44th Parl. 1st Sess.
February 13, 2023 11:00AM
Mr. Speaker, I have served on the special joint committee both in the previous Parliament and in this one. It was a lengthy amount of work, and certainly there was some very difficult testimony to go through.
I do not want to cover the same ground that previous members have asked questions on, so maybe I will change tack.
My friend, the member for Courtenay—Alberni, is our mental health and addictions critic, and he has constantly asked the government to bring mental health care funding up to parity with physical health care, understanding that there is in fact a real crisis. When I look at the conditions in ridings like mine, where we see the opioid crisis and the way it has been ravaging communities, there is so much underlying trauma and so many undiagnosed mental health disorders that are not being addressed.
I would like to invite the member to comment on that. In the midst of this very difficult conversation, and I agree that Bill C-39 is a necessity, we have to take this opportunity in time to make sure that our system is appropriately resourced and funded so that we are getting to Canadians who are falling through the cracks.
206 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, the member for Cowichan—Malahat—Langford has contributed thoughtfully to the special joint committee.
In answer to his question, I note that during the 2021 election campaign, the Prime Minister claimed that mental health was a priority of the government. He committed to a $4.5-billion mental health transfer, but none of that money has gone out the door. There is no mental health transfer.
Instead of providing support and help, the government has been almost singularly focused on offering death, on offering MAID to persons who are struggling with mental health. It speaks to how misplaced the priorities of the government are. It also speaks to the fact that once again, like so much of what the Prime Minister says, his words are nothing more than empty words.
134 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, I want to thank my colleague from St. Albert—Edmonton for the incredible work he did on the committee. I was able to sub in a couple of times and was certainly impressed with his advocacy.
One thing that has arisen lately is the government's officials offering MAID to our veterans. I have a constituent who is one of those veterans and is an advocate. This was very upsetting.
I want to get the member's opinion on the slippery slope this legislation is on and the message it is sending to vulnerable Canadians, like those who have mental health issues. What kind of message is this legislation sending to those vulnerable Canadians?
117 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, the message it is sending to persons who are struggling with mental illness is that their life is not important and that we are going to offer them death instead of help and support.
The member raises the issue of veterans who are offered MAID completely inappropriately and, frankly, in contravention of the Criminal Code. The Minister of Veterans Affairs, when he came to the veterans affairs committee, said that it had happened once or twice and that he had undertaken a thorough review. We now know that is not true and that it has happened multiple times. It speaks more broadly to how the government has mishandled MAID in so many different ways.
116 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, pursuant to Standing Order 43(2)(a), I would like to inform the House that the remaining Conservative Party speaking slots will be divided in two.
28 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 thank the member for Montcalm for his speech.
I have to say that it has been a pleasure working with him over the last several months at the AMAD committee. He is an exceptionally thoughtful individual and I have learned a great deal from him.
Based on his numerous years of experience with MAID, and this particular issue of mental health as the sole underlying condition, could he outline for us, in a very short way, why he thinks there is a need to extend the deadline for the implementation of this provision?
97 words
- 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 am really upset this morning. Let me explain. In 2017, my father passed away after a very difficult life. Many people here know his story. He struggled with ALS for 20 years. I was there with him during the five years he was in palliative care. At the time, he told me, “Don't worry. I have a respirator. I had an extra eight years of life and now I know that I can choose what to do with the rest of it. I have control over my life.”
My father had the right to medical assistance in dying before 2017, but he did not want it. He chose to refuse treatment. There were consultations and discussions and they gave him hope. Humans want to live. Perhaps some people in the House are lucky enough to have never experienced this type of situation.
My colleague mentioned all of the precautionary measures that are in place. He said that we need another year to make sure that we are doing things right. I would like him to tell us whether we can hope that, after this additional year, our Conservative colleagues will come to understand that humans are worthy of life and that, in the end, it should be their decision.
216 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, let me just say from the outset what a pleasure it was to serve on the special joint committee with the member for Montcalm, both in the last Parliament and in this one. I always appreciated his very thoughtful interventions and I could tell that he always came to committee quite well prepared.
The member and I have been here since 2015. He will remember that in the original bill, Bill C-14, there was a statutory requirement for a five-year review. We know that Bill C-7 was introduced before that review happened and that the government decided to accept a Senate amendment before it had a chance to establish a special joint committee. That process, that timeline, underlines why Bill C-39 is necessary now.
