44th Parl. 1st Sess.
February 13, 2023 11:00AM
moved that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.
He said: Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.
An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.
My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.
In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.
The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.
In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.
Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.
Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.
Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.
The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.
In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.
The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.
I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.
This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.
As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.
That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.
As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.
In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.
This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.
The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.
These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.
I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.
I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.
I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.
I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.
The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.
Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.
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Mr. Speaker, some have opined that the extension sought today is potentially for re-debating the issue of mental health as a sole and underlying condition for MAID. I am wondering if the minister could outline why that is not the case.
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Mr. Speaker, I thank the hon. member for his work as a critic and his work on committee.
We are in a far different place than we were two years ago. We have now done a great deal of the work, particularly at the federal level, on mental illness as the sole criterion for seeking MAID. As I said, a number of leading experts feel that we would have been ready next month to have moved forward. We are trying to be prudent and to allow others to internalize the learning that has been developed over the last two years.
I mentioned before, and I will repeat it again, that this is a small fraction of people who are in the non-end-of-life scenario. Indeed, the people in the non-end-of-life scenario generally are a small fraction of those who seek MAID. It is not the case that somebody will simply be able to get MAID by going to their doctor and saying that they are contemplating suicide. That is not the case, and we are misleading Canadians if that is what we say.
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Mr. Speaker, I rise to speak on Bill C-39, a legislation that imposes a new arbitrary deadline of March 2024 in place of the Liberal government's arbitrary deadline of March 2023 whereby persons with a sole underlying mental health disorder would be eligible for MAID.
I support Bill C-39 only because it is better than the alternative, namely that in one short month from now, on March 17, MAID would be available to persons with a sole underlying mental health disorder. This would be an absolute disaster and certainly result in vulnerable persons prematurely ending their lives, when otherwise, they could have gone on to recover and lead healthy and happy lives.
Rather than imposing a new arbitrary deadline that is not grounded on science and evidence, what the Liberal government should be doing is abandoning this radical, reckless and dangerous expansion of MAID altogether. This is why I wholeheartedly support Bill C-314, which was introduced last Friday by my friend and colleague, the member for Abbotsford, and would do exactly that.
One would expect that before deciding to expand MAID in cases of mental illness, a responsible government would take the time to study the issue thoroughly and consult widely with experts. After all, we are talking about life and death. We are talking about a significant expansion that would impact a vulnerable group of Canadians.
However, the Liberal government is not responsible, and that is not what happened. This is why the government finds itself in the mess it is in today with this rushed, 11th-hour legislation to delay the expansion.
Instead, the Minister of Justice accepted a radical Senate amendment to Bill C-7, which established an arbitrary sunset clause. That set in motion this expansion of MAID in cases of mental illness, effective in March of 2023. To provide some context, Bill C-7 was a response to the Truchon decision; its purpose was to remove a critical safeguard, namely that death be reasonably foreseeable before someone is eligible for MAID. It was a terrible piece of legislation that the government should have appealed but did not.
As bad as the bill was, when it was studied at the justice committee, of which I was a member at the time, nowhere in the bill was there any mention of expanding MAID in cases of mental illness. The justice committee did not hear evidence on that point. Indeed, when the minister came to committee, he said that there were inherent risks and complexities with expanding MAID in cases of mental illness, and therefore, it would be inappropriate to do so.
The bill went over to the Senate, and all of a sudden, the minister unilaterally accepted the amendment. Then what did the Liberals do? After little more than a day of debate, they shut down debate on a bill that had drastically changed in scope and rammed through the legislation for this expansion of MAID in cases of mental illness.
There was no meaningful study and absolutely no consultation with experts, including psychiatrists; persons struggling with mental illness; or these person's advocates. There was nothing. In short, the justice minister made the decision to go ahead with this significant expansion and then said the issue would be studied later. Hence, there was the establishment of an expert panel that was appointed after the government had already made the decision to go ahead. One would think that if an expert panel were going to be appointed, it would be appointed before deciding. However, that is not what happened with the justice minister and Liberal government.
