44th Parl. 1st Sess.
February 12, 2024 11:00AM
- Feb/12/24 12:51:36 p.m.
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Does the hon. member have unanimous consent to split his time?
Some hon. members: Agreed.
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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 1:02:28 p.m.
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The hon. member is to address questions and comments through the Speaker and not directly to the member.
The hon. member for Cumberland—Colchester.
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- Feb/12/24 1:02:31 p.m.
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Madam Speaker, the question from the member for Thunder Bay—Rainy River is a thoughtful one. I think, as I clearly pointed out, that the assessors and providers of MAID are not suddenly going to be psychiatrists. We do not have enough access to psychiatric care in this country, due to the terrible management of funds by the government.
Am I hopeful that, suddenly, this is going to change in the next two years? With a new government, I suspect that things will be better from a fiscal perspective, but creating more access to health care is going to take some time because of the mess the current government has left it in. Am I hopeful that it is going to be better in two years? Absolutely not.
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- Feb/12/24 1:03:22 p.m.
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Madam Speaker, with all due respect to my colleague, who sits with me at the Standing Committee on Health, I invite him to reread the expert report. Honestly, when I heard him talking in his speech about people with mental disorders being put to death by the state, I thought that was utterly outrageous.
Recommendation 10 states, “The requester should be assessed by at least one assessor with expertise in the condition(s). In cases involving [mental disorders], the assessor with expertise in the condition should be a psychiatrist independent from the treating team/provider.” He talked about two doctors. There they are.
What is more, “Assessors with expertise in the person's condition(s) should review the diagnosis, and ensure the requester is aware of all reasonable options for treatment and has given them serious consideration.”
How can my colleague make such claims, when medical assistance in dying for mental illness has to be requested? Just because someone requests MAID does not mean they are eligible for it. Does he not trust the people who practice his profession?
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- Feb/12/24 1:04:42 p.m.
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Madam Speaker, I think it is very important that Canadians understand that the vagueness of the language does not demand that it be a psychiatrist who would be making the determination of irremediability. As I clearly pointed out in my speech, the majority of psychiatric care in this country is and has been, over the last 50 years, delivered by primary care physicians. We must understand that this is where a person will primarily receive their diagnosis, that they will receive multiple different treatments if they have an illness that is very difficult to treat, and, again, that many Canadians, especially adults, will have more than a year's wait to see a psychiatrist.
Therefore, depending on psychiatrists to provide intervention, along with diagnosis and treatment, is failing in this country. To go on and expect that they would suddenly be MAID assessors is folly.
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Madam Speaker, the member for Cumberland—Colchester had a couple of factual errors in his speech. The NDP voted against Bill C-7's amendment that brought this in. We supported the member for Abbotsford's bill, Bill C-314, and we support the majority report. We have never been for the expansion; let us put that on the record.
We are at a moment in time this week, with an impending deadline, when we can throw blame at the Liberals, and they are well deserving of it, or we can rise to the occasion and be the adults in the room, given that there are only two sitting weeks left before March 17. Which are the Conservatives going to choose? Are they going to be on the side of getting the bill through the House to the Senate in the correct amount of time?
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- Feb/12/24 1:06:40 p.m.
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Madam Speaker, clearly we know that the NDP, part of the costly coalition, will continue to not support the needs of Canadians and that it will continue to vote on all things with the reckless Liberal government, which has led Canadians to be, every month, $200 away from insolvency and to have the greatest numbers of auto theft crime in the most recent history. The chance to believe that it might do something right for Canadians is almost zero.
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- Feb/12/24 1:07:10 p.m.
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The hon. member for New Westminster—Burnaby is rising on a point of order.
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- Feb/12/24 1:07:13 p.m.
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Madam Speaker, not only is the member misleading the House yet again, but he is also not being relevant at all to the subject matter at hand, which is something very important. All parliamentarians should be respectful in the House.
I would ask that you—
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- Feb/12/24 1:07:30 p.m.
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The hon. member knows full well that there is some flexibility when debating and answering questions. I find that the hon member for New Westminster—Burnaby is actually raising points of debate. He may not like what was said; he can address that through speeches or through questions and comments.
Resuming debate, the hon. member for Peterborough—Kawartha.
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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 1:18:05 p.m.
