having won gold at the Alberta Under-18 Girls Curling Championships, the Alberta Under-20 Championship and the Canada Winter Games trials.

This meant that their next stop was the Canadian Under-18 Curling Championship in Timmins, Ontario, which ran from February 5 to February 11 at the McIntyre Curling Club.

The curling club and Curling Canada put on a world-class event, and I’m happy to report that Team Plett went 9-0 to emerge the Canadian Under-18 Girls Curling champions for the second straight year.

Colleagues, the most difficult team they faced in Timmins was the Nova Scotia team, where they were forced into an extra end in order to break a tie. As it turned out, Team Plett would soon face this same team once again at the Canada Winter Games.

This year, the games were held in Prince Edward Island from February 19 to March 4, which my wife Betty and I had the privilege of attending.

Upon our arrival in Charlottetown, and at the opening ceremonies, we received a great reception from Premier Dennis King and the people of P.E.I., where all 3,600 athletes, coaches and support staff, along with the thousands of visitors, were designated as honorary Islanders for the entire winter games.

And throughout the week, Betty and I were also warmly greeted by Senators Brian Francis, Percy Downe and Stan Kutcher, along with our former colleague Senator Diane Griffin, who made us feel very much at home as they hosted us at different lunches and dinners.

Colleagues, what a week of curling it was. Finishing the round robin tied with Nova Scotia — with identical 4-1 records — Team Plett won their quarter-final and semifinal games. Then, they found themselves, once again, pitted against the same team from Nova Scotia in the final. Nova Scotia played an outstanding game, besting us in the final and clinching the gold medal — with Team Plett winning the silver.

I want to offer my sincere congratulations to the Nova Scotia girls’ team consisting of Sophie Blades as skip, Kate Weissent as third, Stephanie Atherton as second and Alexis Cluney as lead. They fought hard for their gold medal and should be proud of their performance.

On a side note, the Nova Scotia boys also won the gold medal. To my granddaughter Myla Plett and her teammates, Alyssa Nedohin, Chloe Fediuk and Allie Iskiw, congratulations on your silver medal. You once again demonstrated excellent sportsmanship and continue to make us proud. I know that all my Senate colleagues will be waiting with bated breath for chapter 4 of this series, when I update them on your success at the Canadian under-21 curling championships in Quebec at the end of March.

Colleagues, I invite you to join me in congratulating all of the athletes who competed at the prestigious Winter Games in Prince Edward Island and wish them well in their continued training as they pursue excellence in their chosen sport. Thank you, colleagues.

Hon. Donald Neil Plett (Leader of the Opposition): Government leader, why is the Prime Minister completely incapable of coming clean with Canadians and telling us the truth? Whether it is reporters or parliamentarians, no one is getting a straight answer from him. Global News reports that the foreign intelligence assessment branch of the Prime Minister’s own department, leader, the Privy Council Office, prepared a special report in January 2022 intended for the Prime Minister and senior PMO staff. It stated:

A large clandestine transfer of funds earmarked for the federal election from the PRC Consulate in Toronto was transferred to an elected provincial government official via a staff member of a 2019 federal candidate.

Yesterday, in the other place, the Prime Minister was asked repeatedly about this. He did everything but answer the questions. Why not, leader? Why can he not come out and tell us the truth?

Hon. Marc Gold (Government Representative in the Senate): Thank you for your question. I think the assumption behind your question, though, is misleading. I won’t repeat everything that I said yesterday.

The Prime Minister and the government have put into place a number of measures to address the situation of not only what has happened in the past, but also how we can protect ourselves in the future. That includes the reference to the National Security and Intelligence Committee of Parliamentarians, or NSICOP, which I understand is accepted; and the National Security and Intelligence Review Agency, or NSIRA, which will set its own mandate and scope of study; the appointment of a special rapporteur; the launch of public consultations to guide the creation of a foreign influence transparency registry, the establishment of the national counter foreign interference coordinator; and Public Safety Canada will coordinate our efforts to combat foreign interference.

These processes are the appropriate ones given the sensitivity and classified nature of the information that’s relevant to these issues. The leaking of information — to which reference was made yesterday, and is rampant throughout the media — is not the way for a responsible parliament to deal with these issues.

Hon. Mary Coyle: Honourable senators, today I rise to tell you the story of a great Canadian who has been lauded for his leadership and outstanding contributions to the arts and media sectors in Canada.

Peter Herrndorf, a towering giant — both literally and figuratively — in both of those sectors and in the places where they intersect, sadly passed away last month surrounded by his magnum opus — his beloved family — Eva Czigler, his wife, and Katherine and Matthew, his children. I was so happy to know that Peter had become a grandfather to baby Nico just months before his passing.

Yes, Peter Herrndorf was the Renaissance man of Canadian journalism, the dream publisher, the godfather of Canadian arts, the media mogul, one of Canada’s greatest cultural leaders, the man of big vision and big heart, as he has been rightly credited in the outpouring of tributes to this wonderful man.

His innovative, extraordinary and transformational contributions to our National Arts Centre; our national broadcaster, the CBC; TVOntario; Toronto Life magazine; the Luminato Festival; the Stratford Festival and many others are clear evidence that Peter deserved these accolades.