We saw a special joint committee established after the fact. Talk about getting it backward, putting blind ideology and hubris ahead of science and evidence, and showing a total disregard for the concerns and lives of Canadians struggling with mental illness. Had the Minister of Justice and the Liberal government done their homework at the outset, they would have learned very quickly that this expansion of MAID cannot be implemented safely.
I serve as a co-vice-chair on the Special Joint Committee on Medical Assistance in Dying. As early as the spring, the committee heard from multiple witnesses, including representatives of the mental health community, and most importantly with respect to some of the clinical issues, leading psychiatrists. The body of evidence showing that this cannot proceed safely was overwhelming. One of the key reasons cited for this was that in the case of mental illness, it is difficult, if not impossible, to predict irremediability. In other words, in the case of mental illness, it is difficult or impossible to determine whether someone can recover and become healthy. This is a serious problem.
Let us look at some of the evidence that was available to the minister in the spring. Dr. John Maher, a clinical psychiatrist and medical ethicist who appeared before the committee, said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”
Dr. Brian Mishara, a clinical psychiatrist and professor at the Université du Québec à Montréal, told the committee, “I'm a scientist. The latest Cochrane Review of research on the ability to find some indicator of the future course of a mental illness, either treated or untreated, concluded that we have no specific scientific ways of doing this.”
Even the government's expert panel conceded the difficulty in predicting irremediability. At page 9 of the expert panel report, the panel observed, “The evolution of many mental disorders, like some other chronic conditions, is difficult to predict for a given individual. There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.” The government's own expert panel said that it is difficult, if not impossible, to predict irremediability.
If one cannot predict irremediability, persons who could go on to lead healthy and happy lives may have their lives prematurely ended. This is a problem that the government cannot avoid and that has not been resolved. Let me remind this House that, under the law, one must have an irremediable condition in order to be eligible for MAID. However, here we have leading experts and psychiatrists, including the government's expert panel, saying that it is difficult, if not impossible, to predict irremediability.
According to the psychiatrists who appeared before the special joint committee, what that means is that medical assessments in cases of mental illness for MAID are going to be decided on the basis of “hunches and guesswork that could be wildly inaccurate.” Those are the words of Dr. Mark Sinyor, a professor of psychiatry at the University of Toronto, who appeared before the special joint committee. These words were echoed by other psychiatrists who appeared before our committee.
The expert panel did not use such language, but it essentially conceded the point in its report because it was unable to come up with any objective standard by which to measure whether a patient's condition in the case of mental illness is irremediable. Instead, the expert panel ridiculously and recklessly said that it was going to wash its hands clean of this and that it was going to give a big green light and say it can all be done on a case-by-case basis. There would be no objective standard whatsoever; all would be guesswork and subjective assessment.
At the special joint committee on the issue of predicting irremediability in the context of mental illness, Dr. Mark Sinyor said that physicians undertaking a patient assessment “could be making an error 2% of the time or 95% of the time.” A 95% error rate is the risk on a matter of life and death, on a procedure that is irreversible and results in the termination of someone's life. For persons who are struggling with mental illness, this is the government's solution. The minister just stood in this place and said, “Damn the evidence. Damn the facts. We are going full steam ahead”.
I cannot think of a more reckless approach than the one the Liberal government has taken on an issue of profound importance to so many Canadians. It is not just the issue of irremediability, although given that this cannot be resolved, it should be the end of the matter. In addition, psychiatrists and other experts at the special joint committee emphasized that in the case of mental illness, it is very difficult to distinguish between a request motivated by suicidality versus one made rationally. In fact, suicidality is a symptom of mental illness, and indeed, 90% of persons who end their lives by suicide have a diagnosable mental disorder.
To illustrate how radical the government is, I note that when the Ontario Medical Association surveyed Ontario psychiatrists in 2021, 91% said they opposed the expansion of MAID for mental illness under Bill C-7. About 2% expressed support. Some 91% were against, 2% were in support and the reset were undecided. This speaks to how reckless, how radical, how extreme and how out of touch the government is on the question of expanding MAID in the case of mental illness.