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Madam Speaker, first of all, no government has invested more in mental health than under this Prime Minister and this Liberal government. What a joke coming across from the other way. They are trying to give the impression that someone who is having suicidal thoughts could just go to a place and get it rubber-stamped, giving them a pill or an injection. That is just stupid.
If the member is so brave, why will she not go to any high school in Winnipeg North and have a debate on the issue with me? Will she accept that challenge? Let us have a debate, let us invite a few people over in a high school. That way we cannot be accused of trying to make it lopsided, one way or another. Will she come to Winnipeg North?
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- Feb/12/24 1:18:52 p.m.
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Madam Speaker, a thousand per cent. I hope that he will pay for the plane ticket himself to send me there. I will be there with bells on.
I think what that member said is so disturbing. He said that their government has invested more in mental health than any other government. What a fallacy and an insult. I do not know who he is talking to, but I have seniors, family members and other people calling me who are living on the street and using food banks. What does he think that does to mental health? We are 35 out of 38 in the OECD with regard to teen suicides in this country, yet the government has invested the most. There is a wait-list of almost two years for a teenager who needs access to mental health, but the government has done its best job. What about that $4.5-billion mental health transfer that was supposed to happen? Where is that?
I am sorry, but the stats speak for themselves. We have never been in a worse mental health crisis than under that Prime Minister and that Liberal government that divides people and makes them not want to live.
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- Feb/12/24 1:20:09 p.m.
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Madam Speaker, it would have been good if my colleague could have sat with us on the Special Joint Committee on Medical Assistance in Dying. I think she is confusing two things. Just because a person requests MAID does not mean that they will be eligible to receive it, and all of the experts, whether they are in favour of MAID or not, have said that a suicidal state is reversible.
I am not sure what she was talking about, but it is important not to engage in fearmongering. No one who has just been taken into care will be given that option because, first of all, it is not an option that is offered to people. People have to make a request.
I would invite my colleague to read the panel's recommendations on that.
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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 1:21:44 p.m.
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Madam Speaker, there was a letter that was signed by seven out of 10 provinces and all three territories asking the federal government for a delay. The case is bolstered by those health ministers and ministers responsible for mental health and addictions.
We have a very tight timeline. We have two sitting weeks left until the law changes. There is plenty of blame to be assigned but this week we have to step up to the plate as parliamentarians.
My question to my hon. colleague is this. Are the Conservatives going to support this programming motion on government business No. 34, to get this bill to the Senate so that we have the time? Otherwise, the law is going to change. That is the fact we are dealing with.
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- Feb/12/24 1:22:27 p.m.
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Madam Speaker, what a backward place we work in. Why are we even having this legislation? It should not have even been here in the first place. Why are we expanding it when it should not even exist? It does not make any sense. Now they say, “Well, you know what? We only have so much time. We've got to expand it because we shouldn't have put it in there in the first place. Are you going to support it or what?”
This is so backwards. If it had not been put in place from the first, we would not even be here having this discussion. This legislation should not be offered, period.
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Madam Speaker, let us try to calm down a bit.
In this debate, the government is basing itself on the Special Joint Committee on Medical Assistance in Dying for its amendment to Bill C‑62.
The Bloc Québécois would have liked to lend its support. The problem is that we believe that we should not indefinitely delay the possibility of medical assistance in dying for people with an irremediable mental disorder, when no psychiatrist worth their salt has been able to treat them or relieve their suffering. After 10, 20 or 30 years of suffering, the decision whether or not to request MAID should not lie with this person, who is supposed to determine whether the patient is eligible.
We asked for an amendment to the bill. Why take three years when, last year, we were told that it would take a year to make sure that MAID for people with mental disorders could be set up in a safe and appropriate manner? The main issue we have is that, in 2015, there was an election, but there was also the Carter decision. The government and this Parliament passed terrible legislation, similar to the one Quebec adopted a year earlier.
