44th Parl. 1st Sess.
February 13, 2023 11:00AM
Mr. Speaker, in a debate as sensitive as this, we would expect every parliamentarian in the House of Commons to lend some dignity to this debate and demonstrate a strong sense of responsibility.
Last week, in the middle of question period, on the topic of mental disorders being the sole underlying medical condition, the official leader of the opposition said to the Prime Minister something to the effect that there were people suffering who were destitute, living in poverty and struggling with depression, and that all this government had to offer them was medical assistance in dying.
I would like my colleague to share his thoughts on these types of comments that, in my opinion, will prevent us from having a calm and productive debate not only from a theoretical perspective, but also with respect to the situation with the bill and what it really covers. In short, we are talking here about misinformation.
154 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, as a Conservative, my colleague from St. Albert—Edmonton has never made so many references to science. I understand that he is passionate about this, but he is claiming that the report of the expert panel says things that it does not, particularly with regard to ending one's life prematurely in the case of mental illness.
The only way for a person to end their life prematurely is by attempting or committing suicide. A person who is suicidal will never be given medical assistance in dying based on the assessment of one or even two experts. Feeling suicidal is a reversible condition. A suicidal state is reversible, and the condition for obtaining medical assistance in dying is the irreversibility of the mental disorder. The expert panel report states on page 13 that “the incurability of a mental disorder cannot be established in the absence of multiple attempts at interventions with therapeutic aims.”
A person who attempts suicide and comes under pediatric care as a result will have to be monitored. They will probably never have access to medical assistance in dying on the grounds of a suicidal disorder. Eligibility must be established over a period of years, not in a crisis situation. The individual will also have to prove that they have tried every form of treatment and have never refused treatment that could have treated the condition.
This is a sensitive subject, so people should be careful what they say. I hope my colleague will see reason. Those across the aisle are not the only ones vulnerable to blinding ideology
268 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, I would like to begin by providing some background on Bill C-39, which is not rocket science, when it comes down to it. Then I would like to talk about the philosophical foundation for dying with dignity, as well as the context and whether or not medical assistance in dying should be extended to patients whose sole underlying medical condition is a mental disorder. I would also like to talk about mental illness generally in our societies and the experts' report before finally concluding my speech.
The context is rather simple. This is not about rehashing the entire debate. We are studying Bill C-39, which simply defers the provision in Bill C-7 that would have ended the two-year exclusion for mental disorders on March 17, 2023.
Following consultations, the government has decided to extend this exclusion clause for one year, which means that on March 17, 2024, mental disorders, or rather individuals whose sole underlying medical condition is a mental disorder, would be eligible for MAID, subject to the conditions, limits, guidelines, standards of practice, safeguards and precautionary principles outlined in the expert report.
Before voting, I invite all parliamentarians in the House to read the report of the expert panel. It contains precautionary principles that do not lend credence to last week's comments by, for example, the leader of the official opposition. It really puts into perspective the ideology underlying the comments by my colleague from St. Albert—Edmonton. Let me dive right into this matter.
Why is there such a delay? The reason is that we believe things should be done properly by the medical world. When a mental disorder is the sole basis for a request for MAID, how prepared are those working in this field across the country to ensure that MAID is adequately and safely delivered in light of the safeguards?
More providers and seasoned assessors will be needed. I should note that the experts did say that assessing whether a person with a mental disorder has the capacity to choose MAID is something they are already doing. Often a person may have cancer and also suffer from a mental disorder. It is not the sole underlying medical condition, and they still need to establish the person's capacity to decide for themselves. Again, in response to the oversimplification by my colleague from St. Albert—Edmonton, first a person needs to want MAID, and then they need to meet the criteria.
As far as mental disorders are concerned, to meet the criteria, this is not going to happen overnight or anytime soon. It is going to take decades before anyone can have access. It is going to take time for the whole range of necessary treatments and possible therapies to be tested without the condition that the person demonstrate that they cannot bear any more and that their pain cannot be relieved. That is a long way from people living in poverty, who are depressed and who might have access to medical assistance in dying. We are far from it.
That being said, what are we talking about? When we talk about medical assistance in dying, I know that everyone in the House wants to do the right thing. Everyone has the best of intentions and wants to look after the best interests of patients and people who are suffering. However, being compassionate does not square with undermining human dignity. Human dignity is grounded in the capacity for self-determination.
Those are the philosophical premises. The law grants any individual with a biomedical condition the right to self-determination. Nothing can be done without the patient's free and informed consent. To that end, the role of the state is not to decide what that patient, who is the one suffering, needs. Rather, the state must ensure the conditions needed for them to exercise free will, so that patients can make a free and informed decision.
