SoVote

Feb/7/24 5:30:17 p.m.
Watch

Madam Speaker, I was pleasantly surprised to hear the minister say right off the bat that there was no reason to question whether there is such a thing as an irremediable mental disorder, but the Conservative members do not seem very clear on that. I do not know if she noticed the member for St. Albert—Edmonton's reaction when she said it. I would certainly be worried if I were her, because every time the House has held a debate on medical assistance in dying since 2015, we have been unable to reach a consensus. The Conservatives are always opposed to it. On this bill, however, the Conservatives are in lockstep with the Liberals and in favour of indefinitely postponing access to MAID for people with mental disorders. Why is that? Is the minister not concerned about that? What evidence does she have to explain why, a year ago, the government said it was going to take a year to sort this out, but now it it is going to take three years? By then, the Conservative Party may have had the opportunity to take power. I guess she knows very well that this is not going to happen. I am not talking about the Conservatives being elected; I am talking finally legislating on the issue of mental disorders.

222 words

Context: House Hansard - 277 - Feb/7/24

Mr. Luc Thériault (Montcalm, BQ)

Feb/7/24 6:02:34 p.m.
Watch

Madam Speaker, my colleague is always very eloquent when it comes to defending the “no” camp and the pro-life camp. Does his position represent the position of the Conservative party? Is that the official position of the Conservative Party? I just want us to be able to understand what is at stake in this debate today. Essentially, to him, irremediability is something that can never be proven. That means that, under a Conservative government, people who are suffering intolerably, who are dealing with intolerable suffering because they are victims of a mental disorder, could never be relieved of their suffering. What I am also hearing is that he claims that he can solve the problem of suffering and irremediable mental disorders by injecting a lot of money into the health care system to make access to health care something that can help these people put all their suffering behind them. Is that what he is telling us?

160 words

Context: House Hansard - 277 - Feb/7/24

Mr. Luc Thériault (Montcalm, BQ)

