SoVote

Context: House Hansard - 281 - Feb/13/24

Feb/13/24 11:41:30 a.m.
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Mr. Speaker, I would like to know whether my colleague thinks that, one day, it will be possible to alleviate the suffering of people struggling with an irremediable mental disorder. I would also like to know whether he agrees that it would have been wiser for the government to implement the joint committee's leading recommendation regarding advance requests and to take advantage of the introduction of this bill to add that component.

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Mr. Gord Johns

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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Mr. Francis Scarpaleggia (Lac-Saint-Louis, Lib.)

Feb/13/24 11:43:25 a.m.
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Re: Bill C-7

Mr. Speaker, I joined the latest edition of the Special Joint Committee on Medical Assistance in Dying, which was mandated to deal specifically with the question of the health system's readiness for an extension of MAID to cases of severe mental illness, out of a sense of duty as this is a deeply serious matter for Canadian society, one on which I received correspondence from a great many concerned constituents. At first, I humbly questioned my qualifications to sit on the committee. I am not a psychiatrist. I am not a medical doctor. I do not have expertise or experience in this area. However, in a democracy, not all is left to the experts. The people, through their elected representatives, set legal parameters in areas of public interest by way of legislation and regulations. In fact, that is what has been happening since 2016 on the issue of MAID. That said, it is important to carefully listen to and consult the experts out of respect for the authority of knowledge and experience. This is the opposite, I might add, of the new populism. I agree with the committee's recommendation that we should indefinitely postpone MAID where the sole underlying condition is mental illness, also known as MD-SUMC. The central issue in MD-SUMC is irremediability; that is the question of whether there is the possibility that a person with severe mental illness can be cured of their terrible suffering, a suffering not different from physical suffering. Under the law, for a person to be deemed eligible for MAID, the illness must be irremediable; grievous and irremediable. The problem when we move from somatic, that is physical, illness to psychiatric illness is that irremediability becomes more difficult to establish. In the case of psychiatric illness, an accurate prognosis is infinitely more difficult to produce. Because of the difficulty, in cases of mental illness, of offering a reasonably certain prognosis, the determination of irremediability will necessarily have to be based on a retrospective view; that is on an assessment of the extent of a patient's past treatments and whether the patient exhausted all treatment possibilities in a quest to be relieved of their suffering. The problem is that the MAID assessors will most likely not have been involved in past treatments, which makes it difficult to ascertain the quality of those treatments. When it comes to establishing irremediability in cases of mental illness, evidence has shown accuracy is poor. It is less than 50%, a coin toss. To quote Dr. Sonu Gaind, one of the experts who appeared before the committee, “Worldwide evidence shows we cannot predict irremediability in cases of mental illness, meaning that the primary safeguard underpinning MAID is already being bypassed, with evidence showing such predictions are wrong over half the time.” It should be pointed out that under our MAID law, clinical certainty about irremediability is not actually required. Here it is important to highlight the distinction between legal irremediability and irremediability in clinical medicine. In the MAID law, “grievous and irremediable” has a different meaning than in medicine. It is defined as incurability, “be in an advanced state of irreversible decline” and “enduring...physical or psychological suffering” that is intolerable to the person and cannot be relieved “under conditions the person considers acceptable.” In law, therefore, it is not necessary to establish irremediability with a degree of clinical certainty. Rather, both patient and assessor must come to the shared understanding based, among other things, on the assessor's analysis of the history of past treatments. There is an element of subjectivity on the part of both patient and assessor. Naturally, the assessor will bring their own philosophical biases, values and ethics to this subjective equation. As Dr. Gaind suggested to committee members, “Try those mental gymnastics on your constituents. Convince them it was okay that their loved ones with mental illness got MAID, not because of a clinical assessment based in medicine or science, but because of the ethics of the particular assessor.” An important issue in determining eligibility for MD-SUMC is being able to separate suicidal ideation from a considered request for MAID. It bears keeping in mind that suicide attempts are not always rash and impulsive, the product of a panicked state. This, in some ways, is a stereotype. Psychiatrists will say that some suicides are not frenetic but carefully planned in advance. Dr. Tarek Rajji, chair of the medical advisory committee at the Centre for Addiction and Mental Health, told the committee, “There is no clear way to separate suicidal ideation or a suicide plan from requests for MAID.” To again quote, Dr. Gaind: We cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests, with overlapping characteristics suggesting there may be no distinction to make. In the Netherlands, an assessment by an independent physician is required for MAID, and in the case of psychiatric suffering, a third assessment by an independent psychiatrist, preferably one with specific expertise regarding the patient's disorder. The problem with Canada's law, as it stands, is that there is no requirement for one of the assessors of MAID eligibility to be a psychiatrist, yet psychiatric issues are exceedingly complex. Often a patient has more than one illness. It is said that 71% to 79% of psychiatric patients who died through MAID in the Netherlands had more than one psychiatric disorder. We humans are not self-directed, rational atoms exercising unencumbered clear-eyed autonomy. We are not as free as we think. We are born into families and communities, and influenced by the opportunities they offer, and alternatively, by the constraints they impose on us. I sometimes wonder if we are not in the process of turning personal autonomy into ideology. I say “wonder” because as a liberal, I have not been bestowed the gift of absolutism