44th Parl. 1st Sess.
February 13, 2023 11:00AM
moved that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.
He said: Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.
An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.
My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.
In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.
The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.
In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.
Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.
Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.
Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.
The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.
In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.
The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.
I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.
This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.
As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.
That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.
As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.
In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.
This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.
The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.
These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.
I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.
I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.
I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.
I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.
The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.
Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.
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Mr. Speaker, I 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.
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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 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?
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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.
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Madam Speaker, it is always a pleasure to rise in the House. Of course, speaking on issues as weighty as medical assistance in dying, these are perhaps some of the most difficult things we will speak of in the House. I note that this is going to be an issue I am sure we will face in the chamber over the next several months, and perhaps again, as the bill comes to pass.
Today we are talking about mental disorder as the sole underlying medical condition for Canadians to access medical assistance in dying. The bill is presenting legislation for a one-year delay. Why is the government asking for a one-year delay? Certainly, this is about the concerns Canadians have across this great country with respect to the presentation of the government.
Perhaps, it will be similar to Bill C-21, when the issues Canadians had were brought forward by the Conservatives, and the Liberals had to change position on that bill. We know that there are mental health advocates who have significant concerns about the bill, such as the Association of Chairs of Psychiatry, which brought forth issues related to mental disorder as the sole underlying medical condition.
One of the things that is germane is to help people understand what it is we were studying at the joint committee on medical assistance in dying. We were talking about mature minors. We were talking about advance requests. We were talking about Canadians with disabilities. We were talking about the state of palliative care in Canada, and we were talking about Canadians who suffer with a mental disorder. When we looked at these particular topics, there were many contentious issues, and it became heated and personal at times, which was perhaps as it should be.
For comparison, I think we need to understand that, when we look at Canada and its perhaps 38 million people, we know that in the last year, 10,000 people died from medical assistance in dying. In California, which has a very similar population and perhaps similar rules, there were only 400 deaths due to medical assistance in dying.
People might ask why we would not compare with the Netherlands. It has been at this for a while, and maybe it is a better representation. They have a population of 17 million people and about 5,000 people died to medical assistance in dying.
They already have statutes that include depression, dementia and all the other things I have mentioned previously, so if we wanted to compare that directly to Canada, including depression and perhaps advance requests, they would have about 10,000 deaths at the current time. We know that in Canada, without mental disorder and without advance requests, there are already 10,000 people who have died between 2020 and 2021 due to MAID. That is a year over year increase of 32%.
That, to me, is concerning, and I think that anybody in this chamber would also know that on the world stage, sadly, in my mind anyway, Canada has been a world leader in medical assistance in dying, and many countries around the world have brought forward concerns of the slippery slope that Canada is now going down.
One of the things the government has promised to Canadians, which they have not delivered upon, is the Canada mental health transfer, and I am sure that my hon. colleague just before me spoke about this, so I am sad to have missed it. That was a $4.5 billion transfer that was promised by the government in its platform in the last election. I read a new article about this, and it says, “in August 2021, Prime Minister Justin Trudeau said this brand new transfer was needed”—
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Madam Speaker, it is important to outline what we are talking about here today: Bill C-39. Currently, due to Bill C-7, the Criminal Code explicitly states that, when it comes to MAID, mental illness is not to be considered an illness, disease or disability. However, when Liberals passed Bill C-7 two years ago, it had a sunset clause, and this is an important clarification. That means an important guardrail protecting those with mental illness from being eligible to seek MAID during times of depression or other crisis would expire two years after that bill passed, which means it is set to expire next month.
Now the Liberals, having heard the outcry from across the country, from the medical community and those serving the folks with mental illness, have introduced Bill C-39. This is a last-minute attempt to save face by extending the prohibition on MAID for mental illness for one more year. That is not good enough.
Conservatives have been united in our opposition to expanding the Liberal government’s medical assistance in dying regime to Canadians with the sole underlying condition of mental illness. We do not believe that medical assistance in dying is an acceptable solution to mental illness and psychological suffering. Our health care system should help people find hope when they need to live and not assist in their deaths.
