44th Parl. 1st Sess.
February 13, 2024 10:00AM
- Feb/13/24 10:10:21 a.m.
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Mr. Speaker, I thank the member for her contributions, but reject the characterization.
We indicated quite openly and publicly that we would not proceed with medical assistance in dying where mental illness is the sole underlying condition until after we had received the study from the joint committee that is made up of members of Parliament and of senators.
That joint committee study was tabled in this chamber on January 29. Shortly thereafter, we reviewed that document, prepared legislation and tabled that legislation expeditiously. That legislation is now before this chamber, and we have a statutory deadline to meet prior to March 17 that relates to the sunset clause, thus necessitating the need to move it expeditiously through both this chamber and the upper chamber.
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- Feb/13/24 10:12:36 a.m.
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Mr. Speaker, I would say, quite candidly, that I agree with the member's supposition. When we are dealing with a matter of such compelling interest and such consequential interests that are at stake, with respect to a life-and-death situation involving medical assistance in dying, it is important that parliamentarians work in unison. There have been divisions on this issue in the past, and there remain divisions in this chamber with respect to this issue.
What we are saying is that we are dealing distinctly with the issue of mental illness as a sole underlying condition. On that piece, we believe the prudent course is to have an extension of time for a following three years. We hope that all parliamentarians would support that and the pressing need to get this piece of legislation through both Houses to royal assent prior to March 17 to avoid the very confusion the member identified.
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- Feb/13/24 10:14:31 a.m.
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Mr. Speaker, I thank the hon. member for his contributions today and every day in this Chamber.
The journey has been a detailed one, a responsible one and a prudent one. What we understand, as a government and as parliamentarians, is that mental illness causes suffering, and that suffering is equivalent to physical suffering. We also understand people have decision-making capacity, including those who are mentally ill.
We also understand that, as a federal government in a federation where the health care system and the delivery of health care is primarily the jurisdiction of provinces, proceeding in a situation where the provinces have spoken with one voice, saying that provinces and territories are not ready to deliver medical assistance in dying for people who have mental illness as their sole underlying condition, in that context, we have to listen to those provinces and work with those provinces to help them with their readiness.
The provinces have spoken uniformly to the Minister of Health and to myself about their lack of readiness and about the fact that more time would be beneficial to ensure that there is better take-up of the curriculum and that supports are in place for those who would assess and provide MAID, and that there is more understanding of how those safeguards would be implemented in the context of an individual who has mental illness as their sole underlying condition. Based on that, we are seeking, through this chamber and through the upper chamber, an extension of three years. That would be a prudent course when the situation is very significant, when the interests are significant and when then consequences are very permanent.
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- Feb/13/24 10:17:59 a.m.
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Mr. Speaker, I thank the hon. member for Saanich—Gulf Islands for her contributions today and every day in the chamber.
She outlines exactly the balance that we are trying to craft, and have tried to craft since 2016, in response to the Carter decision. Those are basically two different ideas: promoting the dignity and the autonomy of an individual in this country, and ensuring that we are protecting vulnerable people with adequate safeguards so they are not victimized. In this context, the safeguards and the protection are critical in the context of those who are mentally ill. That has been guiding theme here.
In addition to the provinces and territories that have spoken up about the lack of system readiness, we have also heard from the Canadian Mental Health Association and from the Centre for Addiction and Mental Health that they are also not ready and concur with the provinces' and territories' assessments.
With respect to the last point raised by the member for Saanich—Gulf Islands, she talked about mental health supports. This is critical now more than ever, particularly coming out of the COVID pandemic. What I would say to her is that when we reached a deal about one year ago to provide a record number of dollars in support of the Canadian health care system, we outlined certain parameters for that support. One of the pillars of that support was to support mental health and the mental health needs of Canadians. That is a fundamental priority for us and will remain so.
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- Feb/13/24 10:20:59 a.m.
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Mr. Speaker, I would like to give a two-part answer to that question.
First, the Province of Quebec itself has said that it is not prepared to provide medical assistance in dying to people whose only medical condition is a mental disorder.