However, what I would like to highlight today is that Peter Herrndorf also had an influence on so many other aspects of Canadian nation building, ones that are far harder to quantify.

Like many Canadians, I was fortunate to be in Peter’s orbit. Like others, I was a person with a cause that Peter took an interest in.

I first met Peter when he was the new president and CEO of the National Arts Centre, NAC, and I was the new director of the Coady International Institute at StFX University in Nova Scotia. Peter attended an event that we held in Centre Block. He liked what he heard and offered to help me.

Peter ended up hosting events for us at his home in Toronto and at the NAC. Those events bore important fruit for our institution, supporting community leaders internationally and in Canada.

Peter also became my friend and mentor and would be there to offer advice whenever we spoke on the phone or met in person, like in 2018, when I was a newly appointed senator to this chamber. He took me out to dinner to fill me in on the Ottawa scene.

Colleagues, my experience was quintessential Peter Herrndorf — while excelling at his rather important “day job” transforming Canada’s performing arts scene, Peter Herrndorf was causing huge positive ripples in so many other important sectors across Canada and around the world.

Colleagues, Peter Herrndorf was a national treasure. May he rest in peace.

Wela’lioq, thank you.

[Translation]

Senator Plett: Well, of course, my question was why didn’t he answer the questions not what is he doing on the side, but you mentioned the National Security and Intelligence Committee of Parliamentarians, or NSICOP. Another document provided to Global News was an unredacted copy of an August 2019 report prepared by the National Security and Intelligence Committee of Parliamentarians.

This committee reports directly to the Prime Minister, and he and his office approve redactions or edits to their reports before they are made public. By the way, leader, this is a committee that the Prime Minister has been bragging about that all registered, recognized parties are part of. Ironically, he is failing to appoint somebody from the official opposition in the Senate to that committee but appoints supposedly independent senators and not somebody from the Conservative Party of Canada.

I am curious about that, leader, why is that not happening?

My question is — and I will continue with this — Global News says that this report:

. . . offered several examples of alleged Chinese election interference from 2015 to 2018 that involved the targeting and funding of candidates.

The Prime Minister would have seen this report, leader. He saw it and did nothing about it. I have to wonder if he wants the leaks of both this report and the Privy Council Office, or PCO, report investigated the same way that he wants the Canadian Security Intelligence Service, or CSIS, whistle-blowers hunted down.

Leader, you said this committee would get to the bottom of this in a responsible and prudent way. Maybe we need to have a Conservative on the committee from the Senate. That might help us.

How is a secret committee whose reports the Prime Minister already ignores going to do that?

Hon. Pierre-Hugues Boisvenu: Honourable colleagues, this year, I decided to speak to International Women’s Day on March 9.

You’re probably thinking I’m a bit late, or you may be wondering why I would talk about this on March 9. To me, every day of the year should be a day for talking about women’s rights. Shouldn’t we reflect on the importance of recognizing women’s rights every day of the year, instead of just one day a year?

My mother reminded me of this every day. At 18, she already had a university degree. She went on to have 10 children and taught for 35 years, until she was 65. My mother never needed to remind me or any of my brothers or sisters to respect her rights. She instilled in us the fundamental value — or duty, I would say — of respecting her as a woman and as a mother.

Ever since my daughter Julie was murdered 20 years ago, the fight for women’s rights, especially the right to be better protected, has been in my DNA. The death of my daughter Isabelle a few years later reminded me that the fight for this fundamental right to be recognized was central to women’s sense of security in our society, and that as many men as possible must be part of that fight. In my head and in my heart, I know it is not just women who must wage this fight. Above all, it must be fought by all men, by fathers, brothers, husbands, friends and all men who are important in the lives of all women and girls. Men must dedicate themselves to standing alongside their mothers, their sisters, their wives and their friends so that these women do not fight this battle alone.

The theme for International Women’s Day 2023 is “Every Woman Counts.” I’m thinking of every woman and girl who lived through the horrors of violence as a child or as an intimate partner because she was a woman who “didn’t count,” and who had injuries inflicted on her by a man because she was a woman.

Today, women are gradually taking back control over their lives because they are reclaiming the right to speak up and to speak out. This empowerment is fragile because female victims have lost trust in the justice system. That loss of trust is a deep scar that will heal if, and only if, we make it a priority in this place.

Honourable senators, let us take a moment to think about the 185 women who were murdered in 2022 because they were women. Today, let’s recognize that every one of these murdered women counted, but we failed to protect them.

To give true meaning to the theme of International Women’s Day, let’s make a commitment to make women safer in 2023. Honourable senators, we need to make this commitment, because every woman counts.

Senator Gold: The position of the government is clear. It has confidence in the committee of parliamentarians. It welcomes the work that it did. As I said, I commend to all senators that report on foreign interference. He continues to have confidence in the members who represent all parties.

It will —

The Hon. the Speaker informed the Senate that a message had been received from the House of Commons with Bill C-224, An Act to establish a national framework for the prevention and treatment of cancers linked to firefighting.

(Bill read first time.)