I wonder if my hon. colleague would just reflect on what has led us to this point and why Bill C-39 is necessary, and for this House to pass it quickly, because of the impending deadline and the fact that we do need to have some space to make sure we are getting these standards right. It is extremely important.
191 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, I think it is very important to have choice. However, without palliative care, there really is no choice. The government has not done its part to continue putting palliative care measures in place.
What is the situation in Quebec?
42 words
All Topics
- 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
- Feb/13/23 1:32:53 p.m.
- Watch
Mr. Speaker, I would like to speak to the question of privilege raised on Wednesday, February 8 by the hon. member for Regina—Qu'Appelle concerning freedom from obstruction and technical difficulties related to the interpretation service and to the comments made by the member for Mégantic—L'Érable, which dealt more specifically with technical difficulties in parliamentary committee work.
The Bloc Québécois agrees with the House leader of the Conservative caucus that the parliamentary privilege of his caucus was indeed breached because of the technical problems that occurred and that prevented the interpretation of members' remarks during the last caucus meeting of the official opposition.
We want to acknowledge the remarkable work that the interpreters do and the support they provide to members of Parliament during parliamentary proceedings. The interpretation service is essential to the proper functioning of Parliament.
As the member for Regina—Qu'Appelle pointed out, subsection 4(2) of the Official Languages Act requires that “Facilities shall be made available for the simultaneous interpretation of the debates and other proceedings of Parliament from one official language into the other.”
The Bloc Québécois would like to thank the interpreters who interpret every day. I would like to point out that most of the interpretation is done from English to French, so it is all the more important to ensure the right of francophone members to participate in parliamentary proceedings in their language, which is also the language of the majority of their constituents.
The second part of the intervention by the member for Regina—Qu'Appelle concerned the problems caused by the technical arrangements for caucus meetings. He rightly referred to pages 111 and 112 of the House of Commons Procedure and Practice, which state, “A member may also be obstructed or interfered with in the performance of his or her parliamentary functions by non-physical means.”
A little later, he added:
It is impossible to codify all incidents which might be interpreted as matters of obstruction, interference, molestation or intimidation and, as such, constitute prima facie cases of privilege.
The member for Mégantic—L'Érable went further in his reply. He asserted the following about the technical problems:
We need to have a plan B. Meetings must take place at the scheduled time and proceed normally with the possibility of access to interpretation services and interpreters and, especially, to the equipment that makes those services possible.
On that particular issue, the Bloc Québécois wants to note that technical problems are unfortunately increasingly delaying the work of parliamentary committees and becoming a recurring obstacle to their operations. This poses a significant problem considering the scope and nature of the work done by the committees within the parliamentary apparatus. Parliamentary committees play a fundamental role, including in the legislative process, by conducting a comprehensive review of bills and improving them by adopting amendments, as well as in the oversight process when they conduct investigations into the government's activities, policies, expenses and programs.
As a whip, member of the Board of Internal Economy and a member of Parliament, I find the situation to be very alarming. Last week alone, we on this side related the following events. There were incidents: on February 6 at the environment and sustainable development, veterans affairs, and agriculture and agri-food committees; on February 7 at the health, human resources, skills and social development and the status of persons with disabilities, and national defence committees and at the Special Joint Committee on Physician-Assisted Dying; on February 8 at the industry and technology, and citizenship and immigration committees; on February 9 at the foreign affairs and international development, international trade and veterans affairs committees. There is more. On February 10, there were problems at the human resources, skills and social development and the status of persons with disabilities, and official languages committees and again at the Special Joint Committee on Physician-Assisted Dying. Just this morning, there were problems at the Canadian heritage committee.
We submit to your attention that technical difficulties affecting interpretation services, both during the Conservative caucus and during various committee meetings, may be considered obstruction, interference, molestation or intimidation, and as such constitute a prima facie breach of parliamentary privilege.
I thank you for taking these situations into consideration during your reflection, as I believe they are very serious.
753 words
- Hear!
- Rabble!
- add
- star_border
- share
- Feb/13/23 1:37:55 p.m.
- Watch
I thank the hon. whip of the Bloc Québécois for his intervention. I believe the Speaker will rule on the matter shortly.
