44th Parl. 1st Sess.
February 13, 2024 10:00AM
Mr. Speaker, I thank hon. Minister of Justice for sharing these comments with other members of the cabinet, particularly the Minister of Health.
This is perhaps the most difficult issue any of us will ever deal with as members of Parliament. Strangely enough, I will just add that, had she been alive when I was a member of Parliament, Sue Rodriguez, who went all the way to the Supreme Court of Canada for the right to die with dignity, would have been my constituent. She lived in North Saanich.
There is tremendous public support in my area for medical assistance in dying being available to Canadians. However, I have to say, when it came to Bill C-14 and extending it to where mental illness was the only underlying cause, I voted for that bill only because there was a time delay, and we should be ready before it comes into effect.
I support what the Minister of Justice just said. We know the provinces have spoken with one voice. I am very concerned that access to treatments for mental health are still not available and might push people toward seeking MAID because they cannot get access to something like psilocybin that could deal with their underlying causes.
I very much object to using time allocation. I do not think I have ever voted for time allocation in this place, but now I must because the court deadline is approaching; March 17 is soon. We need to make sure that we do not leave Canadians in this awful gap where we do not have anything in place, as a Parliament, to deal with the current crisis.
I offer those comments just to say that I will be voting differently from the way I typically have, but I still vigorously object to time allocation being used routinely.
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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 11:42:13 a.m.
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Mr. Speaker, my colleague has done incredible work at the health committee and the AMAD committee. I really appreciate him for that.
I hope that some day we will have an opportunity so that those with the sole underlying medical condition of mental disorder will have the ability to make that decision. However, we are so far away from parity, given that consecutive Liberal and Conservative federal governments have not prioritized mental health. We are also far behind other countries, including U.K. and France, when it comes to delivering parity with our mental and physical health care systems, and that needs to be addressed.
With respect to the member's other question, absolutely I support that. The AMAD committee needs to put its next focus and amount of work around advance directives.
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- Feb/13/24 12:02:29 p.m.
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Madam Speaker, it sounds like we are in agreement around the importance of us not moving forward MAID legislation that includes those living with mental illnesses as the sole underlying condition.
I worked in mental health and addictions prior to becoming a member of Parliament. As somebody who is in the governing party, what can the member share with those living day to day who are not getting access to the mental health supports they need when there was a promise of $4.5 billion in the last election to be transferred to those who need it most, those who do not have access to the housing they need and those who are not getting the money from a disability benefit actually in their bank accounts at a time when they need it most?
I am wondering if the member can share what he would say to those who need the supports today around mental illness.
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- Feb/13/24 12:49:22 p.m.
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Madam Speaker, there is wisdom in life, in our decisions, but fear should never dictate our actions. I do not want use the word “chaos”, but I think we need to recognize all the work that has been done on this file.
Today's bill adds a three-year delay to the inevitable question that arises when mental health comes into play. It seems to me that re-establishing the Special Joint Committee on Medical Assistance in Dying and giving it an extra year to do a more in-depth study might have been a better solution.
This is just going to postpone suffering. Psychological suffering exists. Some people who have it talk about cancer of the mind. That is also a reality.
That said, it is 2024. Much progress has been made, such as being able to make an advance request for MAID for certain illnesses.
Why has the progress made at the special joint committee not been moving forward? Can my colleague tell us why—
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- Feb/13/24 1:22:10 p.m.
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Madam Speaker, I did not realize until the member's speech today that she was a social worker prior to becoming a member of Parliament. I worked in mental health and addictions prior to become a member of Parliament as well.
Can the member share her reflections on what is at the root of this discussion, which is the importance of those most vulnerable in our communities accessing the supports they need and deserve? Can she reflect on the importance of us having the mental health transfers that were promised in the last election, as well as housing and wraparound supports? What are her reflections now that she is in this position as a member of Parliament?
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- Feb/13/24 3:43:30 p.m.