In the face of the overwhelming evidence that we heard at committee, we issued an interim dissenting report calling on the Liberals to put a halt to this radical and reckless expansion. The minister ignored our interim dissenting report. He ignored the experts. He ignored the evidence. It appears he is so blinded by ideology that it is impossible for him to see what is in plain sight: This cannot be done safely.
In December, when it was evident that the minister was not listening, the Association of Chairs of Psychiatry in Canada, which includes the heads of psychiatry at all 17 medical schools, said to put a halt to this expansion. However, the minister still was not prepared to act. Indeed, it was not until the day after Parliament rose for Christmas that he had a late afternoon press conference where he made some vague commitment to introducing legislation in which there would be some type of extension. Then, with only 17 sitting days left before the expiration of the sunset clause, the minister finally saw fit to introduce this bill. I think this very clearly illustrates the shambolic approach with which the government has handled this issue.
We now have legislation, but what does this legislation do? As I noted at the outset of my speech, it provides for a new arbitrary deadline, even though issues of irremediability, suicidality and capacity to consent have remained unresolved for the past two years. There is absolutely no evidence that those issues are going to be resolved a year from now.
What we have is nothing more than an arbitrary deadline, and a year from now, we are going to find ourselves in exactly the same place. Let us be clear. When we speak about suicidality, irremediability and capacity to consent, these are not issues to be brushed under the rug. These are serious legal and political issues that are fundamental to determining whether this can go forward.
In closing, whether this expansion takes place a month from now or a year from now, it will be an absolute disaster and will result in persons struggling with mental illness having their lives wrongfully terminated. It is time for the government to get its head out of the sand, stop being blinded by extreme ideology, follow the science, follow the evidence and scrap this ill-conceived expansion.
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Mr. Speaker, at the outset, let me say how fundamentally different a view I have of the committee hearings and of the many experts who came forward and testified at the special joint committee, which is set to release its report on Friday.
I note that the member mentioned the expert panel. On one side he says it is supporting his position, and on the other side he is saying it is proposing to go ahead with MAID for those with mental health issues as the sole underlying condition. I do not think he can have it both ways.
Ultimately, the expert panel has recommended that we move forward. We have consulted with an enormous number of individuals and organizations. We have heard from them at committee, and I think it is very clear that we should be going forward. However, there is a need for prudence and a need to ensure there is a little more time available for experts to be ready with the right training.
I ask the member why he is being misleading in his debate regarding the many people who came forward and gave us a different perspective than his at committee.
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Mr. Speaker, I want to thank the member for Montcalm, who serves on the special joint committee and is a very thoughtful member on it.
At the end of the day, the member is arguing that somehow expanding MAID in cases of mental illness could be appropriate, but what he is demonstrating is exactly the opposite. He is highlighting why it would be inappropriate, given the fact that suicidality is a symptom of mental illness and given the fact that 90% of persons who commit suicide suffer from a diagnosable mental disorder. I think that all underscores the fact that this is not acceptable.
Expanding MAID for mental illness is not an appropriate treatment. It is not an appropriate solution for mental illness. What the government should be doing, instead of offering the mentally ill death, is offering the mentally ill hope, support and the care they deserve.
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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.
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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.
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Mr. Speaker, I would like to inform the House that I will be sharing my time with the member for Thunder Bay—Rainy River.
I am pleased to rise today to speak to the government's proposed Bill C-39, which seeks to extend the exclusion clause for those requesting MAID and whose sole underlying medical condition is mental illness.
I would like to take a few moments to draw our attention to the MAID monitoring regime and what we know about MAID cases to this point.
Canadians hold personal and very strong views on medical assistance in dying. They deserve accurate and reliable information to inform their decisions and their opinions. This is why we are working to ensure that our public communications are clear and comprehensive through our annual reports.
