44th Parl. 1st Sess.
February 7, 2024 02:00PM
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 Unless Bill C-62 is passed by March 17, 2024, the exclusion of eligibility for MAID will be automatically repealed.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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Madam Speaker, everyone in the House should feel the urgency and the necessity of tackling intimate partner violence and gender-based violence. As has been said, every six days in Canada, a woman is killed from intimate partner violence. This fact is not new, yet the Liberals, and the Conservatives before them, have not addressed it adequately. New Democrats refuse to stand idly by while countless individuals, primarily women and girls, face physical and psychological trauma and fear for their lives on a daily basis.
Intimate partner violence and gender-based violence are not just private matters; they are systemic issues rooted deeply in ingrained inequalities and power imbalances in Canada. It is women, especially those from marginalized communities, who experience the worst of this violence.
We also know that individuals with disabilities are disproportionately impacted by this kind of violence. People with disabilities experience higher levels of intimate partner violence, and they face unique barriers to accessing support and escaping abusive situations. As the NDP critic for disability and inclusion, too many times I hear from residents who say that there is not enough research done on this, that there is not enough data on this and that there is not enough investment from the government in understanding the impact of domestic violence on persons with disabilities. Therefore, I encourage the government to invest in more research on violence against persons with disabilities, all genders.
I also want to note that indigenous women face higher levels of violence and that the current government has failed to meaningfully tackle the horrific levels of violence experienced by indigenous women, girls and 2 people. The Liberal government could immediately address some of that violence by investing in housing.
In 2019, the Downtown Eastside Women's Centre presented a report called “Red Women Rising” at the Metro Vancouver indigenous relations committee. The presenter said that no woman should be homeless on her own land. That really stuck with me, and I hope the Liberals will make the investments needed to ensure that every single indigenous woman and every single indigenous person has a home to call their own.
We cannot achieve an equitable and just society until we address the underlying structures that enable and perpetuate this kind of violence. As a New Democrat, I am committed to dismantling these systems of oppression and creating a society where everyone lives free from violence. All New Democrats are committed to that. A society where everyone has a home and has access to full and universal health care and pharmacare is also something the current Liberal government needs to move on immediately.
I want to acknowledge the work of survivors, frontline organizations and advocates who helped to make Bill C-332 a possibility. I also want to thank my colleagues: the MP for Victoria, for bringing this important piece of legislation forward; and the MP for Esquimalt—Saanich—Sooke, for his work on criminalizing coercive and controlling behaviour. We would not be here without the commitment of those people.
Coercive and controlling behaviour is a form of abuse that so many people, especially women, have experienced and that many are experiencing today, living in fear in their own homes. It is a form of domestic violence that, rather than a single instance, is a repeated pattern of behaviour by the perpetrator. This pattern often includes physical violence and sexual violence, but in many instances, it starts with other types of abuse, like humiliation, threats and attempts to take away the person's support systems and independence. Often, that means limiting transportation options, like taking car keys or intentionally damaging vehicles, and also controlling their access to communication, like taking or breaking cellphones. It also often involves limiting access to bank accounts, passports and immigration documents.
We know that 95% of people who report physical abuse also report coercive control; they correlate. We need women and girls to know what these abusive red flags are and to know what this kind of abusive behaviour is and that it is unacceptable. It has terrible impacts on the person's mental health. It often means they live in fear of violence all the time. Too frequently, it ends in tragedy.
These stories are all too common. Coercive control is not only a serious issue on its own but also so often it is precursor to physical violence. This is an opportunity to stop physical harm before it happens.
I want to take a moment here to recognize an organization called BOLT Safety Society, a youth-funded, not-for-profit, building safer and equitable communities. I have known the women in this organization for many years. I am happy to say that my office in Port Moody—Coquitlam is called a safe hub. It is a place where women and gender-diverse residents can come and get information about support groups in our community and also to get a wellness kit, if they need it.
I want to thank BOLT Safety for their work, and I want to thank them for raising the issue with young women and diverse genders of what coercive and controlling behaviour looks like. Coercive control is one of the most common risk factors for femicide, even in cases where there were no instances of physical violence before the murder.
Passing this legislation gives victims and police the tools they need to prevent some of the most tragic examples of intimate partner violence. It is time we said, “enough is enough”. Years ago, the justice committee recommended criminalizing coercive and controlling behaviour in Canada, but the Liberal government, despite its claims to be feminist, has not acted. It continues to delay and disappoint.
All parties should listen to survivors, listen to frontline organizations, make sure we support those who experience this kind of abuse and give victims the tools they need to leave the situation.
I am urging every member in the House to take immediate action to protect women and victims of intimate partner violence, and to support this important bill. This is one important step in tackling gender-based violence and working to eradicate intimate partner violence from our communities forever.
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