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Ms. Elizabeth May (Saanich—Gulf Islands, GP)

Feb/7/24 5:01:49 p.m.
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Re: Bill C-310

Mr. Speaker, I am so proud to present a petition signed by a firefighting force within my riding. On the very small island of Piers Island, the fire truck is the only internal combustion engine on the entire island. The volunteer firefighters of Piers Island have asked me to present this petition in support of the private member's bill by the hon. member for Courtenay—Alberni, which has been spoken to a number of times this afternoon. Volunteer firefighters account for 71% of Canada's total firefighting first responders. Right now, we have a good step in the right direction, which we supported at the time, of a $3,000 tax credit for volunteer firefighters. Bill C-310 is supported by the petitioners, and it asks that volunteer firefighters and search and rescue volunteer services have that grown from a $3,000 tax credit to a $10,000 tax credit. I am proud to present this petition, and I urge Parliament and the House to get behind it.

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Mrs. Rosemarie Falk (Battlefords—Lloydminster, CPC)

Feb/7/24 5:03:04 p.m.
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Re: Bill C-318

Mr. Speaker, adoptive and intended parents are at a disadvantage under the current EI system here in Canada. All parents are deserving of equal access to parental leave benefits. Bill C-318 would deliver equitable access to parental leave for adoptive and intended parents. The undersigned citizens and residents of Canada call upon the Government of Canada to support adoptive and intended parents by providing a royal recommendation to Bill C-318.

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Mr. Kevin Lamoureux (Winnipeg North, Lib.)

Feb/7/24 5:03:30 p.m.
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Mr. Speaker, as we all know, Canadians are very passionate and care deeply about health care. However, the backbone of that system, of course, is our health care workers, and this petition is dealing particularly with our nurses at the many different levels. The petitioners are asking, in essence, to have their valuable contributions recognized, whether it is through enhancement of salary, credentials being recognized, incentives or the type of workload they have to experience. In general, they are looking for governments at all levels, whether it is provincial or federal, to be more proactive in supporting our nurses.

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

Feb/7/24 5:04:26 p.m.
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Mr. Speaker, I would ask that all questions be allowed to stand at this time.

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Stand
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The Deputy Speaker

Feb/7/24 5:04:33 p.m.
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Is that agreed? Some hon. members: Agreed.

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

Feb/7/24 5:04:37 p.m.
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Mr. Speaker, I would ask that all notices of motions for the production of papers also be allowed to stand.

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The Deputy Speaker

Feb/7/24 5:04:45 p.m.
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Is that agreed? Some hon. members: Agreed.

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Mr. Alain Therrien (La Prairie, BQ)