We know that a lack of accessible information opens the door to misinformation about evolving MAID systems. To be clear, while the proposed legislation would not impact the monitoring regime directly, a year's delay could bring the added benefit of more time to collect and the ability to report on important data regarding those complex cases where death is not reasonably foreseeable.
Putting this into perspective and context, our government acknowledges the importance of the data and reporting in relation to MAID, so much so that the original 2016 legislation obligated the minister of health to collect the necessary information and report annually on MAID activity.
This formal monitoring system is important to informing our understanding in three ways: who applies for MAID in Canada, medical conditions prompting requests and trends in MAID cases since the 2016 legislation.
As such, we have been working in collaboration with provinces and territories, as well as other health care partners, to ensure a robust monitoring system. It is important to understand that this is a significant, collaborative commitment.
Let us begin with a glimpse into what we know right now. As of December 31, 2021, there had been a total of 31,664 MAID deaths in Canada. This is the total number of MAID deaths since the law permitting medical assistance in dying passed in 2016.
MAID deaths represent 3.3% of all deaths in Canada as of 2021. This is very much in line with jurisdictions that have MAID regimes similar to Canada's.
The proportion of all deaths attributed to MAID varies across the country, with the highest rates reported in Quebec and British Columbia, and lower rates in the remaining provinces and territories.
Conditions include multiple comorbidities, cardiovascular disease, organ failure and respiratory illnesses.
Although the current sample is small, 2021 data also shows that, where death was not reasonably foreseeable, 50% of individuals were approved for MAID, compared to 81% of cases where death was foreseeable.
Each MAID request where the person's natural death is not reasonably foreseeable is complex and unique, and early indicators show that approvals for MAID in this stream are much lower than when the person's death is reasonably foreseeable, 50% versus 81%.
The assessment process for a person whose natural death is not reasonably foreseeable is often much more challenging due to the nature and complexity associated with medical conditions of this population. These assessments require detailed clinical analysis of each one of the elements of the eligibility criteria, which define a grievous and irremediable medical condition.
Let us spend a little bit of time talking about the human aspect of this data collection.
We should acknowledge that behind every data element in our annual report is, indeed, a human story. Implicated in each case is a group of people, their families, MAID assessors and providers, health care teams, and most importantly, the person making the request for MAID. The data we collect comes from thoughtful and compassionate conversations involving people who are making the most important decision of their lives and the MAID practitioners. The practitioners are responsible for assessing the requester in accordance with the person's wishes and the law. Through these discussions and the recording of information arising from them, we have a robust monitoring and reporting system for MAID in Canada.
MAID practitioners must ensure that every requester is aware of the services available that might relieve their suffering. This includes exploring treatment options, facilitating referrals and following up on the outcomes. When faced with a MAID request where death is not reasonably foreseeable, assessors spend much more time gathering the necessary information about the person and their condition. The process often involves a review of many years of treatments, surgeries and/or medications, as well as consultation with one or more experts in order to exercise due diligence in making a decision regarding eligibility.
New regulations for the monitoring of medical assistance in dying came into force on January 1 of this year. The MAID monitoring system will report on an expanded set of MAID data points that are collected according to these new regulations. The additional information should provide a greater understanding of persons applying for MAID whose natural deaths are not reasonably foreseeable, as well as their associated circumstances.
In conclusion, we are committed to transparency and accountability across all levels of government to ensure public confidence in the MAID regime. We are honouring this commitment by providing Canadians with accurate and reliable information on MAID as it continues to evolve in this country.
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Madam Speaker, I was very surprised listening to my colleague talking about the numbers they have. In 2016 there were 1,200 cases of MAID. That doubled in 2017 and doubled again in 2018. It was over 10,000 in 2021. That is nearly 30 people dying in this country every single day. That is more than double all the deaths from breast cancer or all the suicides in this country. We were promised a process to make sure we were not implementing a regime that was doing this without really strong checks and balances.
I find it staggering that the member could say this thing is working when we see such massive increases, much higher than in Europe or anywhere else, in medically assisted death in this country.