Allowing MAID for people with mental illnesses such as depression blurs the line between suicide assistance and suicide prevention. Experts have been clear that expanding eligibility for medical assistance in dying to Canadians living with mental illness cannot be done safely. It is impossible to determine the irremediability of an individual case of mental illness.
For example, Dr. Sonu Gaind, who is the physician chair of the MAID team at the Humber River Hospital in Toronto, where he is chief of psychiatry, states, “I know that some assessors think they can make those predictions of irremediability in mental illness, and some assessors think they can separate what we consider traditional suicidality from what’s fuelling psychiatric MAID requests. And on both counts they’re wrong. The evidence shows that.”
Andrew Lawton, Canadian columnist and journalist, wrote a harrowing personal article two years ago, stating:
If Bill C-7 were the law of the land a decade ago, I’d probably be dead....
In 2010, I nearly succeeded in committing suicide. My battle with depression was worsening, and I was losing. Miraculously, I pulled through: I count my lack of success in that attempt as my happiest failure, for which I’m grateful to God’s intervention and a team of dedicated healthcare practitioners.
It’s saddening to think that under different circumstances, these practitioners could have been the ones killing me rather than saving me....
Bill C-7 undermines years of attention and billions of dollars of funding to bolster mental illness treatments and supports, including, ironically, suicide prevention and awareness campaigns and programs.
This bill kills hope and reinforces the flawed belief afflicting those with mental illness, that life is not worth living and that one’s circumstances cannot improve.
Every time I have risen to speak on these bills, that has been my emphasis as well: Life is worth living. Every life has dignity and value. We need to be far better as a nation at communicating that to those who need to hear it the most.
Two years ago my friend Lia shared her story with Canadians. She said, “I was 15 when I first tried to kill myself and I attempted suicide seven times in the years that followed...I’m speaking about my mental health struggles because I’m scared that doctors could soon be able to end the lives of people suffering with mental illness - people like me. To be honest, if medically assisted suicide had been available when I was in university, I would have used it to end my suffering as soon as I could.”
This is Lia's call to parliamentarians: “I don’t need someone to tell me how to die, I need someone to tell me to stay.”
The House should be writing laws that instill the value of life and that there is no question this is what we value. Laws need to encourage people to stay rather than seek to end their lives.
Dr. John Maher is an Ontario psychiatrist and editor-in-chief of the Journal of Ethics in Mental Health. Dr. Maher has highlighted that the wait times for mental health treatment in Ontario programs are up to five years long, and that one of his patients recently told him that he would like assisted suicide because he believed that nobody loved him.
Dr. Maher also rejects assisted suicide as a solution for mental illness by stating the following:
You're assisting someone in the completion of their suicide. The doctor is the sanitized gun...I'm not at all disagreeing that there are people who have an irremediable illness. What I defy you or any other person in the universe to prove to me is that it's this person in front of you.
The suicide prevention community has also pointed out the harsh reality for costs. Shawn Krausert, the executive director of the Canadian Association for Suicide Prevention, testified at committee and said the following:
Ending the life of someone with complex mental health problems is simpler and likely much less expensive than offering outstanding ongoing care. This creates a perverse incentive for the health system to encourage the use of MAID at the expense of providing adequate resources to patients, and that outcome is unacceptable.
Most Canadians do not support expanding MAID to those with mental illness as the only underlying condition. Today, a survey was published in which a mere 30% of Canadians support MAID for those who have a mental illness.
I can assure members that, among my constituents, that number is far lower. The vast majority of my constituents want the federal government to focus on helping people live well and to invest in palliative care and suicide prevention instead of assisted suicide.
Some of the petitions I have tabled here over the years were sent to me by constituents who have recognized that suicide is the leading cause of death for Canadians between the ages of 10 and 19. They are specifically calling on the government to protect Canadians struggling with mental illness by facilitating treatment and recovery, not death.