Quebec passed a law that only covers end-of-life cases, people who are terminally ill. I want to reiterate that, in the terminal phase of life, the process of dying has begun and is irreversible. People can be well taken care of in palliative care. Good palliative care, as described by Cicely Saunders at the time, is full, comprehensive, holistic support for people as they are dying. It involves adequately managing the person's pain and suffering, both physical and emotional, and supporting their family. All of this should be done in an environment that resembles a normal environment as much as possible. However, it is possible that, all of a sudden, in the midst of this process, the patient, who is slowly dying, will request MAID because, one day, they are feeling at peace and ready to let go. That is not a failure, in my opinion. It can be seen as successful palliative care. When my colleagues are about to depart this life, I hope that they will be calm and at peace. That is what I would wish for everyone.
So Quebec had taken those steps. Then in Parliament came the Carter decision, which stated that Ms. Carter was not at the end of her life, but she was suffering a great deal. It was therefore decided that depriving her of medical assistance in dying impinged on her right to life. Why? She was being forced to end her life prematurely, when the fact is that letting her decide what happened next would empower her. It was up to her to define when her suffering became intolerable.
It was a bad law. Bill C‑7 had to be introduced. When we began studying Bill C‑7, there was another factor that had to be considered; that was in 2021.
The Carter decision states that there cannot be an absolute prohibition on MAID simply because people belong to a particular group, one that is vulnerable. It must be assessed on a case-by-case basis.
The reality is that people can and do struggle with irremediable mental disorders. Irremediability is established through a rigorous process. During that process, practitioners must be certain that the person has never refused treatment that we know would have absolutely improved their situation.
There are indeed people whose mental disorders cause intolerable suffering, and psychiatry does not help them. If anyone here wants to claim otherwise, I would say that they lack intellectual integrity. Psychiatrists cannot cure everyone; it is impossible. That said, psychiatry is rife with medical paternalism.
That being said, what we wanted was for the government, whose Bill C‑62 is based on the work of the Special Joint Committee on Medical Assistance in Dying, to plan ahead for when it might have to introduce Bill C‑62 and include another key recommendation of the special joint committee in the bill. That recommendation was presented a year ago and was the subject of a consensus. One Conservative member even joined the majority. There is a consensus in favour of advance requests.
Why was that not included in the bill? It should have been anticipated. The government knew that the date would have to be pushed back. It had a year to introduce a measure in the House that would have also covered people suffering from dementia and Alzheimer's. Why did the government not do that? We asked the government why it was not doing so when it had the chance. Quebec drafted its own legislation. It is structured, rigorous and unanimously supported in Quebec.
An Ipsos poll shows that 85% of the Canadian population supports advance requests. In British Columbia, 84% supports advance requests. In Alberta, it is 84%; in Saskatchewan and Manitoba, it is 81%; in Ontario, it is 84%, in Quebec, it is 87%; in Atlantic Canada, it is 81%. I could go on. There are other figures. They vary. The results are based on a sample of 3,500 people. That is not nothing. When will the government take action? Why has it not heard this request? Why has it not spoken with Quebec, who has worked on this issue? Why did it not hear the unanimous will of the National Assembly, just last week? Why is it afraid of its own shadow? Why do the Liberals lack courage so?
The last time they lacked courage, we ended up with Bill C‑14. What is the problem with Bill C‑14? The real problem with Bill C‑14 is not a legal problem. The problem is for a patient who is suffering, who, to satisfy the reasonably foreseeable natural death criterion, has to go on a hunger strike. We have seen that. The problem is for people who, like Ms. Gladu and Mr. Truchon, have to fight for their constitutional rights in court. When I say there is a lack of courage, that is what I mean.
My only viewpoint is the viewpoint of patients who are suffering. The only thing I am standing for here is the suffering patients' right to self-determination. Patients had to fight an uphill battle against medical paternalism when it comes to MAID.
As I mentioned last week, there was a time when the palliative care that is so dear to the heart of my Conservative friends and that I personally consider to be very important was called passive euthanasia. Doctors obstinately used aggressive life-support measures because their duty was to save their patients. As we know, every doctor thought that they could save every patient back then. It was actually doctors suffering from cancer who started to assert their right to refuse treatment. Today, cessation and refusal of treatment are part of what are considered to be good medical practices.
Why are we not studying the bill today? The government is imposing a gag order. We will not be overly critical of this decision. I understand that this has to be done before March 17. We are not getting too worked up about this, but still, we have not consented and will not consent to this. Why not? It is because we wanted a bill that was based on the recommendations from the Special Joint Committee on Medical Assistance in Dying. I want answers from the government in that regard.