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Madam Speaker, let me clarify and reiterate what I said in my intervention. I talked about the total number of MAID-related deaths in 2021 being 10,950, of which 2% related to MAID for individuals whose deaths were not reasonably foreseeable. The numbers the member is quoting might be accurate, but that was not the point I was trying to make. As I also indicated, the total was nearly 30,000 since 2016, when the legislation came into force.
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Madam Speaker, first of all, I do not think that MAID has been abused, especially as it relates to mental health. As I intervened, I lost my father to cancer back in 2016. At that time I wished the MAID option were available to us. Having said that, we have felt in our government that the base of 219 cases is not representative enough of the data that we want. We want to ensure that the safeguards we should have are in place and strengthened. This is the fundamental reason that we are extending the timeline by a year and introducing this bill. If this bill is to protect those individuals who are dealing with mental illness, then they need all the supports to be able to make that decision.
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Madam Speaker, I support this legislation putting a one-year hold on allowing MAID for mental illness.
We need to hold off on this until we have a broader consensus as to if and how we are going to do this. We need more safeguards in place. If we are going to do this, we need to make sure that we do it right. I do not think that we ought to have an automatic start date in one year as is planned.
To be clear, yes, I support this legislation in that MAID for mental illness will not be allowed beginning in March. However, from my perspective, we ought to make this hold indefinite. I know there are a lot of people out there who are really worried about this legislation because they have loved ones who are going through a hard time and they think, probably rightly, that some of those people will want to access MAID.
There are parents, siblings, partners, spouses and friends who are worried. Parents touch my heart the most because they are worried that the lives of their children could be affected. I can certainly sympathize with this because I have six children of my own. One does not have to be a parent to realize that almost everyone goes through a difficult time at some point in their life, hence our concern.
I know there are also a lot of psychiatrists out there who are really worried about this. There are psychiatrists who know that if their patients were to have more treatment, they would probably get better, but they are requesting MAID at this time.
Both these groups have legitimate concerns about this legislation. At the moment, I do not think the safeguards are in place, and if implemented now, the law would end up affecting a lot of people in a way that was not intended.
What is the intention of the law? I would submit that the intention of MAID for mental illness is that it should only apply to a very small group of hard-core cases. This seems to be the case in Holland, where only one in a thousand people, I am told, who apply for MAID for mental illness are actually granted it.
It is not intended for a 25-year-old who was abused as a child and has had intermittent depression ever since. It is not intended for the 30-something-year-old who remains depressed a couple years after the breakup of a marriage. It is not intended for somebody who is schizophrenic and is fine on their medication, but having stopped their medication, now wants to access MAID.
Some out there may say, “Why not? It should be the individual's choice”. As a teenager, I read Jean-Paul Sartre, and at the time, I agreed with him that the ultimate choice in life is being over nothingness. Perhaps I still agree with this. However, neither suicide nor attempted suicide is illegal in Canada. The question today is what role, if any, the state has in assisting suicide.
I worked a lot of years as an emergency room doctor, and I saw many people who were suicidal. My job was to assess whether people were suicidal, and if they were, to bring them into the hospital even if it was against their will. The law gave me the power to do so.
Many people would ask what right I have to tell someone what to do with their body and say that it should be their own choice. My response to them is that I think there are two legitimate reasons for the state intervening to prevent suicide.
One is in order to protect people from themselves. When someone is in the depths of depression, they do not see a light at the end of the tunnel. They cannot contemplate the possibility, let alone the probability, that they are going to get better. That is the nature of depression. That is what makes someone suicidal. Most of us know that, eventually, with a change of circumstances and enough time, people actually do get better.
The other legitimate reason for the state to interfere is to protect loved ones. A person who commits suicide is dead; they feel no pain. However, the loved ones continue to live the rest of their lives with the anguish of losing someone, often haunted by feelings that perhaps it was because of something they did or did not do.