I agree with my constituents, and the majority of Canadians, that the government should withdraw this bill entirely and table a bill that permanently removes the extension and expansion of assisted suicide for mental illness when it is an underlying condition.
I want to end with some words from my friend Lia. She says:
I want to say right now, to whoever might need to hear this: death doesn’t have to be the answer. It takes work. It takes time. It takes others. And it's complicated. But there is hope...I’m sharing my story because I’m not the only one who has more to live for. There are people in your life who do too. As someone who struggles with mental illness, I don’t need someone to tell me how to die. I need someone to tell me to stay.
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Madam Speaker, my colleague from Tobique—Mactaquac gave a very heartfelt speech. He has followed this closely.
If all of us in this House remember, when this bill was originally put forward, it was supposed to be very narrowly cast. One of the trade-offs was that the government was going to be putting in supports for palliative care for mental health. Sadly, we have not seen those investments. Even the original justice minister, Jody Wilson-Raybould, was not in support of extending this to people with mental illness.
The member mentioned at the beginning of his speech that sometimes countries have to make a decision on how they want to be perceived in their heart and soul. Why is it so important right now that we make a stand to not continue down this slippery slope? Canadians are going through a horrible time and need that support.
What does he recommend at this time in history?
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Madam Speaker, we have been here before, with the Liberals scrambling to meet a deadline, unable to get their act together. In this case, though, perhaps the delay will provide us with the opportunity to get things right, or at least, that is my hope.
The question that we need to ask here is not whether there should be a delay in when medical assistance in dying is extended to the mentally ill, but whether such an expansion is a wise move at all.
Seven years ago, I stood in the House and predicted that we would be here today. On May 5, 2016, I said:
It does not take much talent to predict that in the aftermath of this legislation there will be confusion.
However, if killing patients becomes an option, for whatever supposedly good reason, how long will it be before that reason becomes more flexible than rigid? What about those with no family who are a drain on hospital resources? Would it not be in the financial best interests of society to end their lives?
How are we going to prevent families from pressuring their aged ones, urging them to request death so that the next generation of the family will be financially better off? There are so many issues that are still unresolved. We are acting in haste, and it seems to be almost guaranteed that we will get it wrong....
We might not be discussing this issue if we were doing a better job as a nation in assisting those approaching the end of their natural life. Where is the commitment of the government to increase funding for palliative care, which was an election promise unfulfilled in budget 2016?
I did not, at that time, address the issue of so-called assistance in dying for those who are mentally ill. I confess that, at that time, it never occurred to me that such an idea would be considered.
We were talking about those whose deaths were not only foreseen but imminent. The idea of hastening natural death was put forward as something compassionate, to ease the pain of those suffering from terminal illness.
How quickly times have changed. What was once unthinkable is now being promoted as normal, which may explain why, in October of last year, a representative of the Quebec college of physicians suggested that MAID be extended to infants under the age of one with serious health conditions. These children are obviously too young to make such a decision themselves.
It was somewhat reassuring to hear the Minister of Employment, Workforce Development and Disability Inclusion say that she was shocked by the suggestion and found it unacceptable. It was less reassuring when the minister also said that she could not speak on behalf of the entire government on the issue, which means that I would not be surprised if, in the not-so-distant future, we are being asked to make yet another extension to the circumstances in which MAID is available.
According to the Centre for Addiction and Mental Health, Canada's largest mental health teaching hospital and one of the world's leading research centres in the mental health field, in any given year, one in five Canadians experience a mental illness. That, to put it mildly, is a significant number. Furthermore, by the time Canadians reach 40 years of age, one in two, which is half the population, have or have had a mental illness.
We need to recognize what that means for our country. Mental illness is a serious problem, but addressing it by making assisted suicide an option is not the way to proceed.
Speaking to the CBC, the minister of disability said that she frequently hears that some people with disabilities are seeking assisted death because they cannot find adequate housing or sufficient care, that they are choosing death because of a lack of social supports.
