44th Parl. 1st Sess.
February 13, 2023 11:00AM
Mr. Speaker, as I clearly outlined in my speech, the safeguards are very clearly laid out, not only in the Criminal Code, but also in what we believe the standards of practice should be, and that is going to apply to the medical community. That being said, the medical community has indicated it does need more time, hence the need for Bill C-39. I would just remind the hon. member that many stakeholders in the field of mental health have underlined the fact that the Liberal government needs to step up to the plate and increase the funding and the resources to appropriately address this major crisis happening from coast to coast to coast.
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Madam Speaker, I just want to follow up on the statistics my hon. colleague from Timmins—James Bay pointed out from across the way. They are staggering. When we begin to consider them, it should cause all Canadians to pause, reflect and say that the legitimate concerns many of us raised in this House when this was first proposed continue to this day. There are inadequate safeguards in place to protect those who are struggling with mental illness and have other ailments in their lives that have challenged them for a particular season. MAID opens the door to a decision of such finality that it can cause grave consequences for many Canadians and their families.
What safeguards are going to be put in place to stop this from being abused any further?
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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 have not in fact read the report. At the moment, the problem is that we have 10 provinces and three territories that are all expected to come up with the appropriate safeguards, and I do not think any of them have actually publicly come forward with those safeguards.
I would further suggest that it ought not be the colleges of physicians and surgeons that are put in the position to have to put those safeguards in. It is up to us, the elected representatives who are accountable to the people, who ought to be the ones making those decisions, not the colleges of physicians and surgeons.
I would agree with the member that one person who stays in suffering is too many; however, I would also suggest that one person whose life is taken prematurely because of an overly liberal approach to MAID and the pain that that causes, particularly to the family, ought to be something we consider before making any decision that would allow that to happen.
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Madam Speaker, I do not know how many times I have to rise to say the same thing, but my Conservative colleagues are oversimplifying. That is okay. They are entitled to do that, what with free speech and all. However, among the experts who drafted the expert report and who addressed the issue of mental health care, none of them supports the idea of giving access to medical assistance in dying to someone who is depressed. It is quite the contrary. The expert report includes all the necessary safeguards to exclude those people.
It is true that socio-economic determinants can lead to depression and suicidal ideation, but those people would not be granted medical assistance in dying. I invite my colleagues to read the report because I have noticed that there is a lack of understanding of the safeguards and precautionary principles underlying each of the recommendations. There are 16 very important recommendations in the expert report, and I invite my colleagues to read it.
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Madam Speaker, this is humorous because of the expert panel my colleague referenced. When it had finished all of its work and finished hearing from all of the witnesses, what did it actually say? It did not come up with one safeguard. The panel said to do this on a case-by-case basis, that we do need safeguards and to just go ahead with the legislation as it is. That was the expert panel.
There are no safeguards in place in Canada right now, none. That is why the government is asking for an extension of another year. However, even if there were safeguards in place, we have never had a debate in this House on the merits of including the mentally ill and mentally disordered within Canada's assisted suicide regime.
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Madam Speaker, I remember being involved in the very first debates, and serious concerns were raised. What kinds of safeguards? What kinds of protections? We were told to pass it and then we would get a review. We never got that review.
What we got was the unelected, unaccountable Senate, whose members are responsible to nobody but themselves, deciding that what we needed to do was rewrite the law so that anyone who was depressed or had any kind of mental depression could be allowed to die. The government accepted that. It did not even throw it back. It accepted it, and we are one week away from this outrageous extension of MAID becoming law because it sat on the Liberals' desks.
Now we have to bring in a law that does not actually deal with that. We are just putting it off. We have never had a discussion as the elected representatives of the Canadian people to decide what is fair, what is right, how we do this and how we ensure safeguards. I would like to ask my hon. colleague about his position on this.
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Madam Speaker, not surprisingly, I totally agree with the member and his analysis of what has gone on. We have had the unelected, unaccountable senators plugging in a provision that has life-and-death consequences, and the government just rolled over when it came back to this place. That is an abdication.
The fact that there are no safeguards in place is of grave concern. However, once those safeguards are in place, we should fully expect that over time the government is going to chip away at them so that it can expand the scope of this legislation even more.
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Mr. Speaker, it gives me mixed emotions to rise today in the House on this subject. Our hearts are full of stories. I do not think there is a family that has not been touched by those who have battled with mental illness in some form at some period in their lives. The mere thought that MAID could be extended to those battling mental illness is beyond disturbing.
I believe Canadians from coast to coast are in agreement that this is an extension that goes way too far. I rise today in this House as someone who will definitely support Bill C-39 to delay the extension of MAID to those with mental illness. With that pause and delay, I hope the government will take advantage of that time to finally put in place adequate safeguards to protect our most vulnerable.
It has been said that the character of a nation is revealed in how it treats its most vulnerable. Right now, the character of our nation is being tested. How will we respond to this time of testing? Will we rise to the occasion to help our fellow man, our fellow humans and our fellow neighbours and friends, who are battling and struggling? Will we respond to their anguish? Will we respond to their pain? Will we respond to the cries from many across this country right now who are under increased strain mentally?
Many are coping and trying to self-medicate. It has led to addictions in their lives and further mental health struggles. We are seeing a rise in depression, anxiety and other types of mental illnesses. It is moving across the country at a very rapid rate and to younger and younger Canadians. Our hearts are moved by this.
The importance of this delay cannot be overstated. Let us not just delay this for another year and then have to revisit it again and have this debate again. Let us move with urgency toward putting in the necessary safeguards to protect our most vulnerable. Canadians are demanding that we respond.