Historically, it was difficult to fight medical paternalism. At one time, people who had reached the terminal phase of an incurable disease did not have the right to die. The right to die was acquired, and it was called palliative care. Life was artificially prolonged, and people died from clinical trials or new therapies rather than dying a peaceful death in palliative care. However, palliative care is not a substitute for medical assistance in dying.
I find it strange that my colleague thinks it is unacceptable to grant access to medical assistance in dying to someone whose soul is suffering, and that he even opposes any form of medical assistance in dying, even when people are at the end of their life. He is opposed. At some point, if people are opposed, they need to explain why.
Why does the law recognize people's right to bodily autonomy throughout their lifetime but take it away from them at the most intimate moment of their lives? The government or our neighbour is not the one dying, so on what basis is the government giving itself the authority to decide for us at the most intimate moment of our lives?
These are the ethical and philosophical grounds and principles behind our position. Just because someone has a mental disorder does not mean that they should also be subject to social discrimination and stigma. Even though mental illness is now considered to be an actual illness, mental health is still not on the same footing as physical health. Mental illness results in discrimination and stigma.
Should we be telling people who have to deal with such discrimination and stigma that they will also never be given the right to MAID, even if they have been suffering from a mental illness and have had schizophrenia, for example, for 25 or 30 years? On what grounds are we refusing them that right? That is the basis of the expert panel's report. Do we give that right to someone with a mental disorder who is suffering, who has tried everything, whose problems are far from over and who says that they cannot go on?
There are people out there who have an ache in their soul, and unfortunately, we lose them when they attempt suicide. It is really no better. We absolutely must fight against suicide because it is one decision that cannot be undone.
In the report, the experts set out several precautionary measures. They talk about structural vulnerabilities like poverty. On page 11 of the report, the experts state the following: “In the course of assessing a request for MAiD—regardless of the requester's diagnoses—a clinician must carefully consider whether the person's circumstances are a function of systemic inequality”, and, if so, this should be addressed.
With respect to suicidal ideation, experts offer us another precautionary measure. It is not enough for a person to request MAID to have access to it.
The report states: “In any situation where suicidality is a concern, the clinician must adopt three complementary perspectives: consider a person's capacity to give informed consent or refusal of care, determine whether suicide prevention interventions—including involuntary ones—should be activated, and offer other types of interventions which may be helpful to the person”.
What is this claim about people who are depressed being able to request MAID? Members need to stop talking nonsense. That is not what the expert panel's report says. It says that incurability can be established over the course of several years. The patient must have exhausted all available therapies and treatments. However, that does not include overly aggressive therapy.
What does the member for St. Albert—Edmonton think should happen? When a person with a psychiatric disorder says that they reached their breaking point years ago, should psychiatric science insist that there is a treatment out there and that it is going to find it? That is what I mean by overly aggressive therapy.
Overly aggressive treatment may exist for all types of illness. Who gets to decide when it is too much? The Supreme Court and the Superior Court of Quebec have told us that it is up to the patient to decide. That is important, because the member for St. Albert—Edmonton keeps saying that we are cutting lives short, ending lives prematurely.
In reality, the opposite is true. Everyone wants to live as long as possible. People who are on what we call the second track, whose natural death is not reasonably foreseeable, want to live as long as possible. What they do not want is to be denied help when they reach their breaking point. If we do not give them access to MAID, they will find their own way to avoid ending up in that situation, because it is currently illegal for them, and they will end their lives prematurely. They will commit suicide.
The ruling that some contend should have been appealed to the Supreme Court states that there is an infringement on the right to life. The Conservatives' position infringes on the right to life because it forces people to end their lives prematurely rather than waiting for the moment of death, which sometimes is in one or two years. As proof, there is the case of Ms. Gladu. She did not go ahead with MAID, but she was relieved to know that she had that option. She did not commit suicide; she died naturally.
However, if her suffering became intolerable, she knew that she could access MAID because our compassionate and empathetic society would take care of her and ensure that she had a peaceful and dignified death. This meant that she could have the death that she did. Many people say that they choose to end their lives because they are not certain that they will be taken care of.
Is there anything more devastating than a suicide? That is a societal failure. We cannot be complacent about suicide attempts, about people feeling suicidal. In the health care system, mental illness, which is an illness like any other, absolutely must have all the necessary resources.
