44th Parl. 1st Sess.
February 7, 2024 02:00PM
- Feb/7/24 2:08:20 p.m.
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Mr. Speaker, there is only one weekend left to attend the world's greatest and most popular winter carnival, the Quebec Winter Carnival. Visitors will be just in time to watch the parade in upper town this Saturday. Come one, come all, for some dancing and some fun.
Come one, come all, to marvel at everything made of ice, such as cups, sculptures, and even Bonhomme's Ice Palace. Come one, come all, to enjoy the warm, friendly welcome that the 1,500 volunteers, Quebec City residents and shopkeepers are so well known for.
Quebec City is like no other city in North America, and its carnival is unlike any other in the world. Come one, come all, and join in the 70th Quebec Winter Carnival.
Enjoy the carnival.
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- Feb/7/24 2:25:32 p.m.
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Mr. Speaker, the only thing the Conservative leader is offering is insults and more insults aimed at elected officials from Quebec. He described the home of a family in Niagara as a shack. He is using the homeless as accessories for political photo ops.
The reality is that a responsible leader will take action to invest in communities and housing. That is what we are doing by eliminating the GST on the construction of new apartments and by making funding announcements, including $900 million for Quebec to invest in housing.
We are here to invest and build. He is here to hurl insults.
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- Feb/7/24 2:31:35 p.m.
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Mr. Speaker, indeed, there is a solution to consider. With the support of the Quebec National Assembly, Quebec has proposed that the Liberal government's legislation include a conditional provision allowing Quebec or any other interested province to authorize advance requests for medical assistance in dying. If that happens, the three-year extension would then be acceptable because Quebec could proceed according to the values of Quebeckers.
Is the Prime Minister willing to agree to Quebec's proposal?
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- Feb/7/24 2:32:13 p.m.
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Mr. Speaker, as I pointed out, the issue of advance requests was raised a number of years ago and has been identified as one of the important but difficult discussions we need to have as a society.
Could someone make an advance request to receive medical assistance in dying if their condition reaches a certain point, even if they are unable to consent to it? This is a difficult and important issue.
I welcome Quebec's debates on the issue. We are going to pursue our discussions on that.
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- Feb/7/24 2:44:33 p.m.
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Mr. Speaker, former minister Lametti and other members of the Liberal Party openly considered the idea of opening up the Canadian Constitution. As it happens, Quebec is considering—warning, I am about to use a dirty word—a referendum. Yes, it is considering having a referendum on repatriating all powers in the area of immigration.
Why does the Prime Minister not talk to the Quebec government and give it all the powers so that we can finally have an immigration policy by Quebec, for Quebec?
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- Feb/7/24 2:45:11 p.m.
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Mr. Speaker, every country is in charge of its responsibilities in immigration. Canada is responsible for border management and immigration in Canada.
Recognizing Quebec's unique status and the need to defend the French language and Quebec culture, Canada has long given Quebec specific powers that no other province has for the defence of Quebec. We will continue to work with Quebec on immigration.
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- Feb/7/24 2:45:53 p.m.
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Mr. Speaker, we agree, Quebec should be a country and should have all the power. We will get there.
In the meantime, the Prime Minister and his minister are saying that they are working hand in hand with Quebec. The Minister of Immigration says that he is working hand in hand with Quebec. However, Quebec's immigration minister wants to hold a referendum to repatriate all immigration powers.
Does the Prime Minister realize that this is a repudiation of the Liberals' immigration policy, a repudiation of their failure in immigration, and a repudiation of his immigration minister?
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- Feb/7/24 2:46:29 p.m.
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Mr. Speaker, we keep seeing how desperate the Bloc Québécois always is to pit Quebec and Canada against each other and look for excuses to hold a referendum.
The reality is that, yes, we are working hand in hand with the Government of Quebec, and Ottawa and Quebec have been doing that for decades to ensure that the immigration numbers are appropriate for Quebec. We will continue to work respectfully, without fighting, despite what the Bloc Québécois wants.
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- Feb/7/24 3:03:45 p.m.
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Mr. Speaker, as I have often said in the House, Quebeckers have shown tremendous generosity and commitment to the vulnerable people who come to Canada. We are grateful for that, and we are here to help and to invest in Quebec to make it possible to welcome these people.
We recognize that this has created additional costs not only for the Quebec government, but also for social services and community organizations. That is why we are working with Quebec on an ongoing basis to make sure that we recognize its sacrifices and efforts, and to make sure that we thank and reward it for that.
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- Feb/7/24 3:04:28 p.m.
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Mr. Speaker, the Prime Minister must also ensure that there are not too many asylum seekers entering the country at the same place. Quebec has exceeded its intake capacity. There are 289,000 asylum seekers in Canada, and Quebec has shown that it has taken in 160,000, or 55% of the total number.
Quebec's immigration minister even announced yesterday that she is considering holding a referendum on the repatriation of all immigration powers because she is so frustrated with the federal government's inaction.
Does the Prime Minister understand that when people start talking about a referendum, it might be time for him to wake up?
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- Feb/7/24 3:05:09 p.m.
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Mr. Speaker, for many years, Quebec grappled with the challenge of Roxham Road. We worked with the Quebec and United States governments. We fixed that problem.
