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

Hon. Ya'ara Saks

Feb/7/24 5:31:35 p.m.
Watch

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.

159 words

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

Feb/7/24 5:32:50 p.m.
Watch
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.

286 words

Hon. Ya'ara Saks

Feb/7/24 5:34:18 p.m.
Watch

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—

178 words

The Assistant Deputy Speaker (Mrs. Alexandra Mendès)

Feb/7/24 5:35:34 p.m.
Watch

I have to give the opportunity for further questions. The hon. member for St. Albert—Edmonton.

17 words

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

Feb/7/24 5:35:38 p.m.
Watch

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?

114 words

Hon. Ya'ara Saks

Feb/7/24 5:36:34 p.m.
Watch

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?

162 words

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

Feb/7/24 5:37:37 p.m.
Watch
Re: Bill C-62 Bill C-39

Madam Speaker, here we are again, just as we were last February. We are faced with an arbitrary deadline set by the Liberals for their radical plan to expand MAID for mental illness. The Liberal government is completely unprepared and, therefore, needs to bring in eleventh hour legislation to extend the implementation deadline that it set in the first place. I cannot think of another time or another issue in which a government has effectively had to bring in emergency legislation twice to extend a deadline for the implementation of its own law. It is truly shambolic. How did we get into this mess, thanks to the Liberals? Very simply, what we have across the way is a radical and reckless government that put blind ideology ahead of evidence-based decision-making. That has been the consistent pattern, in terms of decisions the government has made with respect to this planned expansion. This started with David Lametti, the former justice minister, who accepted a radical Senate amendment back in 2021 to implement MAID for mental illness and then set an arbitrary two-year timeline for implementation. It should be noted that the charter statement for the bill in which Lametti accepted that radical Senate amendment provided a rationale for excluding MAID in cases of mental illness. The minister said at the time that he and the government were against MAID for mental illness because there were inherent risks and challenges. Indeed, he was right, but then he suddenly flip-flopped and rammed the amendment through with very little debate, one and a half days of debate. There was no parliamentary study, no consultation with experts and affected groups, and no evidence that MAID for mental illness can be implemented safely and appropriately. The Liberals got it completely backwards. Instead of studying the issue first to determine whether this could be implemented safely, they decided to move full steam ahead and study the issue after the fact. Had they approached this matter responsibly, they would have learned very early on that there are significant clinical, legal and ethical problems with expanding MAID in cases of mental illness. Among those problems are two fundamental clinical issues. The first is the difficulty of predicting irremediability. In other words, it is difficult to predict whether someone with an underlying mental health condition will get better. That is problematic in two major ways. One is from the standpoint of the law. Under the Criminal Code, in order to qualify for MAID, a person must have an irremediable condition. More specifically, an irremediable condition is defined as one in which a person has an incurable disease or illness and is in an irreversible state of decline. If it is not possible to accurately determine that someone with a mental illness is in an irreversible state of decline and will not get better, then how can MAID for mental illness be carried out within the law? It cannot. More significantly, from an ethical standpoint, if it is difficult to predict whether someone will get better, what that means with certainty is that persons who could get better will have their lives prematurely ended. Such persons could go on to lead a healthy and productive life. This was underscored by evidence heard by the special joint committee on MAID, during both its initial study two years ago and its more recent study this past fall. The special joint committee heard evidence that clinicians can get the prediction around irremediability wrong 50% of the time. In other words, it is like flipping a coin with people's lives. Is that a risk that members of the House are prepared to take? When I posed that question to the minister responsible for mental health, she essentially answered in the affirmative. She doubled down on her support for an expansion of MAID for mental illness in three short years. Flipping a coin, gambling with people's lives, is what MAID for mental illness will result in. A second fundamental problem is difficulty on the part of clinicians in distinguishing a rational request for MAID from one motivated by suicidal ideation. That is underscored by the fact that, in 90% of suicide deaths, persons suffer from a diagnosable mental disorder, not to mention that suicidal thoughts are often a symptom of mental disorders. This is why psychiatrists who appeared before the special joint committee said that it is not possible to distinguish MAID for mental illness from suicide. At the very least, MAID for mental illness significantly blurs the line between suicide prevention and suicide facilitation. It fundamentally changes the character of MAID and transforms it into something akin to state-facilitated