44th Parl. 1st Sess.
February 12, 2024 11:00AM
- Feb/12/24 12:40:48 p.m.
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- Re: Bill C-7
Madam Speaker, the decision to expand MAID in the case of mental illness was not a decision of the courts. It was a political decision made by the Liberals. That is evidenced by the fact that the government's initial legislative response, Bill C-7, expressly excluded MAID for mental illness in response to the Truchon decision, which was not an appellate decision, as the member said, but a lower court decision that, yes, the government should have appealed.
We have heard from experts the fundamental clinical issues, including the difficulty, if not impossibility, of predicting irremediability as part of the reason why there was a one-year delay. It is part of the reason why now the government is kicking the can down the road with a further three-year delay. What evidence can the member cite that the issue is going to be resolved in three short years?
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- Feb/12/24 12:51:50 p.m.
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Madam Speaker, today, it is interesting to follow the member across the aisle when we are speaking about a matter of grave importance. I find it absolutely fascinating, in a very strange sense, that the member opposite would suggest that somehow MAID has saved lives, when, indeed, 13,200 Canadians have died because of MAID. On top of that, we know that is a 30% increase year over year. We also know that in California, which has a similar population, if I have my statistics correct, about 450 people died because of MAID.
MAID for mental illness presents a serious difficulty for all Canadians, and thankfully, Conservatives on this side of the House are ready to stand up for those who have mental illness and who have suffered with it for a very long time. We know clearly, from the DSM-5, that there are many conditions that, if Canadians were aware were classified as a mental illness, they would find this legislation even more appalling than they do now. We know that over half of Canadians reject this terrible idea of MAID for mental illness. When Canadians think of mental illness, they think of things such as depression, schizophrenia and bipolar illness, all of which are chronic medical conditions with available treatment.
However, we also know the reckless government and this reckless expansion of MAID is causing some of the major difficulties. In the DSM-5, what would also be classified as a mental illness would be things such as substance use disorder and autism, both of which are chronic illnesses. I believe Canadians specifically would find it appalling for the reckless government and its reckless agenda to suggest that Canadians who are suffering from a substance use disorder or Canadians with autism are never going to get better, and that they should be subjected to the MAID regime.
When we begin to look at and understand the difficulties associated with the reckless, costly coalition's expansion of MAID, we also know that the 17 chairs of the departments of psychiatry from Canada's universities have spoken out specifically against this expansion of MAID.
There are two things that are very important. Let us start with, perhaps, suicidality, which the member across did mention. I guess the question then remains how an experienced, or even inexperienced, primary care physician or nurse practitioner would be able to determine the difference between suicidality and a demand for MAID. The member across is right. I did practise as a family physician for more than 25 years. Practising in an emergency-room setting on a Saturday night when somebody comes in and is suicidal is probably one of the most stressful things someone can possibly deal with. I think every one of my physician colleagues across this country would admit to that.
We are incredibly well trained, and we have incredible protocols for dealing with trauma, strokes and heart attacks, but when somebody comes in with suicidal ideation, it is incredibly personal. It is situational. It is related to medication. It is related to family. It is related to every single difficult relationship they have in their lives. If there is a physician out there who suggests that, when they go home after a shift Saturday night that ends Sunday morning where they told someone who was suicidal that they are okay to go home, and they know that person is fine, but they do not worry about that decision, I would challenge them on that.
That, for me personally as a physician, was something that created significant distress and angst, and it should. What we are talking about is somebody's life and their decision to end it or not. We have a regime put forward by the reckless and costly coalition to have people with mental illness receive medical assistance in dying, to be put to death by the state.
That is the suicide part of it, which, again, can be with respect to an acute or a more chronic condition. However, it is the irremediable aspect of the mental illness that creates significant difficulties for the reckless and radical expansion of the MAID regime. What does the word “irremediable” mean? It means, in basic terms, that the condition cannot be fixed, that the treatment that has been rendered is all the treatment available and that the condition is going to either continue the way it is or get worse in the future. Who is going to decide that?
There is a Canadian Association of MAiD Assessors and Providers. The group is staffed by family physicians and nurse practitioners, despite the opposite thought of many Canadians who would think it would be psychiatrists who would be determining whether a condition is not fixable and chronic and that all of the possible treatment out there has been rendered. That is not the truth; at the current time, the decision would be rendered by two different care providers who are either primary care providers or nurse practitioners. That is incredibly important because we know that even the diagnosis of a mental illness is based on probabilities: Has someone had a particular set of symptoms for a certain amount of time over a certain amount period of time?