Second, my colleague mentioned advance requests. That is another issue. I have tremendous respect for the crucial work that has already been done in Quebec on advance requests. However, Canada has only one Criminal Code, and there is a very good reason for that. Canadians deserve to have consistent standards and clarity about what is criminal and what is not criminal across the country. There is no quick way to safely allow an exception for Quebec on this issue at this time.
The conversation does not end here, though. We are committed to working with Quebec to determine the next step. We have taken a cautious approach to medical assistance in dying from day one back in 2016. We will continue to proceed with caution on this issue for the whole country.
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- Feb/13/24 10:23:46 a.m.
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Mr. Speaker, I respect the member opposite, but I am going to take issue with some of the submissions he just made. It is precisely because of the contentious nature of what is at issue that we are ensuring, using every tool that we have, that the bill becomes law prior to March 17 and the expiration. If the bill does not become law by March 17, we would have the confusion that was mentioned by the member for New Westminster—Burnaby, a situation where people may be able to avail themselves of MAID where the context is mental illness as the sole underlying condition.
We do not believe the system is ready, because we have heard that, to a person, from every health minister in every province and territory. We have heard it from the health care practitioners, the nurses, the MAID assessors and the MAID providers. A curriculum has been designed, but take-up of the curriculum is not where it needs to be. The safeguards are not in place. The oversight mechanisms are not in place.
It is precisely because of the unpredictable nature of some people's mental illnesses that we need to ensure that we are working prudently and safely before we propose an expansion of the regime to persons for whom mental illness is the sole underlying condition.
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- Feb/13/24 10:26:27 a.m.
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Mr. Speaker, I appreciate my colleague's remarks and his hard work on the special joint committee.
I have several points to raise. The first one is that the bill addresses mental illness as the sole condition. The act requires that we deal with the issue before March 17, 2024.
I have a lot of respect for my colleague across the aisle. He mentioned that Canadians from coast to coast agree on the issue of advance requests. Although Quebec has expressed its willingness, I do not believe that all Canadians agree; that is the second point.
Obviously, if we want to extend medical assistance in dying to advance requests, we need to do so responsibly and with caution, as we did with all of the other issues, in other words, with all of the health experts, namely health ministers, psychiatrists, doctors and nurses. We need to proceed with caution, making sure to respect individual rights. We also need to strike a balance between individual rights and the protection of vulnerable persons. That is how we have been doing things since 2016, and that is how we will continue in the future.
Once again, it is important to note that the Criminal Code applies to the entire country. It is important to have clear information for all Canadians, so that everyone understands their rights and the criminal rules that apply across Canada. Criminal law must be consistent from one province to another.
That said, political discussions with Quebec are ongoing because this conversation needs to be had. However, we need to proceed carefully, cautiously and prudently.
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- Feb/13/24 10:30:44 a.m.
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Mr. Speaker, I want to thank the member for Esquimalt—Saanich—Sooke for his contributions today and every day, particularly on the justice committee and on the joint mixed committee. I agree with him that this is probably the most challenging and personal issue that any of us has touched, particularly for those who were elected in the class of 2015, who have been dealing with this for the last eight years. Because what is at issue is so significant, because the consequences are so permanent by definition, it is critical to get it right and to proceed in a prudent manner.
Some of those things are outlined in the charter statement we have tabled in the House. It talks about the screening for decision-making capacity being particularly difficult in the context because of the symptoms of the person's condition or because their life experiences can impact their ability to understand and appreciate the decision they are about to make. Further, feelings of hopelessness and wishing to die are common symptoms of some mental illnesses, which can make it difficult for even an experienced practitioner to distinguish between a wish to die that is fully autonomous and considered, and something that is a symptom of one's personal illness.
Also, the course of a mental illness over time is very much less predictable than that of a physical illness. Last, and importantly, we do not have a record of evidence that has been built up in this country with respect to how the practice would unfold. Ensuring that we build up that record of evidence and that we build up the important curriculum and the uptake of that curriculum for the assessors and providers is critical.
For these and many other reasons, we are adopting a position that we would proceed responsibility, cautiously and prudently in three years' time with the initiative, but also reconvene the joint committee on which the member has sat so it can assess system readiness about two years from now, prior to the three-year deadline's coming to the fore.
