Hon. Clément Gignac: Last week, some of my colleagues and I were at NATO headquarters in Brussels for the annual meetings with the parliamentary associations of NATO countries. It would appear as though 19 of the 32 member countries will meet the required defence spending target of 2% of GDP in 2024. With a rate of 1.38% of GDP, it seems as though Canada is still far from meeting the required minimum target.

In an interview last Tuesday with the Canadian channel CTV, NATO’s Secretary General said that he was still waiting for Canada to give him a date as to when it expects to meet its commitment. The U.S. ambassador to NATO added that Canada is the only member country that has not committed by providing a timeline.

On this historic day marking Sweden’s accession to NATO, when does your government intend to honour its commitment to our allies?

Hon. Robert Black: Senator Gold, primary packaging is essential for the sustainability of the global produce supply chain, ensuring that Canadians have access to a diverse range of produce year-round. It plays a crucial role in preserving the quality, safety and affordability of perishable goods sourced from fresh fruit and vegetable producers across this country. The industry continues to strive to enhance packaging sustainability.

However, Canada’s produce sector has concerns with the government’s proposed regulatory and policy actions, which, if implemented, will have adverse and potentially irreversible impacts on Canadians. The proposed regulatory and policy actions single out fresh produce as the only food category subject to a plastics ban.

The Canadian Produce Marketing Association, or CPMA, conducted six studies highlighting the negative effects of the proposed regulations on the fresh produce industry. Of particular concern is the impact on fresh produce affordability and availability. Senator Gold, why is the government proposing regulatory and policy actions that will lead to increased food costs and loss in fresh produce availability for all Canadians?

Hon. Marc Gold (Government Representative in the Senate): Thank you for the question. Again, I’m not accepting the premise that the government at the time provided misinformation. I simply do not know how the evolution of that work evolved. It is quite common for companies in Canada, indeed around the world, to take advantage of subsidiaries in other countries. Beyond that, I don’t have the details to respond to your question.

Hon. Marc Gold (Government Representative in the Senate): I’m glad that you have the opportunity to ask me the question, dear colleague, but I simply don’t have the answer. However, I will certainly raise those considerations with the minister as soon as I can.

Hon. Marc Gold (Government Representative in the Senate) moved second reading of Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2.

He said: Honourable senators, I rise today to speak at second reading of Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, which was introduced in the other place by the Minister of Health on February 1, 2024.

[Translation]

The bill proposes extending the temporary exclusion of mental illness as the sole underlying medical condition as an eligibility criterion for medical assistance in dying, or MAID, for three years, until March 17, 2027. Without this legislative change, the exclusion will be automatically repealed on March 17, 2024, at which point eligibility for MAID in those circumstances will become legal under the eligibility criteria and safeguards.

[English]

Colleagues, I appreciate that this is and continues to be a difficult issue for many of us.

On a personal level, this engages our deepest values and beliefs as human beings. How can it not, when we are faced with the human suffering of those who wish to avail themselves of MAID to end their own lives? But MAID is also an issue that engages us as senators as we work through our role as legislators in Canada’s constitutional democracy.

In my remarks today, I will focus on two main issues. The first is whether our health care systems, which fall under provincial and territorial jurisdiction, are ready to implement MAID where the sole underlying condition is mental illness, often referred to as MAID MD-SUMC. The second concerns the compatibility of Bill C-62 with the Canadian Charter of Rights and Freedoms.

I hope to persuade you that the government’s policy reasons for proposing a further delay are well-founded and reasonable, and to ask for your support in passing Bill C-62 as presented and to do so before we rise this week for our March break.

At the outset, colleagues, let us be clear about what Bill C-62 is not about.

Bill C-62 is not about whether medical assistance in dying is or should be the law of Canada. That was decided by the Supreme Court of Canada in the Carter decision and is now entrenched in our Criminal Code.

Nor does Bill C-62 invite us to decide whether MAID should be made available to those whose sole underlying medical condition is mental illness. Bill C-62 does not remove the expansion nor reopen it for debate. That was decided by Parliament and is already entrenched in the Criminal Code.

Bill C-62 provides for a three-year extension to ensure that MAID MD-SUMC can be implemented safely and consistently across Canada.

Colleagues, it is not the case that no work has been done to get the systems ready; on the contrary, since 2021, when Parliament adopted the initial sunset provision for this exclusion of eligibility, important progress has been made in preparation to address MAID for those whose sole underlying medical condition is mental illness. The federal government has been working closely with the provinces and territories on several measures, such as the development of a model practice standard for use by regulatory bodies and clinicians and the development and launch of a nationally accredited training curriculum for clinicians.

Despite this progress, however, all provinces and territories have asked for a further delay to ensure a consistent and safe approach across the country.

[Translation]

On January 29, 2024, several provincial and territorial health ministers sent a letter to the federal Minister of Health requesting an indefinite suspension to the expansion of MAID eligibility criteria. Since then, other provinces have indicated that they also support an extension of the sunset clause, although not necessarily indefinitely. This includes the province of British Columbia, which has one of the highest MAID application rates, and the province of Quebec, one of the most progressive MAID jurisdictions in the country.