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Mr. Speaker, I am a bit surprised in how the Conservatives are approaching the debate. They have made it very clear that they do not support the expansion of MAID with regard to mental health. However, it will automatically take effect come March 17, unless this legislation passes. They seem to want to prevent the legislation from passing, especially if we take a look at the vote.
Does the Conservative Party want this legislation to pass and, if so, will they support it?
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- Feb/13/24 3:58:21 p.m.
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Mr. Speaker, the member is a great speaker in the House. I certainly enjoyed the story about one of my constituents. That was really great, and I agree. I am an advocate for mental health access. Actually, I did vote against the previous bill as well in the previous Parliament.
I really want to highlight that it is so important to create the clear distinction between suicidal ideation, what happens when someone is dealing with depression and wants to take their life, and medical assistance in dying. It is really important to have that distinction made.
I wonder if the member could comment on that.
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Mr. Speaker, it is with a sense of profound responsibility and pride that I address the House today regarding the government's proposed bill, Bill C-62, aimed at extending the temporary suspension of eligibility for medical assistance in dying, MAID, for individuals suffering exclusively from mental illness, for an additional three years. This discussion is not just about policy but about the very essence of compassion, dignity and the complexity of human suffering.
The concept of MAID resonates deeply within the Canadian societal fabric, touching upon the core values of autonomy and the right to end intolerable suffering. In Richmond Hill, as in communities across our nation, I have engaged with constituents, health care professionals and advocacy groups. These conversations have revealed a spectrum of beliefs and underscored the critical importance of adopting this issue with sensitivity, respect and an unwavering commitment to the well-being of all Canadians.
Since MAID was introduced, our office organized three community council meetings to deeply engage on this topic. We also partnered with the Canadian Mental Health Association, among many other professional associations, to enhance the dialogue with our constituents. Following the special joint committee's report, we convened our latest community council to gather our constituents' views and insights. Their response was clear and united in support of the delay. This active involvement with our community underlines the importance of careful reflection and thorough examination in addressing this issue.
The proposed extension under Bill C-62 is not merely a procedural delay. It is a crucial break that would let us look more closely into how mental illnesses and the final choice to end a life interact with each other. Mental health issues are complex and different for everyone, making it hard to fit them into our usual ideas about illness that leads to death. We need to look at each situation individually, taking the person's pain seriously while making sure there are strong protections in place to prevent hasty choices.
Our government acknowledges the importance of the data and reporting in relation to MAID, so much so that the original 2016 legislation obligated the Minister of Health to collect and report annually on MAID assessment and delivery. The formal monitoring system is important to inform our understanding of who applies for MAID in Canada, the medical conditions prompting requests, and trends in MAID activity since the 2016 legislation. As such, we have been working in collaboration with the provinces and territories and with health care professionals to establish a robust monitoring system. It is important to emphasize that this is a significant collaborative commitment.
As members know, on March 17, 2021, revised federal legislation was passed, expanding MAID eligibility to persons whose natural death is not reasonably foreseeable, providing they meet the remaining eligibility criteria.
Since the passing of the new legislation, the vast majority of MAID deaths, that is 96.5%, involved individuals whose death was reasonably foreseeable. Of course, two-thirds had a cancer diagnosis. In 2022, just 3.5% of total MAID deaths, which is 463 deaths, were attributed to individuals whose death was not reasonably foreseeable, representing less than 0.2% of all deaths in Canada. Of those 463 deaths, nearly 50% reported that the main underlying medical condition was neurological, such as ALS or Parkinson’s disease, while the remaining cases involved a variety of other complex conditions, including multiple comorbidities, cardiovascular disease, organ failure and respiratory illnesses.
Although the current sample is small, 2022 data also shows that where death was not reasonably foreseeable, 64% of individuals were approved for MAID, compared to 83% of individuals in cases where death was foreseeable. Each MAID request where the person’s natural death is not reasonably foreseeable is complex and unique, and early indications show that approvals for MAID in this stream are much lower than when the person’s death is reasonably foreseeable.