Feb/7/24 5:04:52 p.m.
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Mr. Speaker, I would like to return to the question of privilege that was raised by the member for Regina—Qu'Appelle yesterday regarding who was responsible for inviting Yaroslav Hunka to attend events with the President of Ukraine during his visit to Canada in September 2023. I must say that I agree with the House leader of the official opposition on this issue. Here are the facts. On the afternoon of Monday, February 5, The Globe and Mail reported that the Prime Minister's Office had invited Yaroslav Hunka, a former soldier of the Ukrainian Waffen-SS who received ovations in the House of Commons during Volodymyr Zelenskyy's visit on September 22, 2023, to a reception that was held in honour of the Ukrainian President that evening in Toronto at the Fort York Armoury. The article also stated that the Prime Minister's invitation had in fact been sent by Canada's protocol office four days before the reception. However, when the Prime Minister was repeatedly asked about it in the House in the week following President Zelenskyy's visit, he blamed the Speaker of the House without taking any responsibility himself. He said on September 27, 2023, that the Speaker was “solely responsible” for inviting and paying tribute to former Nazi soldier Yaroslav Hunka. He said, “we all recognize that the former speaker of the House made a serious mistake.” He also said, “the Speaker of this House of Commons invited an individual without apparently doing that Google search, but it is not up to the government of the day to oversee or to have a veto power over those who the Speaker or, indeed, members of official parties choose to invite into this House.” The then speaker took full responsibility for this situation and decided to resign from that role. Two weeks ago, in an interview with CTV News Northern Ontario, he explained that it is actually the Prime Minister's Office that approves invitations for major international events organized on Parliament Hill, such as President Zelenskyy's address during his visit to Parliament in September. Let me quote him directly: “Normally, it goes to the Prime Minister's Office, and they go through it with a fine-toothed comb, and then the invitation goes out from protocol.” According to House of Commons Procedure and Practice, it is appropriate to raise a question of privilege when the House has been misled following statements made in the chamber by one of its members, whether they are a member of Parliament, a minister or the Prime Minister. The Prime Minister's statements on September 27, 2023, seem to meet the three criteria set out in previous rulings by Speakers of the House under similar circumstances. First, the Prime Minister's statements were misleading, in that they implied that the Prime Minister and the Prime Minister's Office did not know Yaroslav Hunka and had nothing to do with inviting him to the House when members of all the opposition parties were attempting to find out exactly what role the PMO or the Prime Minister himself had played in inviting Mr. Hunka during President Zelenskyy's visit. As a matter of fact, acting on behalf of the Prime Minister, the PMO itself had invited the Ukrainian former SS member to a reception that very evening in Toronto. Second, the Prime Minister must have known that those statements were misleading because he would be hard-pressed to claim that he was not aware that the PMO had extended such an invitation on his behalf. Third, it seems entirely reasonable to believe that the Prime Minister intended to mislead the House because, at the time he made those statements, since the entire world was focused on the Parliament of Canada, the Prime Minister had every reason to hope that he would not be held responsible and that the blame would fall on someone other than himself. In his apology on September 27, the Prime Minister described this mistake as a “horrendous violation” of the memory of the millions of people who died in the Holocaust and said it was “deeply, deeply painful for Jewish people...Polish people, Roma people, 2SLGBTQI+ people, disabled people, racialized people and the many millions who were targeted by the Nazi genocide.” This demonstrates how seriously the Prime Minister was taking this matter. Anyone in this situation would have every reason to hope that they would not be associated with this mistake and not be held responsible. In conclusion, the Bloc Québécois is of the opinion that there is a prima facie breach of parliamentary privilege and that the matter must be referred to the Standing Committee on Procedure and House Affairs for study.

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Mr. Eric Duncan

Feb/7/24 5:10:34 p.m.
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Mr. Speaker, I rise on a point of order. I happened to accidentally miss the final vote. My vote did not register. I ask for unanimous consent for my vote on Private Member's Motion No. 86 to be reported as nay.

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Reported

The Deputy Speaker

Feb/7/24 5:10:52 p.m.
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Does the hon. member have unanimous consent to submit his vote as nay? Some hon. members: Agreed.

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Nay

Hon. Ya'ara Saks

Feb/7/24 5:11:44 p.m.
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Re: Bill C-7 Bill C-62