that has blessed ideologues. Requests for MAID can be influenced by, even driven by, extraneous factors like poverty and isolation, that is by psychosocial factors. According to Dr. Gaind, “those with mental illness...have higher rates of psychosocial suffering.” This all means that MAID assessors will be wrong over half the time when predicting irremediability, will wrongly believe they are filtering out suicidality and still, instead, provide death to marginalized suicidal Canadians who could have improved. Archibald Kaiser, Professor at the Schulich School of Law and Department of Psychiatry, Faculty of Medicine at Dalhousie University added that “The Supreme Court concluded in 1991 that people with mental illness have historically been the subjects of abuse, neglect and discrimination.” Dr. Gaind further underscored that “Suffering is cumulative, and life suffering unfortunately fuels much of the suffering of those with mental illness, even more so for marginalized populations.” There is, in fact, the possibility that gender-based marginalization can influence requests for MD-SUMC. We know that in countries that allow MAID for severe mental illness, the ratio of women to men who seek MD-SUMC is two to one. For their part, indigenous representatives have expressed serious reservations about expanding MAID to include mental illness. According to Professor Kaiser: In February 2021...many distinguished indigenous signatories wrote to Parliament that the consultation ... has not been adequate and “has not taken into account the existing health disparities...we face compared to non-Indigenous people.” They said, “our population is vulnerable to discrimination and coercion...and should be protected against unsolicited counsel.” We know there is systemic racism in the health care system. Ask the family of Joyce Echaquan. How would systemic racism influence the rate of acceptance of MAID requests of indigenous and other racialized peoples? That is a pertinent question. As Dr. Lisa Richardson, Strategic Lead, Centre for Wise Practices in Indigenous Health, Women's College Hospital, told a Senate committee on February 3, 2021: In an environment where both systemic and interpersonal racism exists, I don’t trust that Indigenous people will be safe. I don’t trust that anti-Indigenous prejudice and bias will not affect the decision making and counselling about MAID for Indigenous people, no matter how much education is given. Indigenous communities, many of which have felt the scourge of high suicide rates, especially among youth, may have concerns about possible contagion effects of MD-SUMC on suicidality. Then, there is the basic question of the ability of the health care system in Canada, already stretched to the limit, to handle an expansion of MAID. According to Dr. Eleanor Gittens of the Canadian Psychological Association, as a country we have not yet established parity between available physical and mental care. To quote her, “Care and treatment of mental illness are not covered by medicare, nor is it readily accessible.” We do not really know how many people would request MD-SUMC, and thus whether we have enough qualified assessors. By some estimates, we would have well over 2,000 patients a year getting MD-SUMC with countless more requesting eligibility assessments. I know there is dispute around that number. Just because there is a published Health Canada standard for MD-SUMC and a training module does not mean the system is ready. A building built on a soft foundation is not ready for occupancy, no matter the level of completion of its structure. There are today no safeguards preventing poverty, housing insecurity, loneliness, etc., that is psychosocial factors, from significantly fuelling MAID requests of those suffering from mental illness. I will quote Dr. Rajji: “The standards document itself, the one developed by the expert panel, states that these are not clinical guidelines, and this is what is missing to ensure quality.” According, again, to Dr. Gaind, “it is a legal fiction that determinations of the eligibility of MAID are based on objective clinical judgment. In fact, I regularly witness practitioners' values influencing the interpretation of the current MAID eligibility criteria and safeguards.” As per an article in the review Impact Ethics, “The few jurisdictions allowing MAiD for [sole] mental illness have safeguards Canada lacks, notably (unlike Canada) requirement of due care and no reasonable alternative, or treatment futility, prior to MAiD eligibility.” In Canada, a patient would be able to qualify for MD-SUMC even if they refuse treatment. Often a psychiatric patient will refuse additional treatment owing to treatment fatigue. While treatment fatigue has been studied in the context of HIV and type 1 diabetes, with the goal of developing strategies to help overcome it, treatment fatigue has not yet received attention in psychiatry. A better understanding of treatment fatigue could lead to alternatives to MAID, such as palliative or recovery-oriented treatments. I respect the Senate. I value the Senate. Senators bring more than just sober second thought; they bring expertise in fields crucial to good public policy making, but senators are not elected. They are not the voice of the people. It was never the government's intention to extend MAID to those suffering from mental illness. The government was running out of runway to meet the court-imposed deadline in the Truchon decision for amending the law to remove the requirement that death be foreseeable to qualify for MAID. It could not afford a back-and-forth game of procedural ping-pong with the Senate over its last-minute amendment to remove the mental illness exclusion from Bill C-7. It had to accept the Senate's amendment to get the bill across the finish line. In my view, we are not ready for MD-SUMC. We cannot ascertain irremediability with any acceptable degree of certainty and objectivity. We cannot sufficiently distinguish an unfettered request for MAID on the grounds of mental illness from suicidal ideation. We are not able to separate out psychosocial factors that might drive MD-SUMC. We have not properly consulted racialized communities to take account of their views, concerns and fears, notably those of indigenous communities, and we have not built proper safeguards into the law. We do not require the involvement of a psychiatrist in assessment nor require that a person have reasonably exhausted available treatments before making a request for MD-SUMC. The few other jurisdictions that allow MD-SUMC have this requirement. We have not studied and understood treatment fatigue such that we can develop strategies that can possibly lead a patient to other non-lethal treatment options, and finally, we have allowed an unelected body, the Senate, to drive this agenda.