suicide. This demonstrates just how far down the slippery slope we have gone under the Liberals. To paraphrase the minister, she said that there are robust safeguards in place in that persons with a mental illness would only be able to qualify after years of receiving treatments and not getting better. However, that is simply not accurate; no such safeguards are found in any legislation put forward by the Liberals. In fact, the expert panel that the Liberals appointed, incredibly, recommended that there be no additional safeguards. Therefore, under the MAID expansion, it is simply not accurate that one must go through treatments or that one must be suffering over an extended period of time in order to qualify. In fact, the Liberals expressly rejected such additional safeguards. In the face of those political challenges, Conservatives called on the Liberals to put an indefinite pause on this expansion. Likewise, in the lead up to the March 2023 deadline for implementation, the arbitrary deadline set by the Liberals, the chairs of psychiatry at all 17 medical schools called on the Liberals to pause this expansion. What did the Liberals do? Essentially, they kicked the can down the road. They introduced Bill C-39, which merely extended the deadline for implementation from March 2023 to March 2024. In other words, once again, the Liberals put ideology ahead of evidence-based decision-making, making what amounted to a political decision with a new arbitrary deadline. Nearly a year has passed, and with respect to resolving the fundamental issues and problems regarding safely implementing MAID for mental illness, where are we today? No progress has been made. Indeed, when the special joint committee heard from psychiatrists, the message was loud and clear that we should not move ahead with this. It is not safe, and it cannot be implemented appropriately. The responsible course for the government to take is to acknowledge that it simply got it wrong and put an indefinite pause on the expansion. It is no surprise that, in the face of these challenges, there is a professional consensus against the expansion. We saw that last week, when a survey from the Ontario Psychiatric Association was released. It indicated that a full 80% of Ontario's psychiatrists do not believe the health care system in Canada can safely implement MAID for mental illness. Last week, seven of the 10 provincial health ministers, plus the health ministers from all three territories, called on the Liberals to put an indefinite pause on this expansion. What did the Liberals do in response? Once again, they kicked the can down the road with Bill C-62, which is before us. They defied experts, the provinces and territories, and common sense. This bill is basically the same bill we were debating a year ago. Instead of a one-year pause, it provides a three-year pause, with absolutely no evidence to indicate that fundamental clinical problems can be resolved. These problems include predicting irremediability and distinguishing between a suicidal request versus a rational request. We have a government that is telling us to forget the evidence. The minister said it is not even up for debate, that the government does not want to talk about evidence as part of this issue. She basically said to forget about irremediability. The bottom line is that we have a Liberal government that is determined to implement this radical policy against a consensus among psychiatrists and other advocates. Indeed, to get an insight into the mindset across the way, last week, in a press conference, the Minister of Health said that there is a moral imperative to get ready for MAID for mental illness. What is the moral imperative? Is it to give up on people who are struggling with mental illness? Is it to offer death through the provision of MAID to persons who are struggling with mental health issues? That is what these Liberals characterize as a moral imperative? I say it speaks to the moral bankruptcy of these Liberals after eight years of the Prime Minister. When the Liberals talk about MAID and mental illness, they are always very vague about what they mean. They know that if Canadians fully understood what MAID for mental for illness meant, most Canadians would be absolutely appalled. The model practice standard, which I believe the minister alluded to, that was prepared by the government's so-called task group of experts provides that a mental disorder would include anything in the DSM-5. Any condition listed in the DSM-5 is what these Liberals are contemplating as constituting a condition that would qualify someone for MAID in the case of mental illness. What are the conditions listed in the DSM-5? They include personality disorders, depression, schizophrenia and issues when persons suffer from addictions challenges. That is what we are talking about when it comes to MAID and mental illness. It is truly repulsive, it is morally bankrupt to the core and it says everything Canadians need to know about the values of these Liberals. There is only one piece of good news in all of this, which is that this legislation provides a three-year pause, and what will happen between now and the expiration of those three years is a federal election. Canadians will have a choice. They can choose between a Liberal government that wants to provide death to persons who are struggling with mental illness or they can choose a common-sense Conservative government that will not give up on anyone, will be committed to offering persons struggling with mental health issues hope and health, and will permanently scrap this radical Liberal experiment that gambles with the lives of vulnerable Canadians.