The suicidal individual's inability to appreciate the possibility that they might get better should certainly make us reluctant to allow MAID for people with mental illnesses. Some people would ask whether there are people who really will not get better and who are irremediable. That is the requirement of law: The illness has to be irremediable.
The problem with that is that doctors are not really good at determining who is irremediable. Doctors do not have a crystal ball that can predict the future. In fact, studies show that doctors are not good at determining who is irremediable.
A recently published study by Nicolini et al. looked at clinicians' ability to determine irremediability for treatment-resistant depression. It reviewed 14 different studies. I will cite its conclusion: “Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard for irremediability cannot be met”. Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of MAID assessments.
As a long-time doctor, I find it absolutely mind-boggling that there are practitioners out there who are willing to administer MAID to someone knowing that perhaps with a bit of extra time the person would have gotten better. Good doctors worry about making mistakes. Good doctors do not want to kill off their patients. It seems to me that if there is even one person who is administered MAID and who, if they had not been given MAID, would have gone on to a happy life, that is a horrific tragedy. I would say it is something akin to capital punishment when it turns out the person was actually not guilty of the crime. If this happens, it is certainly on the conscience of every one of us in this place.
The number of people we can confidently say are irremediable is probably small. Some would say no, but I would offer a few comments. One is that anyone under 40 should never be considered irremediable, and in fact anyone under 60, unless they have had ongoing years of illness. I would also suggest that somebody who has not tried every kind of treatment and has not seen a lot of doctors and therapists should not be considered irremediable. Who is left? Perhaps if there is some 75-year-old who has no family and who has undergone many years of illnesses, tried every sort of treatment available and seen numerous doctors and no one can help, then maybe, and I emphasize the “maybe”, they should be considered for this.
Do I believe that the law, as implemented now, would really be confined to that small number of cases? No, absolutely not. Like a lot of members, I have been paying attention to the media and have heard of the many cases where we are just left shaking our heads that somebody would allow MAID for that. The reality is that there are a lot of practitioners out there with a very liberal approach to allowing medical assistance in dying, who seem to be willing to base it on perhaps just a phone call, practitioners who do not think it is necessary to talk to the family, to get to know the patient, or to consult someone who knows the patient.
Some people will say that the decision about standards of care and safeguards should be left to the colleges of physicians and surgeons. As a 35-year member of the College of Physicians and Surgeons of Ontario, I totally disagree with that. This is not the kind of decision that is normally left to the colleges, nor should it be; this is the kind of decision that should be left to the elected representatives, who in turn are accountable to the people.
In summary, if we are going to allow medical assistance in dying for mental illness, it should be to an exceedingly limited number of people. If we were to implement the law as it is now, I think a lot of people would be getting it whom the law was not really intended for, nor do I think we are that close, so I think there should be no fixed date on which this law comes into effect. When are we going to know we are ready to do this? I would suggest it would be when there is some consensus from the psychiatric community. From all the surveys I have seen, the majority of psychiatrists are against this, which is certainly one indicator.
We need to take however much time is necessary to do this right. This is not like other decisions made by the House of Commons. If we mistakenly take a life, all of the politicians in this room, all of the bureaucrats in Ottawa and all of the Supreme Court justices cannot bring that life back.
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Madam Speaker, I think it would be better for my colleague to choose his words more carefully.
Unless I am mistaken, last week we heard him say in an interview that there was no agreement on the issue of MAID for those with a mental illness. My colleague also went to the trouble of stating that one in two experts did not agree.
I will close by citing the panel he spoke about.
The evolution of many mental disorders, like some other chronic conditions, is difficult to predict for a given individual. There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.
I will stop there.
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Madam Speaker, I rise today to speak to Bill C-39, an act to amend the Criminal Code with regard to medical assistance in dying. It is a bill I will be supporting to protect the most vulnerable Canadians from the Liberal government's reckless expansion of medical assistance in dying to Canadians who are suffering solely from a mental illness.