Now there is a new issue at airports, but we will be there to help the Government of Quebec and Quebeckers deal with the situation. We will always work together. The Bloc Québécois is the only one looking to pick fights and hold referendums.
We will always be there to work hand in hand and respectfully with the Government of Quebec.
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- Feb/7/24 5:56:21 p.m.
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Madam Speaker, there are two points I want to raise quickly and hear his response on. One, he talked about a consensus in the psychiatric community, and I do not know what consensus he is referring to. There are varied views on providing services and cures to people with mental illness. However, my question is in regard to rights of individuals. We have a decision by a Quebec court that required this Parliament to act on the ruling to ensure the rights of individuals guaranteed under the Charter of Rights and Freedoms are protected. I would like to hear his views as to how we will reconcile with those rights and what his plan would be to ensure the rights of Canadians, whether they have mental illness or not, are protected under our charter.
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- Feb/7/24 5:57:11 p.m.
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Madam Speaker, I would submit that 80% of psychiatrists in Ontario saying MAID should not be expanded in the case of mental illness is approaching a professional consensus. The member I would hope would be concerned by a government policy to expand MAID in cases of mental illness significantly impacting vulnerable persons and that he would question the appropriateness of such a policy in the face of opposition from so many experts.
With respect to the Quebec court decision he alluded to, and I believe he is referring to the Truchon decision, there was no pronouncement of the Quebec Superior Court on the question of mental illness. That was not part of the fact pattern in the case. The plaintiffs were not suffering from an underlying mental health disorder. There is no binding precedent forcing the government to enact this legislation. This is a political decision made by these Liberals.
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- Feb/7/24 6:01:02 p.m.
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Madam Speaker, I do not think the member is fully online on this. There is a Quebec court decision. That decision does put in a deadline that the government does need to respect and respond to.
At the beginning of his arguments, the member was trying to pass the blame. Let me remind the member that it was Stephen Harper's government, the same government which he worked for, back in 2015, that chose to do nothing, ignoring the issue. That was based on a Supreme Court decision.
Would the member not recognize that the issue cannot just be ignored? That is the track record of the Conservative Party.
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- Feb/7/24 6:05:29 p.m.
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Madam Speaker, it is arrogance, it is recklessness and it is incredible. It is incredible in the sense that they hide behind a Quebec court decision. It is a decision, frankly, they should have appealed but did not. It did not pronounce on the question of MAID and mental illness, and they are now using that as the basis to say we need to move forward with this legislation, even though, when they initially responded, they said they were going to exclude mental illness from the legislation. They are trying to have it both ways.
They got into this mess because David Lametti accepted a radical Senate amendment and it has been a three-year mess ever since.
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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.
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- Feb/7/24 6:27:19 p.m.
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Madam Speaker, I extend my sincere thanks to the member across the way for the details and the compassion with which he made his comments about patient-centred decisions and things around the Charter of Rights and Freedoms that we protect in the House. Right now, I understand the Quebec legislature is debating the Superior Court decision. I was hoping we would have a more fulsome debate tonight, and I was surprised the Bloc did not support having that debate.
I spoke with a nurse practitioner in my area who comes from Ottawa to Guelph to provide service, and she can only do it as a volunteer because she is not paid by the province to work outside of Ottawa. On the ground, we really have problems building capacity. Something that this bill tries to address is building the capacity of our health care system within the provinces to be able to provide MAID effectively in our communities.
Could the member maybe reflect on the need for us to work with provinces and their health care systems to build our capacity and, at the same time, to work with legislatures, both provincially and federally, so that we can get this across the line together, and comment on the amount of time that could take?
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- Feb/7/24 6:28:44 p.m.
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- 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.
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- Feb/7/24 6:29:57 p.m.
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Madam Speaker, it was a pleasure to work the member for Montcalm on the Special Joint Committee on Medical Assistance in Dying. We have both been on that committee from the get-go, and we have both been exposed to a wide range of witness testimony and the briefs.
Following up slightly on the earlier question, our responsibility here in the federal scene, of course, deals primarily with just the Criminal Code. Once we complete our task with the Criminal Code, the oversight and accountability of the system falls largely on the provinces.
It is not insignificant that seven out of 10 provinces and all three territories had their health ministers and ministers responsible for mental health and addictions sign a letter, in which they referenced the fact that back in November, they were already raising concerns, and they have clearly called for an indefinite pause. I understand Quebec was not a signatory to this, but the very fact that seven provinces and three territories are, and those ministers are responsible for the oversight of those medical systems, I do not think that is insignificant.
I am wondering if the member for Montcalm can reflect on that. When we have clear direction from ministers responsible for the system saying that they are not ready, how does he respond to those concerns?
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- Feb/7/24 6:34:05 p.m.
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Madam Speaker, from what I understand there are inconsistencies between the processes in the different provinces. Quebec has done its part.
What I am hearing this evening is often what individuals may have experienced. We are talking about human suffering. I know what I am talking about because I have experienced it. Everything my colleague is talking about, everything he got out of all these experts, I experienced it.
Beyond a potential fear of getting to the bottom of things, of figuring out what else is needed to make an informed choice, there is urgency. I would like my colleague to tell me what our dear colleagues here might be lacking to make an informed decision on the fate of human life.
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