Bill C-62 also follows the Special Joint Committee on Medical Assistance in Dying’s recommendation that an extension of the sunset clause was necessary.

[English]

In their report MAID and Mental Disorders: The Road Ahead, tabled on January 29, 2024, the committee noted that while considerable progress has been made in preparing for the expansion of eligibility for persons suffering solely from a mental illness, more time is needed to ensure that the health care system can safely provide MAID in these types of complex cases. The committee also recommended that a joint parliamentary committee be re-established to assess preparedness one year prior to expanding MAID eligibility.

As Minister Holland acknowledged during the Committee of the Whole, some provinces or territories are more prepared than others, as are some clinicians. The main issue is variation across the country. More time is needed to ensure that health systems Canada-wide are better prepared to address MAID requests that may arise in any given institution and that these requests be assessed and administered in a consistent manner throughout the country. Indeed, the government has also heard from major institutions, such as the Centre for Addiction and Mental Health, or CAMH, to the effect that they have not yet reached a consensus on how to implement MAID based solely on mental illness.

Honourable colleagues, the current date for the sunset clause to be lifted and to allow for MAID applications where mental illness is the sole underlying condition is March 17, 2024. Should Bill C-62 not receive Royal Assent prior to that date, a significant legal gap would be created that would lead to tremendous uncertainty across the country.

During this gap, the practice may be deemed legal, and it would create very real challenges for jurisdictions and practitioners. It would also create difficulties for individual applicants, especially where there is an absence of both resources and the required framework for the safe administration of MAID.

All parties need clarity, and applicants, assessors and practitioners all need consistency in the application of the criminal law throughout the country so that no one is in fear of running afoul of the law — at the same time ensuring that the best quality of care and service are provided across jurisdictions.

The coming-into-force provision of Bill C-62 should in no way be considered an invitation for us in the Senate to give rise to this legal gap.

[Translation]

Colleagues, we know that opinion differs on the fact that the health care system is not ready. We heard that the training program and the model practice standard are in place, that some clinicians believe that they and their colleagues are ready to assess those who apply for medical assistance in dying when their sole underlying medical condition is a mental disorder — otherwise known as MAID MD-SUMC — and that only a small number of people whose sole medical condition is mental illness would qualify for medical assistance in dying. In fact, the Minister of Health acknowledged all of this when he appeared before the Committee of the Whole. However, this is only part of the equation. What do people mean when they say that our health care systems are not yet ready?

[English]

With respect to the availability of trained assessors, let’s start with the numbers.

The provinces and territories responsible for the administration of health care have identified that only 2% of psychiatrists have currently been trained. Of the 1,100 clinicians who registered for training, only 130 are psychiatrists. And of those 1,100 clinicians, only 40 have received the full training module. Since the curriculum was launched in August 2023, 26 facilitated sessions have been delivered in six jurisdictions — Alberta, British Columbia, Nova Scotia, Ontario, Quebec and Saskatchewan — and 15 sessions are still planned in other jurisdictions: Manitoba, Newfoundland and Labrador, Ontario and Quebec. To be sure, more clinicians will be fully trained as time goes on, but the numbers fall far short of what is required for a country as big and diverse as is Canada.

Senators, we have heard, and will hear, that a number of practitioners are ready to address MAID based solely on mental illness, but there is not unanimity in the field.

Let me cite Dr. Tarek Rajji, who is the chair of CAMH’s medical advisory committee who testified:

We have several physicians and nurse practitioners who are open to being involved in the process of MAID assessments for eligibility, but we hear them very loudly that they need more guidance. They have no consensus standards to determine, if they see a patient in their office, whether this person has an irremediable illness or not.

Colleagues, the issue of readiness goes beyond the raw numbers of trained MAID assessors. It also engages the question of ensuring that there is consistency within and across jurisdictions in the implementation of the MAID regime.

For example, the Collège des Médecins du Québec, which is in principle supportive of MAID MD-SUMC, submitted that there was a need for further clinical guidelines that were yet to be formalized or adopted in that province.

Dr. Gaudreault, the president of the Collège, explained that, while guidelines were being developed and five criteria relating to MAID MD-SUMC had been identified, more work was needed.

British Columbia’s Minister of Health has publicly supported the federal government’s decision to delay the expansion of MAID eligibility. He stated, “It is my recommendation that additional safeguards are required to ensure the safe and appropriate delivery of MAiD . . . .”

This was also underscored in the submissions to the Special Joint Committee on Medical Assistance in Dying by the Centre for Addiction and Mental Health, CAMH, which is Canada’s largest mental health teaching hospital and one of the world’s leading research centres. Allow me to quote from their written submissions of November 28, 2023:

The Federal Model Practice Standards are a good first step in highlighting the benchmarks that health professional regulators can expect from their members who choose to offer MAiD. But it is not enough. Health professional regulators also rely on their members having access to the best available evidence through clinical practice guidelines. Guidelines for MAiD cases where mental illness is the sole underlying condition do not currently exist . . . .

While some provinces and territories regulatory bodies have successfully implemented practice standards developed by an independent task group made up of clinical, regulatory and legal experts into their guidance documents for clinicians . . .