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Mr. Garnett Genuis (Sherwood Park—Fort Saskatchewan, CPC)

Feb/13/24 11:57:30 a.m.
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Mr. Speaker, I listened with interest to my colleague's speech, but there is this framing of not being ready. We support further delay so that a Conservative government can forever protect Canadians by ensuring this expansion never happens, but it does not make sense to me that the member would identify obvious problems with this, and not just present problems or short-term problems, but structural problems, with allowing the medically facilitated killing of those with mental health challenges, and say that just means we are not ready. I think it is quite obvious that, after years of the government trying to fit a square peg into a round hole and trying to say that somehow we can have medically facilitated killing for those with mental health challenges while at the same time not increasing other kinds of risks and problems, the government has tried to figure out how to do this for years and has clearly concluded that it is not something that is desirable. Why not just admit that this was a terrible idea from the beginning rather than couch it in this framing of not being ready, but that maybe we will be soon?

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Mr. Francis Scarpaleggia

Feb/13/24 11:58:45 a.m.
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Mr. Speaker, I do not have a crystal ball. I do not have a monopoly on the truth. As I said in my speech, I am not blessed by absolutism. I am torn by this issue as much as I think anyone in this House is. Even if we hide behind the certainties we put up as political parties, we still question ourselves and we are still torn by this issue. I do not know if we will ever be ready. What I was trying to do in my speech was to point out some of the things we have not done to be ready. Maybe we will never be ready. I am not a psychiatrist. I do understand psychiatric suffering can be as severe as physical suffering, and I do feel for the people, especially John Scully, who I have heard from in testimony in a small working group. I feel for him and what he is living through. To be honest, I do not have the answer.

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Mr. Luc Thériault (Montcalm, BQ)

Feb/13/24 11:59:53 a.m.
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Re: Bill C-7

Mr. Speaker, my colleague participated in all three sessions on the issue. When Quebec tabled its report and when we voted on Bill C-7 in 2021, I was very reluctant to consider opening up MAID to mental disorders. However, I worked my way through the experts' report and I invite my colleague to read it again. My colleague says there is nothing in the legislation. However, it does not have to be in the legislation. The regulations can set out the “how to”. Recommendations 10 and 16 are important safeguards. Let us assume I am not questioning anything in my colleague's speech; the fact remains that, today, as I speak, there are people who are suffering irreversibly and intolerably. What solution does my colleague have for those people?

