44th Parl. 1st Sess.
February 13, 2023 11:00AM
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.
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Madam Speaker, the disability community has reached out to me repeatedly over the last number of years, given the regime on euthanasia and how there are two classes of citizens in this country when it comes to the eligibility for MAID. There are those who will be offered help and those who will not be offered help. That is a troubling thing.
I believe that the health care system in this country should be out of the business of MAID and should be in the business of helping to cure people. I understand the Supreme Court rulings, but the Supreme Court never said anything about having to have the health care system assist suicide or euthanizing people in this country. I think we can bring forward a system that works to ensure that life is valued in this country and that folks with disabilities feel that they are not being burdens on our society.
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Madam Speaker, there was a proposal from the Quebec medical association to allow children to be euthanized. In particular, that proposal was for infants born with disabilities. It is horrifying to see that somebody, purportedly a doctor, would come before a parliamentary committee and actually advocate the killing of children on the basis of their having a disability, and that the same association would double down on it. If someone had told me 10 years ago that this would actually be happening in the Canadian Parliament, of all places, it is unbelievable just how far we have slid so quickly.
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Mr. Speaker, it is an honour to rise this evening to speak on Bill C-39. Before I do, I want to let you know I will be splitting my time with the member for Saanich—Gulf Islands.
This legislation might be the simplest one I have had the chance to speak on in the House since being elected, but it is also one of the more serious and emotional ones. Simply put, it would allow for an extension for mental illness to be a condition for eligibility for medical assistance in dying.
I strongly support this delay for several reasons. The first is about concerns I heard about from so many neighbours of mine in Kitchener. In particular, I remember one conversation a group had in their backyard on a colder afternoon just last month. It was between Hannah, Peter and some friends of theirs, and they wanted to share with me specifically some of their serious concerns with medical assistance in dying being expanded further than it already had been.
I really appreciated them sharing their stories, concerns and recommendations. In my view, that was the best of how our democracy is supposed to function, which is for folks like myself who are sitting in legislatures like this one, who have a say in laws like this, to be hearing from neighbours about their concerns. In that conversation and in emails since, it has been almost been universal that folks in my community want to see at least a delay, if not more.
Second, I am supportive because we heard the concerns of experts across the country, such as doctors and health care professionals. On December 1, I really appreciated hearing from the Association of Chairs of Psychiatry in Canada, which includes the heads of the psychiatry departments of all 17 medical schools across the country, as they appealed for the governing party to delay what was then an expected expansion of MAID for those with mental illness.
The third reason I am supportive is because I believe we should spend more time closing the social safety net before we expand medical assistance in dying. I would put it to all colleagues here and ask why it is we are seeing a movement to expand medical assistance in dying much more quickly than we are seeing an expansion to the social safety net. I will give a few examples.
In my community, as colleagues well know as I have shared it many times, the unsheltered population has tripled in the last three years from just over 300 to over 1,000 people living rough. It is clear what is being done when it comes to the affordability of housing is not nearly enough, that we are going in the wrong direction and that more needs to be done.
As well, there are income supports, whether that is a guaranteed livable income for all or as many in this place, myself included, have pushed very hard for, a guaranteed income for those with disabilities across the country. Although we have made progress, and I am glad to see that Bill C-22 was passed in this House and is now in the Senate, the fact is it is yet to be funded. I would strongly encourage the governing party to fund the Canada disability benefit to get on with closing the social safety net with the urgency it deserves.
Next is mental health specifically. Just last week we saw a big announcement about health care, and yet absent from that announcement was dedicated mental health funding. It is all the more egregious when in the 2021 campaign the governing party ran that campaign on a commitment for a $4.5-billion Canada mental health transfer.
I hope there is no sleight of hand here, that with this new health care announcement we are not going to continue to see dedicated mental health funding. It is imperative that all parliamentarians in this place continue to apply pressure to ensure the Canada mental health transfer is in budget 2023. When I last asked the parliamentary secretary about it on Wednesday night, I did not get a clear answer, and it should concern all of us to not see dedicated mental health funding.
In fact, it was because of this absence of sufficient supports for affordable housing, income supports and mental health care that I joined the CEO of the Canadian Mental Health Association of Waterloo Wellington to encourage the Minister of Justice to follow through on the delay that had been promised in December of last year. I am glad to see him follow through on that.
With my remaining time before I close, I just want to quickly mention the importance of quality journalism in this country and how it relates to this legislation.
I am glad to hear that all parties are supportive of Bill C-39, but I am not surprised to hear that, because of the work of Althia Raj and the Toronto Star. Specifically, back in November, as other members have shared, Ms. Raj spoke with the Minister of Justice. At the time, he said nothing could be done and that it would be a “challenge in the current Parliament” to delay the expansion of medical assistance in dying.
Ms. Raj then did something very reasonable. She reached out to all of the opposition parties, including the Green Party, and asked them if they would support what is now Bill C-39. Opposition parties responded, and days later, on December 11, Ms. Raj published an article sharing that all opposition parties were supportive. Then the question was put back to the Minister of Justice, and days later, on December 15, it was announced that this legislation would come before this House.
