SoVote

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

Feb/13/24 4:29:57 p.m.
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Mr. Speaker, through you, I would like to thank my colleague across, not only for the work he has done as part of the special committee, but also for the point of view he is raising. We have to remember that, at that time, we were looking at the bill from a constitutional aspect as well, so when we looked at it we addressed many issues. We put the policies, the procedures, the constitutional concept of it and the rights of Canadians into perspective. I believe that was the right decision to make. However, since then we have had the opportunity to look at the next phase, which is the implementation and the rollout of that. As we started to address working with the provinces and the professionals, we realized there was a lot more opportunity for collaboration as far as readiness and safeguards are concerned, and that we needed more time. We were hoping that one year would give us that, but once again it became clear that we needed more time. Therefore, the extension we are talking about is finding that fine balance between making sure that all Canadians can exercise their constitutional right and making sure we have the safeguards in place to ensure that no missteps are taken.

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Mr. Stephen Ellis (Cumberland—Colchester, CPC)

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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Mr. Majid Jowhari

Feb/13/24 4:31:51 p.m.
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Mr. Speaker, let me address the last part first. I have had the honour and privilege of representing Richmond Hill over the last three terms and am counting on people and my hard work to be able to be re-elected so that I can come back here to continue representing them. Let us leave it at that. What is key is that the issue of irremediability is a very complex issue, and it takes time to understand each case. We need to make sure all the safeguards are put into place to ensure that we do not cause any undue risk and harm.

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Mrs. Julie Vignola (Beauport—Limoilou, BQ)

Feb/13/24 4:32:42 p.m.
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Mr. Speaker, we are talking about a bill that is very sensitive for many different reasons. This bill affects us all for one reason or another. There is a motion calling for a distinction between neurodegenerative disease and mental illness. I wonder if my colleague could tell us what he thinks about the possibility of moving faster on legislation that covers neurodegenerative disease so that people with Alzheimer's can decide, while they are still lucid, if and when they want to end things, because it is still a choice.

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Mr. Majid Jowhari

Feb/13/24 4:33:34 p.m.
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Mr. Speaker, I have had the pleasure of working with my colleague on a number of committees, and I thank her for her point of view. The point is that it is those complexities that have necessitated, now that we are at the point of rolling out this legislation, that we really take a step back and look at the spectrum of diseases and the challenges that exist to be able to ensure that the right safeguards are in place. Yes, all of those need to be taken into account. I am hoping that, over the next three years, working in collaboration with the provinces and with professionals, as well as with those with lived experience, we will be able to answer some of those key questions.

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Mrs. Claude DeBellefeuille (Salaberry—Suroît, BQ)