moved that Bill C-62, an act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, be read the second time and referred to a committee. She said: Mr. Speaker, I am pleased to have the opportunity to speak today about Bill C-62. This is a sensitive and very personal subject for so many around the country. We have debated many of the core issues, but today we are talking about the legislation that proposes to extend the temporary exclusion of eligibility for medical assistance in dying for persons suffering solely from a mental illness by three years, until March 17, 2027. I want to be clear: The question we are debating today is not whether mental illness can cause irremediable and intolerable suffering on par with that of physical illnesses. We know that it can, and that is not up for debate. We must proceed cautiously and we must get this right. We must ensure that the appropriate measures are in place across this country to affirm and protect our most vulnerable. We have heard significant concerns from partners, provinces and territories and the medical community, regarding health care system preparedness. In its latest report, tabled on January 29 of this year, the Special Joint Committee on Medical Assistance in Dying found that while considerable progress has been made in preparing for the expansion of eligibility for persons suffering solely from a mental illness, an additional delay is needed to ensure that the health care system can safely provide MAID in these types of complex cases. These concerns must be addressed before we can move forward with extending eligibility to persons whose sole underlying condition is mental illness. While that critical work is happening, we must also take action to ensure that vulnerable people are protected. Unless Bill C-62 is passed by March 17, 2024, the exclusion of eligibility for MAID will be automatically repealed. That means that individuals suffering solely from mental illness could be eligible to receive MAID as of that date, without the system being ready. Although progress has been made to support the safe assessment and provision of MAID in complex cases, now is not the time to extend the exclusion, as highlighted by the letter we received from provinces and territories. Over the past few years, the Government of Canada has been collaborating closely and carefully with partners to support the implementation of MAID. We have taken a compassionate and careful approach to this in our support of the safe assessment of MAID in complex cases, including where the sole and underlying medical condition is a mental illness. I would like to take a few minutes to highlight some of the key areas of progress that have been made. As required under former Bill C-7, we appointed an independent expert panel with a mandate to provide recommendations on protocol, guidance and safeguards to apply to requests for MAID made by persons whose medical condition is a mental illness. The final report, tabled by the expert panel in the spring of 2022, included 19 recommendations for governments and health system partners to support the safe expansion of MAID for persons suffering only from a mental illness. The panel noted that the recommendations would benefit all complex track 2 MAID assessments and provisions, even those where mental illness was not a factor. At the same time, the Special Joint Committee on Medical Assistance in Dying was also studying the question, and concluded that, at that time, they believed additional work was needed before moving ahead. Both the reports by the Special Joint Committee on Medical Assistance in Dying and the expert panel highlighted the importance of education and training, consistent professional guidance, enhanced data and analysis, meaningful indigenous engagement and strong oversight. The government has taken these recommendations very seriously and has worked diligently to advance them. In September 2022, Health Canada convened an independent task group made up of clinical, legal and regulatory experts to develop model MAID practice standards based on the expert panel's recommendations. Its mandate was to create resources that could be used by regulators to operationalize the expert panel's guidance with respect to complex MAID cases, including those based on a mental illness alone. The task group's efforts resulted in a model practice standard for MAID and a companion document, “Advice to the Profession,” which were both published in March 2023. To date, the majority of provinces and territories have indicated that their practice standards for MAID have been updated or are in the process of being reviewed using these materials as a guide. The supporting “Advice to the Profession” document is being used to support and inform regulatory bodies, public authorities and health professional organizations, and is intended to support a consistent and safe approach to MAID practice across Canada. In addition, Health Canada has been working closely with the Canadian Association of MAiD Assessors and Providers, also known as CAMAP, on a number of key activities to support preparedness among practitioners. Among them include funding the development of a nationally accredited bilingual MAID curriculum to support access to high-quality MAID training and a standardized approach to care across the country, while recognizing that differences in the delivery of health care services among provinces and territories do exist. As of the end of January, more than 1,100 clinicians have already registered with CAMAP to take the training. We supported a knowledge exchange workshop on MAID and mental disorders that took place in June 2023. The workshop brought together MAID assessors and providers, as well as psychiatrists, from across the country to discuss the assessment of MAID requests based on mental illness alone, to build a network for ongoing knowledge exchange and to inform future practice. Additional knowledge exchange sessions are being planned for May 2024 and 2025 to support ongoing interjurisdictional lesson sharing and clinical guidance for complex case assessment, including for mental illness as the sole underlying condition. When it comes to the question of eligibility criteria for MAID, we must consider all situations and all outcomes. While important work has indeed been done, we have heard clearly from our partners that they need to have sufficient time to implement safeguards and address capacity concerns that are expected to result from the expansion. As my hon. colleague, the Minister of Justice, has pointed out, we are trying to calibrate two fundamental ideas: the autonomy of the individual in terms of dignified decisions about the timing of their own passing, coupled with protecting vulnerable communities and individuals. As the deadline to lift the exclusion of eligibility for mental illness approaches, calls to further extend the deadline have grown louder. We understand from our engagement and outreach with health stakeholders that there are varying levels of readiness to manage and assess requests for MAID where the sole medical condition is a mental illness. All provinces and territories have indicated that they are not yet ready to move forward. More work needs to be done. On January 29, the Special Joint Committee on Medical