Is that not also the case for those suffering from mental illness? The Centre for Addiction and Mental Health tells us that about 4,000 Canadians commit suicide each year, an average of almost 11 a day, people of all ages and backgrounds. Those numbers are sobering.
In Ontario, 4% of adults and 14% of high school students report having seriously contemplated suicide in the past year. More than 75% of suicides involve men, but women attempt suicide three to four times more often. More than half of suicides involve people aged 45 or older.
In Alberta, each year, according to the University of Alberta, one in six people will seriously think about suicide. There are an average of 2,400 hospital stays and more than 6,000 emergency room visits annually for self-inflicted injuries, the result of suicide attempts. More than 500 Albertans will die by suicide each year. According to Alberta Health Services, in 2018, 7,254 Albertans visited the emergency department for suicide attempts. Three out of four suicide deaths are male, about 50% being middle-aged men aged 40 to 64.
After accidents, suicide is the second leading cause of death for people aged 15 to 24. Indigenous people, especially youth, die by suicide at rates much higher than non-indigenous people. First nations youth aged 15 to 24 die by suicide about six times more often than non-indigenous youth. Suicide rates for Inuit youth are about 24 times the national average. This is a national tragedy.
Experts tell us that mental and physical health are linked, which means that people with long-term physical health conditions such as chronic pain are much more likely to also experience mood disorders. In the same way, people suffering from mood disorders are at much higher risk of developing a long-term medical condition.
What does it say about Canada as a society and Canadians as people that our response to mental illness is now going to be focusing on killing people rather than appropriate medical treatment? If we were doing a better job of supporting those who are mentally ill, we might not be having this discussion today.
Many of those suffering from mental illness in its various forms will tell us that there are good days and bad days. On the bad days, when the dark cloud descends and it feels like it will never lift, death seems a pleasant option, but for most people, it does lift. As I said earlier, about half the population will experience some form of mental illness at some point in their lives. For most, it is something they can overcome.
Making suicide easier by calling it “medical assistance in dying” will, I am certain, mean that people with treatable mental illness will choose death. Some may do so because they are having a low period and do not see any hope for the future. For others, it may be a lack of medical and social support to help them deal with their illness.
Mental illness in Canada is estimated to cost about $50 billion annually when we include health care costs, loss of productivity and a reduction in health-related quality of life. That cost could be reduced if we were to invest more in mental health promotion and illness prevention programs, more support for early intervention aimed at children and families, and more emphasis on treatment for depression and anxiety disorders.
We need to pass this legislation, because there is a deadline approaching. Even more, though, we need to look at how we support those who are suffering from mental illness. Killing them should not be an option.
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Madam Speaker, the member's question speaks to the spirit of my speech and what I was trying to address here, the last-minute actions and the non-action on the government side when it comes to addressing even election promises. It has been dragging for the last eight years, and there is no action happening to support the palliative care promise the government also made.
We are on the same page here, to call for a stop in dealing with last-minute legislation that comes in and does nothing but delay. It is toxic. This is a poison that we could ask Canadians to take at some point, but it is not acceptable. It is our responsibility, on our shoulders, to address this and deal with it as we are representatives of the Canadian population.
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Mr. Speaker, I want to begin by thanking my colleague, the hon. member for Kitchener Centre, for such a thoughtful speech, one that anticipates much of what I want to say.
We have not done enough in the year since Bill C-7 passed to know with any degree of certainty that we have lived up to our obligations when passing that act to fully study what it would mean to extend medical assistance in dying to those who are dealing with deep suffering that comes from a mental health issue, not from a medical diagnosis of traditional medicines, such as ALS, cancer or the other cases that moved us forward on this trajectory.
I want to briefly canvass what brought us here and the way in which the Parliament of Canada and the Supreme Court of Canada have dealt with medical assistance in dying, and I want to suggest, in closing, that when one looks to the Supreme Court of Canada for guidance, I do not believe we can say that the Supreme Court of Canada's guidance takes us to the availability of MAID in cases of deep mental health distress.