Feb/13/24 4:34:29 p.m.
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Mr. Speaker, I would like to inform you that I will be sharing my speaking time with the hon. member for Shefford. I rise today to speak about a topic I am passionate about. I am a social worker. I spent my career supporting seniors who wished to live at home, as well as seniors living in long-term care centres. I could say that I will be giving a speech, but it is more like a first-hand account, because this morning, quite frankly, I could not believe my ears. I could not believe the outrageous remarks I was hearing on the issue of medical assistance in dying. I would like to remind the House that the Bloc Québécois has a humanist vision of medical assistance in dying. Our focus is on the importance of the individual's right to dignity, to free and informed consent and, most of all, to self-determination. That means that I am the best person to decide what will happen to me, because I am making a free and informed choice. I want to tell the House a story, but I should mention that it is not a very pleasant one. As I said, I am a social worker, and I have kept up my membership in my professional association, because I think that is very important. Today, I am addressing my colleagues as both a member of Parliament and a social worker. I worked with an elderly lady in a long-term care home. She had multiple sclerosis. She had been living there for years. Slowly, little by little, she lost her autonomy, until all she could do was move her head, swallow, and move two fingers. It was just enough to operate her wheelchair. She asked for medical assistance in dying. As a social worker, it was my job to professionally assess whether her request was free and informed and whether she was asking for care in a free and informed way. I did my duty. I went to university, so I have clinical knowledge that enabled me to examine her condition, professionally evaluate her and use my clinical judgment to assess the request from this woman who had been suffering for years, confined to her bed. Imagine what it is like for someone who has to stay in bed all day long, having people turn them over so they do not get bedsores. Imagine what it feels like for someone who can no longer go to the bathroom, who is incontinent, who can no longer scratch their own forehead and has to ring for an attendant to come scratch it for them because it is itchy. The woman I am talking about made a request for medical assistance in dying. Her request was denied because the members of the multidisciplinary team concluded that this person was not in a condition to make a truly free decision, that she was depressed and that it was not the right time for her to take that step. When I hear our Conservative friends say all someone has to do is ask and they will get an injection the next day and die, I can tell my colleagues that, as a health professional and a social worker, it is tough to listen to that. As a member of Parliament, I am ashamed, because it is bad to spread misinformation. Just because someone asks for medical assistance in dying does not mean they will get it. There are tons of people around these patients who assess their state of mind and their disease. Together, they decide whether that person can request medical assistance in dying and receive it. We live in a democratic country. People can submit requests. That does not mean anything goes and requests will automatically be granted. This morning, I decided I had better listen to the speeches from my office, because I would have had trouble facing the members who were saying outrageous things. The same goes for people with disabilities. It seems like some members believe that people with disabilities are not smart, that they cannot make decisions and that they need to be guided. I am sorry, maybe I am getting emotional, but I have profound respect for human beings, and human beings are capable of making decisions about themselves. I want to reiterate that just because someone requests MAID does not mean they will receive it. The professionals surrounding these people are not naive. They are educated people: doctors, nurses, social workers and occupational therapists. Care providers are professionals. MAID is a lengthy process in Quebec. Sometimes, people make the request too late. They lose their ability to consent again to the process, and they miss their chance. They suffer because they lost the cognitive capacity to consent one more time to medical assistance in dying. We agree that today we are discussing a very sensitive and complex issue. There are some members in the House who are really lowering the level of the discussion and debate. Frankly, I feel sick about this, and I repeat that I am ashamed of what I heard this morning. The Bloc Québécois’s proposal is balanced. We know that Quebec passed a law and wants to allow people to make advance requests. What does that mean? If the hon. member for Rosemont—La Petite-Patrie received a diagnosis of early dementia or Alzheimer’s around the age of 45, he could decide that he did not want to die in a long-term care home, hunched over and completely dependent on others. He would then decide to draft his advance requests and trust those around him so that he could receive medical assistance in dying when all the criteria he described were met. In Quebec we are ready to do that. Furthermore, the Special Joint Committee on Medical Assistance in Dying, which analyzed the issue for a year, reached the same conclusion, namely that it makes sense. A person who is mentally sound, who has been assessed and wants to make their advance request should be able to do so and, above all, to obtain it. The bill we have here is very timid. It lacks ambition and political courage. We are abandoning people who, at this very moment, would like to use advance requests because they are suffering from a form of dementia, a kind of incurable neurocognitive disease. They see the end coming, and it is terrible, because it comes with atrocious suffering and complete loss of autonomy. If I received a diagnosis of early onset dementia and no longer recognized my children and my grandchildren, if I was aggressive, if I defecated in my underwear and did not stop walking all day long because I kept wandering and had no life left, I would want my children to say that I met all the requirements and to ask that they let me go because I would be ready and those were my wishes. In Quebec, this has been recognized. Unfortunately, because this government will not listen to Quebec, it will not allow practitioners, doctors, nurses and social workers to do their work. They could face legal action launched by the family or by a third party. What is going to happen? People in Quebec are really going to suffer because here, in the House, people lack courage and do not want to support the one province that is ready to move to another level. When it comes to advance requests, we are ready. We in the Bloc Québécois nonetheless agreed that we had not necessarily fully explored the issue of mental disorders and that we needed an extra year to reflect and lay the groundwork. However, three years is too long. Society is moving ahead faster than legislators. Members of the House need to understand they are abandoning people who will suffer. My grandmother was religious. At age 91, she was suffering terribly and was about to die. She refused morphine because, in her religion, those who suffer go to heaven. She refused care, and she suffered. It was a choice. We respected her choice to suffer so she could go straight to heaven, even though we knew full well she would. She believed she had to suffer. We respected that. She refused all morphine injections. Today, we have made progress. People have the right to choose how they want to leave this earth. I repeat, just because people ask for medical assistance in dying does not mean they will receive it. Today, I am making a plea from my heart. For everyone who will need it, let us listen to the consensus of Quebec society. Let us listen to Quebeckers, who are saying that Canada can take the time to reflect, but that Quebec is ready and wants permission to do it properly and legally.