He cites Alberta, Nova Scotia, Newfoundland and Ontario and then continues, “. . . others are still in the process of reviewing and updating their existing standards . . .”

For example, British Columbia, Manitoba, Saskatchewan, New Brunswick and the Northwest Territories, and, “. . . others have indicated that they have not made any advancements on this front.”

If I may continue with the written submissions of CAMH:

It is also important for the government to understand that the health care system is not equipped to handle the increase in MAiD requests that are expected to come in March 2024 . . . .

Without time to ensure that guidelines, resources and experts are in place, access to MAiD for people whose sole underlying medical condition is mental illness will be limited and inconsistent, and may exacerbate existing inequities within the health care system. It may also lead to confusion, distress and frustration for patients, their families, and health care providers.

Therefore, CAMH is urging further delay in extending MAiD eligibility to people whose sole underlying medical condition is mental illness at this time, and until the health care system is ready and health care providers have the resources they need to provide high quality, standardized and equitable MAiD services.

In addition to the submissions of CAMH, the Canadian Mental Health Association in their January 2024 statement in support of the extension wrote:

A delayed expansion of MAID will allow for the greater training of frontline mental health and substance use health staff. We ask that the government make the training modules available to community mental health and substance use health providers and the staff that support our organizations. Additionally, we suggest developing specific resources to help these providers address ethical, legal, and practical questions and concerns that will arise once MAID MD SUMC is available.

Colleagues, it is not only CAMH and the Canadian Mental Health Association who support the extension of the sunset clause.

The Ontario Hospital Association, which represents Ontario’s 140 public hospitals, has indicated that it is still struggling with how their institutions will implement MAID based solely on mental illness.

Colleagues, there is also the question of oversight.

Several provinces have implemented robust oversight mechanisms, including some of the larger provinces — British Columbia, Alberta, Ontario and Quebec — while others do not have formal MAID quality assurance and oversight processes in place, notably Manitoba, Prince Edward Island and New Brunswick.

Furthermore, the decision to pause the expansion was also predicated on the serious concerns about ensuring what may be called “wraparound services” to support the mental health needs of those contemplating making a MAID application. For example, is there enough capacity to refer individuals to suicide prevention resources if appropriate in a given case?

Last summer, a Best Brains Exchange facilitated by the Canadian Institutes of Health Research addressed MAID Track 2 — that is, where death is not reasonably foreseeable — including MAID based solely on mental illness. The meeting report states that the two-day exchange brought together stakeholders from multiple sectors including regional health care authorities, academics and clinicians.

During the Best Brains Exchange, it was noted:

Not everyone will be eligible and this can increase risk of suicide. Alleviating suffering might be a role in and of itself. Alleviating suffering and putting effort and focus into this discussion can mitigate potential problems, given the shortage of physicians and backlogs of mental health services.

Meeting participants further noted:

Being on a MAID waitlist after the process of asking for MAID can be stressful and can increase suicidality, and long wait lists can increase risk of suicidality, which all relates to the process being difficult for patients.

In addition to ensuring MAID applicants are adequately given wraparound supports, it is also important to ensure that clinicians or practitioners will be well supported as they undertake the highly complex assessments for those whose sole medical condition is mental illness.

During the same Best Brains Exchange, another system-wide need that remains to be fulfilled is:

It will be important for Health Authorities (HAs) and leaders to continue developing Communities of Practice and related support systems. HCPs [health care professionals] need space to reflect on their personal and professional boundaries, including the conditions under which they may say ‘no.’

[Translation]

Indeed, it is not just the provincial and territorial health ministers who raised these concerns during their meeting in Charlottetown. These concerns were also at the heart of the January 30 statement by the Canadian Mental Health Association to support an extension of the sunset clause. In their view, there aren’t enough time and resources to consult the community partners and people with a lived experience of mental health problems and addiction, or even to support the front-line mental health and addictions personnel, who have to respond to requests for information and who are likely to proceed with the assessments.

[English]

Colleagues, there is also the related issue of the coordination of mental health and other support services that are important in this process.

Some jurisdictions have robust coordination services to manage requests and provide ancillary services, as do British Columbia, Alberta, Saskatchewan, Manitoba, Nova Scotia and Newfoundland and Labrador. Other jurisdictions take a decentralized approach, which can result in less coordination across services and disciplines, for example, in Ontario, New Brunswick and Prince Edward Island. The availability of necessary support services for both practitioners and patients vary, depending on the region.

Colleagues, the government has also heard from Indigenous communities that they are not ready for MAID MD-SUMC to be available in their communities. Discussions with Indigenous leadership and communities have begun, but more time is needed to properly engage and consult.

On this, the Government of Canada has launched a two-year engagement process on MAID to hear the perspectives of First Nations, Inuit and Métis, including urban Indigenous people, non-status/off-reserve Indigenous people, Indigenous peoples living with disabilities, and Two-Spirit, LGBTQQIA+ and gender-diverse Indigenous people. This engagement takes a two‑pillar approach through both Indigenous-led and Health Canada‑led engagement activities.