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Mr. Francis Scarpaleggia

Feb/13/24 12:01:00 p.m.
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Mr. Speaker, first, I want to congratulate my colleague on the thoughtfulness of his remarks. His speeches, his interventions, offer fresh perspectives. I learned a lot just from listening to him at meetings of the Special Joint Committee on Medical Assistance in Dying or even in the House. It is complex. As I was saying earlier, I am torn. The problem is that this becomes very subjective at some point. We are giving a lot of power to a doctor or a nurse practitioner who may not have the necessary background in psychiatric illnesses. As I said in my speech, a person might present with one psychiatric illness, but roughly 80% have more than one. It is complicated enough to deal with psychiatric illness; when we add two or three more, it becomes even more complicated. I very much appreciate the interventions of my colleague. Like everyone else, we are doing everything we can on this file.

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Ms. Lisa Marie Barron (Nanaimo—Ladysmith, NDP)

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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Mr. Francis Scarpaleggia

Feb/13/24 12:03:20 p.m.
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Re: Bill C-22

Madam Speaker, I would tell them I would always vote for those kinds of supports, and I am very pleased we have passed Bill C-22 on creating a framework for an eventual disability benefit. It is excellent public policy and I am, quite frankly, hoping the next budget includes something more concrete on that around a figure of the kind of financial support people with disabilities can expect. Yes, there are many social problems, and this is one of the reasons I do not think we are really ready. We do not know how to extract those influences such as the inability to find housing, loneliness, drug addictions, etc. We do not have the ability to extract those motivators from what we could call, I suppose, for lack of better words, a more considered request for MAID. It is a big problem. As a society, we have many problems to deal with, and that is why I am here. I am trying to do my best, as the member is, to solve those problems.

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Ms. Elizabeth May (Saanich—Gulf Islands, GP)

Feb/13/24 12:04:25 p.m.
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Re: Bill C-14

Madam Speaker, this has become an issue, because it was inserted in the legislation at Bill C-14 by the Senate. Does the hon. member have any knowledge of what attitude the Senate is going to take? We are operating under the gun here. We have to do something before March 17. Do we have any indication of whether the Senate will, once the House dispatches this matter, take it up quickly?

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Mr. Francis Scarpaleggia

Feb/13/24 12:04:58 p.m.
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Madam Speaker, I do not, because I am not in the Senate. Now that the Senate is on the other side of the street, it is a little harder to confer with the senators. I understand their position. They are generally for this extension. I would like to believe that they are also responsible, and they would not want to see a void open up after March 2024. Therefore, I expect and hope that they will do the responsible thing.

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Mr. Marcus Powlowski (Thunder Bay—Rainy River, Lib.)

Feb/13/24 12:05:42 p.m.
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Madam Speaker, I would like to thank the member for his excellent speech and hard work on the MAID committee. He talked about the problem of irremediability. I think it would be an absolute tragedy if legislation we pass led to a situation where a MAID practitioner took the life of someone who would have actually gotten better had we given them some more time. How are we going to know? The person will be dead. I was troubled to hear the testimony of some people on the committee, some psychiatrists, who did not seem very worried about the problem of determining irremediability. They would still be willing to allow MAID even though they were not totally sure if the situation was irremediable. Could the member comment on the issue of what he heard at the committee and what he thought about it?

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Mr. Francis Scarpaleggia

Feb/13/24 12:06:23 p.m.
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Madam Speaker, in fact, I do not know how to answer that question. We have seen that there is a subjective element. There are some who believe they would make the right call. I guess that confidence is at the root of the perspective they bring to the issue. I am not a medical doctor, much less a psychiatrist, so again, I do not have a definitive answer for the member.

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Mr. Gérard Deltell (Louis-Saint-Laurent, CPC)