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Mr. Alexandre Boulerice (Rosemont—La Petite-Patrie, NDP)

Feb/13/24 4:44:48 p.m.
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Mr. Speaker, I would like to thank my colleague for her plea from the heart, her speech. She mentioned me at one point. I hope I do not receive that diagnosis anytime soon. I generally agree with her on this issue. I did not follow all the formalities and procedures surrounding this matter. That said, I agree that there is consensus in Quebec concerning advance requests with defined criteria, loved ones who can care for the patient and health professionals who can provide support. I quite agree with my colleague that the federal government should show some openness, sit down and talk with Quebec to find a solution, maybe even a reasonable accommodation, so we can respect the consensus of Quebec society, which seems to be heading in the same direction in this matter.

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Mrs. Claude DeBellefeuille

Feb/13/24 4:45:45 p.m.
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Mr. Speaker, I am pleased to hear from my colleague who understands the consensus in Quebec. Now, I will ask him to convince his political party to support the Bloc Québécois amendment, which proposes amending the Criminal Code so that service providers cannot be prosecuted for providing MAID to people who made advance requests and obtained that service. I encourage him to speak up and to be a leader in his party to convince his colleagues. Just because the other health ministers from the other provinces and territories are not ready does not mean that Quebec is obligated to move as slowly as them. Quebec is ready to help people who are suffering who want MAID and who request it. I will say it again. I do not know if there are any anglophone MPs here who are wearing their earpieces, but just because a person requests medical assistance in dying does not mean that they will get it.

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Mr. Damien Kurek (Battle River—Crowfoot, CPC)

Feb/13/24 4:46:48 p.m.
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Mr. Speaker, I find aspects of the debate we have had here today to be very troubling because there are increasing examples, and I hear of them in my constituency office and from reports in the media, but the member suggests that somehow the debate is settled. Therefore, anybody who would raise valid questions is somehow not entitled to ask those questions. That is simply not how our democracy works. It is troubling that that would be the trend some members of the Bloc Québécois, and even some Liberals today, are following when we have heard a host of very concerning things. Even at the special committee, which has been referenced, Quebec's college of physicians suggested that infants could be euthanized if they were born with a disability. There are concerns about members of the military, veterans, who have been offered MAID instead of treatment. There is a whole host of questions that need to be answered. It is time to give hope in this country and not simply the opportunity for somebody to end their life in the most final way imaginable.

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Mrs. Claude DeBellefeuille

Feb/13/24 4:47:59 p.m.
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Mr. Speaker, I will stay calm because I am not allowed to say what is on my mind. It would be unparliamentary. I want to say something about the Special Joint Committee on Medical Assistance in Dying. There was unanimous consensus on recommendation 21, which I will read, “That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition[,] disease, or disorder leading to incapacity.” This is not coming from me. This comes from a joint committee made up of MPs from every party in the House and several senators. That was said in February 2023. I was a social worker in Quebec. Children have never, ever been euthanized in Quebec. That is not what we are talking about. I think that the member did not listen to my speech. What I said was that not everyone who asks for medical assistance in dying gets it, and those who do have to go through a thorough and professional clinical process first.

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Ms. Andréanne Larouche (Shefford, BQ)

Feb/13/24 4:49:20 p.m.
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Re: Bill C-7 Bill C-62 Bill C-14