Hon. Diane Bellemare: Honourable senators, I have the honour to table, in both official languages, the fifth report (interim) of the Standing Committee on Rules, Procedures and the Rights of Parliament entitled Equity between recognized parties and recognized parliamentary groups and I move that the report be placed on the Orders of the Day for consideration at the next sitting of the Senate.

(On motion of Senator Bellemare, report placed on the Orders of the Day for consideration at the next sitting of the Senate.)

The Hon. the Speaker informed the Senate that a message had been received from the House of Commons with Bill C-232, An Act respecting Arab Heritage Month.

(Bill read first time.)

Senator Housakos: These announcements were made a year ago. This problem that has now arisen because of courage on the part of CSIS officials who obviously were exasperated by the Prime Minister — and they had to go to the media to get this out in the public — is that they have no faith in this government. There is a bill before this chamber that sets out the implementation of a foreign agent registry. It mirrors a bill that had been tabled in the other place in the previous Parliament and ignored then by the government as well.

Both were drafted with wide consultation from the diaspora and the very communities that are being intimidated. It has been a full year that this bill has been sitting here, and Mr. Trudeau, senators, could not be bothered to speak once on this issue. There has been one speech, no follow-up except procrastination on it. It is the job of parliamentarians to study such things. That is what the public expects us to do. It is our role and our obligation.

Why don’t we do our job? Why doesn’t your government embrace Bill S-237, send it to committee for study, for review and get it past this place quickly as we have done with other bills that we think are of public importance? We’ve seen how we come together quickly on issues of public importance and get bills over to the other side quickly. We can do that with Bill S-237 and get the ball rolling instead of wasting another year in consultations and maybe have another election before we get anything done.

Senator Gold: I certainly will. You are quite right, I can’t answer specifically how the task force report might have influenced things. Addressing gender equity, equality and inequality is an ongoing process. It didn’t begin with this task force, and it will not end with the report.

There are a number of measures that the government has taken that have tangible and important benefits for women across the country. A national system of early learning and child care will have an enormous impact on the ability of women to participate in the labour force. The labour force participation rate for Canadian women in their prime working years is at a record 85.6%.

There have also been improvements, since this government took office, in the participation rate to which I just referred. It has risen by approximately 3% since then. I will make those inquiries, senator, and get back to you.

[Translation]

Hon. Marc Gold (Government Representative in the Senate): Thank you, Senator Smith, for the question. The licensing of physicians is a provincial and territorial responsibility exclusively. There is a problem because the provinces and territories have been slow to liberalize their rules to allow for the easier accreditation of those with degrees from elsewhere.

Indeed, the problem is not restricted to doctors coming from outside of Canada; there are problems within Canada. There have been interesting and welcome initiatives from the Atlantic region, but, still, work needs to be done.

You made mention of doing things other than providing funds, but we should not gloss over the fact that the injection of federal funds into the provincial system and the enhancement of those funds — almost $200 billion over 10 years to improve health care services — go a long way to give the provinces the ability to absorb new doctors and to pay for new doctors — as well as other health care professionals, one should add.

The Minister of Health works with his counterparts across the country on a regular basis. I will make inquiries as to how the subject of licensing is progressing on the agenda and report back. The ability of the federal government, and indeed Parliament, to legislate in this area is quite limited by virtue of the Constitution.

Senator Gold: I do not have more details than to say how pleased I am — and I think we should all be — that the federal government has concluded agreements with nine provinces. Discussions are ongoing with the remaining province and the territories.

These discussions, as you know, and the structure of these arrangements include bilateral funding arrangements, which will be tailored to the needs and requests of the provinces and territories. Again, I have every confidence that the discussions that have gone on and will continue to go on in the structuring and crafting of these bilateral agreements will take into account the issues that you raise, but, again, I will make inquiries and report back.

Hon. Marc Gold (Government Representative in the Senate): Honourable senators, I have the honour to table the answers to the following oral questions:

Response to the oral question asked in the Senate on April 26, 2022, by the Honourable Senator Petitclerc, concerning the Canada Disability Benefit.

Response to the oral question asked in the Senate on December 15, 2022, by the Honourable Senator Cordy, concerning the Great Lakes Fishery Commission.

(Response to question raised by the Honourable Chantal Petitclerc on April 26, 2022)

On June 2, 2022, the Minister of Employment, Workforce Development and Disability Inclusion (EWDDI) introduced Bill C-22, Canada Disability Benefit Act, to establish a new Canada disability benefit. After being studied and amended by Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities, the Bill received all-party support in its third reading on February 2, 2023, before being referred to the Senate where it will be debated and studied.

In the spirit of Nothing Without Us, the government will continue to engage with Canadians with disabilities and other stakeholders to inform the design of the benefit and future regulations. Engagement activities began in summer 2021 with ministerial round tables and an online public survey. Consultations have also taken place throughout 2022, and community-led engagement as well as Indigenous-led engagement through national Indigenous organizations is continuing into winter and spring 2023.

The legislation also recognizes the critical role that provinces and territories play in providing supports and services to Canadians with disabilities and the importance of engaging with them. Federal, Provincial and Territorial Ministers Responsible for Social Services met in July 2021 for an initial discussion on the proposed new benefit and discussions with provincial and territorial governments have been ongoing since, including bilateral meetings between the Minister of EWDDI and provincial/territorial counterparts.