Feb/13/24 12:07:06 p.m.
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Madam Speaker, I will be sharing my time with my colleague from Kelowna—Lake Country. Once again, I rise in the House to speak about a sensitive topic, one that is fundamental in our lives, and that is medical assistance in dying. Personally, I am in favour of medical assistance in dying. I am not here to defend my personal opinions. I am here as a legislator who has to consider all the data that support giving the green light, under certain conditions, to medical assistance in dying or, conversely, the red light urging us to not go forward. I believe this is in no way a partisan issue. People can be on the left, they can be on the right, they can be sovereignists, or they can be federalists; that is not the point. It is a matter of how we, as human beings, feel about this issue. Regardless of where we come from or where we are on the political spectrum, we are first and foremost human beings. On that basis, we must make a choice for people who need medical assistance in dying, and we must make sure this is done right, within the proper rules. We are dealing with this situation because the debate began here, at the federal level, in 2015. However, in Quebec, the debate began long before that. It just so happens that I have participated, both at the provincial and federal levels, in the early stages of this legislation that we are discussing today. I would remind hon. members that the first province to have legislated on this issue did not do so overnight, quite the opposite. Only after six years of serious, thorough, scientific and medical debates and hearings did the Quebec government and the National Assembly vote for a law that would be the first step in medically assisted dying. I would like to emphasize the importance of that process. It was done over six years, under three different governments, under three different premiers. That proves this is not a partisan issue. As much as possible, we should always take this approach. I will always remember, during the final debate on the adoption of the first steps toward medical assistance in dying in Quebec, how one of the members was very much against the bill. I can see him now, rising in the National Assembly and telling members not to vote for it. He felt so strongly on the issue and was so against the bill that he was red in the face. Once he sat down and the speech was over, I applauded him. I did not applaud him because I agreed with him. I applauded him because we live in a democracy that allows him to express an opinion that differs from my own. That is the beauty of democracy. Despite the fact that the majority of his party and his government were about to vote in favour of the bill, he was against it, and he had the opportunity to say so with all of the passion that drove him. That is how we should debate medical assistance in dying. Let us not forget that this debate started at the federal level because of the Carter decision. Without going into detail, I will remind members that happened in 2015, which was an election year. Using his good judgment, the head of the Canadian government at the time did not move forward immediately because we were on the verge of an election campaign. At the risk of repeating myself for the umpteenth time today, this is not a partisan issue, while an election campaign by definition is the epitome of political partisanship. That is fine, that is what an election campaign is. That is why the prime minister and head of the Government of Canada at the time, the Right Hon. Stephen Harper, showed good judgment and decided to hold the debate after the election campaign. Canadians made their voice heard. They elected a new government. There was then a debate on the subject. That is when the first steps toward this bill on medical assistance in dying were taken. Some may have noticed that the bill, like all other bills, was not perfect. Nevertheless, it did lead to certain specific situations. Personally, I was for medical assistance in dying, but I did not vote in favour of the bill because I found it was poorly drafted. I remember the Hon. David Lametti who, at the time, was not the minister of justice. As we know, he became minister of justice later on. The Prime Minister removed him from that office, and he decided to serve elsewhere. I remember that Mr. Lametti said that he would vote against the bill because he found that it did not go far enough. The bill was passed, but other things happened, and today we find ourselves having a debate on mental health. I would remind members that I am in favour of medical assistance in dying as long as the rules are well defined. I will give the example of Quebec. Actually, I am going to talk about Quebec's experience, because an example is something that should be followed. Instead, let us take inspiration from the experience of Quebec, which held a political debate on the issue of medical assistance in dying for six years before passing its first bill on the subject. With regard to MAID for people with mental illness, after holding hearings and consultations and thoroughly analyzing the issue, the Quebec National Assembly and the Government of Quebec decided not to move forward with MAID for people whose only underlying medical condition is a mental disorder. They felt that there was no consensus on this issue and that there was no scientific consensus. Some people were in favour of it, while others were against it. That is where we are at right now. That is why I think that we need to be careful as long as there is no strong scientific consensus. Personally, I am in favour of medical assistance in dying, but I think that it must be administered to those who want it within a very clear legal framework. In this case, the framework does not go far enough. I have a colleague from Nova Scotia, the member for Cumberland—Colchester, who is a physician. I listened carefully to what he had to say yesterday because he knows what he is talking about when it comes to his profession. He practised medicine for over a quarter of a century and continues to practise to this day. He cared for thousands of people in his community. He talked about the hardest parts of his practice. One example he shared involved a person showing up in the middle of a suicide crisis on a Saturday night and needing treatment. That is not a broken arm, it is not a growing cancer, it is not trying to get a pebble out of someone's eye. It is much more complicated than that, and it cannot be resolved immediately. That is why his perspective was so valuable. He said he is ready to challenge anybody who is not in that kind of a situation and whether they would be comfortable with that. He said that, in his practice, he had always found these situations very difficult, and that he needed time to recover from that kind of meeting. Anyone who has spoken to doctors dealing with patients who have suicidal feelings will confirm it. Mental health problems are difficult to identify and to treat. I would again remind members of Quebec's experience. After thoroughly examining this issue, Quebec decided not to go forward with medical assistance in dying for people struggling with psychiatric illnesses. The issue of medical assistance in dying can never be separated from the issue of palliative care. Palliative care is an essential part of our health care system; we should always be thinking of doing more, because, unfortunately, we will never do enough in that area. Without going into my life story, I can say that, two years ago, I had a particularly challenging year, given that both my parents died. I remember May 2022, when my mother spent the last days of her life in the hospital. She was in a wing where people were receiving palliative care, one after another. Then there were rooms with people who had requested medical assistance in dying. For the last 15 days of my mother’s rich life, I was with her in the hospital and met people who had requested MAID. They all did so in full knowledge of the facts and with the support, assistance, guidance, and, above all, the presence of their families, in the same way that we were with my mother in the last days of her life. That is how we must look at the issue. Respecting the choices of individuals, insofar as the guidelines have been well established. That is true both for people who wish to receive medical assistance in dying and for those who wish to receive palliative care.