It is not like high blood pressure, which a doctor can check and then have a concrete, objective answer. It is not like diabetes, where a person's blood work is done and they have a concrete answer that, yes, the numbers are elevated and the person does have diabetes and can be told what will be done to help them with it. Mental illness is very, very different, and Canadians need to know that; if they do already know it, they need to remember it.
The other important thing is the terrible job that the costly NDP-Liberal coalition has done with respect to access to health care in general but more specifically to mental health care. We know that across this country, half of Canadians are extremely unhappy with their ability to access mental health care, and we also know that the waiting time for adults to access a psychiatrist in most parts of this country is about a year. This means very clearly that primary care physicians and nurse practitioners are providing the majority of mental health care for Canadians, deciding which treatments are working and which are not, when to increase medications, when to add on, etc.
Very sadly, it is clear that for Canadians under 18, the wait time for mental health care access to a psychiatrist in Canada is more than two and a half years. The system is atrocious. The Prime Minister stood up and promised 7,500 doctors, nurses and nurse practitioners to Canadians. How many have we seen? I dare say it has been almost zero. The terrible situation with respect to access to care is most acute when people are seeking mental health care.
Of course, from this side of the House, we do not want the legislation to proceed, but we see a government in panic mode that has no plan and no clear idea of what it is going to do, wants to do, or should do on behalf of Canadians. Here we are. Multiple times at the 11th hour, senior elected government officials across the aisle have said, “We have to rush this through; we have to get it done on behalf of Canadians.”
What they fail to remind Canadians of is that it is the government's fault that we have arrived at this situation in the first place. The government members did not appeal the right decisions, allowed decisions to be added on in the Senate, and did not make a decision when they should have, on behalf of Canadians. Therefore, I would implore the House to understand clearly that MAID for mental illness is not the correct path to go down.
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- Feb/12/24 1:01:59 p.m.
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Madam Speaker, the member opposite from Nova Scotia is a fellow doctor. The legislation would put a hold on implementing MAID for mental illness. A year before the legislation would come into effect, the committee would have to be re-formed to reconsider the matter and call the experts again. Do you think that in two years' time there is going to be any more of a consensus on the issue than there is at the moment?
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- Feb/12/24 1:07:59 p.m.
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Madam Speaker, it is always a true honour to stand in the House of Commons and represent the beautiful riding of Peterborough—Kawartha.
I believe that what we are talking about today, which we have been talking about for almost a year to the day, is actually one of the most important pieces of legislation this Parliament will ever discuss and decide on. If people do not know about it, I can promise them with certainty that it will either either impact those who are watching or someone they know.
What we are talking about is MAID, medical assistance in dying. The Liberals have put forth the notion to extend MAID to people with mental illness. Members heard me correctly. It sounds absurd because it is absurd. It is the worst message we can send to somebody who is in despair: that they are not worth saving. The worst message we, as legislators and policy makers, can send is that someone's life does not matter. I do not think I can name a member of the House who does not know somebody who has had, or who has not themself had, battles with mental health.
The government is saying it would put forward legislation that would not put more resources, money or time into better understanding mental illness, which includes substance abuse, through which 22 people a day in this country are dying from overdoses, but would offer MAID. This must disturb us. This must make us get up. This must make us speak loudly. I do not care where people sit on a political spectrum; the bill before us is the legislation people should be deciding their vote on, because it is a huge statement of what we as Canadians stand up for.
I want to read this: “To be eligible for MAID under the Criminal Code, a person must have a ‘grievous and irremediable medical condition,’ which is defined as ‘a serious and incurable illness, disease or disability’ that has led to an ‘advanced state of irreversible decline’ and intolerable suffering.” It is impossible to determine irremediability in individual cases of mental illness. Many experts have been clear that MAID for mental illness cannot be implemented safely.
Dr. John Maher, a clinical psychiatrist and medical ethicist said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.” As my colleague from Cumberland—Colchester, who is a medical doctor, has attested to multiple times, we cannot say with certainty what is going to happen to someone. We do not know what tomorrow is. I am going to read the most powerful letter into the record, because I think it is critical for everyone to hear it.
I also want to say that in February 2023, just a year ago, 30 legal experts from across Canada wrote an open letter addressed to the Prime Minister and Liberal cabinet ministers to dispute the claims that the then justice minister had repeatedly made, which were that his government was bound by the courts to expand MAID and to make it available for persons whose sole underlying medical condition is mental illness.
This is hard to comprehend, and I spent hours trying to decide why they would want to do this. My 14-year-old said to me on the weekend that if someone is in a state of mental illness, like bipolar disorder, and is in an extreme low, they cannot make a decision that is right for them. That is the whole thing; they need help. With the legislation before us, someone could, in that state, ask for MAID. On what planet does that make any sense? It does not.