While there are many advocates and many campaigns that lead toward legislation such as this one, I think it is important that we call out and appreciate non-partisan journalists across the country doing important work to help bring to light the agreement that is sometimes there to move forward with important changes like the ones we are discussing, and to call out what might be certain rebuttals that may or may not be justified. In this case, they were not, and I appreciate Ms. Raj, as well as the medical professionals I mentioned earlier, like those from the Association of Chairs of Psychiatry in Canada, for their advocacy, which brought us to this point.
In closing, I applaud the governing party for introducing Bill C-39 and following through on the promise that was made back in December, and for listening to the need to slow down. I have no doubt that other parliamentarians across the country heard concerns similar to the ones I heard from Hannah, Peter and so many others. I also encourage the government to move more quickly on the social supports that are needed in my community and across the country.
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Mr. Speaker, the bill, at this point, is necessary for us to ensure that we are protecting the most vulnerable. To me, and to many of us, as we are hearing, it speaks to a bigger issue: The government is leaving many behind.
I appreciate that my colleague spoke to the importance of closing the social safety net and spoke about the importance of disability supports, appropriate mental health supports, affordable housing and a guaranteed livable basic income. There are many components necessary for us to move forward to address the bigger issue.
I wonder if the member can share with us what he is hearing from constituents in his riding regarding what is most vital for us to move forward with so that those who are struggling the most have what they need to get through each day.
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Mr. Speaker, I thank the member for Nanaimo—Ladysmith because I know what a champion she has been in this place in pushing for people with disabilities to get the follow-through they have been promised and have advocated so strongly for over so many years. We could cut poverty by 40% in this country by providing a guaranteed income for every person with a disability, who are right now disproportionately living in legislated poverty. It is a national embarrassment, in my view, that we have not done more already.
Whether it is related to providing a guaranteed income for folks with disabilities and funding the Canada disability benefit or following through on the Canada mental health transfer, it is important for our democracy that political parties and leaders follow through on promises they have made. I am going to continue to push, alongside the member opposite and others in this place, in the lead-up to budget 2023 to see those important commitments followed through on.
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Mr. Speaker, we know that the government has not delivered a single dollar after its promise of mental health transfers. The member talked about the importance of support. We agree with her given what I heard in her speech.
The government still has not tabled legislation to create parity between mental and physical health, which is absolutely critical. We have heard from the disability community, especially people who are suffering with mental health issues as their underlying illness, and they are all saying they need better supports, such as access to treatment. They are also saying that it is tough to pay their bills, buy groceries and pay for rent.
We put forward a proposal for a guaranteed livable income for those living with disabilities and for seniors. We know tax breaks are not going to help people in that category because they do not have the income. I am hoping my colleague can talk about some of the solutions to help support those who are struggling so they are not considering medically assisted dying for an underlying mental illness.
We can talk about solutions. I know the Liberals want to deflect because they do not want to talk about their track record. That is what they just did in the question to my colleague. I am hoping we can hear more proposals to help support people.
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Mr. Speaker, I thank my colleague for his question. I see his other colleague, whom I sit with on the HUMA committee and work with very closely.
I am really glad the member brought up people with disabilities. We worked really hard on Bill C-22, and it is a classic example of a real failure from the government. It championed that it was going to be bringing in this disability benefit act, and we spearheaded it through Parliament, but people with disabilities still do not know how much they are getting, when they are getting it or when it will be implemented. Everything will be done by regulation instead of legislation.
There is so much uncertainty, and that is how the government governs. It has grand announcements and big fanfare, but its actions have no substance to them. A perfect example is what we saw with that legislation.
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Madam Speaker, I think my hon. colleague touched on the crux of the issue. That review should have occurred. We would have had better insight into what we are dealing with right now.
The issue he is talking about, that balance, is when someone is suffering with mental illness or a disability and how difficult it is to understand if they are making that decision in the right state of mind, let us say. The Liberal government opened this door so wide, when there is no question that Canadians, at their most vulnerable moment, will be making an irreconcilable decision that they may not be making in the best position of their mental health and, certainly, the position they are in economically and financially. Most importantly, are they in the right state of mind to make such an important decision?
That is what we have to take the time to decide.
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Madam Speaker, my colleague from Winnipeg just said that he would hope that we would have more resources for mental health. He is part of the government. He has a government appointment. He sits around the table.
We do not have those supports because the government has not provided them to Canadians. Honestly, he is listening, and he should think about this. This is not a talking point. His government has not got the job done, and that is why we are here. This should not be a pause. We should not be talking about this. This should not happen.
When it comes to his question about medical professionals, we have medical professionals. We have got all sorts of groups from disability experts to indigenous leaders saying there is no way this should be offered in Canada. What we should be focusing on is helping people to live with hope and dignity, something that the government has not yet done. That is why the government should not be proposing this at all. Based on science, based on morality and based on any outcome right now, we should not be offering medically assisted dying to Canadians with mental health issues.
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Madam Speaker, I agree with my colleague. When those numbers went from 1,000 per year to 37,000 Canadians accessing MAID, that was a severe red flag that this has gone much too far. All of us have loved ones who are impacted by mental illness or disability. This certainly hits home for all of us.
I would say that my suggestion would be not to put a timeline on this. We are putting this off for one year. My concern is that the Minister of Justice certainly does not agree with most of us in the House. He said it himself, that the government could just plow ahead and go ahead with this legislation without any additional discussion. I think that is a wrong decision. We are certainly hearing from our constituents and from Canadians that this has gone far enough.
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