26 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, it is an honour to stand to give my thoughts on Bill C-39. For those who are watching the debate today, this is the bill to amend the Criminal Code to delay, until March 17 of next year, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition is a mental illness.
It has to be stated very clearly, because of the timeline with which we are dealing, that if this bill is not passed, the original sunset clause that was put in place by the old Bill C-7 will come into effect on March 17, which is just over a month away. It is for that reason that I will support the bill and will work with all parties to get the bill passed quickly.
Today's conversation has to happen within the context of the mental health crisis in Canada. We know and have heard, and this is not just from members of Parliament, from many advocates and stakeholders that there is an extreme lack of funding and resources. Clearly, there absolutely must be parity between physical and mental health in funding.
The Minister of Mental Health and Addictions has stated in the House that Canadians should have access to timely evidence-based, culturally appropriate and trauma-informed mental health and substance use services to support their well-being. With that I agree wholeheartedly, but words are not enough. We need to see the requisite resources and funding to follow through those words.
We know that beyond the Canada mental health transfer many advocates have long been calling for legislation to enshrine in law parity between mental and physical health. I am very glad today that I am giving my speech beside the hon. member for Courtenay—Alberni, who is our mental health and addictions critic and who has himself tabled Motion No. 67, which calls on the government to develop that legislation and to urgently fulfill its promise to establish that Canada mental health transfer.
In my own riding of Cowichan—Malahat—Langford, many of my fellow citizens are going through extreme struggles with the opioid crisis. They are dealing with trauma. They are dealing with underlying mental health challenges that are simply not being addressed. That is an extreme gap and the cause of an extreme amount of shame for a country as wealthy as Canada to be still having these conversations about the resources that need to be brought to bear in communities like mine.
I have been a member in the House since 2015, so this is now my third Parliament. I have been here for the entirety of the legislative journey of medical assistance in dying. I can remember Bill C-14 and the sometimes difficult debates we had in the House. That legislation was in response to the Carter decision in the Supreme Court, which basically said that to deny people this right was contrary to our charter. It therefore gave the government a timeline to address it with the appropriate legislation.
What is not often talked about with Bill C-14 is that there was a legislative requirement in that act when it received royal assent. There was a five-year statutory review of medical assistance in dying. Unfortunately, that never occurred before the government went ahead in the previous Parliament and introduced Bill C-7, which established a second track for people whose death was not reasonably foreseeable.
The context of today's speech and C-39 is the fact that we have a story here of the government in several instances putting the cart before the horse. It not only introduced Bill C-7 before a statutory review occurred, which was a requirement of Bill C-14, but it then went ahead and accepted a Senate amendment to the bill that ran contrary to its own charter statement. It did that pretty massive expansion to the law without establishing a special joint committee that was a requirement of Bill C-7.
I am intimately familiar with what this process has been because I have not only been a member of the House since 2015, I have not only participated in debate on Bill C-14 and on Bill C-7, but I have also been a member of the special joint committee, both in the previous Parliament and in this Parliament.
The message all along has been that this kind of a review should have occurred before we were dealing with a timeline crunch. It became quite obvious during the special joint committee that too many Canadians, too many professionals in our country had apprehension about mental disorders as the sole underlying medical condition for being able to access medical assistance in dying as early as next month. Hence, we have Bill C-39.
I want to go back to the original charter statement that the government released as a part of Bill C-7. That includes a number of important statements as to why the government felt, originally, that mental disorders should be excluded from accessing MAID. It did say in that charter statement that the exclusion was not based on the assumption that individuals who suffered from mental illness lacked decision-making capacity. It also said that the exclusion was also not based on a failure to appreciate the severity of the suffering that mental illness could produce. Rather, it was based on the inherent risks and complexity that the availability of MAID would present to those individuals.
First, that charter statement identified that the evidence suggested that screening for decision-making capacity was particularly difficult. It could be subject to a high degree of error. Second, the statement identified that mental illness was generally less predictable than physical illness with respect to the course that the illness may take over time. Finally, it highlighted the experience that a few of the countries that permitted MAID, namely Belgium, the Netherlands and Luxembourg, for the sole underlying medical condition of mental illness had and some of the concerns relating to the increasing number of these cases and the wide range of mental illnesses in respect to which MAID could be provided.