(Response to question raised by the Honourable Jane Cordy on December 15, 2022)

The government is committed to preserving our freshwater resources and protecting the Great Lakes from invasive species, given their cultural, social and economic significance to both Canada and the United States.

The Great Lakes Fishery Commission (GLFC) is vital to controlling sea lampreys, conducting research and maintaining cooperation and coordination among Canadian and American agencies in the management of the Great Lakes fisheries.

As part of Budget 2022, the Government of Canada announced new funding of $44.9 million for Fisheries and Oceans Canada to ensure the continued success of the commission in contributing to the health of the Great Lakes. This increased funding, which takes Canada’s annual support for the work of the commission to $19.6 million, demonstrates our commitment to improving the Great Lakes fishery, ensures continued Canadian sea lamprey control activities and supports the GLFC’s research agenda and its coordination of binational fisheries management across the Great Lakes.

Payment for the current fiscal year has been made and departmental officials and commission staff are working together closely in planning for future activities.

Hon. Raymonde Gagné (Legislative Deputy to the Government Representative in the Senate): Honourable senators, pursuant to rule 4-13(3), I would like to inform the Senate that as we proceed with Government Business, the Senate will address the items in the following order: third reading of Bill C-39, followed by second reading of Bill C-22, followed by all remaining items in the order that they appear on the Order Paper.

Hon. Stan Kutcher moved third reading of Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying).

He said: Honourable senators, I rise today to speak at third reading of Bill C-39, which extends by one year the implementation day for medical assistance in dying — mental disorder as the sole underlying condition, or MAID MD-SUMC. Once again, I would like to acknowledge that our debates which address sensitive issues such as suicide can be distressing to some and that seeking help when you need it is a sign of strength.

During second reading, I spoke to the scope and purpose of the bill and the reasons why the extension is necessary. Today I will remind us of those reasons, and I will also spend time addressing some of the misinformation that has coloured public understanding of the complex issues surrounding end-of-life choice and has sadly crept into medical professional and parliamentary discourse on the topic of MAID MD-SUMC.

The one-year extension will allow for readiness within our health care systems through cooperation between federal, provincial and territorial governments, regulators and providers. In my opinion, readiness means that four conditions have been met: one, that the model practice standard is finalized, published and distributed to regulators in each province and territory; two, that the certified MAID training program has been completed and is available for access by MAID practitioners; three, that the updated reporting requirements have been fully implemented, and the government has begun to gather the data that will be critical for ongoing assessments of the MAID system in Canada; and four, that the government has had the time needed to review the report of the Special Joint Committee on Medical Assistance in Dying.

Colleagues, we are addressing one of the most important legislative challenges that Canadians have faced and, as Senator Martin said in her second-reading speech, a “complex and deeply personal” issue. We are dealing with an issue that will go down in our history as a touch point in the evolution of our understanding of the individual rights and autonomy of those who are living with a mental disorder. This is of the same depth, complexity and nature as two other health-related issues that we have previously grappled with: contraception and women’s reproductive rights. This evolution in our thinking reflects a movement towards a more compassionate society in which we respect and value each other regardless of who we are, who we love or how we choose to die.

This evolution also reflects how Canada is moving to health provision in which the traditional autocratic paternalism of the past is being replaced by patient-centred care. Now we expect that health care providers collaboratively work with patients to create the compassionate conditions in which competent individuals can make free and informed decisions about their own bodies in life, as well as when contemplating death.

The complex issues that we are dealing with in MAID MD‑SUMC require careful critical thought, respectful discourse, a deep understanding of the nuances involved and a willingness to put the interests of those who are intolerably suffering ahead of unbending ideology or political expediency. Addressing these complex issues also requires us to avoid creating or spreading misinformation and to call it out when we encounter it. We can respectfully disagree with each other. After all, that is an integral part of democratic discourse. That said, this is not the same as misinforming ourselves and each other.

Since the coming into force of Bill C-7, my office and I have been following the public discussions about MAID for mental disorder as a sole underlying condition in mainstream and social media. We have also carefully reviewed all the debates on Bill C-39 recently held in the other place. Personally, I have had the privilege of being part of the joint committee on MAID, as a number of other senators here have also had, and being privy to the many hours of witness testimony and the reading of many briefs.

As a result of this research and deep exposure to the complexities and nuances that surround MAID MD-SUMC, I have identified three areas of misinformation that have characterized public and parliamentary debate in the last year. I will share those with you, as engagement with this issue will not likely end with the passing of Bill C-39. As we all go forward, knowing what some of the common types of misinformation are can help us in our research, discussions, deliberations and in our conversations with each other, regardless of what viewpoints we may hold. They are the following: MAID is replacing access to mental health care; MAID MD-SUMC is a slippery slope; and MAID is another name for suicide. I will take each and examine their origins.

Before doing so, however, let us be clear about how misinformation arises. Some of it is deliberate, initiated by actors who do not like how our society is evolving and who respond to this by the creation and distribution of misinformation. Some of it may be inadvertent, where well-meaning people are swept up into an emotional state and accept what is being promoted without a deep understanding of an issue and careful consideration and critical analysis of what information they are sharing.