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- Feb/13/24 10:33:50 a.m.
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Mr. Speaker, I thank the member opposite, but I think his comments reflect something that was raised also by the member for Medicine Hat—Cardston—Warner.
Just to be clear for Canadians, if we do not proceed expeditiously in this chamber and in the Senate, the law will change on March 17 so as to allow medical assistance in dying for people who have mental illness as the sole underlying condition.
If the member for Tobique—Mactaquac is concerned about supports for those who are mentally ill, and I believe he has that concern, then what he should be doing is working with us collaboratively to ensure passage of the bill to prevent that situation from arising. The logical premise of his question is false.
What we are doing is proceeding expeditiously as a responsible government after hearing from the joint mixed committee of MPs and senators about the need to put a pause on this. We would be putting a pause on it. We presented the legislation expeditiously and are seeking passage of the legislation expeditiously.
As we have have heard from the member for Saanich—Gulf Islands, in this context even she is making an exception to her principled approach towards closure in order to invoke closure so we can get the bill done and protect Canadians. Fundamentally, my job as Minister of Justice is to do just that, and I will not be deterred in that task.
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- Feb/13/24 10:36:17 a.m.
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Mr. Speaker, what I can add to the conversation I just had with my colleague across the way is that we created expert panels to study several aspects of expanding medical assistance in dying. Experts conducted a study on advance requests. They found that it is extremely complex when we talk in the present about articulating a desire to seek medical assistance in dying, added to the fact that a person might submit a request 30 or 40 years ahead of time. Given the context, their situation, condition and wishes could change.
This said, Quebec has already addressed the issue, and a bill has been introduced in the province. We are well aware of this, and we are starting a discussion with Quebec. Discussions will be held.
We have a Criminal Code that applies across the country. Consequently, the question has to be approached the same way we dealt with the other aspects, meaning nationally. This is what we did when we prudently undertook consultations while taking the necessary precautions.
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- Feb/13/24 10:39:05 a.m.
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Mr. Speaker, I thank the member opposite for his second contribution this morning, because it is very salient and very pointed. I would urge my Conservative colleagues to actually reconsider their presumed position with respect to this legislation and the need for passing it efficaciously, as soon as possible.
As a candid response to his question, so that we are crystal clear, if we do not pass this legislation by March 17, it would be possible in this country for someone whose sole underlying condition is mental illness to avail themselves of MAID. That would occur in the riding of Medicine Hat—Cardston—Warner, in the province of Alberta, as well as in the province of New Brunswick, which the member for Tobique—Mactaquac represents. The ministers of health for New Brunswick and Alberta have both said to us unequivocally that their health care systems, their MAID assessors and providers, are not ready.
I do not want a situation where we have that kind of lay of the land in terms of the criminal law in Canada. We have the power to prevent that from happening by voting in favour of this bill.
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- Feb/13/24 10:41:28 a.m.
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Mr. Speaker, I appreciate the comments of the member for Louis‑Saint‑Laurent.
I want to note two things.
First, my colleague is absolutely right when he says that we must avoid partisanship when we are dealing with such a sensitive subject and where the consequences are so serious for Canadians.
I might add that he and his colleagues sat on the special joint committee both the first and second time. So we have already had the opportunity to hear the Conservatives' views on the matter. We have reflected on those comments and indeed we introduced a bill that reflects the will of their caucus.
I believe that we need to move forward with that expressed will and promote the adoption of this bill today in the House.
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- Feb/13/24 2:38:57 p.m.
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Mr. Speaker, I have tremendous respect for the crucial work that Quebec has done on advance requests.
Canada has one Criminal Code, and for good reason. Canadians deserve consistent standards and clarity about what is criminal. There is no quick way to safely allow an exception for Quebec on this issue.
The conversation does not end here, though. We are committed to working with Quebec to determine the next steps.
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- Feb/13/24 2:40:09 p.m.
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Mr. Speaker, medical assistance in dying is a deeply personal and complex choice. There is always a balance to be struck between an individual's autonomy and dignity, and the protection of the vulnerable.
We have taken a cautious approach from the beginning. We owe it to Canadians and Quebeckers to treat these issues thoughtfully and to proceed with caution.
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