The decision-making process for MAID, especially in the context of mental illness, is fraught with complexity. It necessitates a meticulous evaluation of the individual's condition, an exploration of all viable treatment options and a profound understanding of the person's lived experience. This process is not undertaken lightly. It is grounded in empathy, clinical expertise and a rigorous adherence to ethical standards.
I also previously engaged in discussions on this matter in 2016 and again in February 2023. Today marks my third address to the House on this subject, which holds personal significance for me and, undoubtedly, affects numerous households in Richmond Hill and beyond.
I wish to highlight the government's consistent commitment to thorough and collaborative investigation, in concert with provincial, territorial and societal stakeholders, to ensure that MAID is administered with rigorous safeguards to protect the vulnerable while respecting the rights and dignities of applicants.
In pursuit of these objectives, the government enacted Bill C-39 last year, extending the moratorium on MAID for those with mental disorders as their sole medical condition until March of this year. This extension was pivotal in facilitating the safe provision of MAID, allowing for the broader dissemination and adoption of essential resources among medical and nursing professionals and ensuring the readiness of our health care infrastructure.
Moreover, this period provided the government with a crucial window to review the conclusive report by the Special Joint Committee on Medical Assistance in Dying. The one-year extension has proven invaluable, enabling the special joint committee to conduct a review in October 2023 concerning Canada's preparedness to accommodate MAID requests for mental disorders.
On January 29, 2024, the committee tabled its third report, which outlined recommendations regarding Canada's readiness for the safe execution of MAID under these circumstances. Following the committee's recommendations, the government, via Bill C-62, seeks to extend the pause on MAID for those with only a mental disorder until March 17, 2027. This aims to give our health care system enough time to prepare for MAID under these conditions.
We have held detailed talks with health care experts and the public, which showed a clear need for more time to maintain the integrity of this process. This time would also help in creating and sharing specialized training for health care workers, developing detailed policies and encouraging discussions on this important matter. The goal is to create a system that acknowledges mental illness complexities, protects those at risk, respects individual rights and dignity, as well as the Constitution, and ensures the proper safeguards.
In conclusion, we know that the MAID regime has provided relief from suffering for thousands of Canadians so far, the vast majority of whom are already at the end of life, and that individuals living with intolerable suffering will continue to explore MAID as an option in the future.
We have made a commitment to transparency and accountability across all levels of government to support public confidence in the MAID regime. I am also confident that we are honouring that commitment by providing Canadians with accurate and reliable information on MAID as it continues to evolve in this country.
As I stand before you, Mr. Speaker, acknowledging the profound impact of this issue on myself, the constituents of Richmond Hill and countless other Canadians, I am confident that this bill would facilitate the careful and considered approach required to address this sensitive matter appropriately.
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- Feb/13/24 6:55:29 p.m.
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Madam Speaker, in terms of legislative timing, the government missed an opportunity to actually resolve this issue when it voted against the private member's bill from my colleague, the member for Abbotsford. Conservatives put forward a bill in the fall that would fix this problem and forever put a stake in this terrible idea of euthanasia for those with mental health challenges.
Now, we want the bill before us, which would extend the timeline, to pass so that when we have a Conservative government, we can actually permanently fix this problem. However, it is up to the government to allocate more days for debate; I would suggest that they do so, so more members can speak and so we can get it done before the deadline.
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- Feb/13/24 7:06:09 p.m.
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Madam Speaker, I am not in too much disagreement with a lot of what the member had to say.
As a long-time doctor, I certainly know that one ought to be cautious, and I think our government has been pretty cautious. We first put a one-year pause on this; now we have a three-year pause. I hate to get political in this political place, but the reality is that one of the reasons we should hesitate to implement MAID for mental illness is a lack of mental health services. Our government has been fighting to increase those services.
Will the Conservative Party make the same commitment to providing adequate mental services for Canadians?
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- Feb/13/24 7:22:32 p.m.
