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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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 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 12:32:59 p.m.
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Madam Speaker, persons with disabilities have been very vocal about the part of the legislation that we are talking about here today, specifically the expansion for persons with the sole underlying condition of mental illness. They also have concerns in general about other safeguards in order to protect the most vulnerable, people who cannot necessarily speak for themselves. It is a general concern that I hear from persons with disabilities.
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- Feb/13/24 12:36:59 p.m.
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Madam Speaker, we should not be talking about a delay. We should be talking about not expanding MAID at all to those suffering from mental illness as the sole underlying condition.
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Madam Speaker, I will be sharing my time with the member for Saanich—Gulf Islands.
It is a pleasure to speak today to Bill C-62. The bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID—
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- Feb/13/24 3:44:22 p.m.
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Mr. Speaker, we are going to take every single opportunity to put on the record in this House that these Liberals have broken what is a long-formed consensus in this country, that MAID, for the sole purpose of mental illness, is a no go. We are going to continue to speak about that so that Canadians know where they stand.
I know that they have brought legislation forward, but it is not our responsibility to clean up the mess that has made us stand here at the eleventh hour because they screwed up their schedule and their legislation.
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- Feb/13/24 4:31:18 p.m.
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Mr. Speaker, I am not sure what the constitutional right to MAID is that the member across referred to.
He wants more time to discover this legislation. The difficulty of course is the concept of irremediability. The Liberal government can take the next thousand years to consider this legislation, but it is clear from experts across this country that the issue of irremediability with respect to mental illness is not going to be resolved. How is he going to resolve that with the voters who are going to send him packing in the next election?
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- Feb/13/24 5:01:53 p.m.
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Mr. Speaker, I think it is absolutely disgusting that the parliamentary secretary to the government House leader would stick his head in the sand and deny well-documented cases of abuse and non-compliance with respect to so-called safeguards that are supposedly in place and are to be enforced. It is just disgusting, when speaking of some of the most vulnerable persons in Canadian society.
With respect to the member and her speech, she talked about Conservative obstruction. I would remind her that every member of Parliament, from all recognized parties, on the committee, which I served in, said to put a pause on this expansion, so did chairs of psychiatry, and so did the Province of Quebec in the national assembly, when the committee determined that mental illness as a sole underlying condition was not appropriate in the context of MAID.
I will tell members that when I hear evidence that clinicians could get it wrong 50% of the time, in other words like the flip of a coin, I will obstruct that expansion.
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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 7:06:52 p.m.
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Madam Speaker, I would ask the hon. member to point to the supports his government has offered to those with mental illness. What we heard in this place, in Parliament, from witness after witness is that the supports are inadequate. People desperately need more support.
On this side of the House, I think of my hon. colleague, whose name I am not allowed to use, and his tremendous effort in advocating for support for those who live with a mental illness and his tremendous effort with bringing in a three-digit suicide line to help prevent suicide, and of course we know that is most often associated with a mental illness.
Not only are we going to make tremendous efforts when we are in government, but the reality is that we do not wait. We are already making a meaningful difference for Canadians.
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Madam Speaker, the member is a colleague I have always enjoyed working with. I remember one of the very first files I was asked to work on as Parliamentary Secretary to the Minister of Health back in 2017 was his private member's bill, Bill C-211, on post-traumatic stress disorder, so I know it means a great deal to him, and I appreciate his speech.
I voted with our colleague from the other side to completely abandon the idea of opening MAID to people solely affected by mental illness. I have been convinced, through the discussions I have had with psychiatrists from across the country, that we are not ready nor is it desirable to go down that path for various reasons. One of them is that it is hard to say for certain that a mental illness is irremediable, but another aspect that moved me is that, if someone were to have access to that, theoretically, we would need to exhaust all possible treatment options. As we know, in this country, treatment options are sometimes, depending on the regions, hard to access, so I would like to have his comments on that.
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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 7:37:12 p.m.
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Madam Speaker, Conservatives know that we cannot allow this bill to fail and thus stumble into a wild, unprepared territory where those whose sole underlying health condition is mental illness are permitted to access MAID, when it is so clear that the country is not ready for it.
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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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Mr. Speaker, I thank my colleague for the great discussion that we had on this subject recently.
I agree with him. That is what Bill C-62 is for. This is a very controversial subject. Like my other colleagues, I get letters from various institutions and groups that show that there are differing opinions in our society about people whose only underlying medical condition is mental illness. We need to make sure that everything is in place, including standards, tools and practitioner training, so that patients' eligibility is properly assessed and practitioners are comfortable applying this measure.
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- Feb/13/24 9:45:45 p.m.
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Mr. Speaker, I sincerely want to thank my colleague for her speech. I believe that this is an issue where the debates are particularly instructive for members. We have been dealing with these matters in the House of Commons since 2016 and my position has changed over time, including on advance requests.
I think I still need to study the issue, but I understand that this can be useful in some cases. I have met people who could have used this. I have heard some very touching stories, even from people close to me, about people who could use this. However, on the subject of mental illness, my position has also crystallized. Many psychiatrists have told me that this track was not necessarily desirable, that it was far too difficult to gauge the irremediability of a mental illness.
My colleague mentioned the consensus in Quebec. Yes, there is one on advance requests. However, as far as mental illness as a sole reason for opening the door to medical assistance in dying goes, the National Assembly of Quebec did vote in Bill 11, in June 2023, as my colleague mentioned. It excludes mental illness because there is in fact no consensus within the medical community. Some members of that community shared their deep concerns with me about opening up MAID for this.
I would like my colleague's thoughts on that.
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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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