44th Parl. 1st Sess.
February 12, 2024 11:00AM
- 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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- Feb/12/24 1:43:49 p.m.
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The amendment is in order.
Questions and comments, the hon. member for Cumberland—Colchester.
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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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- Feb/12/24 1:45:26 p.m.
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Madam Speaker, perhaps the interpretation was not accurate, because what I said is that the suicidal state is reversible and that all experts agree on this, whether they are for or against expanding medical assistance in dying to cover mental disorders. It is reversible. People need to stop fearmongering.
I was also saying that if we expand MAID to cover things like mental disorders, it could have a preventive effect. Some people who have suicidal ideation today are going to commit suicide, and they will never have received treatment in the system. Sometimes no one sees it coming.
I am not saying that my colleague's quote does not exist. I am saying that some people suffering today will commit suicide and no one will see it coming. I am more thorough than that. He knows that very well. He does not have to insult me to ask me questions.
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- Feb/12/24 1:46:39 p.m.
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Madam Speaker, the member asks a question about why the legislation is there. I want to amplify the fact that many regions of the country, I believe it is seven provinces and others, are looking to get themselves into a better position to provide the level of expertise and other issues related to it, to have it in place. Stakeholders and provinces are asking for the delay. That is the reason for it.
The question I have for the member is specific. What does he think about the Conservatives intentionally misleading Canadians, giving a false impression that if people are going to commit suicide, they can apply and the government will assist them in committing suicide? It is ridiculous, yet the Conservatives seem to think they can get away with saying those outrageous things.
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- Feb/12/24 1:47:38 p.m.
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Madam Speaker, that is precisely why I am saying that the government lacks courage. Faced with the political rhetoric machine, the government thinks it is better to backtrack, knowing full well that, by postponing this until 2027, it is quite possible that the same government will not be deciding what to do about mental disorders. What it could do is extend it for a year, and if we are still not ready in a year, nothing would stop us from taking another year. Putting this off until 2027 right now essentially leaves the ball in the Conservative demagogues' court.
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- Feb/12/24 1:48:19 p.m.
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Madam Speaker, my hon. colleague is well aware of all our work on the special joint committee. We sat together on that committee from the beginning.
In our recommendation of our most recent report, we put in that recommendation “qualitative benchmarks”, not any kind of a reference to a time frame but more based on whether we had appropriate recommendations from departments and on consultation with provincial and territorial governments, and also the indigenous peoples of Canada.
Similarly, in the letter that was received by the federal government from seven out of 10 provinces and all three territories, there were more qualitative benchmarks, in that the ministers were asking for an indefinite pause based on further collaboration and consultation.
I know Bloc members have asked for a one-year delay, but how do they reconcile that with the fact that so many are calling for these qualitative benchmarks to be established rather than an arbitrary timeline?
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- Feb/12/24 1:49:25 p.m.
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Madam Speaker, I have already answered my colleague's question.
What I told him and I will say it again is that the Special Joint Committee on Medical Assistance in Dying sat for too little time. I would have liked to be able to question the people who wrote that letter to get them to support my position, which is that decisions cannot be forever.
He is telling me that the NDP, which is a progressive party, believes that mental disorders are totally related to our ability to meet demand, when no matter how good the treatment a person receives is, they may still experience a mental disorder that will be irremediable.
Instead of putting it off indefinitely, why not work on it over the next year? That is the Bloc Québécois's position. It is a matter of hearing from those people to see what their arguments are based on, knowing that this cannot be postponed indefinitely.
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- Feb/12/24 1:50:36 p.m.
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Madam Speaker, medical assistance in dying is a very thorny issue. Each of us in the House has our own opinion on it.
Yesterday, in the Les coulisses du pouvoir interview on Radio-Canada, he said that the nasty Conservatives on the religious right were against advance requests and were keeping the House from moving forward.
I checked this morning with our House leader; that is not true at all. We have never objected to anything in that respect.
Can the member apologize for his misleading statements to Radio-Canada?