I am going to read a letter into the record. It is extremely powerful. Kayla has been writing to me since the issue first came aboard, and she has been very vocal in letting me share her story. I shared her original letter, and now that she knows the government wants to extend MAID yet again instead of throwing it out, she wanted me to read this letter to every member of the House of Commons:
“Hello, Michelle.
“I am thrilled to hear that MAID for people with mental health disorders as their only condition will not be put into place next month. However, it is deeply disturbing to me that the Liberals think time to get this right makes it better. What will be the difference in 2027? They will still be offering death to people who may very well live long lives with improved quality of life.
“In my own darkest moments I also thought things would never get better. I thought I would be sad and scared and hallucinating for the rest of my life, but they did get better, and offering MAID to people like me when in their worst moments is robbing them of the opportunity for things to get better. It is robbing people of the opportunity to receive help. It is robbing them of the opportunity to heal.
“It is also disgusting to me that death would be offered as a solution to people with mental health disorders when the resources for people with mental health disorders, at least where I live in Ontario, are in shambles. People are living on the streets with addictions. People are coming to myself to help them get help knowing that I have been through my own dark mental health struggles, and I am at a loss for where to send them. Wait lists are long, and while I know of some early psychosis intervention programs, people who have been struggling past early adulthood have nowhere to go but the hospital where they can't stay forever.
“I want to tell you about my dear uncle. He lives with paranoid schizophrenia. He recently hit rock bottom. He lived on the streets for over a year, and not for a lack of my family trying to help him. He almost died of pneumonia. Every time my family would take him to the hospital and try to get him help for his mental health, he would be released. Then he would get arrested and return to the hospital only to get released again. This went on for years. I understand a normal hospital doesn't have resources for him, but the point is no one knew what to do.
“But back to MAID. This idea needs to be scrapped. Offering death as hope to people in mental health crises is despicable. Just because it is a needle does not give people more dignity. It denies the dignity that already exists in every single human life. Just because the government hands you the knife while smiling doesn't change the fact that they are handing you the knife to kill yourself.
“Our lives are not useless or lesser just because we struggle with mental health disorders and it is time the current Canadian government started to believe that.
“Thank you, Michelle.
“Kayla.”
Can we please give Kayla a round of applause for her bravery? She has spoken up so many times about this, and in genuine distress.
I heard my colleague across the way, the Liberal member for Winnipeg North, say that he struggled with this because it is so personal. He said that this was what his constituents wanted. My response to him would be: I would like to see the data. I would like to see a referendum that this is what his constituents want, that they would rather MAID be offered than support to resources in understanding how the brain works, why the brain does what it does and what is mental illness. I challenge him right here, right now, to give me that data, because I can say with certainty that the families I know, the children I know who are on wait lists over two years long, do not want to be offered death. They want hope, they want treatment and they want solutions.
It is insane that we are even having this discussion, “Well, we'll just extend it.” Do members know what the Minister of Mental Health and Addictions said in the House? She said that it is not a matter of if any longer; it is when. This is such a deep ideology that the Liberals cannot even say, “Okay, all right, we get it. We heard from the 30 experts. We have heard from the people. This does not make any sense and there is no science here. We will pull it back. This was a mistake.”
There is no shame in admitting there was a mistake. We are here to make people's lives better, not worse, absolutely, without a doubt, not this message of, “You know what? Yeah, it is not going to get better. So, here, sign this paper. We are going to give you MAID.”
For those who are watching and have voted Liberal and are loyal, I plead with them to look at this. This is the most disgusting piece of legislation that has ever been put on the floor of the House of Commons, and we must invest in mental health and treatment.
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- Feb/12/24 1:21:00 p.m.
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Madam Speaker, I guess my response to that member is to ask why medical assistance in dying should be offered to somebody who has a mental illness, when what they need is help. It does not make any sense. As I said, I cannot reconcile those two things. If we do not know with certainty whether somebody is going to get better, why would we put that into legislation to even make it an option?
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- Feb/12/24 1:44:21 p.m.
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Madam Speaker, it is interesting. The member talked a bit about intellectual rigour in some of his comments. He really conflated the demande anticipée with this bill on mental illness.
He also went on to say something about suicide, that it is sudden, that these people have never had any health care. Clearly, studies say that 30% of individuals who have died by suicide sought health care in seven days, 16% within 30 days and greater than 90% within 365 days.
When the member has no intellectual rigour with respect to his comments related to medicine and how it is practised, and the difficulties with irremediability in suicidality, why should we take his idea and say that anybody with mental illness should be eligible for MAID?
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