To date, nine Indigenous organizations have been funded to lead community engagement on MAID and/or palliative care. Health Canada is supporting additional engagement activities including an online survey open until June 30, 2024, and a suite of 23 national knowledge exchange round tables, led by an Indigenous-owned business, scheduled to take place between February and April 2024 in seven locations across Canada and virtually.

The information collected through all engagement activities will inform a What We Heard report, or WWHR, on the views and experiences of Indigenous peoples on MAID, planned for release in 2025. This report will help to guide culturally safe and informed MAID policy at all levels of government and respect the diversity of Indigenous peoples.

Health Canada plans to provide an official update to Parliament on Indigenous engagement on MAID in March 2024.

Colleagues, the government has listened to the provinces and territories, to medical professionals, to people with lived experience, to Indigenous communities and to other stakeholders. Bill C-62 is the product of that engagement, and it reflects the government’s considered view that our health systems across Canada simply need more time to be properly and consistently ready.

Honourable senators, the bill before us is about process, prudence and, yes, about cooperative federalism. The request for a pause was made by those with the constitutional responsibility for MAID applications, the provinces and territories, and they spoke with one voice.

Let me switch to the second of my topics.

[Translation]

Many things have been said about determining whether excluding eligibility for MAID where the sole underlying medical condition is a mental disorder is consistent with the Charter. Some have argued that the exclusion not only doesn’t comply with the Supreme Court ruling in Carter, but that it also perpetuates the stereotypes and discrimination against people suffering from mental illness.

Respectfully, I disagree with that statement. Allow me to underscore three points on this.

[English]

The first is in relation to the decision of the Supreme Court in the Carter case.

Now, colleagues, it is true that the declaration of invalidity in Carter was broadly framed and that it did not expressly exclude mental illness from its ambit. But the court took care to specify that its declaration was “. . . intended to respond to the factual circumstances of this case.” Those circumstances involved plaintiffs suffering from advanced and grave physical illnesses. The issue of MAID on the basis of a mental illness was not before the court in Carter, and the court did not purport to decide it. Indeed, the court expressly noted that MAID for persons with psychiatric disorders would “. . . not fall within the parameters . . . ” of its reasons. In fact, no court has yet determined that excluding persons whose sole underlying medical condition is mental illness infringes the Charter.

Moreover, in concluding that the blanket prohibition on MAID for those whose death was not reasonably foreseeable — in concluding that that was unconstitutional — the Court in Carter recognized that physician-assisted death involves complex issues of social policy and a number of competing societal values and interests. It acknowledged that these competing interests are themselves protected under the Charter and that Parliament faces a difficult task in balancing the perspective of those who might be at risk in a permissive regime against the perspective of those who seek assistance in dying. Importantly, the court suggested that a high degree of deference would be given to the particular balance struck by Parliament’s response.

The court stated at paragraph 132 in its reasons for judgment:

. . . nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying. The declaration simply renders the criminal prohibition invalid. What follows is in the hands of the physicians’ colleges, Parliament, and the provincial legislatures. However, we note — as did Beetz J. in addressing the topic of physician participation in abortion in Morgentaler — that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief . . . . In making this observation, we do not wish to pre-empt the legislative and regulatory response to this judgment. Rather, we underline that the Charter rights of patients and physicians will need to be reconciled.

The second point I want to make concerns the rights protected by the Charter itself, notably the equality rights provisions of section 15, and the right to life, liberty and the security of the person guaranteed by section 7 of the Charter.

Regarding section 15, the government has acknowledged, through its Charter Statements for former Bill C-7, Bill C-39, and now for Bill C-62, that the exclusion of eligibility creates a distinction on the ground of disability.

But this is not the end of the constitutional inquiry under section 15. As the Supreme Court has stated in several leading decisions, section 15 of the Charter is designed to protect substantive — not formal — equality. Otherwise put, the equality rights protected by the Charter do not necessarily require identical treatment. For a law to infringe section 15, the distinction in the law must be discriminatory in the substantive sense. The court has told us that this is a contextual analysis that looks at whether the distinction created by the law reinforces, perpetuates or exacerbates stereotypes and social disadvantage.

As outlined in these Charter Statements, and as stated by the Minister of Justice when he appeared before us in the Committee of the Whole, the temporary exclusion of eligibility is not based on an assumption that persons with mental illnesses lack decision-making capacity, or on a failure to appreciate the severity of suffering that mental illnesses can produce. Rather, it is based on the complexities and risks of permitting MAID in circumstances where expert opinion is divided and where all provinces and territories have indicated that they need more time to get ready. Accordingly, it is the view of the government that Bill C-62 is not discriminatory and therefore does not infringe the equality rights protected by the Charter.

As confirmed by the Minister of Justice, Minister Virani, at Committee of the Whole:

. . . When you get at the heart of an equality analysis under the Charter, you look at whether you’re perpetuating negative stereotypes, or attacking or impugning the dignity of the individual. . . . there’s an equivalence between mental suffering and physical suffering. There is no daylight between those two. As well, there is no perpetuation of a negative stereotype about the decision-making capacity of an individual who is mentally ill.