Again, it really highlighted the fact that precaution was the necessary mode that was required before we embarked on this path. However, the government in its wisdom decided to accept a late stage Senate amendment to the bill after the House, full of its duly elected members, had given a final vote on Bill C-7. As a member at that time, I could not bring myself to accept that Senate amendment. Therefore, I ended up voting against the final version of Bill C-7 because of that.
It also needs to be said, when we are going over the history, that the special joint committee that was a requirement of Bill C-7 got a very late start. It was first brought into being just before the summer recess in 2021. We only had a few meetings before the summer of 2021 and we had the unnecessary election, launched solely at the request of the Prime Minister, in August of that year. This completely wiped out anything that was happening during the 43rd Parliament. That Parliament ceased to exist, and all of the committees that were a part of it did as well.
The new Parliament, the 44th, reconvened later that year, but it was not until around April or May of 2022 that serious discussions started coming together and we could actually get the special joint committee reformed. Again, we have to put that in the context of the impending deadline of March 17, 2023.
An incredible amount of time was wasted, not only from an unnecessary election but also from the delays of getting that committee up and running. We had to twice request an extension of our mandate from both houses of Parliament because the timelines we had been given were completely unrealistic, not only in hearing from as wide a range as possible of witnesses but also in producing a report that would reflect the gravity of the subject matter with which we were entrusted. That has to be highlighted in the debate today on Bill C-39.
I also think it is important because there have been a few narratives around this legislation. It is important to go back to understand what the Criminal Code actually says, and also to put that in the context of the definition of irremediability.
It is important that, in order to be eligible for medical assistance in dying, a person has to meet all of the following criteria: they have to make sure that they are in fact eligible for health services in the province they reside in, they have to be at least 18 years of age and capable of making decisions with respect to their own health, they have to have a grievous and irremediable medical condition, and they have to have made a voluntary request. All these conditions must be satisfied. A person must also give informed consent to receive medical assistance in dying, after having been informed of the means available to relieve their suffering, including palliative care.
Now we get to the definition of a grievous and irremediable medical condition as outlined in the Criminal Code. A person has to meet the following criteria for that definition: it has to be a serious and incurable illness, disease or disability; they have to be in an advanced state of irreversible decline in capability; and that illness, disease or disability, or that state of decline, has to be causing them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.
Those are the definitions in the Criminal Code, so despite the narratives we hear out there, those conditions must be met or the person administering MAID will have committed a crime. They will be in violation of the Criminal Code of Canada and will get the appropriate punishment as a result.
One of the difficulties is the fact that the term “irremediable” is not a medical or scientific term. It is a term that finds its definition within the Criminal Code. If we go to scientific or medical literature, it is a difficult term to define, and that, I think, is why we are seeing a lot of the apprehension around accessing MAID for mental disorders where the sole underlying medical condition is a mental disorder.
Some witnesses who appeared before our committee expressed the opinion that this should not be permitted, because there cannot be any certainty with respect to the incurability of a mental disorder. However, other witnesses told us that certainty is not required and that there are ways to consider irremediability, for example by looking at the years of treatment that people have had and whether any responses of the patient have actually been positive.
We also have to understand that the respect for personal autonomy in all of this is paramount, and it is has to be a treatment that is acceptable to the individual receiving it. They not only have to express informed consent, but it has to be something acceptable to them as a person.
I now want to talk a little about the special joint committee, which I have had the honour of being a member of, as I previously mentioned.
I think it is important to underline that our committee has struggled with the question of how to balance individual autonomy with protections for the vulnerable. We were tasked with looking at five themes through the passage of Bill C-7 and the motion that guided our work from both the House of Commons and the Senate: how we institute protections for persons with disabilities; the state of palliative care in Canada; advance requests; mature minors; and, of course, the subject of today, mental disorders as a sole underlying medical condition and their eligibility with respect to applying for medical assistance in dying.
Our final report is due to be tabled in the House this Friday, February 17. We wrapped up our committee meetings last week and finally approved a draft report. That draft report, as I speak, is going to translation services so that it can be ready for tabling here in the House, and so we will be able to meet the deadline that was given to us.
Before we did that work, we had others who did some important work ahead of us. We had the expert panel that was established. They also wrestled with major concerns, such as incurability, irreversibility, capacity and suicidality, and of course the intersection between structural vulnerability, mental disorder and medical assistance in dying.