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Madam Speaker, my hon. colleague is absolutely right. We do not treat mental illness in parity with physical illness. If I have a broken arm, we can see that injury and will offer all our assistance to it, but if I am struggling with mental illness or mental health challenges, it is an invisible illness and an invisible injury, and we do not do enough as a nation to put those supports in place. That is why I said we are giving up on Canadians when we take the easy way out. We need to put more resources in place so that people can get the help they need when they need it, wherever they need it and for as long as they need it.
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- Feb/13/24 7:24:15 p.m.
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Madam Speaker, I have sat with many people who have struggled for their lives with mental illness and mental health challenges. The greatest issue many of them have is that they do not have adequate access to help and that they constantly are waiting for help. I think we need to first go down the path of doing everything in our power to remove the barriers for care so that we can help those who feel helpless and we can provide hope in their times of despair. I believe life is always worth fighting for. When somebody is struggling, I will always tell them that life is worth fighting for. We do whatever we can to fight for them.
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Mr. Speaker, I am pleased to have the opportunity to rise in the House this evening in support of Bill C-62.
I will note, in particular, the government's commitment to respecting people's autonomy and personal choices, while supporting and protecting Canadians living with mental illness who may be vulnerable. I will also talk about the major investments that our government has made to improve access to mental health services for all Canadians.
We recognize that mental illness can cause suffering that is on par with suffering that results from a physical illness. That is not up for debate. We also know that persons with a mental illness are capable of making decisions with respect to their own health, unless individualized assessment suggests this capacity is lacking.
However, while we respect the autonomy of those who choose MAID in response to severe and irremediable suffering, we have an equally important responsibility to protect Canadians who may be vulnerable, including those suffering from mental illness or who are in crisis. That is why federal legislation provides rigorous safeguards and criteria that must be applied to all MAID assessments.
The experts who made up the expert panel on MAID and mental illness were of the opinion that the existing legal safeguards provide an adequate structure for assessing cases where a mental disorder is the sole underlying medical condition, provided those safeguards are interpreted correctly and applied appropriately. In its final report, the group made 19 recommendations, including the development of model MAID practice standards and training for clinicians.
Our government has made significant progress, in collaboration with the provinces and territories and other health care stakeholders, to implement the recommendations of the expert panel and to prepare for the expansion of MAID eligibility. However, the provinces and territories have expressed concerns regarding the current March 2024 timeline and are asking for more time.
The Special Joint Committee on Medical Assistance in Dying also recognized the progress made in preparing for the expansion of eligibility for MAID. However, as noted in the committee's recent report, it is recommended that additional time be provided to ensure that eligibility for medical assistance in dying can be safely assessed for individuals whose sole medical condition is a mental illness.
The three-year extension we are proposing in this bill will allow more time for the adoption and integration of the necessary resources, such as the model MAID practice standards and the training program recommended by the expert panel. This will ensure that MAID assessments for people with complex conditions, such as people suffering solely from mental illness, are conducted with the appropriate level of rigour.
I believe that any Canadian who is suffering grievously and wishes to consider MAID as an end-of-life option should be free to do so. I also think that, in parallel with the implementation of MAID for those who are assessed and deemed eligible, we also need to commit to improving our mental health care system.
As such, it is important for all Canadians who are struggling with mental illness and/or thoughts of suicide to have timely access to critical mental health resources. As parliamentary secretary, I am pleased to speak about our ongoing and future investments as well as progress being made on key interventions to support the needs of Canadians with regard to mental health and substance use care.
Budget 2023 confirmed the government's commitment to invest more than $200 billion over 10 years starting in 2023-24 to improve Canadians' health care. Of that amount, $25 billion will go to the provinces and territories through adapted bilateral agreements that will focus on four key pillars, including improving access to mental health services and addictions-related services. Other key investment include $598 million for a mental health and well-being strategy with distinction-based funding for indigenous communities, and $350 million for the substance use and addictions program since 2020.
Thanks to the mental health promotion innovation fund, the Public Health Agency of Canada is investing $4.9 million a year in community-based programs for mental health promotion focused on reducing systemic obstacles.