I just want to say a few words about the governments' ability to pay for the health care needs of the patients I am talking about, given the feds' post-pandemic offer. Governments have to deliver care to these people with irreversible illnesses, but they will not be getting money to do so. Over the next 10 years, they will barely be able to cover indexing on chronically insufficient funding. The federal government's share will go up from 22% to 24%. I hope government members are not too proud of that, especially considering that, during the third wave, people told us the system was in critical condition. The pandemic had destabilized it to the point that it would take 10 years to recover from the pandemic's side effects on patients without COVID. Right in the middle of the third wave, the Prime Minister said it would all be dealt with after the pandemic. We were told an agreement was imminent. I figured that they would come close to the $28 billion everyone expected, that they would give the governments of Quebec and the provinces the predictable funding they needed to rebuild their systems, take care of people over the next 10 years and finally recover from the pandemic.
I have heard the Conservatives say they will honour that small percentage. Of all the G7 countries, Canada still has the best borrowing capacity. If debt is unavoidable, what better justification for it than taking care of our people and restoring and rebuilding our health care systems?
I hear people say that individuals who have had an incurable mental disorder for years should not be given access to MAID on account of structural vulnerabilities. According to the expert report, however, two independent psychiatrists would have to be consulted. Not only would two independent psychiatrists be required, but we also have to consider recommendation 16. So far, I have been talking about recommendation 10, but my colleagues should hold on to their hats, because recommendation 16 states that, unlike for other kinds of MAID, when mental disorders are involved, there would be something called “prospective” oversight. This is different from retrospective oversight, as required by Quebec's commission on end-of-life care, which requires a justification every time MAID takes place. No, this does not happen after, but rather before, in real time.
This prospective oversight needs to be established in each jurisdiction, which is precisely what the delay will be used for. This additional safeguard needs to be established in controversial cases. According to the expert report, when an individual's capacity cannot be properly assessed, MAID is not provided, period. It is not complicated. There will be no slippery slope.
If there is a slippery slope, there is the Criminal Code, the courts, the police. Evil people do not belong in the health care system. They would be fired. If they do harm, they can be taken to court. To my knowledge, the provisions allow action to be taken.
My esteemed colleague seems to assume that everyone in health care is necessarily evil, which is absurd. The slippery slope is based solely on health care workers having evil intentions. However, to work in that field, people have to demonstrate skills proving the opposite. Consequently, all the precautionary measures and principles in this report are sufficient, in my opinion.
What needs to be done now is to ensure that people get training. Not all Quebec psychiatrists have read the report. If they listen to interviews given by the member for St. Albert—Edmonton, they will wonder what is happening with their profession.
We must be able to see things realistically and proportionately, provide training, and ensure that we implement a law that will be both accessible and equitable throughout the country. We must avoid situations where an institution that does not want to provide MAID prevents someone from accessing it, if it is their choice and they meet all the criteria.
This is still a dangerous situation. It is happening in Quebec, and the college of physicians warned last week that, in a simple case of MAID for a terminal patient, some doctors did not want to refer the patient to another doctor who was willing to provide it.
2414 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, I want to start by saying that before I dove into this subject, read the expert panel's report multiple times and asked endless questions, I was among the unconvinced.
Second, because we cannot cut corners on this issue, the entire community of professionals in mental health care, mental wellness and mental illness needs to be informed and trained. It will require an adequate number of service providers and assessors. It will require guidelines. Each of the regulatory bodies from coast to coast will need to establish standards of practice for their members, so as to ensure safe, effective and adequate implementation.
104 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, I do not want to get into petty politics. I am not saying that my colleague's question is at that level, but I do not want to get into that.
What I want to say, however, is that we can see the shortcut that my Conservative colleagues sometimes take when they speak. They act like MAID is the only choice, but that is not true. A person can die a natural death without any problems. MAID is only morally acceptable if, and only if, it is voluntary, period.
I want all my colleagues to feel well supported in dying, because that is what palliative care actually is: support for people who are dying. I hope that as each of them lies on their deathbed, they are able to wake up one morning and feel completely at peace and ready to go, rather than lingering in agony. I hope they will be able to benefit from MAID. That is the best we can hope for for any human being: to depart this life in peace.
177 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, I will have to say it: The government was not a good student. It dragged its feet for too long. It established the Special Joint Committee on Medical Assistance in Dying far too late.
When Bill C-7 was passed, the government committed to reviewing the act. We did more than review the act, because we looked at other facets. What the special joint committee did was review the existing act.
However, there was an unnecessary election in the meantime, and that caused delays. Our work was constantly disrupted by ultimatums from the court or by our own inability to meet the deadlines we ourselves had set. That is unfortunate.