Assistance in Dying tabled its most recent report examining the degree of preparedness for the safe application of MAID for persons whose sole underlying condition is a mental illness. While recognizing the considerable progress that has been made in preparing for the expected expansion of eligibility, the committee recommended an additional delay to ensure that the health care system can safely provide MAID in these types of complex cases. I want to be clear: I understand that suffering from mental illness is just as real and just as serious as suffering from a physical illness. That is why we provided a clear timeline of three years before the lifting of the exclusion, which the provinces and territories and our health care partners can continue to work toward, and a firm commitment for parliamentarians to evaluate the progress after two years. That work will continue in earnest, and we can be assured that all the necessary measures are in place to move forward safely. I understand there will be people who have suffered over many years without finding relief, and for whom MAID may be a serious consideration based on deep and personal reflection. This new development may truly be distressing for them. I want to say to them that we are committed to moving forward. However, we must do so in the most compassionate, responsible and prudent way possible. The system needs to be ready, and we need to get this right. It is clear from the conversations we have had that the system, at this time, is not ready. As I have said, we have worked hard to make sure that the necessary supports are in place for practitioners and our provincial and territorial partners to permit the expansion of the MAID eligibility to people whose sole condition is a mental illness. However, they have also been clear that more time is needed to prepare; that is why we are proposing a three-year extension. The availability of nationally accredited training modules for MAID assessors and providers would help ensure that providers were clear on the requirements of the legislation and good clinical practice. However, it is going to take some time for individual physicians and nurse practitioners to integrate and internalize these practice standards. Provincial and territorial regulatory bodies need to complete the work associated with updating standards. They need to ensure that health care clinicians have the training to ensure a safe and consistent assessment before the MAID eligibility is expanded through the lifting of mental illness as an exclusion. Existing assessment and support mechanisms also need to be examined and revised to ensure that the robust measures needed for these types of complex requests are in place. On that point, we are committed to continuing to support the provinces and territories and help system partners to further strengthen and improve mental health care services and supports, as well as data collection, to better understand who is requesting MAID and why, and appropriate support and oversight for practitioners. While the management and delivery of health services, including MAID, is an area of provincial and territorial responsibility, the provinces and territories have been regularly engaged through a working group to facilitate information sharing and collaboration on MAID implementation. Through this group, provinces and territories have been and continue to be engaged in the work on the federally led model practice standards and are working collaboratively with all of us on all aspects of MAID. The government has also made significant investments to support the provinces and territories in the delivery of mental health services. Budget 2023 confirmed the government's commitment to invest close to $200 billion over 10 years, starting in 2023-24, to improve health care for all Canadians. This includes $25 billion to provinces and territories through tailored bilateral agreements, focused on four key priorities, including improving access to mental health and substance use services and the integration of these services in all other priorities. This is in addition to the $5 billion committed in 2017 to support mental health and substance use services. Our government has also invested more than $175 million to support the implementation and operation of 988, which will provide people across the country with access to immediate and safe support for suicide prevention and emotional distress. As MAID continues to evolve, we need to ensure that accurate information is available to the public by providing clear information. We also take the concerns raised by those who might face systematic disadvantages very seriously. That is why we have expanded data collection on MAID to provide a better understanding of who is accessing MAID and why, including the collection of data on race, indigenous identity and disability. We can only address potential risks if we can uncover them. We are continuing to engage with indigenous peoples through both indigenous-led and government-led activities to better understand their perspectives on MAID. This will culminate in a “what we heard” report in 2025. This will support transparency, provide insight into how the legislation is working, and maintain public trust in how MAID is accessed and delivered in Canada. Finally, both the expert panel on MAID and mental illness and the special joint parliamentary committee highlighted the importance of case review mechanisms and oversight to support the safe assessment and provision of MAID. Most provinces and territories already have systems in place to do this work, but we understand that more can be done. We are working with the provinces and territories to explore enhanced models of case review and oversight, and, in particular, for more complex MAID requests, to support consistency and quality assurance across the country. I understand that medical assistance in dying is a complex issue about which there are deeply held beliefs and opinions. I understand the concerns that have been raised with regard to the expansion of eligibility for MAID to include circumstances where the person's sole underlying medical condition is a mental illness. This would give medical practitioners more time to become familiar with available training and supports while providing time for the public to become more aware of the robust safeguards and processes in place. The Government of Canada has also committed to a joint parliamentary committee to undertake a comprehensive review within two years after the act receives royal assent. This measure would further serve to examine progress made by provinces, territories and partners in achieving overall health care system readiness. In the meantime, our government will continue to work with the provinces and territories to support ongoing improvements of the system to continue to ensure our laws protect those who may be vulnerable, reflect the needs of the people of Canada, and support autonomy and freedom of choice. That is why, after much deliberation, we have introduced Bill C-62 to extend the temporary exclusion of eligibility for MAID for persons suffering solely from a mental illness to March 17, 2027. To put it simply, we need more time to get this right. I urge all members of the House to support Bill C-62.