Feb/7/24 6:07:07 p.m.
Watch
Re: Bill C-7 Bill C-14

Madam Speaker, I never thought I would end up debating medical assistance in dying in the House again, or reliving what we went through when we passed Bill C‑14, a bad law. I never expected that the Liberals would again be in the same position, or show the same lack of courage they did with Bill C‑14, which was prescribed by the Carter-Taylor decision. Quebec passed its legislation on end-of-life care before the Carter decision. In the Carter decision, the court ruled that Quebec had to revise its legislation to include more than end-of-life issues only. The Parliament of Canada, which had never considered this before, was also told that it had to address not only end-of-life issues, but also degenerative diseases like those afflicting Ms. Carter and Ms. Taylor. Ms. Carter had spinal stenosis and Ms. Taylor had amyotrophic lateral sclerosis. In its decision, the court ruled that Parliament had to legislate because both women's right to life was being infringed. Why was their right to life being infringed? The right to life is not a minor right. This should be of interest to the Conservatives, who are pro-life. I am too, in that sense. The right to life was being infringed because these people had to shorten their lives when they would have liked to live until their suffering became intolerable. As members of Parliament, as representatives of the state and the people, our duty is not to decide what the patient needs when it comes to an issue as personal as their death. The role of the state is to ensure the conditions needed for them to exercise free will, so that they can make a free and informed decision. That is the role of the state. Otherwise, we get into government paternalism. I invite my Conservative colleague to do some reading in clinical ethics and not to limit himself to what psychiatrists in Ontario are saying. We know that psychiatrists are divided on the issue. In fact, if there is one discipline in which medical paternalism continues to reign, it is psychiatry. We would never have seen the progress that we have seen in clinical ethics if medical paternalism in general still ruled supreme. What happened for patients to be given back control over their end of life? We find the answer to that question in the bioethics literature. In the past, some doctors who had cancer said they did not want treatment. Now, we have good medical practices, whereas in the past, aggressive treatment was the standard. The doctors said that they wanted to live the two years they had left without undergoing treatment that would leave them bedridden. They claimed that they wanted to spend quality time with their loved ones. It took doctors with cancer demanding that option for patients to be able to discuss these sorts of things with their own doctor. In the 1960s, there were patients who only found out that they were dying of an incurable disease and were in fact at the end of their life when the priest came to their room to administer the last rites. They were not even told that they were terminally ill. That was medical paternalism. Over time, the right to die was granted. Patients were granted the right to die and the opportunity to refuse aggressive treatment. That is when we began providing the palliative care that is so important to my Conservative friends. Before that, palliative care was called passive euthanasia, and it was not allowed. Medical paternalism has been gradually set aside. What has this led to? It has led to the right to refuse life-saving treatment, to stop treatment. These are all rights we have today. We have before us a bill that perpetuates suffering indefinitely for people with a severe mental disorder who have been unable to relieve their suffering through treatment. That is no mean feat. They have spent 10, 20, 30 years suffering, trying multiple treatments and being stigmatized by the society in which they live. We are able to establish the decision-making capacity of people living with a severe mental disorder. For those capable of making decisions, the court told us that it would be discriminatory and stigmatizing if, just because they have a severe mental disorder causing suffering that psychiatry is unable to properly change or relieve, they were told what was best for them and that they should continue to suffer forever, while psychiatry need only provide a palliative care option until the end. That is what we are discussing today. I will calm down. It is just that I heard some nonsense earlier. Then what happens? There was Bill C‑7, which was rather cautious. It set a two-year deadline for creating an expert panel. Who read the report of the expert panel in the House? Who read it before voting? This is the second vote we are having on this subject. We have to read the report of the expert panel. Indeed, the irremediable aspect is something that is hard to implement. Admittedly, there is an additional difficulty, but the expert report does set out guidelines. That is what this is about. Then the Liberals show up today with a clause they added that says we are going to work with an expert panel for two years and create a joint committee. The problem is that the joint committees have always been set up at the last minute, too close to the deadline. When we submitted our report the last time, we were forced to admit that, before moving forward with the issue of mental disorders, we needed to assess the situation in the field. Even though I think the group that was supposed to work on it had developed important guidelines and standards of practice, it was obvious to me that there was still not quite enough time. Everyone told us so, including the Collège des médecins du Québec—I will have more to say later about its criteria and guidelines for proceeding that I find useful. How is it that, a year ago, the government gave itself a one-year deadline and thought that would be enough time? A lot of work has been done in that year, yet the government is saying we should put it off until 2027. We heard what the Conservatives just said. We can forget about MAID if they form government; they will put it off indefinitely. That means that people will continue to suffer indefinitely, and that suffering will be intolerable because psychiatry is unable to provide relief other than by rendering them virtually incapacitated. Somehow, people find that morally acceptable. I honestly do not know where the morality lies in that. Some people have very flexible morals. In any case, it has nothing to do with suffering. When people claim that someone living with depression could have access to medical assistance in dying, it is simply not true. Just because someone applies for MAID does not mean they will be able to access it. The assessors will do their job. Stefanie Green was saying that a person in a suicidal crisis is not eligible for medical assistance in dying. Someone who raises their hand and says that they want MAID simply because we allow mental disorders to be eligible grounds for MAID would not have access to it because they have not received proper care. However, there would be an opportunity for prevention, because we could provide treatment at that time. It is wrong to say that 90% of people who have suicidal ideation and commit suicide received proper care. No, they did not receive proper care. Very often, when people commit suicide, no one saw it coming at all. What are we going to do? What are the Conservatives going to to with people who are desperate and suffering