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- Feb/12/24 1:51:34 p.m.
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Madam Speaker, since 2015, every time we have addressed medical assistance in dying in the House, it has been blocked by the Conservatives.
I understand that my colleague is not happy about it. He tells me that everyone has a right to their own opinion. The Conservatives' opinion is very much based on the views of religious right-wing voters.
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- Feb/12/24 1:52:12 p.m.
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Madam Speaker, my colleague has previously worked on this file; he has also served in the National Assembly, but if I am not mistaken, it was not at the time of the debate on medical assistance in dying. He will correct me if I am wrong.
Could he explain any significant differences that may exist in terms of the sensitivity with which the two parliaments, the two states, have dealt with this issue?
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- Feb/12/24 1:52:44 p.m.
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Madam Speaker, I would like to talk about how the work is organized.
In Quebec City, parliamentary committees are rigorously organized. Witnesses are not invited for just five minutes of speeches with three or four other panellists at a meeting where sometimes there are not even any questions because the witnesses are of no interest to the party in question. Expert witnesses appear at these hearings, and each witness gets 50 minutes. It is altogether different.
Here in Ottawa, the methodology is inadequate and we are not doing a good job. This needs to be fixed.
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- Feb/12/24 1:53:35 p.m.
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Madam Speaker, I know this is a very important discussion on MAID being available to people with mental illness.
If people are in a certain mental state, obviously they are not considered to be of sound mind when they try to make that decision. Who would make that decision in their place? Who decides who avails of MAID and who does not? I have a problem with this part of it, having somebody else make that decision. It almost like someone is trying to cleanse society.
Would he agree that people should be of sound mind to make the decision themselves when it comes to MAID?
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- Feb/12/24 1:54:13 p.m.
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Madam Speaker, I am not so sure about the wording of that question.
It is up to the patient to make the request, but it is not the patient who ultimately decides. The decision is made by the assessors, the treatment team as well as a psychiatrist who is independent of the treatment team and independent of the person who will carry out the procedure. There will also be prospective oversight, not retrospective oversight.
There are enough guidelines for us to make an informed decision in this matter.
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- Feb/12/24 1:54:56 p.m.
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Before I go to the hon. member, I want to remind members, as they are starting to come in for question period, that if they want to have conversations to please take them out to the lobby.
Resuming debate, the hon. member for Cowichan—Malahat—Langford.
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Madam Speaker, I would like to inform the you that I will be splitting my time.
Today, we are not debating Bill C-62; we are actually debating Motion No. 34, which is a programming motion to get the bill through the House of Commons. We are having to resort to a tactic that I do not often like to use, but time is forcing us to do this.
If the House of Commons, the Senate and Governor General do not act and we do not have this bill into royal assent by March 17, the law is going to change. Essentially, many experts have expressed an extreme amount of discomfort with that. There is a lot of professional discomfort. We have seen also from our provinces and territories that they are very uncomfortable with the pace of change that is going on.
What Bill C-62 would do is delay the implementation of MAID for persons who are suffering from a mental disorder as a sole underlying condition. The bill would further kick that can down the road until 2027. It also has a legislative requirement that the Special Joint Committee on Medical Assistance in Dying be reconvened in advance of that date. Hopefully, that committee would have the time necessary.
As parliamentarians, we have to step up to the moment. I am particularly saying this for my hon. colleagues in the House of Commons. There is plenty of blame to be assigned to the Liberals, and, trust me, I have given my fair share. We are in this situation because of an ill-advised 11th hour amendment to Bill C-7 in the previous Parliament, a bill that the government's original charter statement had presented as a reasonable argument against the expansion of MAID to people who had mental disorders. Then that bill went to the Senate and it inexplicably accepted a consequential amendment that brought us to where we are today.