Unbelievably, if Bill C-39 does not pass, Canadians struggling with a mental disorder or illness will be able to access MAID as early as next month. As the Canadian Association for Suicide Prevention said, “Just as life is getting harder in Canada, it is getting easier to die.”
It is important to be perfectly clear that when considering MAID in the context of someone who is not dying as a result of their condition, such as a mental disorder alone, we are talking about suicide. It is almost as if the Liberals have given up. Instead of protecting the most vulnerable in society, they have opted for the easy way out. They have chosen a dangerous path, a slippery slope. They have opened medical assistance in dying to the most vulnerable in our society, and now they want to stop the clock, buy more time and find another politically expedient reprieve without doing anything to help.
I listened intently to the debate today, and honestly, it almost makes me ashamed to be a politician. Earlier today, the minister said that we need more time. Yes, we do. I have said this since the very first debate we had on MAID in 2016. During my intervention back then, I said as a new member of Parliament that nothing prepares one to adequately debate or intervene on such a weighty issue. We need to ensure we get this right, yet the Liberals rushed it through.
We have all heard very real stories: an Ontario man requesting MAID because it was more preferable than being homeless, the woman who has applied for MAID after seven years of not finding affordable housing and Canadians accessing food banks and asking for help with MAID. More and more Canadians are struggling, and we should be doing everything to support them, not giving up on them. We have also heard the unbelievable stories of Veterans Affairs employees suggesting MAID to veterans who are struggling with post-traumatic stress disorder. These are real stories; they are not sensationalism.
As the Canadian Mental Health Association has said, “Canada is failing to meet its human rights obligations when [Canadians] with a mental illness cannot receive the programs, supports and resources they need to be well and live with dignity.” The government is failing to provide even the most basic programs and supports.
This is a topic that my constituents feel very strongly about. It is a divisive topic, to say the least, and I respect people's decisions, but one thing is clear: A majority of my constituents, and indeed Canadians all across our beautiful country, are against the expansion of MAID for Canadians solely dealing with mental illness or disorders.
Canadians need to know what we are fighting for today. We need to look beyond what we are debating. The simplicity of Bill C-39 is a contradiction to the complexity of the issue. What we are really talking about is the ability for those suffering with mental illness to end their lives. Instead, we should be here today talking about what we can do to help those in need and what we can do to provide the services that will save lives.
Earlier today and throughout the debate, the Liberals have tried to explain away the provisions that included mental illness in MAID. They have attempted to shift the focus from what is actually happening to what is politically expedient, with the exception of our hon. colleague from Thunder Bay—Rainy River, whose speech I truly appreciated. Instead of addressing the issue head-on, they are looking for us as parliamentarians to buy more time to find a soft landing.
I will be voting in favour of Bill C-39, but I cannot support the addition of suicide to MAID ever. Let us be honest that this is exactly what we are talking about. There are times when partisan politics are called for and this not one of those times. We can disagree on tax hikes, we can disagree on gun legislation and we can disagree on who is best prepared to move our country forward. However, we cannot disagree on the importance of life and the importance of fighting for those who are struggling and who believe their only way out of the hardship they are experiencing is death. Is that not what we are here for? Is that not what all of us, all 338 members of Parliament, ran on? Was it not to stand up for those who are struggling, Canadians from coast to coast?
We need to be doing everything we can to make sure we are helping those who are struggling and who are the most vulnerable. We should be focused on offering help and treatment rather than assisted death.
Just two short years ago, all members of the House stood and voted in favour of creating an easy to remember three-digit suicide prevention hotline. It has been a long road forward, but this fall, Canadians who find themselves in trouble will have a chance to get the help they need. When seconds matter, they will not be forced to google a 10-digit number. They will simply pick up their phone to dial or text 988, and they will be able to talk to a person to start the process to get help.
The 988 hotline will not be the end point. It will be the beginning. It will provide one more tool with which those who are suffering can reach out for help.
As many of my colleagues know, I have dedicated my life to fighting for those who suffer silently or struggle with mental illness. I have sat with so many families devastated by suicide whose only hope is that we do everything in the House to ensure other families never experience what their families have. There is so much pain and so much guilt. Through my work, I have met many who have struggled with mental illness or mental injury due to their service.