Why the delay in expanding medical assistance in dying to people with mental health issues? We did what the committee asked. Bill C‑62 even provides for the Special Joint Committee on Medical Assistance in Dying to reconvene in order to determine whether the groundwork has been laid. That is what we are doing. We basically took the recommendation and inserted it into the bill. Then, there is the issue of advance requests. There is a consensus on that across the country, but the government lacks the courage of its convictions.
The Liberals are afraid of demagoguery because there has been a lot of it on this issue. They are lumping everything together. However, at some point, they need to be consistent in their approach. The Liberals are well aware that the state's role is not to decide for the patient what is best for them when it comes to a decision as personal as one's own death. The state or the patient's neighbour is not the one who is going to die. The state's role is to determine the proper conditions and ensure that they are put in place so that patients can make a free and informed choice. If people are worried about abuse or the slippery slope when it comes to advance requests, then they should look at Quebec's law, which is a model to follow.
The government could have easily inserted elements of the Quebec law into its regulations. It is all well and good to say that the law is a little vague, but the amendment we are making to the medical assistance in dying legislation, expanding section 241 of the Criminal Code, is followed by a procedure, regulations on enforcing regulations. That is where the various safeguards are put in place.
There are standards of practice when it comes to mental disorders. A year ago, a committee began looking at standards of practice, and they will be sent to the regulatory bodies in each province, namely the colleges of physicians. Once we have clear guidelines and standards of practice and the criteria I was talking about earlier are met, someone in a suicidal crisis will not have access to medical assistance in dying.
It bears repeating, because I am hearing a lot of confusion over this. A suicidal person is not eligible for medical assistance in dying, even if they suffer from a mental disorder and are in suicidal crisis, and even if they have recently been admitted to care and diagnosed. I have often asked psychiatrists if they thought that giving access to medical assistance in dying to people with mental disorders could also provide an opportunity for prevention. Some people commit suicide and no one sees it coming. No one knows those individuals today, no physician took them on.
For example, knowing that MAID is an option, a person might come forward because they are suffering and want to exercise that option. Well, that person would not qualify. However, they would then be taken care of and get the treatment they need, since suicidal ideation is reversible. There is no question about that. However, it is not about those patients. When we asked the chair of the expert panel, psychiatrist Mona Gupta, how many patients in her practice would have been eligible, she told us of two or three patients over her entire practice. Still, these are people who are suffering.
When people talk about the fact that the resources are not there—the resources in terms of someone to assess capacity, for an independent psychiatrist to look at a case—I would point out that right now, the decision-making capacity of a person struggling with a mental disorder, but who has cancer, for example, is verified. Psychiatrists are currently assessing the decision-making capacity of people with a mental disorder and a comorbidity. Depending on their condition, practitioners are able to determine the decision-making capacity of these people who have a mental disorder.
The Supreme Court was clear: Not allowing these people to access MAID creates stigma. Not only does it stigmatize them, it discriminates against them. Why infantilize and weaponize people who have a mental disorder and who, in their entire existence, have not found treatment that can alleviate their suffering?
I rather like having discussions and debating with my Conservative colleagues. They have a sense of conviction, but there are some Conservatives who use scare tactics and conflate everything. It is not enough to repeat some 20 times that someone came to say that irremediability is hard to address. Everyone agrees. Even the expert panel starts with that. They did not hide that fact. In fact, they say that because irremediability is hard to establish there must be safeguards and precautionary principles put in place.
I therefore move the following amendment:
That the motion be amended in subparagraph (b)(ii):
(a) by adding after the words “be deemed referred to a committee of the whole,” the words “that an instruction be deemed to have been given to the committee granting it the power to expand the scope of the bill so as to take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care,”;
(b) by replacing the words “deemed reported without amendment” with the following: “deemed reported with the following amendments:
That the bill be amended by adding the following new section 241.21 to the Criminal Code:
New section 241.21
Medical assistance in dying eligibility criteria for advance requests
“241.21 The government of a province may establish a medical assistance in dying framework for advance requests from persons who have an illness that could deprive them of the capacity to consent to care, in accordance with the laws of that province.””; and
(c) by replacing the words “deemed concurred in at report stage” with the following: “deemed concurred in at report stage, as amended”.
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