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 10:22:24 a.m.
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Mr. Speaker, I too am very concerned about closure on such an important matter. My opinion is that by allowing assisted death on the basis of mental illness alone, we might inadvertently close the door on potential recoveries and the possibility of life returning with dignity and purpose.
Furthermore, enabling medical assistance in dying for mental health conditions could imply that some lives are less worth living and that some forms of suffering are less deserving of the full measure of our medical and social resources. This could lead to a slippery slope where the right to die may, under subtle social pressures, become a duty to die, particularly among the marginalized or the less privileged members of our society. For those reasons and many others, we need to be very, very careful.
Having closure on such a critically important issue, to me, says to those who might be considering this that they are less worthy. That is the farthest thing from the truth. We should be able to debate this. I do not know what took the government so long to bring the debate, given that, as my friend from the NDP said, there are nine days left. What took the government so long to bring it forward in the first place for proper debate?
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Mr. Speaker, it is an honour to rise today on the unceded lands of Tseshaht and Hupacasath on Vancouver Island in Nuu-chah-nulth territory to speak to Bill C-62, which is calling for the extension of the temporary exclusion of eligibility for medical assistance in dying for persons suffering solely from a mental illness by three years, until March 17, 2027.
Clearly, without an intervention by Parliament, this expansion would come into effect on March 17, 2024, in just one month. New Democrats agree with the majority decision made by the Special Joint Committee on Medical Assistance in Dying, also known as the AMAD committee, which I will refer to it as in my speech. It reported that Canada is not adequately prepared to deliver medical assistance in dying to individuals whose sole underlying medical condition is a mental disorder.
The bill would allow more time to implement the necessary safeguards and address the capacity concerns that are expected to be the result of the expansion of medical assistance in dying for those with the sole underlying medical condition of a mental disorder. It would give medical practitioners more time to become familiar with available training and supports, while providing time for the public to become more aware of the robust safeguards and processes in place. I know this is a very sensitive and very personal matter to so many people around this country. Especially in my riding of Courtenay—Alberni, I have heard from many people about this.
We also need to ensure that we have the understanding and compassion to respect the right of an individual's choice of dignity when they have deep, prolonged and ongoing suffering. I will speak to that. Suffering from mental illness is extremely serious, and it is just as real as suffering from a physical illness. In our health care system, we clearly do not have parity when it comes to mental and physical health, and I will speak to that as well.
We must also affirm and protect the most vulnerable when we do any sort of decision-making on such a serious piece of legislation as expanding medical assistance in dying. This additional delay is necessary and needed right now to ensure that we have a health care system in place that can safely provide medical assistance in dying for those whose sole underlying medical condition is a mental disorder.
We know how we got here. The Liberal government made an ill-advised decision and did a complete 180° by accepting the Senate's amendment to Bill C-7 in the 43rd Parliament. That is what got us here. The government changed the law before any kind of comprehensive review had been conducted, and we have been trying to play catch-up ever since. I am going to speak about the important work that needs to be done, and I want us to be thoughtful in our approach to expanding medical assistance in dying.
As New Democrats, we take people's concerns and feedback very seriously. We are committed to helping find the best possible solution for Canadians in the policy of medical assistance in dying to ensure that it does what it was always intended to do. One of the biggest concerns New Democrats have with the expansion of medical assistance in dying is with the barriers that many Canadians face when they reach out for mental health treatment. Because of the Liberals, and the Conservatives before them, the chronic underfunding of our health care system has become even more apparent. It is now more than ever, as we see the disparity between mental and physical health and how people are taken care of.
We heard the Prime Minister promise to implement a new mental health transfer of $4.5 billion over five years, but he has still not done that. Even with the bilateral agreements, the Liberals are falling far short, and that would not even be enough. Everyone should be able to access mental health supports when they need it, but under the Liberal government, and that of the Conservatives before it, this has not been the reality. It is the same with all provinces and territories.
New Democrats wholeheartedly support the delay in expanding medical assistance in dying for those who have a mental disorder as the sole underlying condition, but the Liberal government needs to ensure that proper consultation happens between now and the expansion date, or it would need to be extended again. It needs to ensure that people will be protected while respecting their individual choice.
The Liberals cannot just delay the expansion either. They need to fund adequate supports and treatment options for people dealing with mental illness. Members have heard me say this repeatedly, but we need a pathway, a road map, to how we are going to achieve parity for mental and physical health and ensure people get the timely help they need when they need it.