I discussed the false statements that have been made about MAID MD-SUMD replacing access to mental health care and that individuals in an acute crisis can access MAID in my second-reading speech. Let me be very clear. People who are suicidal or in an acute mental health crisis will not qualify for and will not receive MAID.

Individuals who request and receive approval for MAID MD‑SUMC will have experienced a substantial amount of different kinds of mental health care for a prolonged period of time. They can also withdraw their consent at any time during the minimum 90-day period. Their intolerable suffering is not because they could not access mental health care; it is because none of the many interventions that have been tried over long periods of time have worked sufficiently well to alleviate their intolerable suffering. Sadly, for mental illness, as for other types of illnesses, not every person who is severely suffering finds the relief that they seek with any of the treatments that we have. Thankfully, this is a very small number of people, but it is still a group of individuals who suffer intolerably.

That is why for those who suffer intolerably, decisions as to MAID MD-SUMC eligibility must be made on a case-by-case basis. As I discussed on Tuesday, there is no “cookbook recipe” for determining if a person’s suffering is irremediable and intolerable. There are substantive clinical considerations for sure, and these have been identified in the expert panel report and in the model practice standard. Psychiatrists, using a two-stage Delphic process have also reached a consensus on what this means clinically. The regulatory bodies will further address these in their MAID practice standards, just as they do for all medical care.

It is essential for us to understand that clinical interventions for complex medical conditions are always done case by case, using evidence-based medicine and patient-centred care. Decisions on how and when to intervene eventually come down to a jointly made agreement between the one who suffers and those doing what they can to help alleviate that suffering. That is how modern health care is meant to work. The phrase “to cure sometimes, to relieve often, and to comfort always” aptly captures this patient and healer collaboration.

Another common misinformation argument made about MAID MD-SUMC is that it is a slippery slope — a classic example of a logical fallacy. Of the three different types of slippery slope fallacies, the causal slope variety is the one most frequently found in MAID MD-SUMC discourse. This is defined in the following way:

Causal slopes . . . revolve around the idea that a relatively minor initial action will lead to a relatively major final event.

While the outcome of this so-called slippery slope is not clearly identified, the presumed conclusion is that if MAID is offered for MD-SUMC, then in a short period of time, very large numbers of individuals who suffer with mental illnesses will receive MAID and/or that other horrific and untoward events will occur. A key component of this type of fallacious misinformation argument is that no evidence is provided to prove that what is predicted to happen will actually happen. Furthermore, it often confuses the expected and usual uptake of a new intervention as proof of the existence of a slippery slope and substitutes emotional angst and fear for rational consideration.

Here is what an expert review of the slippery slope fallacy had to say:

In general, slippery slopes are primarily associated with negative events, and as such, slippery slope arguments are frequently used as a fear-mongering technique. As part of this, slippery slope arguments often include a parade of horribles, which is a rhetorical device that involves mentioning a number of highly negative outcomes that will occur as a result of the initial event in question.

Unfortunately, the slippery slope fallacy has been perpetuated in media, in speeches in Parliament and during testimony provided to the joint committee on MAID.

The slippery slope fallacy also “. . . ignores or understates the uncertainty involved with getting from the start-point of the slope to its end-point.”

Therefore, the person making the argument has no idea what will actually happen. But they are certain that what they fear will happen will certainly happen and on this basis they promote this argument.

The misinformation distributed using a slippery slope fallacy can be substantial and have harmful impacts on the health and well-being of individuals and populations. It needs to be countered by pointing out the logical fallacy that this argument is based on and by providing data that addresses the fear that the argument is meant to encourage.

Let’s unpack the slippery slope fallacy as it pertains to MAID MD-SUMC in Canada. In the case of MAID MD-SUMC in Canada, we can look to evidence from other jurisdictions to determine the truth of such arguments. We can study jurisdictions that have introduced MAID MD-SUMC to determine if there is an ever-increasing and very large proportion of the population that is receiving MAID for a sole mental condition.

There is data to examine from the Netherlands and Belgium. In those jurisdictions, MAID MD-SUMC was introduced over a decade ago. We can examine the percentage of people accessing MAID for mental and behavioural disorders as a proportion of those accessing MAID once the pattern of use has been established.

Here is what the data shows us. In Belgium, in the last five years — for which the Library of Parliament was able to provide data to me — the proportion of people who accessed MAID for mental disorder as the sole underlying medical condition was as follows: 2017, 1.7%; 2018, 1.4%; 2019, 0.8%; 2020, 0.9%; 2021, 0.9%.

Let’s put these numbers in a different perspective. In 2021, the population of Belgium was 11.59 million. The total number of persons receiving MAID MD-SUMC was 24 — that is 0.00020% of the population. Clearly, there is no slippery slope in Belgium.

In the Netherlands, the numbers are as follows: 2017, 1.2%; 2018, 1.0%; 2019, 1.0%; 2020, 1.2%; 2021, 1.5%. Again, I’ll put these numbers in perspective. In 2021, the population of the Netherlands was 17.53 million. The total number of persons receiving MAID MD-SUMC was 115, that is, 0.00065% of the population — no slippery slope in the Netherlands either.

