Madam Speaker, I have said it repeatedly, the Bloc Québécois wants Bill C‑62 to include a section on advance requests for MAID. This is our main objection.
We tried to introduce amendments in step with Quebec's request and that of the whole National Assembly. Where mental disorders are concerned, we start from the premise that psychiatry is unable to ease the suffering of every patient stricken by a severe mental disorder.
Psychiatrists told us that 50% of their diagnoses are wrong. It is a wonderfully precise science. However, one thing is true. Although there is no exact diagnosis and a diagnosis can change, what is clear, straightforward, specific and a constant in a patient's journey over the decades is that they suffer. Psychiatrists cannot deny that their patients suffer, and that all they can offer them is a path to palliative care. In fact, Dr. Gagnon told us we had to develop palliative care for people afflicted with mental disorders because that is all we can offer them.
Quebec made its decision in 2021. It did not have the opportunity to work off the expert report that the Special Joint Committee on Medical Assistance in Dying had in 2022.
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Madam Speaker, I will start with an assertion whose veracity will become clear. With Bill C-62, the cowardly Liberal government brought forth a mouse.
If we are talking about Bill C‑62 today, it is because Bill C‑7 created the Special Joint Committee on Medical Assistance in Dying when it passed. The committee's mandate was to review the medical assistance in dying legislation, in particular as regards the issue of advance requests. Because we knew that the problem was more difficult in cases of mental illness, the government set up an expert panel to help MPs do their job. The panel was to issue a report to the special joint committee.
The expert panel was indeed set up. The problem is that, instead of putting everything in place following the adoption of Bill C‑7, the government decided to call an election in 2021. That delayed the process.
Immediately after the useless election, we would have expected the special joint committee to sit but, no, we had to wait. They took their sweet time. The committee was finally convened, but it had a huge mandate. Its mandate was so huge that Bill C‑39 on mental illness had to be introduced, delaying the committee's recommendation.
Since February 2023, the committee has been very clear on the issue of advance requests. In fact, that was its most widely held recommendation. During the entire debate on Bill C‑62 in the House, the government said that we needed to be cautious and proceed slowly. That is fine, but when caution involves making patients suffer, I cannot agree. I think we need to be diligent.
The government took its sweet time. Here we are in 2024, and it introduced legislation seeking to postpone the issue of mental illness. Fine, but what is happening with the main recommendation the committee made in February 2023? The government knew very well that Quebec was laying the groundwork on the issue of advance requests. It knew very well that Quebec would bring in its own law. Instead of taking inspiration from that and seeing what measures could be included in the regulation accompanying Canada's MAID legislation, it did nothing.
I have stood in the House many times to ask the Minister of Justice and the Minister of Health why the government did nothing. Why does the bill not include a component on advance requests, which should have been prepared over the past year? After all, the government introduced legislation enacting the special joint committee's February 2023 recommendation on mental illness. On the issue of advance requests, however, it did nothing, despite the majority recommendation.
Yesterday, I got my answer. The Minister of Health demonstrated in front of the whole committee that he was unfamiliar with the Quebec law, yet he rises in the House and says he has enormous respect for Quebec's process. The Liberals do not even know what they are talking about. The minister told me that the issue of advance requests is more difficult than the issue of mental illness because, for example, there might be family quarrels at the patient's bedside.
I realized that the minister had not read section 29.6 of the Quebec law, which stipulates that, as soon as patient is diagnosed, they can appoint a third party. The third party will not determine when the person can access medical assistance in dying, but will advocate for their wishes, which will be included in the advance request, or the person's criteria.
People in my riding have told me that, when they become incontinent and can no longer control their bowels, when they have reached the point where they no longer have any appetite and it becomes a chore for their caregivers to feed them, although they are well compensated for their troubles, when they are no longer able to recognize their friends and family members and when they can no longer maintain relationships, they would like to have access to medical assistance in dying. The third party in whom they have placed their trust will then ask the care team—because patients are indeed cared for by entire teams—to evaluate whether they are meeting the criteria, if they are there yet.