Last year, we had to quickly pass Bill C-39, because, again, we were not ready for the deadline then. That kicked the can further down the road by one year. Now we find ourselves in the exact same position. I am suffering déjà vu, like a lot of my hon. colleagues are, where we now have to force this legislation to kick the can down the road another three years. I feel like I am caught between two forces right now: the ineptitude of the governing Liberals for putting us in this position and a Conservative Party that seems to just want to cause chaos in this final week.
This is a moment when the adults in the room need to step up to the plate. There is plenty of blame to be assigned, but we cannot work around the deadline and the fact that we have only two sitting weeks left to us. We are still at the second reading stage of this bill, and that is why this programming motion is necessary. That is why we need to step up to the plate and ensure that Bill C-62 is through the House of Commons by the end of this week. It still has to run the gauntlet in the Senate, and who knows what is going to happen in the red chamber. That is something for the government members to figure out.
One thing that is really good about this motion is that there is a requirement that the Standing Committee on Health be convened on Wednesday. That will allow members of that committee to question either the Minister of Health or the Minister of Justice and also have two hours to speak to witnesses. Honestly, we need to come together as a Parliament and ensure that we get this through.
It is further bolstered by the fact that seven out of 10 provinces and all three territories sent a letter to the federal government asking for an indefinite delay. These are signatures of ministers of health and ministers responsible for mental health and addiction, which are essentially the departments that are responsible for oversight of the whole medical assistance in dying regime. We have to listen to those incredibly important voices. We have to listen to their expertise. We have to honour what they are requesting in this letter.
I ask my hon. colleagues to step up to the plate and be the adults in the room. Let us get Bill C-62 passed through the House of Commons this week.
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- Feb/12/24 2:00:12 p.m.
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Mr. Speaker, as we celebrate the spring festival, I wish all Chinese Canadians a very happy, healthy and prosperous year of the dragon. As one of the luckiest animals in the Chinese zodiac, the dragon offers hope for good luck and health over the next 12 months.
I take this opportunity to recognize the important contributions that Chinese Canadians have made, and continue to make, for the socio-economic development of Canada. Arriving about 160 years back, Chinese Canadians worked hard in the mines and built railroads. Today, with their knowledge and expertise, Chinese Canadians immensely contribute to our technology sector to keep Canada at the forefront of the knowledge-based economy.
I also recognize that Chinese heritage has enhanced the rich multicultural fabric of our wonderful country.
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- Feb/12/24 2:01:05 p.m.
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Mr. Speaker, this past weekend, I shared a heartbreaking Facebook post. I reached out to Dave and Susan Girard and asked them if I could share it here in the House of Commons, and they replied, “Yes, please.”
Here is some of the post, as I do not have time to read it all. It states, “After a long battle with addiction, our 28-year-old son, Ryan David Girard, died of a drug overdose on February 8, 2024. Beloved son of David and Susan. Dear brother of Mitchell. Cherished grandson of Ted and Betty Maker, and David (deceased) and Delores Girard.
“Our family would like to speak the truth about his death. Silence would mean Ryan's death was in vain, but if one person’s life is saved by his story, I would tell it over and over. Fentanyl and opioids are terribly addictive substances, and unfortunately, addiction is a disease that has no cure. Ryan loved animals, water sports, hockey and soccer and when he was young, he was above average academically and athletically, but drugs stole his soul.”
We must fight against these drugs that are killing 22 Canadians a day. It is our job to do better.
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- Feb/12/24 2:02:24 p.m.
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Mr. Speaker, February is Black History Month, and I would like to thank all members of Black communities who are making a difference every day in my home of Scarborough Centre.
Over the past several years, I have had the opportunity to visit and work with the CEE Centre for Young Black Professionals. It is doing such important and impactful work focused on youth workforce development, education and advocacy. Another group making a difference is Ògo Tàwa, which helps gifted, under-represented, underserved and underemployed artists of African descent make a living from their art. I would also like to recognize the Heritage Skills Development Centre and its executive director, Charity Lebeanya, who do a lot of important work to recognize and celebrate the many cultures and communities that call Scarborough home.
Let us celebrate Black excellence this month and every day of the year.
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