This data lines up with the recent study by Jordan Potter, published in Medicine, Health Care and Philosophy in 2018, titled, “The psychological slippery slope from physician-assisted death to active euthanasia: a paragon of fallacious reasoning.” Professor Potter concludes:

. . . (1) employing the psychological slippery slope argument against physician-assisted death is logically fallacious, (2) this kind of slippery slope is unfounded in practice, and thus (3) the psychological slippery slope argument is insufficient on its own to justify continued legal prohibition of physician-assisted death.

Colleagues, as practitioners of sober second thought, it behooves us to call out this misinformation based on the fallacious slippery slope argument when we come across it. Indeed, we could identify the phrase “slippery slope” as a yellow light warning us that what follows could be a fallacious argument.

A third area of mushrooming misinformation directed toward MAID MD-SUMC relates to the issue of suicide. Here the logical fallacy called the “jingle fallacy” — yes, there is a logical fallacy called the jingle fallacy — has been extensively used to muddy the reality and to call into question the primary purpose of MAID itself: an end-of-life choice made by a competent person who is suffering intolerably and who meets all requirements established by law.

A jingle fallacy is the erroneous assumption that two things are the same because they bear the same name — Logic 101, I remember. With MAID MD-SUMC, commentators using this logical fallacy state that MAID is suicide either because this medical practice had previously been called “physician-assisted suicide” or because, for their own reasons, they are using emotional rhetoric to activate the fear factor in others.

A very recent example of this is found in a media story on MAID MD-SUMC in which the following quote appears:

. . . when you introduce legislation that allows someone to prematurely end their life with the assistance of a medical practitioner, that is then doctor assisted suicide. By definition, that is suicide.

In this case, nomenclatural confusion may have contributed to the ease with which this type of misinformation has spread. Indeed, it was the 2016 joint House and Senate report that reviewed many of the terms used to describe this end-of-life intervention and settled on the term “medical assistance in dying,” possibly to avoid this confusion.

As a reminder to us all, the 2016 joint committee report was titled Medical Assistance in Dying: A Patient-Centred Approach. Those who have not yet had the opportunity to read it may want to do so. Those who have read it will recall that the third recommendation was:

That individuals not be excluded from eligibility for medical assistance in dying based on the fact that they have a psychiatric condition.

This committee also grappled with and accepted a definition of “grievous and irremediable,” which is similar to what the expert panel recommended in 2022.

If we listen closely to the suicide misinformation narrative, we will find that at no time is there any attempt made to critically parse how MAID and suicide are the same. The statement is simply made that they are, and that is that. So instead of blindly accepting this statement as truth, let us compare death by suicide and death by MAID. If MAID is indeed the same as suicide, these two types of events should have many similarities.

Suicide is often impulsive. MAID MD-SUMC requires a minimum of 90 days’ waiting and is not impulsive. Suicide is often violent, resulting in traumatic experiences for family members or first responders who come upon the body. MAID MD-SUMC does not result in that type of traumatic experience.

Suicide is a secretive and lonely act, often committed by an individual in desperate circumstances. Family and friends are avoided, not included. MAID is not a secretive and lonely act and usually occurs in the presence of family and/or friends.

Suicide often results in unresolved grief and lasting mental anguish for those left behind. Rates of depression, psychiatric admission, suicide attempts and death by suicide are increased in family members who are in bereavement from a suicide. For families involved in MAID, this experience results in grief and feelings of loss that are similar to those of families involved in palliative care experience and does not mirror the negative outcomes found in families who have experienced the loss of a family member to suicide.

Colleagues, you can decide for yourselves how these two items are similar or different. In my estimation, they do not share the same characteristics and are clearly not the same.

Perhaps, however, there are other ways that suicide and MAID could be the same. Let’s explore this possibility. If suicide and MAID were the same phenomenon, they should be similar in their population demographics. Further, if suicide and MAID affect the same population, the introduction of MAID should decrease rates of suicide. If, on the other hand, as some have argued, the availability of MAID will increase suicide rates in the population, the introduction of MAID should be followed by increased rates of suicide. Let’s check these possibilities out.

First, regarding the assertion that MAID and suicide affect the same populations, this is false. The age distribution of MAID deaths and suicide deaths is different. The gender distribution of MAID deaths and suicide deaths is different.

Second, the assertion that MAID will increase or decrease suicide rates in Canada is also false. The suicide rates in Canada did not increase or decrease significantly since the introduction of MAID. This difference in MAID as compared to suicide demographics in Canada and the lack of MAID impact on suicide rates in Canada strongly suggests that the population that chooses MAID and the population that dies by suicide are not the same population. This data simply does not support the contention that MAID and suicide are the same phenomenon.

What about other countries in which MAID is available? Are they the same as Canada or different? Here the data supports the same conclusion: They are not the same. I will quote from a review of this data in Belgium and the Netherlands by Dr. Tyler Black, who was a witness at the special joint MAID committee:

The following is a comparison between countries that enacted death with dignity legislation (Belgium and the Netherlands) and neighbouring countries that did not. Comparisons between countries have several challenges, but there is no empirical support for the notion that suicide rates increased or differed in MAID-legislated countries versus those that didn’t.