I sincerely believe that, once the expert panel tabled its report, after doing the job properly, we needed to take the time to set up all the infrastructure necessary to get past the level of a house of horrors in terms of mental disorders and MAID.
158 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, all the data we have shows that people who are at the end of life have received palliative care. However, there are palliative care units that refuse to take someone into that unit because they allegedly requested medical assistance in dying. I find that unacceptable.
I feel that palliative care is a stepping stone to dying with dignity. As part of the process, someone may request medical assistance in dying. That must be respected. Not everyone can manage to endure their pain and live an existence that makes them suffer to the end.
I do not think the choice is ours; it belongs to the person. There is no reason why the government should not accept a patient's decision, their free choice. They must make an informed decision that is not subject to change, as we heard from some witnesses in committee. We were told that when some physicians had a patient before them requesting medical assistance in dying, they would force them to change their mind so that they would not ask for it and receive only palliative care.
Imagine the opposite scenario. That would make the news everywhere for months.
196 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, my colleague from Thunder Bay—Rainy River is well aware of my great respect for him. However, in listening to his speech, I found it riddled with confusion.
I wondered whether he read the expert panel's report on mental illness as the sole underlying medical condition. I believe that our thinking may not be quite so different. I think that his practice has shown him the need to take care in adopting such an approach. However, in reading the report, he will see that there are many precautions in place and very specific guidelines.
Indeed, just because there are not very many mentally ill people experiencing tremendous suffering does not mean we must not move forward. One person experiencing unimaginable and intolerable suffering is, in my opinion, one too many.
I would like to know my colleague's thoughts on this.
145 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, I commend my colleague who is a member of the Special Joint Committee on Medical Assistance in Dying.
I would just like to provide her with a bit of context. Bill C‑7, which is the fruit of a compromise with the Senate, was meant to respond to a requirement in a court ruling to allow Ms. Gladu and Mr. Truchon to have access to medical assistance in dying.
No one in Quebec considered the passage of Bill C‑7, which allowed Ms. Gladu and Mr. Truchon to have access to medical assistance in dying, to be reckless. There was a consensus on it. It needed to be passed. We passed it while creating a special panel of experts that was meant to table a report within two years to inform a joint committee, which was tasked with reviewing the report and making recommendations that would come later.
We have to be careful when we talk about rushing things. Let us take our foot off the gas. By March 2024, we will have been thinking about this for three years.
What is more, when my colleague says that the public is not on board, I would like her to show me some polls to support that claim. In any event, the current problem is that her party wanted the committee to table a report in June because the Conservatives were against giving the joint committee any extensions on its deadlines so that it could do a good job. Each time, we fought for an acceptable deadline to do decent work. I think they are being a bit hypocritical.
272 words
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, I thank my colleague for his touching testimony.
I want to tell him that, in a debate like this, it is important to be able to distinguish between various realities. This is not a debate about mental health. A debate about mental health means talking about prevention. This debate is not about all mental disorders but rather incurable mental disorders. We must accept that there are people with mental illnesses such as schizophrenia which is incurable and irreversible.
The suicidal state to which he refers, as he demonstrated both through his own testimony and that of other friends, is reversible. If he reads the expert panel's report, he will understand that this is not what is being discussed here and not what we will legislate. A suicidal state is reversible. No effort will be spared to provide the resources needed to reverse that state.
147 words
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, I thank my colleague for his effort.
That said, if Bill C-39 were withdrawn, on March 17, mental disorders would not be excluded from medical assistance in dying. It is important to know what we are talking about.
Also, I do not know on what authority my colleague can claim that he would have had access to medical assistance in dying, given that the expert report clearly states that no expert on the planet considers suicidal ideation to be irreversible. Therefore, even if he was thinking about suicide, he would not have had access to medical assistance in dying.
What makes him say that he would have had access to MAID?
116 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Madam Speaker, I do not know how many times I have to rise to say the same thing, but my Conservative colleagues are oversimplifying. That is okay. They are entitled to do that, what with free speech and all. However, among the experts who drafted the expert report and who addressed the issue of mental health care, none of them supports the idea of giving access to medical assistance in dying to someone who is depressed. It is quite the contrary. The expert report includes all the necessary safeguards to exclude those people.
It is true that socio-economic determinants can lead to depression and suicidal ideation, but those people would not be granted medical assistance in dying. I invite my colleagues to read the report because I have noticed that there is a lack of understanding of the safeguards and precautionary principles underlying each of the recommendations. There are 16 very important recommendations in the expert report, and I invite my colleagues to read it.
166 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