If people make advance requests, it is because they want to avoid shortening their life. They want to live as long as possible. We could be good to them and take care of them until they cross their tolerance threshold.
The minister does not even know what I am talking about right now. Do members think it is normal that people say they respect Quebec, that they have great admiration for Quebec's progress on this issue, but that they do not even know what is in Quebec's law?
It is no surprise that they come out with a bill like Bill C‑62, that does not address this at all. Then they have the gall to say that Quebec has made good progress, but that not all Canadians are ready for that, so they have to wait and watch their patients suffer. Quebec is not the only province that supports advance requests. According to an Ipsos survey, 85% of Canadians from coast to coast support advance requests.
The Conservatives claim that they want to do good, they want to take care of Canada's most vulnerable. I, too, want to take care of the most vulnerable, but who is more vulnerable than a patient who is about to cross their tolerance threshold, who is suffering and who is being told no by the government?
Some claim that there could be abuses, as if the Criminal Code did not provide for punishment of abuses. They seem to believe the medical system to be inherently evil. I heard my Conservative colleague earlier. Listening to the Conservatives, one would think everyone working in the health system wants vulnerable people euthanized. I heard another Conservative member say there is an opioid crisis, there are people in the streets, and we are going to euthanize them. That is absolutely false. It is really far-fetched. That kind of rhetoric is meant to scare people; it amounts to spreading misinformation on a crucial topic.
When we care, we do not infringe on individual autonomy. The role of the state is not to decide matters so personal as how someone wishes to cross their threshold of tolerance. It is not to tell patients what is right for them. It is to provide the conditions so they can make a free and informed choice.
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- Feb/15/24 11:03:54 a.m.
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Madam Speaker, my colleague complains that people are accusing him of fearmongering, but he is unable to use the right technical terms to debate this issue. The Council of Canadian Academies does not refer to children. Referring to children in general shows a lack of intellectual rigour in a debate like this. The right term is “mature minors”.
For example, at the age of 15, Charles Gignac was diagnosed with a cancer that ate his bones. He was fit as a fiddle, an athlete with a very strong heart. He suffered for two years because he was not eligible for medical assistance in dying. He requested medical assistance in dying. He passed away at 17 years and 10 months, without MAID, in pain and anguish. What treatment did he receive? He was given palliative sedation because no one was able to relieve his suffering. After he received palliative sedation, his loved ones watched him spend 24 hours in an agitated, delirious state before he died. Is that what my colleague calls compassion?
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Madam Speaker, we just witnessed a great NDP-Conservative coalition.
The member is reiterating the Conservatives' argument to the effect that the ruling in Gladu and Truchon was not challenged before the Supreme Court. However, the reason why it was not challenged before the Supreme Court is that people were suffering and Ms. Gladu and Mr. Truchon deserved to have relief. This was based on the Carter decision. However, the NDP voted against Bill C-14, which did not go far enough. I do not know why the member is being so inconsistent today.
I would like to know whether the member is aware that, basically, his party is trying hard not to say that it lacks courage, that it is backing down when it comes to mental illness and that it is throwing the ball back into the court of the Conservatives who, as they announced, are going to do away with all of this.
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- Feb/13/24 10:06:15 p.m.
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Mr. Speaker, we need to move quickly to save people. I am all in favour of implementing social programs to save people, but does the member have a different point of view from the Conservatives right now? If we invest in social programs, will people all of a sudden get relief after 30 years of suffering and inadequate treatment?
The accessibility of frontline services is another debate. How can we shut down debate today by claiming that, if ever we move forward with expanding MAID eligibility to people with mental disorders, then that would be an affront to people's integrity, when the fact is that MAID is voluntary? What is more, there are people who are going to examine the request and, if a person is suicidal or receiving care for the first time, then they will not have access to medical assistance in dying.
I am trying hard to make people understand that just because a person makes a request does not mean that they will be eligible. When the member says things like that, how does she think that her point of view differs from what we have been hearing from the Conservatives today?