We have had many examples of the overreach and overextension of this. Veterans have been offered and advised to utilize medical assistance in dying. This is something that should never happen to those who are heroes and have served, and at a time of post-traumatic stress or in a season of anxiety and depression. We know that with adequate supports and proper care, they can traverse to the other side of the deep valley they may be in temporarily.
I have family and friends who have had these bouts. I have seen the effects of mental illness in very deep and profound ways. In my previous vocation, I rushed to a bridge where someone was on the edge considering taking the step of ending their life. I have been called to a dam in my area in the dead of winter to respond to someone who had reached their end.
This was some time ago, but I am very thankful to report to this House that both those individuals have moved on with their lives. They are living. They are enjoying their lives and have made some very positive changes. I am so thankful that in that moment they chose life. I am also very thankful that at that time, medical assistance in dying was not extended to those who were battling mental illness alone.
This House must put in the adequate safeguards that are needed. Experts are telling us very clearly that this should not be extended to those solely battling mental illness, because there is no way they can adequately determine if the mental illness is irremediable.
With that uncertainty, with those legitimate concerns coming from health professionals and the majority of doctors and physicians across the country, it would behoove this House not only to pass this bill and give the delay but also to take immediate steps to implement adequate safeguards that would protect our most vulnerable.
I pause for just a moment upon probably one of the most famous passages that has ever been quoted in times of stress and duress for many people. It is oftentimes featured in movies and at most funerals that we attend; it is a verse of great comfort:
Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me.
Death casts a very big shadow, and those of us who have lost loved ones know that pain and grief very well. Those who have lost family members and loved ones to suicide know how dark and deep that shadow is.
However, there is hope that when we are traversing the very valley of the shadow of death, we can pass through and come out on the other side. There is hope for those who are battling mental illness, depression and anxiety; though it may feel permanent in the moment, there are many people who have traversed that valley and come out with hope and light again in their hearts and souls.
Primarily, it is because they came to the realization that they were not alone. They had loved ones who were with them, family who cared for them, neighbours who extended a hand and those who would run in when everyone else ran out of their lives. When it looked darkest, someone lit a candle in their night that brought hope.
I am thankful for those who brought light to me in the darkened times of my soul. I hope that everyone in this room will take the pause that this bill would grant the House, be a light in a darkened place for those who are hurting and extend the hope that is in the valley of the shadow of death. We do not have to fear, but we can walk with people through the most difficult of seasons in their lives.
Let us bring hope and life. Let us not encourage death or a culture of death but foster a culture of hope and life for those who most desperately need it.
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Madam Speaker, I believe that we are doing something very positive when we take the time to reflect on what has been brought into place through Bill C-7 and MAID and adequately address the ever-growing concerns of this legislation being abused or overextended to those dealing with mental illness alone.
We need to take this time, pass this bill and make sure that in the time it allots us, we put in place the safeguards that Canadians are demanding. These safeguards will make sure that veterans who are vulnerable and people with mental illness are protected and that those who are passing through a temporary season in life do not make a decision with such finality. We need to make sure we put the safeguards in place.
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Madam Speaker, I thank the member for his speech this evening. I enjoy my time on the fisheries committee with him.
The member spoke at length about putting into place the necessary safeguards to protect those most vulnerable. I cannot agree more. I am hearing from people who are at their wits' end; for them, it feels easier to die at this point than to keep living. That is horrific. I have spoken about this before.
This bill needs to be put into place. I absolutely agree that we need to have the appropriate information to know how we can move forward and protect those most vulnerable. We also need to ensure that people have what they need to live with dignity and respect.
Could the member share with us whether he agrees that we need to put into place a guaranteed livable basic income, as well as ensuring that the government is offering mental health transfers?
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Madam Speaker, it is a pleasure to serve on the fisheries committee with my hon. colleague.
With regard to this matter, obviously the challenges of poverty, desperation, hurt and pain are evident throughout our country at this time. Many political parties of various stripes are going to come up with all kinds of potential solutions to that, but the bill that is before us for consideration today is about delaying the legislation to provide time for reflection and the ability to implement safeguards. Safeguards need to be implemented for people across the board, especially our vulnerable youth, seniors, veterans and all individuals who are dealing with mental challenges and the addictions epidemic that is plaguing this nation. We need to look at it holistically.
I do not believe government can solve all these problems. We must expand that circle of solutions to include those from all sectors of society, including our faith-based communities, as well as non-profits and other great NGOs that are doing tremendous work in our communities.
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Madam Speaker, that is the value and the absolute purpose of the pause. This bill would enable a pause so that we can take immediate steps. Internationally, questions are being raised suggesting that we have gone to the extreme on this issue. It is time to put some adequate safeguards in place to make sure our most vulnerable are protected.
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Madam Speaker, my friend, the member for Peterborough—Kawartha, was absolutely right when she said that there is no science and no evidence to support this expansion. Indeed, the overwhelming evidence at the special joint committee, of which I am a co-vice-chair, was precisely the opposite.
The hon. member for Longueuil—Charles-LeMoyne asked the member about whether it is appropriate to extend the deadline to essentially get it right, but evidence before the committee from a leading psychiatrist was that the medical error rate on the question of irremediability could be anywhere from 2% to 95%. In the face of that, it would seem to me that there are no safeguards to get this right. The only thing to do to get it right would be to scrap this ill-conceived—
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Mr. Speaker, I wonder what the member's thoughts are on what is going to happen in the next year. We have had two years to develop guidelines, regulations and safeguards around MAID for those suffering a mental illness, and yet we have not developed a consensus at all. What we did was hear conflicting evidence and conflicting opinions at committee. Is the member confident that in the next 12 months we will actually come to a consensus, or are we going to be here a year from now seeking another extension?
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