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

Feb/13/24 12:16:51 p.m.
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Madam Speaker, I appreciate many of the member's comments. One thing that stuck in my mind was when he made reference to the fact that the Province of Quebec took a number of years to design its legislation. It is important to demonstrate the contrast with the federal government back in 2015; the member made reference to the Supreme Court decision. We had a very short window to get the legislation passed. I personally do not believe, and I suspect that no one really believed, that the legislation at the time was absolute, in terms of being perfect. However, we needed to get it through. Could he reflect on the many discussions and debates inside and outside the chamber with Canadians as a whole, with respect to how important it was that, at least, we bring forward and get the legislation in, in order to meet court requirements?

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Mr. Gérard Deltell

Feb/13/24 12:17:53 p.m.
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Madam Speaker, that is an interesting question. I was there in 2015, when I got elected for the first time. As I said earlier, the prime minister at that time made the right decision not to put the bill on the table just before the election because this is everything but a political issue; it is a personal issue. An election campaign is anything but straight. An election campaign is the epitome of political partisanship. It was good that we did not have the debate during the campaign; after that, yes, for sure. We had a time frame established by the Supreme Court and we had to act as fast as possible, and that was not exactly the picture-perfect time to do it. Based on the Quebec experience, we have to take our time to study an issue. The bill that has been adopted was not perfect. I voted against it because I saw many loopholes in the bill. I remember David Lametti; we voted against because it had not, in his mind, gone far enough to support. This is part of the debate, and there is no political-partisan agenda behind the debate. It is only a human agenda that we shall have.

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Mr. Luc Thériault (Montcalm, BQ)

Feb/13/24 12:19:14 p.m.
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Re: Bill C-7

Madam Speaker, my colleague gave us a history lesson. He said that his party was not able to move forward because there was an election. I would point out to him that Quebec has had two elections in those six years. That did indeed delay the work, as he will agree. However, I do agree with him that Quebec's approach crosses party lines and is far more thorough. Some people complain about the delay associated with the Carter decision, but that is because this Parliament never took the opportunity to try to change the Criminal Code before there was a court order. It never had the courage to do that, and so we were then stuck with a court order. Mr. Lametti did not stand up solely because the bill did not go far enough. He stood up because it violated patients' constitutional rights. Bill C-7 corrected that. I would like my colleague to explain what he is advocating when it comes to advance requests for MAID. Does he think that the government, which had a year to introduce legislation, could have included that component in this bill?

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Mr. Gérard Deltell

Feb/13/24 12:20:34 p.m.
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Madam Speaker, for starters, yes, the work took place over a period of six years under three different governments. There were two elections during that time. That is exactly what I said earlier. This is not meant to be a partisan issue. It took years for the debate to come before the House. We know that, but we also know that it would not have been a good idea to start a debate on this issue, which is supposed to be non-partisan, on the eve of an election campaign. I think my colleague would agree, especially since, as we know, there was a lot of opposition on all sides regarding many issues at the time, and the people spoke. On the issue of prior consent, personally, I agree, as my colleague said.

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Ms. Niki Ashton (Churchill—Keewatinook Aski, NDP)

Feb/13/24 12:21:24 p.m.
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Madam Speaker, in terms of accessing MAID, we know that many people have shared their thoughts publicly, particularly through the media, about how desperate they feel and how they are not getting help from the social safety net. They need help with health care, housing and mental health therapies. Everyone knows we need to acknowledge that reality. Does my colleague think our country is making progress if it recognizes the need to shore up our social safety net and provide the right supports to people who need them? That way, they will not ask for MAID if they do not really need it.

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Mr. Gérard Deltell

Feb/13/24 12:22:18 p.m.
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Madam Speaker, I thank my colleague for her question and the quality of her French. That is similar to what I was saying at the end of my answer. Palliative care must go hand in hand with the issue of MAID. They are not mutually exclusive. We must think about palliative care before we think about medical assistance in dying.

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