Mr. Speaker, the member for Salaberry—Suroît is a tough act to follow. This is not easy, because we all have someone in mind when we talk about this. We have all lost loved ones over the past few months and years. We all have gone through different experiences. Some people request medical assistance in dying, others do not, but one thing is certain: this is a very sensitive topic. It is with great humility and sensitivity that I rise today to speak to Bill C-62, an act to amend An Act to amend the Criminal Code (medical assistance in dying), no. 2, something we have been talking about for a long time. We must act by considering the fact that, currently, the Government of Quebec's Bill 11 does not include non-neurocognitive mental disorders as being eligible for medical assistance in dying and that Quebec wants to fill the administrative void surrounding the federal government's position on the subject of mental disorders relative to neurocognitive disorders. Therefore, I am not here to repeat my whip's testimony. I am here to provide some background and talk about Quebec's specificities. I will close by going into more detail about the Bloc's position. First, in 2014, Quebec passed the Act Respecting End-of-Life care after five years of consultations and of working together across party lines. I want to emphasize that the work was non-partisan. In 2015, the Supreme Court ruling in Carter indicated that some provisions of the Criminal Code that prohibited medical assistance in dying contravened the Canadian Charter of Rights and Freedoms. In 2016, the Liberal government passed Bill C-14, in response to Carter. In 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, who claimed that excluding people whose death was not reasonably foreseeable from eligibility for medical assistance in dying was discriminatory. As a result, the court ordered that federal and provincial laws be amended before December 18, 2020. In 2021, after a pandemic-related delay, Parliament passed Bill C‑7, which created two pathways to medical assistance in dying: One for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable. Quebec simply chose to drop the end-of-life criterion. Bill C‑7 required that an expert panel be created to review MAID and mental illness. The Expert Panel on MAID and Mental Illness was formed in August 2021 and produced a final report containing 19 recommendations. Recognizing that the legislation was flawed and that issues related to medical assistance in dying remained unresolved, Bill C-7 created the Special Joint Committee on Medical Assistance in Dying, composed of members of the Senate and members of the House of Commons, which had a five-part mandate. The joint committee tabled an interim report on June 22, 2022. There was not much time between the tabling of the joint committee's report, which was initially expected in 2022, and the March 17, 2023, deadline for excluding people from MAID for mental illness, so members postponed eligibility for one year to allow the committee to finish its work. The goal was to give the professions involved more time to develop standards of practice. At last, in February 2024, the joint committee produced its final report. The report contains only one recommendation. Bill C‑62 implements the report's recommendation by postponing eligibility for MAID MD-SUMC, for mental disorders, for three years and by forcing the creation of a joint committee one year before the report. Sections 241.1 to 241.4 of the Criminal Code govern medical assistance in dying in Canada. What is more, under the law, the government is required to oversee the use of medical assistance in dying via the Regulations for the Monitoring of Medical Assistance in Dying. I am providing all of this background to illustrate that the government could have and should have taken action a long time ago. Second, in Quebec, medical assistance in dying is governed by the Act Respecting End-of-Life Care. The activities surrounding medical assistance in dying are supervised by the select committee on end-of-life care. In June 2023, the National Assembly of Quebec passed Bill 11 to expand access to medical assistance in dying in Quebec and harmonize Quebec's legislation with the Criminal Code. There are some notable changes to Quebec's legislation. Minister Sonia Bélanger and her colleagues Roberge and Jolin‑Barette held a press conference on February 7 calling on the government to include a provision in the Criminal Code that would allow Quebec to move forward with advance requests, because, even though Quebec's legislation allows it, the Criminal Code does not. Although doctors who choose to go ahead with advance requests are unlikely to be prosecuted by Quebec's attorney general, the risk of a civil lawsuit is still there, and that will make many doctors think twice about granting advance requests. Quebec's National Assembly has passed a unanimous motion demanding that the federal government legislate on the issue. Third, the Bloc Québécois will vote for the bill on the condition that the postponement is for one year, not three. The Bloc Québécois believes that eligibility for people suffering from mental disorders must be postponed so that Quebec, the provinces and professional bodies can create a framework for their MAID practices. However, it should not be postponed indefinitely. The Bloc Québécois believes that postponing eligibility