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Hon. Rob Moore (Fundy Royal, CPC)

Feb/7/24 5:27:52 p.m.
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Madam Speaker, the arrogance of the government knows no bounds. In its brief, based on a “review of evidence, the Board of Directors of the Society of Canadian Psychiatry believes the process leading to the planned 2024 MAID for mental illness expansion was flawed, insufficiently responsive to evidence-based cautions and resulted in a lack of safeguards.” It is calling on this expansion not to be paused for three years but to “be paused indefinitely, without qualification and presupposition that [any] implementation can safely be introduced at any arbitrary pre-determined date”. It urges that it not be “driven...by ideological advocates”. Why are the minister and the government continuing to press on when the experts have spoken? We should not be moving forward in this dangerous direction. It should be paused indefinitely.

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Hon. Ya'ara Saks

Feb/7/24 5:28:56 p.m.
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Madam Speaker, I will acknowledge that there are many different opinions that have been shared on this view by many different experts. As a matter of fact, some of the members of the special joint committee are going to be participating in the debate we are having tonight. We have to clear that this is not a matter of “if”. We are debating “when”. It has been recognized, and it is not up for debate, that a person suffering from mental illness, when it is irremediable, continued and impacting the quality of life of the individual, has the right and the dignity to make choices with their health practitioners. The expert panel noted that there were differing opinions on this and concerns, but when we are debating this tonight, it is not about arrogance. It is about having compassion and understanding the right to an individual's choice and dignity when they have deep, prolonged and ongoing suffering.

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Mr. Luc Thériault (Montcalm, BQ)

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

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Hon. Ya'ara Saks

Feb/7/24 5:31:35 p.m.
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Madam Speaker, this is why we have put a set timeline on this. We took the expert panel recommendations. There were 19 recommendations in that report, which included system readiness and a comprehensive set of modules for MAID assessors across the country to be able to do this work safely and compassionately. That is the work that we have done on implementation. Eleven hundred practitioners, including physicians and nurse practitioners, have participated in these training modules, but we have also been working with regulatory bodies. We want to make sure that there is quality and a standard of care across the country that sees people in their suffering, especially when they are vulnerable, and especially when mental illness as a disorder has caused such suffering and such harm over the years and over a prolonged period of time. We are very sensitive to the concerns of the member, and we are setting clear guardrails on the timelines for this.