However, there is an appreciation of the complexity of applying determinations about capacity and decision making in the context of people who are struggling, and who may be making requests in a time of crisis . . . and where suicidal ideation can enter as part of, as a feature of or as a symptom of someone’s mental illness. . . . It’s not just that MAID is different from what general health care practitioners do, but it’s also that providing MAID in this context is substantively different — qualitatively different — than any other context that has been provided. Are there Charter issues at stake? Absolutely the Charter is at stake. But . . . we have to make triple sure that we have the rigorous assessment and training in place so that people can make the evaluation. It’s critical to get that evaluation right. I don’t think the Constitution mandates . . . [the] government to provide a health care service when it is not safe to do so, and that’s our determination: It is not safe at this time.

A review of section 7 of the Charter leads to a similar conclusion. Although the temporary exclusion of eligibility clearly triggers the right to life protected by section 7, Bill C-62 does not violate the principles of fundamental justice as elaborated by the Supreme Court of Canada, and the right is the right not to be deprived of life, liberty and security of the person except in accordance with the principles of fundamental justice. In that regard, Bill C-62 is neither vague, arbitrary nor overbroad. As such, the government is of the view that it does not infringe section 7.

Furthermore, colleagues, as we know, rights under the Canadian Charter of Rights and Freedoms are not absolute but are subject to such reasonable limits that can be justified in a free and democratic society. It is the position of the government that given the concerns about readiness, delaying eligibility for a three-year period is both reasonable and justified.

Finally, let me say a word about the role of Parliament in relation to Charter issues of this kind. As the Supreme Court of Canada has stated in several leading decisions, including but not limited to the Carter case, where cases raise complex issues of competing rights and social values, Parliament is to be given some latitude in choosing between a range of constitutional policy options. Indeed, the Supreme Court in Carter, as I mentioned earlier, acknowledged that Parliament’s response — its decision on how to strike the balance amongst these diverse and competing interests — would be owed a high degree of deference from the courts.

Given the important and competing interests, given the stated positions of all provincial and territorial governments, given the lack of consensus within the medical profession as to their readiness to implement MAID where the sole underlying medical condition is mental illness, I submit, colleagues, that Bill C-62 falls squarely within a range of reasonable alternatives that are permissible under the Charter and permissible for Parliament to pursue.

Colleagues, I stated at the outset that this is a difficult issue for all of us, for it engages both our personal convictions and experiences as well as our role as senators in our constitutional democracy, but as I have endeavoured to demonstrate in my remarks today, Bill C-62 represents a legitimate and reasonable policy response to a very complex and challenging social issue. It is supported by an overwhelming majority in the other place and by the health ministers in every province and territory in our country.

Although significant progress has, indeed, been made on the question of access to MAID with mental illness as the sole underlying condition, or MAID MD-SUMC, more work still needs to be done. The additional three years strikes the correct balance between ensuring that individuals across Canada can safely access MAID MD-SUMC while providing a clear target to ensure that our health care systems continue to do what is necessary to be ready. It is a prudent measure to ensure that Canada has a MAID regime in place that is carefully studied, properly equipped and able to respond safely and consistently to the complex issues raised in the cases with which it will be confronted.

For these reasons, colleagues, I would respectfully ask you to support Bill C-62, and I thank you for your very kind attention.

Hon. Marc Gold (Government Representative in the Senate): Thank you for your question, senator. The government is committed to supporting Canadian employers and helping them to adapt to the current economic conditions. Canada has experienced continued low unemployment rates. While there are some signs that current labour shortages are easing, the rebound is inconsistent. Furthermore, certain sectors such as the agricultural sector are still facing challenges.

In April 2022, the government introduced the Temporary Foreign Worker Program Workforce Solutions Road Map to help employers fill job vacancies in the wake of labour shortages.

More recently, the government has announced changes to the road map to better reflect current labour market conditions and to reflect the economic outlook for the future. These extended measures will be in place until August 30 of this year and will be reviewed as labour market and economic conditions continue to evolve in the coming months.

Hon. Donald Neil Plett (Leader of the Opposition): My next question concerns the secret contracts given to Accenture to run the Canada Emergency Business Account, or CEBA, loans program, leader, for small businesses.

The Trudeau government originally claimed the vast majority of the workforce was based in Canada with just four employees in the United States. Then late last year, an answer to one of my questions on the Senate Order Paper — which I don’t get very often — led to the discovery that work on the loan accounting system for this program is, in fact, being done in Brazil. Last month, the Trudeau government admitted to The Globe and Mail that about one third of all employees working on this program are based in Brazil through an Accenture subsidiary.

Leader, why did your government provide Canadians misinformation about these contracts?

Hon. Patti LaBoucane-Benson (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: second reading of Bill C-62, followed by Motion No. 156, followed by all remaining items in the order that they appear on the Order Paper.

Hon. Julie Miville-Dechêne: Senator Gold, a year ago, during the study of Bill C-11, you said this about my age verification amendment:

. . . The Government of Canada is looking to introduce legislation to address potential online harms with the goal of keeping all Canadians safe online, including being safe from the kind of harm that this amendment would propose. In the government’s view, this would be the most appropriate forum, in the context of that legislation, to discuss this important issue. . . .

In other words, the government said, “We’ll take care of the issue in our online safety bill.”

