44th Parl. 1st Sess.
February 13, 2023 11:00AM
moved that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.
He said: Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.
An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.
My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.
In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.
The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.
In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.
Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.
Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.
Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.
The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.
In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.
The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.
I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.
This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.
As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.
That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.
As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.
In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.
This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.
The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.
These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.
I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.
I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.
I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.
I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.
The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.
Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.
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Mr. Speaker, I thank the hon. member for his work on this file.
What is different now, two years later, is that we have done a great deal of work. The expert committee, led by Dr. Mona Gupta, thinks we are ready to move forward with the protocol it has developed, as do a number of professionals and professional bodies across Canada, but there is not unanimity. That is why we are proposing a one-year extension so we, along with medical professionals and Canadians, can internalize what the next step will be.
Let me point out that we all have a duty as parliamentarians to not participate in exaggeration or misinformation. What this bill would not do would be to allow a person suffering from depression or anxiety to immediately get MAID. This is for a small fraction of individuals who are suffering intolerably from long-standing mental disorders under long-standing care of medical professionals and who want another option. That is what this is about. It is not about people who are contemplating suicide.
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Mr. Speaker, I thank my colleague for his question and comment.
The criteria for receiving medical assistance in dying in situations where the person is not at the end of life are very strict and rigorous, particularly when it comes to the subject we are considering today and in cases where mental illness is the only factor.
A person cannot automatically get medical assistance in dying just by requesting it. It is much more serious than that. Our practitioners, the medical community and those who provide medical assistance in dying take their responsibilities very seriously.
With regard to the comment made by the leader of the official opposition, I completely agree with my colleague. That shows a rather jaded attitude toward a subject that is very complex and morally difficult for many people. We therefore have to be respectful about it, even in our discussions.
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Mr. Speaker, I thank the hon. member for his work on the special committee, and we look forward to the recommendations of the special committee. One of the reasons to have a delay is precisely to take what that special committee might recommend better into account.
Mental illness is an illness, and I strongly support initiatives to better resource the encadrement, the support we are giving to people suffering from mental illness. It is something that our government has recognized.
We put $5 billion into the system a number of years ago. However, when we did that for mental illness, we found that we could not guarantee that the provinces would actually spent that money on mental illness. In the current set of negotiations between the Minister of Health and his counterparts, as well as the Prime Minister and his counterparts, we are trying to build some accountability into that system, but we definitely do agree with the need to invest in greater mental health resources, particularly in this case. We want people to be able to live a dignified life with the supports they need to accomplish that.
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Mr. Speaker, we passed the law in 2019. Part of the parliamentary process was the interactions between the House and the Senate. We came to a compromise at the end of that process with the Senate to include mental illness as a sole criterion with a two-year delay.
We felt at the time that this could be done in two years. COVID intervened and an election intervened, but we do feel that a great deal of work has been done, in particular, by the expert committee. However, in order for everyone to internalize those recommendations, and for faculties of medicine, provincial and territorial bodies, and expert groups to build out the didactic materials, we need another year, but this is only a year extension. Of course, this would also give us time to look at what the special committee reports on this particular area, as well as evaluate other suggestions it makes.
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Mr. Speaker, I thank the hon. member for his work as a critic and his work on committee.
We are in a far different place than we were two years ago. We have now done a great deal of the work, particularly at the federal level, on mental illness as the sole criterion for seeking MAID. As I said, a number of leading experts feel that we would have been ready next month to have moved forward. We are trying to be prudent and to allow others to internalize the learning that has been developed over the last two years.
I mentioned before, and I will repeat it again, that this is a small fraction of people who are in the non-end-of-life scenario. Indeed, the people in the non-end-of-life scenario generally are a small fraction of those who seek MAID. It is not the case that somebody will simply be able to get MAID by going to their doctor and saying that they are contemplating suicide. That is not the case, and we are misleading Canadians if that is what we say.
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- Feb/13/23 2:44:09 p.m.
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Mr. Speaker, we are strengthening the system to support victims. We have made significant investments to protect victims in many cases. What is the best thing for victims? It is a judicial system that works, does not have backlogs and is more efficient.
We are in the process of allocating resources for the most serious crimes to eliminate backlogs in the system and help victims. We will continue in that vein while the opposition continues to pick fights.
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