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- Feb/13/24 9:32:55 p.m.
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Mr. Speaker, some Conservatives seem to think the Criminal Code no longer exists. We have had these debates before. When someone nefarious is working in the health care system, they simply need to be fired and reported to the police. That can happen. The provisions are there.
I therefore invite my colleagues who know of cases like this, which are always very specific cases, to report these people to the police. Are we going to generalize to such an extent that we are going to prevent any suffering person from asserting their right to self-determination and deciding what is good for them when it comes to something as intimate as their own death?
It is odd that Conservatives are libertarians when it comes to economics, yet when it comes to moral issues, they think the government needs to be in charge.
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- Feb/13/24 9:15:25 p.m.
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Mr. Speaker, I have two questions for the member for Sherbrooke.
First, her minister acknowledged that Quebec's interdepartmental action plan for 2022-26 was excellent. We have heard a number of people here say that services need to be improved. What is she waiting for to transfer the money to Quebec?
Second, given what our Conservative colleagues have said, does she realize that by postponing the decision until 2027, the Liberals are passing the buck to a potential future Conservative government that will put an end to any hope of relief for people suffering from mental disorders?
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- Feb/13/24 8:52:40 p.m.
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Mr. Speaker, I request a recorded division.
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- Feb/13/24 7:52:41 p.m.
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Madam Speaker, I have high regard for my colleague. We are both members of the Standing Committee on Health.
However, I am a bit shocked this evening. I say this quite honestly and without being condescending, but, if I were to return to teaching and present a speech to show how much sophistry there can be in one speech, I would take his. It is a perfect example.
On one hand, he says he knows what he is talking about because he is a doctor, and we should believe him. On the other hand, because he is a doctor, he tells us we should not trust doctors. Then who should we trust? He tells us he is a doctor, he knows what he is talking about, but he is concerned for his children. Then he gives examples of people feeling suicidal when we know full well, and it has been established beyond a shadow of a doubt, that suicidal states can be reversed.
What is he afraid of?
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Madam Speaker, my colleague is claiming that Bill C-14 resulted in good legislation with its reasonably foreseeable natural death criterion. However, that did not even address the Carter ruling, since Ms. Carter did not have a condition that made her terminally ill. The Supreme Court ordered Parliament to regulate situations like those of Ms. Carter and Ms. Taylor. Limiting medical assistance in dying to people who are terminally ill completely ignores people like Ms. Gladu and Mr. Truchon, who had to go to court to assert their constitutional right. People have had to go on hunger strikes to meet the reasonably foreseeable natural death criterion.
Is that what my colleague calls compassion?
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- Feb/13/24 7:23:24 p.m.
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Madam Speaker, I have great deal of compassion for my colleague and want to thank him for so generously sharing his life experience. He says he speaks for those who have no voice, and he is living proof that suicidal ideation is reversible.
I wonder if he could dig a bit deeper and acknowledge that there are people who have no voice, who have yet to find a psychiatric treatment that eases their suffering and who struggle with mental disorders? What solutions does he have for them after 30 years of treatment?
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- Feb/13/24 6:39:06 p.m.
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Madam Speaker, I am having a hard time understanding what my colleague is saying. He knows very well that structural vulnerabilities, such as poverty, have an impact on overall health.
Is he saying that we need to deal with that before we can allow people who are mentally ill to get relief from their irremediable suffering? That is what I am getting from his speech, when recommendations 5 and 6 of the panel's report indicate that, if there is any doubt whatsoever as to structural vulnerabilities, then medical assistance in dying will not be made available.
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- Feb/13/24 5:17:30 p.m.
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Mr. Speaker, my colleague opposite was wondering about the Carter decision. In my opinion, Carter clearly demonstrates that absolute prohibition would indeed be discriminatory and stigmatizing.
That said, I would like to ask him the following question.
My colleague obviously supports his government's bill, which defers application of the law by three years. Does this mean that he is going to lobby within his government so that, the day after tomorrow, once we have voted, the bill has gone through the Senate and the law has come into force, the committee will get back to work and eventually come up with a bill focusing on mental disorders, in particular, as well as on advance requests?