Going way back, as the member of Parliament for Saanich—Gulf Islands, I want to reflect on one of the champions, heroes or, as one might even say, martyrs on the issue of access to medical assistance in dying. I speak of Sue Rodriguez. She lived in North Saanich, in the electoral district that I am honoured to represent. She had ALS. She famously said, “[W]hose body is this? Who owns my life?” She went all the way to the Supreme Court of Canada back in 1993 in an effort to get access to the alleviation of suffering from a disease that would kill her. This was not in doubt. However, the Supreme Court of Canada, in 1993, denied her request.
As others have mentioned in this place over the last couple of days of discussion, a colleague and friend of many of ours and a dear friend of mine, Svend Robinson, stayed with Sue Rodriguez when a doctor assisted her illegally, and she took her own life, with the doctor's assistance, in probably the first public case of medical assistance in dying in Canada.
The courts took a long time to change, and that decision in 1993 was not changed until 2015 in the Carter case. In the Carter case, the Supreme Court of Canada found, taking a different view, that the charter rights in section 7 to life, liberty and security of the person were violated by not allowing a person to make such a decision and to have access to medical assistance in dying. The Carter case changed things by putting squarely to the Parliament of Canada that it had to deal with this.
I will quote from the Carter case. The Supreme Court of Canada said, “competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering”. That was the basis for creating legal access to medical assistance in dying.
When Bill C-14 went through, I tried so hard to put forward amendments saying we have to allow advance directives. It was not right not to allow them for someone who knows they are terminally ill and are facing incredible suffering. It is their choice and they should be able to access medical assistance in dying with an advance directive. However, back when Bill C-14 went through, this was rejected. My amendments were rejected in the House as well. Similar amendments were then passed in the Senate, and we all recall it came back here without those amendments having been accepted.
Bill C-7 repaired that but opened the door to something entirely different. I do think it is entirely different to say that when people are suffering incredibly and intolerably due to a deep, chronic and unsolvable mental health condition, they should also have access to medical assistance in dying.
I will go back and say what the political promises were when we started down this road. I first want to address the medical conditions.
When Bill C-14 was first debated, a lot of members in this place were asking about palliative care: Would people choose medical assistance in dying if they had the option for palliative care? We heard many promises from the government benches that we would see increased funding for palliative care. That has not happened. That is one thing that concerns me greatly.
We have also heard, since we passed Bill C-7, that there would be more supports for mental health. That has not happened either.
What would we do if we were serious about making sure that every Canadian could exercise, fully, their rights, under section 7 of the charter, to life, liberty and security of the person?
At least, one would know that the health care system should be working well. I am pleased to see that the premiers accepted the federal offer today. I hope that the federal government will defend our public health care system with every ounce of its energy and make sure that the deals with the provinces are specific and tied to outcomes and results.
However, our health care system is in trouble. I was just talking to an incredible indigenous woman. I will not say her name; it was a private conversation. She is Cree. She lost a dear friend recently because that Cree dear friend could not get access to medical care in time to diagnose and treat her cancer. She leaves two small children behind.
The health care system in the country is not equal, any more than the litany of deeply racist and distressing conditions in which the system works against justice for indigenous peoples. We all know it. In the context of the health care system, how can we not know it?
In terms of mental health care supports, we know even more deeply that the suicide rates among youth in this country are a huge source of concern. We know that mental health issues have been worsened among our youth, through the pandemic, through isolation, through all kinds of things, through being preyed on by social media.
We know that our schools, universities and post-graduate programs are failing young people because they cannot get the mental health supports that they need when they need them. They need help to avoid addictions and to kick addictions. Our young people need so much help and we are failing them.
Opening up MAID is not a solution to solvable mental health care issues where we are just falling down on the job because we are not providing the mental health supports that we have promised over the years.
What would we do if we wanted to be serious about section 7 rights? We would bring in a guaranteed livable income, to ensure that no Canadian is living in poverty, poverty being the number one social determinant of ill health, in terms of physical health and mental health. We would address poverty and end it through guaranteed livable income.