I am also very proud to recall that we have recently taken an important step to provide suicide prevention support for people who need it, when they need it most. Canada's new three-digit suicide crisis helpline, 988, launched on November 30, 2023. It is available to call or text, in English and in French, 24 hours a day and seven days a week across Canada. An experienced network of partners, as trained responders, are ready to answer 988 calls and texts. Responders provide support and compassion without judgment. They are here to help callers and texters explore ways to keep themselves safe when things are overwhelming.
We understand that the past few years have been hard and that many people have been struggling to cope. There is still a lot more to do, and we are committed to continuing to work with our partners to address Canadians' needs in the areas of mental health and substance use. In the future, we remain determined to improve access to mental health care services and to help those with substance use issues.
To that end, the Minister of Mental Health and Addictions and I met with a wide range of partners and stakeholders, including the provincial and territorial ministers responsible for mental health and addiction, to discuss their priorities and needs. This commitment will ensure that mental health and substance use services and programs are based on core expertise.
We have been listening to Canadians with lived and living experiences, to health care professionals on the front lines and to experts to make evidence-based investments and interventions to support timely access to mental health care needs. However, we recognize that no matter what treatments and services are available, sometimes they are not able to relieve intolerable suffering in a manner acceptable to an individual. That is when MAID may be an option for individuals who make a request and who are deemed eligible by two independent medical practitioners.
Ultimately, we are committed to respecting the personal autonomy of each and every Canadian, while protecting the interests of those who may need more care. The three-year extension we are proposing will enable us to do all we can to train and support clinicians who will assess complex cases, including those in which mental illness is the sole medical condition. In the meantime, we will continue to invest in resources and support for mental health and substance use problems.
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- Feb/13/24 9:29:21 p.m.
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Mr. Speaker, there are a few important points that we need to talk about first.
First of all, the Liberals did not actually complete the mandatory review that the original legislation had. If that review had happened properly, I would be willing to bet that we would not be where we are today.
The next point I want to make is that a couple of years ago the government promised $4.5 billion or maybe $6 billion for mental health. I do not remember the exact amount. I stand to be corrected, but as far as I am aware, so far, it is zero dollars. The government talks about making sure there are supports there for people with mental health, but the only support I am aware of right now is the 988 hotline that my Conservative colleague has been able to get in place.
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- Feb/13/24 9:47:07 p.m.
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Mr. Speaker, as for that vote, I want my colleague to know that it came out to 57%. Also, the member should be careful when talking about provisions that exclude mental disorders. It is time to get educated. Tomorrow morning, I am going to talk about advance requests.
Let us imagine that I have been diagnosed with Alzheimer's disease and I choose not to put my loved ones through that. The day I am no longer able to recognize my children or I act a certain way because I do not recognize myself and have no awareness of my situation, a whole host of specialists will come on the scene. I experienced that with my father, who, incidentally, had no dementia whatsoever. Falling through all those safety nets means far more exclusion than acceptance.
When it comes to mental health, again, what we might need to do is dig a little deeper and ensure we have all the tools to reassure people. They need to know that this is not a slippery slope to culling the herd, as some people are saying.
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Mr. Speaker, I apologize to the parliamentary secretary. He is used to this, but I think he can make room for others.
I fully agree with my colleague on many things. We need more mental health resources and more access to care. There are several socio-economic factors that can exacerbate mental illness.
As far as today's bill is concerned, I would like us to look at things from another angle. Let us look at the genesis of what brought us to include mental illness as grounds to request medical assistance in dying. It came from a Senate amendment that, in my opinion, should not have been accepted by the government. I do not want to make any assumptions, but we are hearing rumours that senators might try to block what could be the will of the House to delay this for three years, as Bill C‑62 seeks to do.
What is my colleague's opinion about the role the Senate should play with respect to the House, whose members are duly elected to make decisions?
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- Feb/13/24 10:07:46 p.m.
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Mr. Speaker, I will just go back to the comment from one of my residents who said that they are imploring “the government to reconsider this expansion...and to engage in a meaningful dialogue with the mental health professionals to safeguard the well-being of...Canadians, especially the most vulnerable”.
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