and who currently still have hope that we are going to consider their suffering and find a solution so that things are done properly and by the law? What do they think those individuals are going to do in their despair? Is suicide morally acceptable? Suicide attests to the failure of our system and our society. I will never, ever accept suicide. That is why, when we talk about medical assistance in dying, we are not in the same page at all. A person who is feeling suicidal is not eligible. Someone who has just been taken into care and diagnosed is not eligible. Applications take structural vulnerabilities into account. Just because someone is poor and does not have access to care does not mean that they will be eligible for medical assistance in dying. They would not be eligible, because they would have to have tried every possible treatment. Someone who unjustifiably refuses treatment that could improve their condition will not be eligible. If accessible and effective treatments are available and the person refuses them, they are ineligible. If the assessors cannot agree that the criteria have been met, the person is not eligible either. The Collège des médecins du Québec told us that it remains at the discussion stage, that it has established its guidelines and it still needs time in order to eventually get there. Personally, I think one year would have been enough, otherwise we might give up. We could end up being hypocritical and leave it to chance. We might as well flip a coin. The Liberals need to work hard if they want to win the election. If not, they are going to be leaving the fate of those who are suffering in the hands of people who just told us today that this will not happen on their watch, that they support suffering for life everlasting, and that they know what is moral and right for these people. The Quebec college of physicians said, and I quote, “the decision to grant MAID to someone with a mental disorder should not be viewed solely as an episode of care. Rather, the decision should be made following a fair and comprehensive assessment of the patient's situation.” We are talking about taking the time to establish the chronicity of the condition. The college of physicians also set out a second condition. It said, and I quote, “the patient must not exhibit suicidal ideation, as with major depressive disorders”. It might be a good idea for the members of the Special Joint Committee on Medical Assistance in Dying to hear that, although they are on the same committee as I am and that was said in committee. That is a far cry from the grandstanding Leader of the Opposition who stands up in the House and asks the Prime Minister, in prime time, whether medical assistance in dying is the only thing he has to offer those who are depressed and having a hard time making ends meet. That is a bit much. The third criterion laid out by the college of physicians states that the patient must “experience intense and prolonged psychological suffering, as confirmed by severe symptoms and overall functional impairment, over a long period of time, leaving them with no hope that the weight of their situation will ease. This prevents them from being fulfilled and causes them to see their existence as devoid of meaning.” The experts tell us that they cannot apply irremediability and suffering metrics to mental health, and that prevents them from creating a category as a grounds for MAID. It has to be done on a case-by-case basis. All questions of clinical ethics, in terms of clinical assessment, are examined on a case-by-case basis. Some seem to think that going on a case-by-case basis is hell and that it is not a rigorous process. It is very rigorous. The fourth condition states, “the patient must have been receiving care and appropriate follow-up over an extensive period of time.” Access to care must have been available. Otherwise, no access to medical assistance in dying will be provided for mental disorders. It seems to me that we heard the same thing in committee. We heard the same criteria. At some point, we have to have the courage of our convictions. I believe that we have to offer relief to people experiencing intolerable suffering, who have reached their limit. I also believe that we must not make decisions about their life or quality of life for them. They alone can decide what is tolerable or intolerable. When people talk to me about a slippery slope, they seem to be working on the assumption that all health care workers are evil. However, people who work in health care need to be kind. As far as I know, gaining admission to medical school is not easy. I imagine that the selection criteria are quite strict and challenging. The same goes for nursing. The fifth condition states, “requests [from social workers] must undergo a multidisciplinary assessment, including by the physician or specialized nurse practitioner in the field of mental health who has treated the individual”. This is in the case of a follow-up assessment, not in the midst an episode. A person cannot get medical assistance in dying simply by saying that their life no longer has any meaning. Making a request does not mean one is eligible. The Collège des médecins du Québec concluded by saying, “Under these conditions, it would be possible, in the CMQ's view, to provide individuals suffering from a grievous and irreversible mental disorder with access to MAID. It is important to prevent situations where individuals opt for MAID out of desperation, because they do not have access to proper care or do not consider the care available to be acceptable, such as an extended stay in a facility without the prospect of gaining more autonomy.” That is the exact opposite of the nonsense we heard earlier. We were told that this was like a house of horrors, that we were dealing with experts and doctors who simply wanted to harm people's physical integrity. We have to be careful. To access MAID, the individual must first make a request, which is then followed by informed consent. When it comes to mental disorders, doctors currently perform a daily assessment of a person's decision-making capacity if they have a mental disorder and a comorbidity, an additional illness that is hastening their death. Everyone agrees that these people are capable of choosing and consenting to medical assistance in dying. MAID practitioners have long been determining the decision-making capacity of people with a mental disorder. Just because someone has a mental disorder does not mean that their right to self-determination and to make decisions should be violated. That is discrimination and stigmatization. When people tell me they want to protect the vulnerable, I wonder who could be more vulnerable than someone who has suffered for decades with a mental disorder and has tried every treatment. Who could be more vulnerable than someone grappling with a paternalistic psychiatrist—I am choosing my words carefully—who thinks he knows better than his patient what treatment they need, then chains them to a palliative care pathway and throws away the key because he cannot bring himself to admit that he is unable to provide relief to his patient? At committee, I put the question to some psychiatrists who told us we were on the wrong track. They admitted that, in 25 or 30 years of practice, they had seen some patients fall through the cracks. Indeed, it is for this small group of people who fall through the cracks in psychiatry that this expansion is necessary. We need to show a little humanity here in the House.