We would do more, as I mentioned, for the end-of-life issues and access to palliative care. There is such a thing as having a good death. We do not like talking about death in our society. We are all supposed to be young and preferably sexy forever. Let us face it: people get old and it is a lovely experience. It is a good thing to be healthy in old age and enjoy it right up to the moment when whatever one thinks is going to happen to oneself happens: meet one's makers or feed the worms, whatever. A good death is a good thing.
Medical assistance in dying does give people that option of a good death, surrounded by family, feeling loved. I am very supportive of the work that we have done in Bill C-14 and half of what we did in Bill C-7, but where are the mental health supports?
Again, to the point that the hon. member for Timmins—James Bay made, I totally agree. I say yes to housing, to supports and to ending poverty.
However, I do think that we have to explore and open up. In the next year, let us get serious at looking at non-traditional therapies for people dealing with what appears to be irremediable depression. Do psychedelics make a difference? I am not going to prescribe. As the hon. member for Timmins—James Bay said, do not take health advice from politicians.
However, the evidence is coming in on using such products as psilocybin to actually trigger something that results not just in a bit less suffering and mental health conditions. There are certainly papers out there that are peer-reviewed and very interesting, that one can cure depression. I certainly would not want to turn my back on a potential cure and then embrace medical assistance in dying for people who could be cured.
Neither do I want to turn my back on people who are suffering and who are saying that we are making them wait another year and asking why we are doing that. These are not easy issues but these issues, life and death issues, are at the heart of the sacred and they are at the heart of our work in Parliament.
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Mr. Speaker, we have had a number of speakers make reference to the issue of mental health and this member, the leader of the Green Party, also referred to palliative care. The greatest contribution that Ottawa can do in regard to the areas of mental health, health in general, palliative care and hospice care is provide the financial resources and then use the Canada Health Act and raise the profile of the issue itself. We can put a checkmark on all three of those with respect to the last five or six years of this government. At the end of the day, we do need to see more working together with provinces and indigenous communities, in terms of continuously raising the profile of the issue to make sure the resources are being properly allocated.
When she reflects on the legislation and the special joint committee that is out there, is there something specific that the leader of the Green Party would filter out or like to see?
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Mr. Speaker, I want to thank my colleague for talking about some opportunities and she also cited broken promises when it came to palliative care. As members know, I was here last Monday and the Monday before and would have been here tonight on Adjournment Proceedings, to drag the government here to talk about mental health, but it was disrupted so I am back.
I asked the minister about mental health just last week. She cited:
Through the proposed bilateral agreements on the shared health priorities, we are working with the provinces and territories to integrate mental health and substance use as a full and equal part of our universal health care system.
However, when it comes to the reality on the ground, the Liberals have still not delivered on their promised mental health transfer of $4.5 billion. Even the agreements that they signed with the provinces today do not assure that.
Does my colleague agree that we need, enshrined in the legislation, parity between mental and physical health to have a proper conversation in this House about expanding medical assistance in dying for those whose sole identified underlying medical condition is a mental illness?
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Mr. Speaker, I rise with great pride and emotion to take part once again in the debate on medical assistance in dying.
I have had the privilege of being a member of Parliament for nearly eight years now. I was also a member of the Quebec National Assembly from 2008 to 2015. I, along with my colleague from Bourassa, am one of the few here who have participated in the debate on medical assistance in dying as a member both at the provincial level and the federal level. I can say in all modesty that this gives me a very unique perspective. I will expand on this in a moment.
If there is one issue that calls for political partisanship to be put aside, it is medical assistance in dying. I have a fundamental belief that has not altered one bit in the time I have been involved in these debates: There is no right or wrong position, there is only the position that each person, as a human being, is comfortable with.