This had a control group in it. Again, it’s not the same there either.

Another component of this MAID-is-suicide misinformation is falsely arguing that suicide is unique to MAID MD-SUMC, a comment that is easily debunked by simply turning to the facts. For example, in the same recently published media article, a self‑identified opponent of MAID MD-SUMC stated:

The traditional form of MAID with a reasonable foreseeability of death allowed MAID to actually operate on a plane that didn’t intersect with suicide.

So let’s look at this assertion. I addressed this during my second reading speech on Bill C-7 and will quote myself:

. . . the presence of a severe and chronic illness is, by itself, an elevated risk factor for suicide. This elevated risk is not only found in persons with a sole mental disorder.

For example, the Canadian Community Health Survey found that, in young adults, attempted suicide was four times higher in those with chronic illnesses such as asthma and diabetes. Suicide rates in persons with cancer are twice as high as in the general population and eight to ten times higher in persons with Huntington’s.

In a study of suicide and chronic pain, Fishbain et al. found that the rate of suicide in chronic pain patients was two to three times greater than in the general population. Tang and Crane, in a global review of suicide and chronic pain, found that the risk of death by suicide is at least double in those with chronic pain.

A similar pattern of significantly increased rates of suicide in chronic illnesses occurs with other chronic illnesses, including cancer. A recent global meta-analysis published in Nature Medicine in 2022 by Heinrich and colleagues reported that the suicide rate was 85% higher for people with cancer than in the general population.

Colleagues, according to Health Canada data for 2021, over 65% of all people who chose a MAID death had cancer as the underlying condition. Remember, suicide deaths in cancer patients are 85% greater than in the general population.

It is false to say that chronic diseases that are not mental illnesses do not have similar concerns about suicide. That is just completely wrong. So why is this misinformation being spread? Whatever the reason may be, our role in providing sober second thought behooves us to follow the data, not pontifications or personal opinions.

As I wrap up this speech, I will turn to another issue that, in my opinion, has been poorly addressed in all these discussions: that of the need to improve rapid access to effective mental health care for all who require it. This is something I fought for my whole professional life and continue to do so.

When I graduated medical school in the 1970s, the number one mental health care need was rapid access to effective care for all those who required it. When I completed my residency in psychiatry in the 1980s, the number one mental health care need was rapid access to effective care for all those who required it. When I entered the Senate, the number one mental health care need was rapid access to effective care for all those who required it. According to the World Health Organization, the expenditure for mental health care should be about 10% of the total health care budget. The Canadian Mental Health Association calls for that number to be about 12%.

This is not solely a federal government issue. Provinces and territories set budget allocations for health and mental health. In my research, the proportion of health care budgets allocated to mental health care fall between 5% and 7% in most provinces and territories — well below required amounts.

We keep hearing that mental health care is on a priority list. Well, colleagues, let’s take mental health care off the priority list and put it on the equitable funding list.

We currently have a national push and environment to move beyond talk to implementation. There is now a federal Minister of Mental Health and Addictions. There is discussion of a targeted mental health transfer fund. Perhaps this will result in the federal government providing more support for improving rapid access to high-quality mental health care for all who need it.

Perhaps this will be the impetus that provinces and territories require to step up their investments in mental health care and also to invest in what works and not what ticks a box.

Honourable senators, we need to keep up the pressure on all levels of government to equitably invest in improving rapid access to effective mental health care for all Canadians. But this pressure is not because of MAID MD-SUMC. It is because we need this to happen, MAID or no MAID.

As we prepare to go to a vote on Bill C-39, I thank you for allowing me to share concerns I have about the misinformation surrounding MAID MD-SUMC and for your continued support for doing better for those Canadians living with mental illness. They deserve compassionate, equitable treatment throughout their life journey, and that includes the end of life.

Colleagues, thank you for your attention and your careful consideration to the complexities and nuances of the MAID MD‑SUMC debate.

For the many reasons that we have discussed this week, in my opinion, it is the right thing to do to delay implementation for MAID for mental disorder as a sole underlying condition by one year.

Wela’lioq, thank you.

Hon. Julie Miville-Dechêne: I rise to speak briefly in support of Bill C-39 at third reading. The bill delays, by one year, eligibility for medical assistance in dying in cases where mental illness is the sole underlying condition.

As my colleagues Senator Manning and Senator Kutcher have mentioned, this is a very difficult issue. It’s not easy to talk about medical assistance in dying. I’m feeling quite emotional after listening to my colleagues, so I will continue.

I support this delay, which will give experts another 12 months to try to refine the guidelines around this extremely rare practice globally. More fundamentally, however, I don’t see any need to act too quickly on such a serious issue, especially in light of the critical shortage of psychiatric resources.

I have always believed that the issue of medical assistance in dying for people with psychiatric illnesses can’t be boiled down to just individual rights or a constitutional analysis. Mental illness is more complex than physical illness, because it often progresses slowly and unpredictably. Unlike degenerative neurological diseases, whose course is known and predictable, it is not uncommon for the psychological suffering associated with mental illness to improve over the medium and long terms.