by three years will prolong the suffering of individuals who could be eligible for MAID and is contrary to their rights as guaranteed by the charters. The Bloc Québécois wishes to point out that the report of the Expert Panel on MAID and Mental Illness, as well as the Collège des médecins du Québec, emphasized that the safeguards—namely irremediability, severe physical or mental suffering, and free and informed consent—currently provided for in the Criminal Code are sufficient to allow access to MAID where mental disorder is the only underlying condition. In our supplementary opinion attached to the report of the Special Joint Committee on Medical Assistance in Dying, the Bloc Québécois points out that, even though preparations on the ground for medical assistance in dying when a mental disorder is the sole underlying medical condition are not yet complete across Canada, this does not change the fact that several professional associations, including the Collège des médecins du Québec and the Association des médecins psychiatres du Québec, would still like it to be made available in the future. The Bloc Québécois also acknowledges the requests made by several provinces to postpone eligibility. It should be noted that many countries have adopted policies on medical assistance in dying specifically for mental disorders. The Bloc Québécois deplores the government's failure to be proactive and the Conservatives' obstruction on the issue of medical assistance in dying when a mental disorder is the sole underlying medical condition and on the issue of advance requests. We fear for the patients who will have to turn to the courts to assert their rights while also bearing the burden of their illness. Finally, the Bloc Québécois condemns the fact that this bill does not distinguish between mental disorders and neurodegenerative diseases, such as Alzheimer's and Parkinson's. Quebec's law makes that distinction. It would allow people suffering from the latter category to access medical assistance in dying, as advocated by the Quebec government. In the Bloc's opinion, the social consensus on these illnesses is stronger, and it would have liked to see the Criminal Code brought into line with Quebec's end-of-life care law by allowing advance requests. In his supplementary opinion on MAID, the member for Montcalm, whom I would like to congratulate for all his work on this issue, went into great detail on the reasons that justify MAID when a mental disorder is the sole underlying condition. The position of the Collège des médecins du Québec perfectly sums up the importance of allowing advance requests for medical assistance in dying, as well as medical assistance in dying when a mental disorder is the sole underlying condition. While admitting it needs more time to ensure its members are ready, the Collège des médecins du Québec has established five guidelines for assessing eligibility for medical assistance in dying. In conclusion, the Bloc Québécois has a humanist view of medical assistance in dying that is grounded in philosophical principles and ethical arguments that reflect the evolution of Quebec society. Medical assistance in dying recognizes the right of individuals to choose for themselves, to determine the conditions for a healthy and dignified life. Medical advances allow us to sustain life, but that does not preclude the need and right of the individual to define what is an acceptable life. Section 1 of the Quebec Charter of Human Rights and Freedoms states that every human being has a “right to life, and to personal security, inviolability and freedom”. Quebec society believes that the right to life includes the right to die. In that context, we need to see medical assistance in dying as a right that gives the individual the option of avoiding terminal suffering and medical paternalism in order to maintain their dignity. By allowing medical assistance in dying, we allow people to choose how, when and where they want to pass away. Medical assistance in dying only makes sense if the person's free and informed consent is respected. The word “free” means voluntary and without constraint, and the word “informed” means with all the information needed to make such a decision. Meeting this condition is necessary for accessing medical assistance in dying. The principles we stand for concerning medical assistance in dying are equally valid in cases of mental illness. Let us not forget that the possibility of access to MAID does not mean automatic eligibility. However, when the Quebec select committee was doing its work, it made a distinction between mental disorders and neurodegenerative diseases. The commission concluded that although there was no consensus on mental disorders, there was a consensus on neurodegenerative diseases. With that in mind, the Quebec government opened the door to advance requests. Advance requests allow an individual to determine the conditions under which MAID should be administered when they have lost the capacity to consent because of their illness. In its second report, the Special Joint Committee on Medical Assistance in Dying expressed its support for advance requests. All parties, except the Conservatives, who are against any form of medical assistance in dying, voted in favour of the recommendations. As a final point, the federal government therefore has no reason to drag its feet or to deny Quebec's request.