When we hear an opposing viewpoint, we should listen and respect it, not attack it in a partisan way. I will always remember something that happened in June 2014 in the National Assembly. A Liberal MNA at the time, Saul Polo, was sharing his views in the debate on medical assistance in dying. He was vehemently opposed to it, to an extent that is hard to imagine. I remember it very well, because I was sitting along a line in the National Assembly that was perpendicular to where he was. His face was flushed with passion and his fist was clenched, and he was saying that we should not touch this subject. When he finished his remarks, I stood up and applauded him, not because I agreed with him, but because I was celebrating the fact that in that legislature we could have completely divergent, but respected and respectful views.
That is the approach we should be taking when dealing with an issue as personal, sensitive and human as medical assistance in dying. We can trade jabs back and forth all day long, and let us just say that I do pretty well when it comes to attacking my opponent. There may be 1,000 good reasons to attack one's opponent, but please, we must not use MAID to attack one another. We must respect opposite views.
We have come together today because the government has decided to set aside its goal to allow access to medical assistance in dying for people with mental illness. It is the right thing to do. While I personally support a well-regulated MAID regime combined with extensive palliative care, the issue of medical assistance in dying for people with mental illness is extremely sensitive, so these kinds of measures must not be rushed through.
The government had intended to expand access to MAID as soon as possible, that is, in just a few days, to include people struggling with mental illness. It has since decided to take a pause. I cannot call it a step back, because the government still plans to go ahead with this, but in a year from now. This is not the right way to go, and I will explain why.
Any number of personal reasons may be in play when people decide where they stand. I imagine we all know one person who has experienced serious mental health issues and hit rock bottom, never to recover—or so those around them believed. We all also know people who have bounced back from terrible trials that dragged them into a downward spiral, an abyss of profound sadness. With time, they managed to adapt to their reality, gradually build themselves back up and regain the sense of self-worth we all need.
That is why, as I see it right now, medical assistance in dying cannot be for people tumbling in the darkness. I have found the Quebec experience to be helpful in pondering this issue. To be clear, I am not saying that Quebec is better than anyone else. That is not it at all, but the fact is, there has been more legislative work and more studies on medical assistance in dying in Quebec than anywhere else. In Quebec, we have been talking about it for 15 years. I know what I am talking about because I participated in the debates in the National Assembly and in the House of Commons.
Here is a statistic that members might find surprising. More people are dying with medical assistance in Quebec than anywhere else in the world. The statistics published in Le Devoir in January show that 5.1% of the deaths in the province were medically assisted.
That is more than in the Netherlands and Belgium, which have rates of 4.8% and 2.3%, respectively.
Should we be proud of that situation? Should we be ashamed of it? No. It is just something that we should be aware of. It is not up to me to judge the fact that 5.3% of people in Quebec are currently choosing to have medical assistance in dying. That is just the reality. The figures do not lie.
The Quebec nation worked hard on this issue at the parliamentary level and, a few years ago, the government opened the door to studying the idea of whether medical assistance in dying should be made available to those suffering from mental illness.
After many weeks of thorough and rigorous work and hearing from as many as 3,000 people and hundreds of experts as part of a consultation process, the committee that examined the issue and the government in office decided not to move forward on medical assistance in dying for those suffering from mental illness. Why?
Here is what it says in the committee's report, and I quote:
We note, at the conclusion of our work, that there is no clear medical consensus on the incurability of mental disorders and the irreversible decline in capability that would be associated with them. There are differing positions among specialists. As legislators, it is difficult for us to comment on this issue.
The Liberal MNA David Birnbaum explained:
There is no clear consensus in the medical community on the incurability and irreversibility of mental disorders. Yet [these criteria] are part of the fundamental guidelines in the current legislation. Persistent doubts about the evaluation of these two criteria lead us to exercise [the greatest] caution.
That prompted the former Parti Québécois MNA for Joliette, Véronique Hivon, to say:
This decision proves that the goal is not to open up access more and more, to expand, but to open up the right amount of access to respect the individual while protecting the vulnerable.
That comes from Quebec, where 5.3% of the population chooses medical assistance in dying. This legislative measure came from Quebec. For 15 years, Quebec has been studying the issue of medical assistance in dying in an objective, neutral, non-partisan manner. I know what I am talking about, and so much the better.