Today, the government finally introduced its long-awaited bill, and there’s no age verification to prevent children from accessing online porn. So my question is this: What happened to that clear commitment?

Hon. Marc Gold (Government Representative in the Senate): Thank you for the question. Canadians of all ages and certainly children deserve a safe place and a safer online place. The government’s commitment last year remains true today, namely, to put into place a regulatory framework that ensures that there is a protection for Canadians while respecting other important constitutional values, like privacy and freedom of expression.

The bill that was tabled today, the Online Harms Bill, is something which will be debated in the House and will be debated here. I know the major points, and it is clear that it does not include an age verification measure, but it does — if I understand correctly — contain other measures that, in the government’s view, are designed to protect children and to make the internet a safer place. We look forward to the study of that bill.

Hon. Robert Black: My question is for the Government Representative.

Senator Gold, on February 15, 2024, the Canadian Agricultural Human Resource Council, or CAHRC, released a new report which outlines that Canada’s agricultural sector is facing a looming crisis with over 100,000 job vacancies projected by 2030. This shortage threatens local food security, economic growth and sustainability of our agricultural sector.

The report emphasizes a crucial role of temporary foreign workers in bridging the gap and also highlights the necessity for long-term solutions to attract and retain workers domestically.

Senator Gold, given the gravity of this situation, can you provide insight into the government’s plans to address the workforce challenges outlined by the CAHRC report and ensure the future viability of our agricultural sector?

Hon. Yuen Pau Woo: Thank you, Senator Gold, for your exposition. I think you have made a good case for the bill, and I intend to support it. However, I was struck by a comment in the middle of your speech, and I would like to ask you about it.

You referred to the lack of consensus among practitioners around the issue of irremediability and cited that as a reason for the three-year delay. Is it the government’s view that at the end of three years, the psychiatric community will come to a view on irremediability and therefore remove that impediment to the implementation of MAID MD-SUMC?

Hon. Stan Kutcher: Thank you very much, Senator Gold, for that speech, and I think you are absolutely correct in pointing out the challenges of sorting out this very difficult issue, one that is both personally difficult and professionally difficult for me, but also one that is difficult for all Canadians. People in the chamber know that of the nine countries that provide some form of MAID, Canada is the only one that excludes people with a mental disorder.

You mentioned that at this point in time — and you correctly noted that more psychiatrists are being trained — about 2% of psychiatrists have been trained, and that is a very small number. But you neglected to mention to the chamber that only about 2% of Canadian doctors are trained in MAID, and fewer than 1% of all MAID recipients in the Benelux countries are for a sole mental disorder.

We have 2% of psychiatrists that can’t do the work, but 2% of doctors can do the work. This goes to the heart of the discrimination against the people with mental illness. We use one argument that 2% is not good enough, but then 2% is just fine.

Can you help us understand why, if it is okay for 2% of Canadian physicians to be trained, and we can do MAID for physical illnesses, it is not okay for 2% of psychiatrists to be trained?

Hon. Denise Batters: Senator Gold, thank you very much for your speech tonight.

In your speech, you stated that Indigenous groups say that they are not ready for this and that the government was then going to be launching a two-year process of consultation. However, Senator Gold, three years ago at our Senate Legal Committee, we had witnesses representing many different Indigenous organizations, and they were crystal clear then that they weren’t ready. They said this to us both at our pre-study for that bill and at the Bill C-7 subject-matter study at that committee. The reason we decided to call them as witnesses was because there was a clear gap in the House of Commons’ study in that respect.

Many of these Indigenous witnesses told us on behalf of their organizations that they did not want assisted suicide for mental illness as a sole underlying condition. They told us that many of their communities were actually in crisis, and they wanted help for their communities on mental illness and substance abuse — and not easier access to the legal means for suicide.

Given this, Senator Gold, why hasn’t the government started this process of proper Indigenous consultation long before now? And will your government actually listen to what they say this time?

Hon. Flordeliz (Gigi) Osler: Thank you, Senator Gold, for your speech. My question relates to the health care system issues that were previously identified and that you touched on in your speech. In fact, today in the Canadian Medical Association Journal published online, Canadian health care leaders noted “. . . inadequate funding to allow for service ‘coordination,’ ‘consistency in services,’ and equitable access to care . . .” for both MAID and palliative end-of-life care.

In the spirit of cooperative federalism, does the federal government have a plan — and not leaving it entirely to the provinces and territories — in the next three years to address the health care system problems that have been identified?

Hon. Stan Kutcher: Honourable senators, today I rise to speak against this bill. I do not support it. I believe it to be contrary to the Charter and two provincial court decisions that directly address this issue. It is discriminatory toward people with a mental disorder, and not based on best available evidence of readiness.

We must focus on what this bill addresses, and not our personal feelings about medical assistance in dying where a mental disorder is the sole underlying medical condition, or MAID MD-SUMC; MAID Track 2; or MAID in general. This bill is about regulators and providers being ready. It is not about expanding MAID — as has been promoted by those who oppose it — but about ending the legal exclusion of people who have a mental disorder from a type of medical care available to those who have a different kind of illness.