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Mr. Alistair MacGregor (Cowichan—Malahat—Langford, NDP)

Feb/7/24 5:32:50 p.m.
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Re: Bill C-7

Madam Speaker, we need to have a reminder of why we are in the situation we are in. I was here in the 43rd Parliament when Bill C-7 was being debated. I remember very clearly the government's original charter statement, which included its rationale for excluding mental disorder as a sole underlying medical condition. I thought the charter statement was quite reasonable. However, we are in this situation because, when Bill C-7 went to the Senate, for some inexplicable reason, at the eleventh hour, the government did a complete 180° and accepted the Senate amendment. It changed the law before the hard work had been done. I have been a member of the special joint committee from the get-go, and on that committee, we feel like we have been playing a game of catch-up ever since, having to do the work racing against an arbitrary timeline. That is why we have see letters from seven out of the 10 provinces and all three territories asking for an indefinite pause. I hope the minister and the Liberal government can take responsibility for putting Parliament in this position. I would also like the minister to comment on the fact that there are so many populations, whether they are in rural or remote communities or urban centres, that simply cannot get the mental health care they need. When is her government going to step up to the plate and start servicing communities such as those in Cowichan—Malahat—Langford along with with those from coast to cost to coast? That is a huge problem that really needs to be addressed before we entertain any kind of a change to the law.

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Hon. Ya'ara Saks

Feb/7/24 5:34:18 p.m.
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Madam Speaker, my colleague and I are in lockstep in understanding how important a robust and integrated set of mental health services and substance-use services are. They must be available within health jurisdictions throughout the country. That is exactly why last year we committed to $200 billion to improve the health of Canadians. That is exactly why there are bilateral agreements that are tied to our four key principles, which include mental health. Provinces had to ensure that there were plans as part of their agreements and show a clear commitment to providing mental health services and substance-use services for those who are struggling with those disorders. That being said, we also want to make sure that our health care systems, when it comes to MAID, have the level of system readiness, consistency and quality assurance across the country. We do not want a pick-and-choose system. We want to make sure that our most vulnerable are safe and that those who make this decision are doing it not only to acknowledge the dignity—

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The Assistant Deputy Speaker (Mrs. Alexandra Mendès)

Feb/7/24 5:35:34 p.m.
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I have to give the opportunity for further questions. The hon. member for St. Albert—Edmonton.

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Mr. Michael Cooper (St. Albert—Edmonton, CPC)

Feb/7/24 5:35:38 p.m.
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Madam Speaker, at the beginning of her speech, the minister stated that irremediability is not up for debate. Respectfully, it is the core of the debate about whether MAID can be expanded in cases where mental disorders are the sole underlying condition. The overwhelming evidence from leading experts, including psychiatrists, is that it is difficult, if not impossible, to determine irremediability. That was the conclusion of the government's own expert panel, at page 9 of the report. The special joint committee heard evidence that clinicians could get it wrong 50% of the time. In other words, it is like flipping a coin with people's lives. Is the minister comfortable with that risk?

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Hon. Ya'ara Saks

Feb/7/24 5:36:34 p.m.
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Madam Speaker, I will remind the member that we cannot speculate on treatment. Treatment is something that a patient decides with their health care provider. There is a lengthy process of assessments that are done for those who struggle with mental illness. That being said, the criteria of eligibility are crystal clear. It has to be prolonged. It has to be determined irremediable, not only by the patient but also by a group of expert assessors. There needs to be a full assessment of what treatments have been engaged. I know there has been some debate in the House in the past asking about future treatments and all of that. We are looking at an individual and their prolonged suffering. I would ask the member to really contemplate it. Does an individual's own lived experience with prolonged mental illness, and the suffering that goes with it, not weigh in, beyond that of the experts who have not walked in their shoes?

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