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

Feb/13/24 4:59:28 p.m.
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Mr. Speaker, I appreciate a number of things the member has said, and I like to think that all of us have personal feelings on a wide spectrum of issues, this being one of them for me personally. Having said that, I understand and appreciate the importance of the Supreme Court of Canada's decision and the Charter of Rights and Freedoms. I think it is good to bring responsible public policy in regard to MAID. Does the member share in the concerns that I have with respect to the Conservative Party's propaganda of spreading things that are grossly exaggerated, like people going to a food bank, feeling poor and wanting to apply for MAID? At the end of the day, they try to make it sound as if one can go and apply today and have suicide-by-government on the Friday. I personally believe that is damaging to the whole debate we are having.

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Ms. Andréanne Larouche

Feb/13/24 5:00:45 p.m.
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Mr. Speaker, I am glad my colleague from Montcalm has arrived. He can answer that question as well as I can, and he must have heard a thing or two from the Conservatives at the Special Joint Committee on Medical Assistance in Dying. I sincerely sympathize with him. As my whip herself said earlier, we can hardly believe what we have been hearing since this debate began. I am speaking today because I have been hearing about this bill from seniors' groups ever since I was named the critic for seniors. They have certainly made me aware of this issue. Seniors' groups in Quebec want this freedom of choice. I have said this before, but I will say it again because I think it is appalling. Anyone who says that seniors are going to food banks to request medical assistance in dying is engaging in blatant and serious disinformation. This debate reinforces my conviction about why states must be secular. This is an example of why it is dangerous to let religious elements participate and pay for a political party's leadership race in Canada.

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Mr. Michael Cooper (St. Albert—Edmonton, CPC)

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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Ms. Andréanne Larouche

Feb/13/24 5:03:06 p.m.
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Mr. Speaker, I talked about the Conservatives' obstruction. Unfortunately, I could also talk about the Liberals' inaction, which is why we are still here today, why this file was delayed. What is more, they are asking us to wait another three years. Enough is enough. As for my colleague's remark, the Conservatives are bringing up cases that might have more to do with the justice system. Before being elected, I worked on the issue of elder abuse. These are isolated cases and they have more to do with the justice system. In the case at hand, we are talking about professional bodies. I talked about it in my speech. We are also talking about a joint committee made up of senators and MPs who worked hard and proved that the safeguards are there and that, no, it is not true that a person can ask for medical assistance in dying as easily as ordering food in a restaurant. It is not true. There are safeguards and, in Quebec, this is clearly understood. What we need to do is to let ourselves be guided by the scientific evidence and by what professional bodies are saying, not by isolated cases and regressive religious attitudes.

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The Deputy Speaker

Feb/13/24 5:04:12 p.m.
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The hon. member for Beauport—Limoilou on a point of order.

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Mrs. Julie Vignola

Feb/13/24 5:04:20 p.m.
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Mr. Speaker, may I remind my esteemed colleagues that when they ask a question, they should want to hear the answer? At the moment, members seem to be talking to each other across the aisle and not listening to the person who was asked the question. Respect needs to be shown not only at school, but in everyday life.

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The Deputy Speaker

Feb/13/24 5:04:41 p.m.
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I thank the hon. member for pointing out that members need to listen to each other in the House. Those who have been recognized are the ones who should take part in the discussion. Resuming debate, the hon. member for Vaughan—Woodbridge has the floor.

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Mr. Francesco Sorbara (Vaughan—Woodbridge, Lib.)

Feb/13/24 5:05:04 p.m.
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Re: Bill C-62