The Alberta Court of Appeal and the Quebec Superior Court have already dealt with this issue. Both decisions have considered the Charter issues. Both decisions clearly discounted arguments that we have been hearing from the anti-MAID MD‑SUMC activists.

We, in this chamber, are not relitigating. Litigation is for the courts. We don’t have the same tools that the courts have to get at the essence of a matter. Our committees are not structured in a way to function like this. We are a political body and subject to those pressures.

We must consider this bill on its merits to determine if its merits justify postponing equal access to medical care for a small number of Canadians — who have met all the established criteria to apply for this end-of-life care — just because of their diagnosis. We must be confident that this bill does not discriminate against people with a mental disorder.

This is a blanket bill premised on the opinion that nowhere in Canada is there readiness. We must be certain that this is indeed the case. This opinion uses the shield of a flawed joint committee majority report that stated, “. . . the medical system in Canada is not prepared . . . .” without studying Canada’s medical system. It ignored the weight of expert testimony, ignored the government’s own readiness criteria and did not propose or study any alternative criteria, and suppressed the voices of those most affected. It should not be used to justify the bill.

It is supported by a letter from some provincial and territorial ministers saying they are not ready, but they provide no readiness criteria. In many cases, they directly contradict what their own providers and regulators have told us. Are they really not ready, or are they playing some kind of political game?

We heard from two ministers that some Canadians are urging delay. This is not surprising. There is a well-organized, persistent lobby that wants to eliminate MAID or eliminate all MAID Track 2. They do not speak for persons who are grievously and irremediably suffering from a mental disorder. They have successfully drowned out those voices. They are using MAID MD-SUMC to attack MAID Track 2. We must not be overwhelmed by their cacophony.

This bill’s blanket clause prevents people from receiving MAID MD-SUMC while living in a jurisdiction that is ready, because some jurisdictions claim that they are not ready. There is no other medical intervention in Canada that is so prohibited. This is discriminatory.

This bill has extended the deadline even though we have solid evidence that many parts of Canada are ready. We have received the signed letter from over 125 providers indicating that they are ready. One provider wrote in The Hill Times that the justice minister is ignoring the evidence and claiming the contrary.

This bill has been pushed through even though we did not hear from the people most affected. It seems that the mantra “nothing about us without us” applies to all Canadians except those suffering from a grievous and irremediable mental disorder — an illness that, if it were a grievous and irremediable physical illness, would be fine. This is discrimination.

Discrimination against those suffering from a mental disorder has a long and dark history. We need to decide this week what side of this dark history we will stand on.

Colleagues, we have been snowed with canards and erroneous, inflammatory language on this issue. These canards have promoted discrimination — for example, no MAID MD-SUMC until we can fix mental health care. Yet, as I can attest from personal experience, our physical health care system is broken. Over 6 million Canadians have no family doctor, yet we allow MAID access for physical illness despite a broken health care system.

We have heard that there should be no MAID MD-SUMC anywhere in Canada until everyone everywhere can have equal access. Indeed, that’s what Senator Gold just told us. Yet, nowhere in Canada does anyone have equal access to any kind of health care, including end-of-life care. It is only when it’s for those with a mental disorder that it is considered okay to legally deny them access to that kind of care. This bill considers some Canadians not as people but as a diagnosis. This, my friends, is discrimination.

We frequently hear that anyone who is feeling depressed or suicidal will receive MAID MD-SUMC; this is not true. We hear that just because there is not enough palliative care, people will instead choose MAID when what they really want is palliative care; this is not true. This cacophony has fed us fear and falsehoods.

Colleagues, I have spoken to many people who have been waiting for three years to apply for MAID. They told me that they know this cacophony is full of that misinformation, yet they now have been put into purgatory again. Some have told me that if this bill passes, they will choose suicide or will travel to another country to receive this care.

Colleagues, I have practised psychiatric medicine for about 30 years, and I have seen much suffering. Yet, I have not encountered anyone with such prolonged and unsuccessful treatment regimens as those whom I spoke with on this issue — decades of every kind of treatment imaginable, and nothing relieving their intolerable suffering. They were clear that they want to speak for themselves. They were clear that none of the organizations and individuals, such as those that Senator Gold quoted, speak for them. Indeed, these organizations and individuals have never even spoken to them. This may be because the issue that some are attacking is actually MAID Track 2. Denying a few people with a grievous and irremediable mental disorder their end-of-life choice seems to be a political strategy.

The joint committee chose not to hear from those affected. The House chose not to hear from them. The ministers chose not to hear from them. Colleagues, we chose not to hear from them.

What would you think if any other group of people were left out of discussions about legislation that directly impacts their health and well-being? There would be a national uproar. This cacophony has subjected us to numerous accounts of unverifiable anecdotes, misinformed data and sensational media coverage. For example, we have the recent poll on Canada’s support for MAID MD-SUMC as reported by the Canadian Press. The headline reads, “Fewer than half of people support assisted dying exclusively for mental illness: poll.”

But, colleagues, that’s not what the poll says: 42% said yes; 28% said no; 30% said they don’t know. The denominator is not 100, colleagues. It is 70, and 42% of 70 is 60% out of 100. That is a clear majority.