I think about my friends. Jason is a giant of a man who was a firefighter. He was gripped with PTSD and wanted to die by suicide, but instead, he chose life. Now he helps others on their journey to beat PTSD and OSI. My friend Kent continues to serve our community each and every day. I think about their families every day and how I am so thankful my friends chose life.
I think about my own life and how at one point, I was struggling. It was one intervention, one by chance intervention that made me chose life. When someone is struggling with a mental injury, it is sometimes tough to see the forest through the trees. Sometimes people cannot see the light through the darkness. Sometimes people just need someone to tell them they are fighting for them and to help them get the assistance they need.
I live every day to fight for those who are struggling. We need to be doing everything we possibly can to make lives easier for Canadians, to give hope when it seems there is none. We need the government to be working with stakeholders to find the means to support those with mental illness. We have spent far too long talking about it. We have spent far too much time on studies that sit on shelves somewhere and gather dust. We have spent far too long doing nothing.
I will be supporting this legislation, but I will never support the inclusion of mental illness in MAID. It is a slippery slope. We need to take the next year or longer, find out how we can provide real support and figure out where we can actually make a difference. We need to spend the next year at least working on solutions that will keep Canadians alive.
A few weeks ago, I had a meeting with a man whose young daughter had ended her life by suicide. We spoke over Zoom for almost an hour, and I listened to his story. I heard the grief. I heard the despair, and I heard the regret.
Those who have children know what I am talking about. We live our lives to make our children’s lives better. We want the world for them. We want to give our kids everything we never had. We want this place to be better for them, and we want them to know we care.
What I heard in that man’s voice was utterly devastating. It was heart-wrenching. He said to me, “Todd, I can live with the death of my daughter, but thinking of what she had to go through, how many hoops she had to jump through just to access help, and how she had to navigate her crisis all alone is unbearable.” He said that he can live with the death of his daughter.
I honestly do not know how someone can listen to those words and think that what we are doing here is totally acceptable. I do not mean the year-long reprieve the government wants us to support. I mean the fact that we are even at this point, having this discussion. Until we have provided every support, exhausted every means, done everything we possibly can to help someone through their pain and suffering, my God, how can we even be here talking about this? The impact of that meeting will live on with me forever: the pain in his voice, the hurt, and the image of his daughter reaching out for help that was not available.
Conservatives do not believe that medical assistance in death is an acceptable solution to mental illness and psychological suffering. Our health care system should help people find the hope that they need to live, not assist in their deaths.
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Madam Speaker, I have been sitting on the special MAID committee with the member for some time, and I appreciate his contribution.
I take issue when he said that the conversations have been heated and personal. I do not remember it being that way. There were passionate discussions, but it was certainly never personal. I hope he did not find that I ever contributed to that impression.
We can disagree all day long on whether the government has been making mental health funding a priority. He has made a point of talking about the mental health transfer. If the mental health transfer had happened yesterday, is there any scenario in which the member would agree that mental health is appropriate grounds for MAID, or is it just full stop for him?
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Madam Speaker, I do not recall my hon. colleague making anything personal in the MAID committee, so I am thankful for that.
There is one thing that is very important. We can talk about scenarios, what-ifs, therefores and plausibility, but let us be clear. What we know is that the Liberal government committed $4.5 billion to fund the Canada mental health transfer, and it sent none of it, zero, zilch, nada.
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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?
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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, I thank the member for sharing the experience of his cousin. That took a lot of courage to do and I appreciate that.
The underlying concern that I have here is this. I know that this member and most Conservative members have been against any form of MAID legislation. They have voted against it every step of the way. I heard the member, a few seconds ago, talk about turning back the legislation on MAID if there is an election. Is he referring to just what we are talking about now, in terms of the mental health aspect of it, or is he talking about MAID in its entirety? It was something that was created out of a ruling of the Supreme Court.
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