The federal government outpaced the Government of Quebec on this file before conducting a similar review. Less than a month ago, in mid-February, the Government of Quebec introduced a bill that does not extend medical assistance in dying to patients suffering solely from mental illness.

This exclusion was recommended in the report of the Select Committee on the Evolution of the Act respecting end-of-life care, after extensive consultation with the public and experts. The report states, and I quote:

Self-determination is not the only principle that should be taken into account in this discussion. The protection of vulnerable persons, the ability to consent and the risk of abuse are all elements that enter into the equation.

The Quebec report notes that psychiatrists are divided on the incurability and irreversibility of certain mental disorders. That division reflects the complexity of these illnesses, which are more unpredictable than physical illnesses.

Consequently, there is a real risk of making medical assistance in dying available to a patient too soon. Senator Kutcher, I do not believe that I am participating in what you referred to in your speech as a misinformation campaign on this matter by saying that. I think that there are fundamental differences of opinion in the medical profession, which is why we need to be very careful.

The Quebec report cites psychiatrists who explained that suicidal thoughts are inherent to certain mental disorders. What’s more, the response to psychiatric treatments varies. Alleviated suffering can be a long time coming, after months or years of psychiatric treatment, assuming such treatment is available. I will quote another excerpt from the same report:

We heard the testimonies of several individuals who, after years of unsuccessful treatments, managed to achieve a better balance. These witnesses told us that if they had been eligible for medical aid in dying, they would undoubtedly have applied for it at a time when their health condition seemed hopeless. Today, these same persons are doing much better and are able to cope with their illness because they have received a correct diagnosis and appropriate treatment. Thus, the uncertainty surrounding the trajectories of mental disorders prompts us to be very cautious.

The testimony that made the biggest impression on the select committee came from the Association québécoise de prévention du suicide, the Quebec association for suicide prevention. According to the association, expanding MAID would have an impact on people with suicidal tendencies. There is concern that it could send the signal that death is a legitimate or appropriate option for people with mental disorders. This would undermine years of suicide prevention efforts. I should point out that this does not mean that these suicidal patients would access MAID, but their distress could increase. Let me remind you that Quebec is a pioneer in medical assistance in dying, yet Quebec’s elected officials decided not to rush into the specific issue of eligibility where mental illness is the sole underlying condition, because there are too many differences of opinion.

I also want to point out two things that I think reinforce how important it is to take the time to think about these sensitive issues. First, Quebec now leads the world, with 7% of deaths in the province resulting from MAID. That is higher than Ontario and even long-time pioneers Belgium and the Netherlands. The fact that the rise in MAID was markedly faster in Quebec than elsewhere prompted the chair of the Quebec select committee to investigate the cause and launch a consultation, while advocating for better access to palliative care.

Second, it seems as though, in Quebec at least, it is now easier to get medical assistance in dying than it is to get comprehensive palliative care, and yet both of these options should be available under Quebec law, which guarantees all citizens access to both medical assistance in dying and palliative care, whether at home or in a health care facility.

Some tragic events that occurred in Quebec recently exposed flaws in the system. Andrée Simard, widow of former Quebec premier Robert Bourassa, was denied palliative care during the last three days of her life at St. Mary’s Hospital in Montreal. According to her daughter, Michelle Bourassa, with whom I spoke at length, Ms. Simard died in a lot of pain because she was not given any palliative sedation. Ms. Simard forbade her family to use her fame to get preferential treatment. Her daughter chose to fight in memory of her mother so that all dying persons are treated fairly and with humanity, whether they choose palliative care or medical assistance in dying.

That’s why, even though these issues don’t fall under federal jurisdiction, I think that the availability and quality of palliative care and psychiatric services are a prerequisite for expanding medical assistance in dying. We can’t legislate in a vacuum, in the abstract universe of the Charter of Rights, with no regard for what care is actually available to patients. As responsible legislators, we need to think about the applicability and actual consequences of the laws on which we vote. In this case, we need to prevent the current trend of the health care system getting around providing access to care by expanding access to medical assistance in dying. Better access to psychiatric care is a prerequisite for treating people’s suffering. That is also how we show our compassion. For all of these reasons, I will be voting in favour of Bill C-39. Thank you.

Hon. René Cormier, pursuant to notice of March 7, 2023, moved:

That the Standing Senate Committee on Official Languages be authorized to examine and report on minority‑language health services, including matters related to the following:

(a)the inclusion of language clauses in federal health transfers;

(b)population aging, including the ability to obtain health care, long-term care and home care in one’s own language, which encompasses linguistic resources to support caregivers, the quality of life of seniors and disease prevention;

(c)access to minority-language health services for vulnerable communities;

(d)the shortage of health professionals in public and private facilities serving official language minority communities and the language skills of health care personnel in these facilities;

(e)the needs of francophone post-secondary institutions outside Quebec and anglophone post-secondary institutions in Quebec respecting recruitment, training and support for future graduates in health-related fields;

(f)telemedicine and the use of new technologies in the health sector, including the associated language challenges; and

(g)the needs for research, evidence and solutions to foster access to health care in the language of one’s choice; and

That the committee submit its final report to the Senate no later than October 31, 2024, and that the committee retain all powers necessary to publicize its findings for 180 days after the tabling of the final report.