The headline could have read, “Only one quarter of Canadians don’t support MAID MD-SUMC.” We see another subtle promotion of misinformation.

Colleagues, we need to look beyond headlines and sound bites. This bill is not based on independently obtained regulator or provider evidence of readiness. It does not assess readiness for these sufferers the way we assess readiness for any other medical intervention. We have heard directly from regulators and providers, and many say they are ready. We must ask ourselves: Would we have ignored regulator and provider evidence for any other kind of illness apart from a mental disorder? I predict the answer is no. So that’s discrimination.

Colleagues, we have not even done this for MAID itself. When MAID began, no federal minister said the system was not ready. Yet nothing was in place. But clinicians and regulators quickly geared up and the system worked. No provincial health minister said Canada wasn’t ready for MAID. They are only saying this without any clear rationale for MAID MD-SUMC. This is discrimination.

We have been told by the Minister of Justice there was unanimity in providers, that Canada was not ready. He said:

. . . the decision . . . has been informed by what we heard unanimously from both the people that lead the health-care systems . . . but also to health care professionals that are . . . delivering MAID.

But we have solid evidence to the contrary. For one, we have the numerous briefs submitted by the providers but suppressed by the joint committee, and, two, a letter we all received signed by over 125 providers saying they and the system are ready.

“Not ready” is a slogan designed to politically avoid this issue. In the Committee of the Whole, the ministers were repeatedly asked what specific parts of the system are not ready. They could not tell us. They just said, “This is what we’ve been told.”

Colleagues, this is not grounds for legislation. This is an excuse for discrimination. Indeed, the weight of evidence that all of us have seen demonstrates that the federal government’s own readiness criteria have been met and that many of the regulatory bodies and MAID providers across Canada are also clinically ready.

Even if a province or territory does not want to go ahead to provide this medical intervention, they don’t need to do so. It’s their choice, but they cannot hold hostage people who live elsewhere in this country. That is what’s happening with the blanket exclusion in this bill. If you live in a province that’s ready — and my home province is ready — but because another province says they are not, you can’t obtain this medical service in your home province.

The ministers told us that CAMH says it is not ready. Well, colleagues, just as Toronto is not the centre of Canada, CAMH does not speak for mental health in Canada. There is a group in CAMH who are opposed to this and who have created their own criteria for readiness. They want Canadian clinical practice guidelines, and they have decided that they are the only people who can create them. By the way, CAMH is part of the network that had written to the joint committee saying that Ontario is ready to go ahead with MAID MD-SUMC.

So, honourable senators, let’s get a better understanding of what clinical practice guidelines, or CPGs, entail. There are international criteria for how CPGs are created and applied. They are only created after an intervention has been in place for some time and require, one, critical review of the literature; two, input from clinicians with substantial experience; and, three, input from patients and families. CPGs are voluntary; they do not direct clinical care.

In the Benelux countries, CPGs already exist. They were created after seven years’ experience with the practice, following international criteria. Colleagues, here’s a perfect Catch-22. Since we can’t create clinical guidelines in Canada until MAID MD-SUMC has been in place for some time, demanding clinical guidelines before it begins is designed to stop it from ever happening.

Colleagues, a major problem with this bill is that there are no criteria on how we will know if Canada is ready in three years. If there are no criteria for readiness, or if the so-called criteria make no sense on close examination, how will we ever know if we are ready? We can predict this discussion in the future: We’re ready. No, we’re not ready. My province is ready. I’m sorry, my province is not ready so we can’t go ahead.

The ministers told us that they did not support a Conservative private member’s bill that would never allow MAID MD-SUMC. They told us they just wanted more time to be ready, but, in reality, because they provided us with no criteria for readiness and they created a blanket exclusion that prevents any jurisdiction from going ahead independently of any other jurisdiction, they did exactly what the defeated legislation attempted to do. They did exactly what they told us they were not going to do. They are indefinitely shutting down equal access to this type of health care.

Colleagues, I will sum up. I reiterate that this bill is not based on evidence of readiness from those responsible for the delivery of the health care, the regulators, the providers on the ground. Indeed, it flies in the face of what they have clearly told us. Many are ready.

Second, none of the voices of people most affected by this bill have been heard. This is untenable and discriminatory. The rushed and problematic work done by the Special Joint Committee on Medical Assistance in Dying as presented in its majority report is so problematic that it cannot be accepted as a valid justification for this bill.

The blanket exclusion in this bill prevents people living in provinces or territories that are ready, or that will be ready before three years to provide that care, from accessing that care. I live in a province that’s ready. You live in a province that’s not ready because your province says, “We don’t know what the criteria are.” They’re not ready, so I can’t receive this care in my province. That’s what this bill actually does.

Clearly defined preparedness criteria for future evaluation of readiness have not been created. The bill doesn’t tell us what criteria will be used, so there is never an ability to determine whether we’re ready or not.

Hon. René Cormier (The Hon. the Acting Speaker): Senator Kutcher, I’m sorry, but your time is up. Are you asking for five more minutes?

Hon. Senators: Agreed.

The Hon. the Acting Speaker: Honourable senators, is leave granted?