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- Feb/13/24 2:39:29 p.m.
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Mr. Speaker, Quebec would not have to ask for an exemption if Ottawa had implemented the majority recommendations on advance requests issued a year ago by the Special Joint Committee on Medical Assistance in Dying.
Quebec is ready today, and patients should not have to suffer because of the government's inaction. If it does not want to condemn people to suffer needlessly, the federal government has two choices. It must either offer this exemption to the Criminal Code immediately or introduce a bill on advance requests.
Will the minister make the humane, compassionate choice?
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- Feb/13/24 2:38:21 p.m.
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Mr. Speaker, medical assistance in dying is about freedom of choice.
The role of the state is not to decide for the person who is suffering; it is to guarantee the conditions under which people can make a free and informed choice. If someone does not want medical assistance in dying, they can simply not ask for it.
The National Assembly is unanimous: Quebec is ready. It has its own legislation.
Will the federal government amend the Criminal Code to allow for advance requests for people who are suffering?
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- Feb/13/24 1:05:42 p.m.
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Madam Speaker, I am sure my colleague's intention is not to exploit the pain of people who have been enduring irremediable suffering for decades. However, she is repeating an argument that we have heard often in this debate and that I feel is something completely separate.
The issue of access to primary mental health care has nothing to do with the decision we must make on whether to expand medical assistance in dying since, with regard to access to care, these people would not qualify under the criteria and guidelines of the expert report.
I do want us to advocate for better care. I wholeheartedly agree with that, but that is another debate. However, there are people who have been receiving care for decades and who are suffering, and the government wants to tell them to keep suffering for three years.
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Madam Speaker, that is a rather accurate summary of what happened in committee. The government decided to include in legislation the committee's main recommendation on mental disorders. My colleague sat on the committee that produced the report tabled in February 2023, which recommended allowing advance requests.
Why has his government not introduced a section on advance requests after a year of waiting? I think that would have been good for people who are currently suffering and who cannot make an advance request. Why is this not included in Bill C‑62?
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- Feb/13/24 12:19:14 p.m.
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- Re: Bill C-7
Madam Speaker, my colleague gave us a history lesson.
He said that his party was not able to move forward because there was an election. I would point out to him that Quebec has had two elections in those six years. That did indeed delay the work, as he will agree. However, I do agree with him that Quebec's approach crosses party lines and is far more thorough.
Some people complain about the delay associated with the Carter decision, but that is because this Parliament never took the opportunity to try to change the Criminal Code before there was a court order. It never had the courage to do that, and so we were then stuck with a court order. Mr. Lametti did not stand up solely because the bill did not go far enough. He stood up because it violated patients' constitutional rights. Bill C-7 corrected that.
I would like my colleague to explain what he is advocating when it comes to advance requests for MAID. Does he think that the government, which had a year to introduce legislation, could have included that component in this bill?
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- Feb/13/24 11:59:53 a.m.
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- Re: Bill C-7
Mr. Speaker, my colleague participated in all three sessions on the issue. When Quebec tabled its report and when we voted on Bill C-7 in 2021, I was very reluctant to consider opening up MAID to mental disorders. However, I worked my way through the experts' report and I invite my colleague to read it again.
My colleague says there is nothing in the legislation. However, it does not have to be in the legislation. The regulations can set out the “how to”. Recommendations 10 and 16 are important safeguards.
Let us assume I am not questioning anything in my colleague's speech; the fact remains that, today, as I speak, there are people who are suffering irreversibly and intolerably.
What solution does my colleague have for those people?
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- Feb/13/24 11:41:30 a.m.
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Mr. Speaker, I would like to know whether my colleague thinks that, one day, it will be possible to alleviate the suffering of people struggling with an irremediable mental disorder.
I would also like to know whether he agrees that it would have been wiser for the government to implement the joint committee's leading recommendation regarding advance requests and to take advantage of the introduction of this bill to add that component.
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