2677 words

Context: House Hansard - 277 - Feb/7/24

Mr. Luc Thériault

Feb/7/24 6:28:44 p.m.
Watch
Re: Bill C-7

Madam Speaker, that is an interesting question. I would like to point out to my colleague that the committee had very little time to assess whether the system was ready. We had two or three meetings to determine that and the deadline was ridiculous. However, many people came and told us that the system was ready. The Quebec National Assembly took a stand in 2021. Bill C‑7 was passed after that, after a lot of work had been done and brought to a halt in Quebec. The Quebec college of physicians said that it still needed a little more time. However, there is a big difference between needing a little more time to ensure that everything is done safely and properly and putting off indefinitely the need to deal with the suffering of people with serious mental disorders.

140 words

Context: House Hansard - 277 - Feb/7/24

Mr. Luc Thériault

Feb/7/24 6:31:26 p.m.
Watch
Re: Bill C-7 Bill C-14

Madam Speaker, that is an excellent question. In the supplementary report that I tabled, I note that, if we had had more time, we could have engaged with these people. By engaging with these people, we could have understood exactly what their concerns were. A certain number of associations did tell us that everything was ready for us to do this. The member knows that. For example, the Association of Medical Assistance in Dying Assessors and Providers came and told us after Bill C‑14 and Bill C‑7 were introduced that not all doctors were trained to be MAID providers. There was only a small number and they would be able to meet the demand. When it comes to mental disorders, we are talking about an even smaller number still. The people from this association felt that they were able to do this safely. There was also the Canadian Psychiatric Association, the Canadian Bar Association, the Association des médecins psychiatres du Québec, the Federation of Medical Regulatory Authorities of Canada, the Nova Scotia department of health, and so on. It comes down to the way people followed the debate and the way they debated within the governments because they sometimes have other concerns. I would have liked to hear them. The government did not call on us as soon as Parliament returned so that we could do a review and ask all of the questions we had. We could have even gone out into the community to see what was missing, but we were unable to. Here is what I think: We could do it right now, in the next year. We need to work together, get out there and explain it, see what is going on, and share the guidelines. Then, if we need another year, we can take it. Waiting until 2027 to do this is definitely not a progressive way of going about it.

325 words

Context: House Hansard - 277 - Feb/7/24

Mr. Luc Thériault

Feb/7/24 6:35:01 p.m.
Watch

Madam Speaker, briefly put, I would say they lack courage. In this place, courage and compassion are lacking, and action is based far too much on ideology. As I said earlier, only the individual can compare their life in one condition to their life in another condition, and this does not mean comparing two different lives. In that sense, we cannot turn a deaf ear to suffering. We have to listen and we have to act to make sure that these people receive care, of course. That is our goal. However, no matter how difficult it may be to determine whether a condition is irremediable, it would be intellectually dishonest to claim today that psychiatric treatment can relieve the suffering of everyone with severe mental disorders. For those whose suffering cannot be relieved and who request MAID in a considered and coherent manner, with all the safeguards I mentioned earlier in place, we have a duty to listen to what they think and to legislate accordingly.

166 words

Context: House Hansard - 277 - Feb/7/24

Mr. Luc Thériault (Montcalm, BQ)

Feb/7/24 6:58:15 p.m.
Watch
Re: Bill C-7 Bill C-14

Madam Speaker, I appreciate the comments of my colleague, who always speaks very calmly and moderately. It is a pleasure to serve with him. The NDP voted against Bill C‑14, which did not address the Carter decision's requirements at all. Bill C‑7 met the Carter decision's requirements with additional changes that required hard work, to clarify the issue. Is the NDP saying no to the idea of one day moving forward on mental disorders, or would it rather put the subject off indefinitely? We could start working on this tomorrow morning, and I am convinced that within a year, we could come up with something very promising.

114 words