The current government wanted to proceed hastily on this issue. No. I applaud and will vote in favour of this bill we are discussing this evening. It will allow us to take a lateral step to delay the Liberals' ambition. We will see where things stand in a year and whether they want to go further on this.
Everyone needs to understand one thing. By its very nature, medical assistance in dying is irreversible. Louise-Maude Rioux Soucy said it well in an editorial that appeared in Le Devoir on January 4:
MAID is offered as part of the continuum of care...There is an unwritten obligation attached to it: the quality and universality of palliative care must be beyond reproach in order to guarantee, at all times and in all circumstances, that medical assistance in dying is an exception.
I will now talk about a much more personal story. Last year, I was confronted with the reality of death. My mother, aged 97 years and 10 months, died in May, and my father, aged 99 years, four months and two days, died in December. As we can see, they died seven months apart and lived for a century. They were seriously ill at the end of their lives. In the winter of their lives, my mother and father fought to survive and death came for them.
MAID never came up because it was a non-issue. They were not interested. Our family was lucky. They got the most excellent palliative care available, and we are grateful. We were able to talk to them. Their children, grandchildren and even their great-grandchildren were able to talk to them. I wanted to share this because, at the hospital where my mother was, there was a section for people receiving palliative care who were about to die in a matter of days and, just down the hall, there was another section for people about to receive MAID. I had some great conversations with family members and even the individuals who requested MAID. The point is, we can and must respect the wishes of every individual. There is no right or wrong. There is only what we are comfortable with. I am comfortable with MAID as long as palliative care is available.
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Mr. Speaker, I appreciate the comments from the member opposite because, for the most part, I concur with what the member is saying. In the debate that took place in regard to Bill C-14, if the member looks at Hansard he will see that the issue of palliative care and hospice care was huge. Members on both sides of the House understood how important it was that we have that in our communities, as we did not want to see people using MAID as an escape because of not having that care.
Again, when I reflect on what we are talking about now, more and more members are talking about the issue of mental illness. It is good that we all have a consensus. No one is talking about depression as being something that would allow someone to apply for MAID. If they do apply, the doctors and medical professionals are not going to authorize something of that nature. We are talking about the extreme situations. That is my understanding.
It is good to hear those independent voices on this particular issue and, as much as possible, I would concur. I would just ask the member to continue to expand upon why it is important that we take the party politics out of it, because it is very much a personal issue.
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Mr. Speaker, I want to say a huge thanks to my colleague and dear friend from Louis-Saint-Laurent for his speech. I totally agree with him.
Perhaps he would agree with me that in the debates on Bill C-14, the government promised to do more for palliative care, if I remember correctly. That was a few years ago. I think those promises have been broken.
I would like to hear what my colleague thinks.
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Madam Speaker, there is so much that is being left on the table in the back room, I do not know where, that is not being done, and it raises doubts in veterans' minds as to the true intent of the government in truly meeting their needs. I am serious.
We have a backlog that continues to grow, while the minister is talking about the billions of dollars we are throwing at this, and it is the same with mental health, yet things are not improving. They are getting worse.
We have a responsibility in the House to do everything we can to make life valuable. We should have top-notch palliative care across the entire nation. We should be taking care of our veterans from the moment they enlist until the moment they are successful in a civilian life after they are done serving. There are so many things that could be done by the government.
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Mr. Speaker, that is a debate for the provinces. It falls under the issue of health care funding, which, as we know, is a provincial responsibility.
I will let the provincial legislatures debate the ongoing funding for medical assistance in dying, especially for palliative care.
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Mr. Speaker, certainly I agree that there needs to be more investment in palliative care and it is a very important aspect of our society. Today, we are talking about mental health and MAID. We know that one of the pillars of recovery from mental illness is a financial pillar: the ability to have a house, to buy food and to get access to medication and supports. Does the member feel that a guaranteed livable basic income is something that could alleviate suffering in the wake of the mental health crisis in this country?
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