1734 words

Mr. Yasir Naqvi (Parliamentary Secretary to the Minister of Health, Lib.)

Feb/7/24 5:56:21 p.m.
Watch

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.

134 words

Mr. Michael Cooper

Feb/7/24 5:57:11 p.m.
Watch

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.

150 words

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

Feb/7/24 5:58:26 p.m.
Watch
Re: Bill C-7

Madam Speaker, as my colleague knows, I have been on the Special Joint Committee on Medical Assistance in Dying from the get-go. If he will recall, in the 43rd Parliament, when this House was dealing with Bill C-7, the government's original charter statement, which provided its rationale for excluding mental disorders as the sole underlying medical condition, was fairly well reasoned, and explained that section 7 and section 15 of the charter can be involved here. However, we have to remember section 1. Sometimes we may need to limit rights. For me, personally, I am big believer in the charter, but I struggled through this whole process in how to find that balance between an individual's charter-protected rights but also the need of society to sometimes step in and protect the most vulnerable. Could the member tell us how he personally approached finding that balance, and to also put it in the context that so many people in Canada, whether they are in rural or remote communities or in our urban centres, are marginalized and do not have access to the proper mental health care supports they so desperately need?

195 words

Mr. Michael Cooper

Feb/7/24 5:59:44 p.m.
Watch

Madam Speaker, I enjoyed working with my colleague, the member for Cowichan—Malahat—Langford, on the special joint committee. The manner in which I approached this issue was by following the evidence to determine whether this expansion could be implemented safely and appropriately. The overwhelming evidence is that it cannot. It need not have been this way. We need not be here for a second time on the eve of an implementation date that was arbitrarily set by the Liberals. We could have studied this issue. We could have heard from experts. We could have heard from other groups about this, without moving ahead with legislation before undertaking that important consultation. Let me simply say that the Liberal government has gotten it backwards. It has gotten it wrong. What the government should be doing is coming back to this House and putting an indefinite pause on this expansion.

150 words

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

Feb/7/24 6:01:02 p.m.
Watch

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.

109 words

Mr. Michael Cooper

Feb/7/24 6:01:59 p.m.
Watch
Re: Bill C-7

Madam Speaker, if the member is referring to the Truchon decision, that was not what the Truchon decision provided for. That was outside the scope of the Truchon decision. Evidenced by that is the fact that when the Liberals responded to Truchon by introducing Bill C-7, mental illness as the sole underlying condition was expressly excluded from the legislation. This is a political decision brought on by the Liberals.

70 words

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

Mr. Michael Cooper

Feb/7/24 6:03:57 p.m.
Watch

Madam Speaker, the member for Montcalm is a thoughtful member on this issue. With respect to irremediability, I am absolutely not comfortable with moving ahead with this expansion if it cannot be accurately determined. We have psychiatrists come before committee and say it is like flipping a coin, that clinicians get it wrong 50% of the time. That is not an appropriate risk. That is evidence of a policy that has not been well thought out, and that is dangerous and will negatively impact vulnerable persons on a matter of life and death. With respect to the position of the Conservative Party, yes, the position is that a common-sense Conservative government would permanently scrap this radical and dangerous expansion.

120 words

Hon. Rob Moore (Fundy Royal, CPC)

Feb/7/24 6:04:53 p.m.
Watch

Madam Speaker, the arrogance and incompetence of the members opposite on this issue is truly alarming and frightening. Are they not aware that 30 legal experts wrote a letter to the former justice minister and cabinet saying, “Parliament is not forced by the courts to legalize MAID”. What does the hon. member make of this argument, from the minister who spoke earlier, that somehow, in her words, the debate is over?

73 words

Maid

Mr. Michael Cooper

Feb/7/24 6:05:29 p.m.
Watch

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.

118 words

Mr. Anthony Housefather

Feb/7/24 6:06:37 p.m.
Watch

Madam Speaker, I rise on a point of order. I made a technical error in my vote on PMB Motion No. 86 on the seventh vote today, and I would very much appreciate the House's unanimous consent to allow me to change my vote to no.

47 words

Change
Pmb

The Assistant Deputy Speaker (Mrs. Alexandra Mendès)

Feb/7/24 6:06:43 p.m.
Watch

Is that agreed? Some hon. members: Agreed.

7 words

SoVote

House Hansard - 277