Mr. Speaker, it is always an honour and a privilege to rise in the House on behalf of the wonderful residents of my riding of Vaughan—Woodbridge and all of the residents in the city of Vaughan. I will be sharing my time with my friend and colleague from the wonderful riding of Kitchener Centre. Before I begin my formal remarks, this is a debate on Bill C-62, medical assistance in dying, which is obviously highly personal to all members in the House. Remarks are being delivered today with much passion, substance and thought. I will add a few words on that front. I have provided my personal beliefs on medical assistance in dying, which I am obviously in favour of. I know many individuals in many families who made tough decisions that were not with regard to mental illness. That gives me great consternation and much thought. I am glad that a pause will be put in place because mental illness is a complex subject. I am not an expert and will not profess to be an expert, but we all know someone who has struggled with mental illness. We all know family members or friends for whom mental illness continues to be an issue. Unfortunately, many folks have taken their lives, and we need to make sure there is a system in place that is robust, where people can get the help and assistance they need to live their full lives, which God has blessed them with. I am convinced that our current MAID system is working well. I would like to take the next ten minutes to explain why Canadians should have confidence in our MAID legislation and its application over the past seven years. I also want to describe some of the activities that will help sustain that confidence when eligibility is expanded in March 2027, as proposed in Bill C-62. When the law authorizing medical assistance in dying was originally passed in 2016, it included a number of mandatory eligibility criteria for anyone requesting MAID. The person must be an adult of at least 18 years of age and capable of making health-related decisions. The request must be voluntary. Their request must be fully informed, and the person must have knowledge of the options available to relieve their suffering. They must have a grievous and irremediable health condition, meaning it cannot be cured, which is defined as follows: They have “a serious and incurable illness, disease or disability; they are in an advanced state of irreversible decline in capability”, and they are experiencing “enduring physical or psychological suffering” that cannot be relieved under conditions that they consider acceptable. In 2016, the law also required that the person's natural death be reasonably foreseeable. In 2019, the Quebec Superior Court ruled that this criterion violated the Charter of Rights and Freedoms. In March 2021, a revised version of the federal law was passed, extending eligibility for MAID to people whose natural death was not reasonably foreseeable as long as they met other eligibility criteria. In addition to these eligibility criteria, the law also sets out many procedural safeguards that a clinician must meet before administering medical assistance in dying. Here are a few of them: Two independent practitioners must provide a written confirmation of the person's eligibility. The person who is requesting medical assistance in dying must be informed that they can change their mind at any time and in any way and that their wishes must be respected. Also, the person must reconfirm their desire to receive medical assistance in dying immediately before receiving it. When a person's natural death is not reasonably foreseeable, a series of enhanced safeguards must be respected. I will talk about some of those critical safeguards. First, at least one of the two MAID assessors must have expertise in the person's medical condition. If they do not have that expertise, they must consult another practitioner who does. Second, the person must be informed of the means available to alleviate their suffering and be offered meaningful consultations. Third, these means must have been discussed, and both MAID assessors must agree that the person has seriously considered these means. Fourth, at least 90 days must pass between the beginning of the eligibility assessment and the day on which MAID is administered. These are legislated safeguards that all practitioners must abide by. We know that MAID practitioners across the country exercise considerable professional judgment in providing this service by keeping patients' interests and wishes at the forefront. Practitioners work hard to ensure that MAID is a last resort. They compile essential information about the person's medical condition, their treatment history and their use of support services. They have the necessary conversations to ensure that their patients are aware of the services available to them that might alleviate their suffering. It is about exploring treatment options, facilitating referrals and following up on the results. If the person who wants to receive MAID consents to involving family members and loved ones, the practitioners will encourage their involvement and include them in the discussions that are part of the overall assessment process. Practitioners are also aware that they do not always have the necessary expertise in the patient's condition to conduct a full assessment. In these situations, they have to consult the relevant experts and other health professionals who have the necessary expertise to make an informed decision. Some provinces or regional health care authorities have put in place MAID care coordination services or case consultation mechanisms that rely on a team or network of doctors, nurses and other professionals, such as social workers and spiritual leaders, to support the assessment process. What does that mean for the future, once we begin allowing MAID requests based on enduring and intolerable suffering resulting solely from mental illness? Are our existing legislative safeguards sufficient? How can we be sure that the same level of care, diligence and consistency in the provision of MAID will be the norm? In 2021, as mandated by the former Bill C-7, an expert panel reviewed the issue and concluded that the existing legal framework for eligibility criteria and safeguards is sufficient, provided MAID assessors apply the existing framework appropriately, with guidance from MAID standards of practice that have been developed as well as specialized training. In the time I have left, I would just like to say that we all rise in this most honoured House on many topics. One of these topics, probably one of the most personal ones that we have risen on in the number of years I have been here, is medical assistance in dying. I look forward to questions from the hon. members in the House, who have been sent here by their constituents. This is an important debate for us to have, and it is an important topic to discuss.

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Hon. Ed Fast (Abbotsford, CPC)

Feb/13/24 5:15:19 p.m.
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Mr. Speaker, I do agree that this is an intensely personal decision for each one of us. I listened carefully to the member's speech. At the beginning, he seemed to suggest that the reason the government was compelled to move forward with expanding MAID for the mentally ill was that the lower courts have forced the government to do this, but the courts have not actually directed the Canadian government to implement MAID for the mentally ill. The Supreme Court of Canada has never opined on the matter. In fact, every time the Liberal government has been given the opportunity to appeal a case to the Supreme Court, it has refused to do so, probably for ideological reasons. I would ask the member for his opinion. Does he believe that the Supreme Court of Canada has directed the House, this Parliament, to implement medical assistance in dying for the mentally ill, yes or no?

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