That panel report, an important precursor to our work as a special joint committee, did state that assessors in medical assistance in dying should be able to establish incurability and irreversibility with reference to treatment attempts made; the impacts of those treatments; and the severity of the illness, disease or disability. The incurability of a mental disorder cannot be established in the absence of extensive attempts at interventions with therapeutic aims.
This means that someone who has not had access to adequate care would not be eligible for MAID. Therefore, MAID could never be used as a substitute for good psychiatric care. I think that is an important thing we have to realize. There will be safeguards in place, not only with the Criminal Code, but also, we hope, with the standards of practice.
For patients who are considering this, we want to make sure that there has been a long track record of attempts to deal with their illnesses. At the same time, we have heard very clearly that there are many Canadians and many professionals who feel that additional time is needed to make sure we get this right.
One of the witnesses before our special joint committee was the chair of the Government of Quebec's Select Committee on the Evolution of the Act respecting end-of-life care. She explained that Quebec had decided that MAID for mental disorders as a sole underlying medical condition should not be permitted at this time because of the challenges of determining irremediability, as well as the lack of social consensus. Another level of government, this time the Province of Quebec, is also underlining the concerns that many members of Parliament are expressing here today.
I mentioned the final report that will be tabled in the House, but our committee did release an interim report. That interim report was specifically on this subject matter. I will read from our conclusion. It states:
We must have standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight in place for the case of [medical assistance in dying for mental disorders as the sole underlying medical condition]. This task will require the efforts and collaboration of regulators, professional associations, institutional committees and all levels of governments and these actors need to be engaged and supported in this important work.
Although some work is already underway to implement the recommendations of the Expert panel, there is concern that more remains to be done to ensure that all necessary steps have been taken to be ready by the March 2023 deadline...
Again, in our interim report, our special joint committee was already, at that time, expressing concern with the upcoming deadline, and I think it is a smart move that we are moving ahead with Bill C-39. If we back that up with the testimony we heard at committee, we had a number of different witnesses who clearly expressed that they had troubles with this deadline and that those standards of practice were not yet ready.
It needs to be underlined again that, if Bill C-39 is not passed, the original sunset clause of March 17 will come into effect. My vote for this bill is occurring because of that very fact. This is aside from the broader conversation we need to have about medical assistance in dying in general. It is support for a bill that is going to extend the deadline by one year so we can make sure that we get these standards of practice right, so we have the necessary time to engage with the broader community.
2743 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, we have heard some pretty wild accusations in the House today. The member for St. Albert—Edmonton suggested that it would be possible for anybody who is looking to commit suicide to be able to access medical assistance in dying. We then heard, through an exchange between him and a member from the Bloc, a completely opposite point of view on whether or not that was something that could be done.
Would the member like to weigh in on where he thinks the reality is? Is it with the member for St. Albert—Edmonton or the member for Montcalm?
103 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, as I clearly outlined in my speech, the safeguards are very clearly laid out, not only in the Criminal Code, but also in what we believe the standards of practice should be, and that is going to apply to the medical community. That being said, the medical community has indicated it does need more time, hence the need for Bill C-39. I would just remind the hon. member that many stakeholders in the field of mental health have underlined the fact that the Liberal government needs to step up to the plate and increase the funding and the resources to appropriately address this major crisis happening from coast to coast to coast.
115 words
All Topics
- Hear!
- Rabble!
- add
- star_border
- share
- Feb/13/23 1:59:41 p.m.
- Watch
Mr. Speaker, I rise to celebrate the 40th anniversary of the Scarborough York Region Chinese Business Association, which serves the needs of Chinese businesses in Scarborough and York Region. For four decades, the organization has advocated on behalf of local small and medium enterprises to various levels of government, as well as supported their growth and development.
My riding of Scarborough North is home to a thriving immigrant community whose roots and people-to-people ties have enabled our diverse economy to flourish. The association has been instrumental in this success by hosting receptions and seminars and by organizing business forums and round tables. It has also fundraised for student scholarships, supporting the next generation of innovators and entrepreneurs, and donated PPE to local hospitals during the pandemic.
I congratulate president Tony Luk, past presidents Grace Yu and Carson Ho, and the directors, members and volunteers who have contributed to the association’s accomplishments over the last 40 years. I wish them many more decades of prosperity and success.
170 words
- Hear!
- Rabble!
- add
- star_border
- share