Seven of the provinces and all three territories have said that they are not ready and have signed a joint letter to that effect, including my home province of British Columbia. That was signed by the ministers of health in those provinces and territories. They are calling for an indefinite pause on the expansion for individuals whose sole underlying medical condition is a mental disorder. That is what those ministers identified.
As New Democrats, we want to see a MAID regime where guardrails are in place to protect vulnerable populations while still allowing for personal bodily autonomy and end-of-life choices. We must make sure that people do not request medical assistance in dying because they do not have access to treatments, supports and services. This has to be absolute. The Liberals need to make sure everybody can access mental health supports. However, after nine years of carrying forward with the Conservative cuts to health care, this is where we are at right now right across the country. Help is out of reach for many people. This needs to change before medical assistance in dying can be expanded.
We know that the housing, toxic drug and mental health crises that are happening are not being addressed. I see that I do not have a lot of time left, but I want to ensure I outline that the AMAD committee heard from plenty of witnesses who cautioned the committee on expanding MAID in cases of persons suffering solely from a mental illness. I want to share what a couple of those experts had to say.
Professor Brian Mishara, who is with the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at Université du Québec à Montréal, said, “The expert panel report on MAID and mental illness states that there are no specific criteria for knowing that a mental illness is irremediable”, and that there is absolutely no “evidence that anyone can reliably determine if an individual suffering from a mental illness will not improve.” He warned us that “any attempt at identifying who should have access to MAID will make large numbers of mistakes, and people who would have experienced improvements in their symptoms and no longer wish to die will die by [medical assistance in dying].”
We heard from many experts. The CAMH raised similar concerns.
Because I see that I only have a couple of minutes left here, I want to talk a bit about the system and the lack of access. We are talking about a crisis going on from coast to coast to coast, according to a poll done just a year ago. The Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction released a report talking about postpandemic findings. It cited that 35% of respondents reported moderate to severe mental health concerns.
This is alarming. It should also be alarming to all parliamentarians that it found that fewer than one in three people with current mental health concerns accessed services. The report identified key barriers to accessing services as financial constraints and help not being readily available. We know that right now we are in a financial crisis, and I am sure those numbers have only gone up. It identified that one of the top stressors was between income and unemployment with mental health concerns.
We need to create a system of parity with mental and physical health. The government has not delivered when it comes to a plan, a road map, on how we achieve parity with physical and mental health. I hope in this budget, it is going to release funding on top of the bilateral agreements directly to community-based organizations as a COVID emergency recovery response because, post-COVID, we know some people are struggling financially, but the biggest concern right now and the biggest epidemic post-COVID is in mental health. I hope the government is hearing that.
I see that I have run out of time. I have a lot to say on this matter. I look forward to taking questions from my colleagues.
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- Feb/13/24 1:37:39 p.m.
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Madam Speaker, once again, while I agree this time with the Conservatives that extending medical assistance in dying to those who have mental disorders as the sole underlying condition is very problematic and should not happen, I cannot understand the Conservatives not supporting moving quickly with the bill we have in front of us, because we face a deadline for when this will come into effect if we do not act.
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- Feb/13/24 3:45:09 p.m.
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Mr. Speaker, medical assistance in dying and mental health are obviously not simple issues. What is surprising, however, is that some people experience intolerable suffering. An expert report found that these people are not eligible. For example, people who are suicidal are not eligible if they are newly diagnosed and being monitored but refuse treatment and their requests are based on systemic vulnerabilities. Help and support are available to these people. Just because someone requests medical assistance in dying does not mean that they will receive it.
The Conservatives' conception of medical assistance in dying is flawed. There are people suffering right now who need their support.
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- Feb/13/24 6:56:11 p.m.
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Madam Speaker, the number of Canadians ending their lives through medical assistance in dying is accelerating at a rate that outpaces that in any other country. Canada's most recent annual report on medical assistance in dying, which I will call MAID from this point forward, shows that MAID deaths are actually up by 30% from just one year ago. This is not just a one-time occasion or occurrence. Rather, this is actually a trend. Year over year, we are seeing a rapid increase.
The matter at hand today, in the most literal sense, is a matter of life and death. Around the world, people are watching Canada and the debate taking place in this House. They are doing so with an overwhelming belief that what the current government is considering is, in fact, reckless. That is extending medical assistance in dying to those with a mental illness. This topic deserves our utmost attention today in this place and, my hope would be, beyond.
Last spring, the Liberals created legislation that would grant MAID to those struggling with a mental illness, starting on March 17, which is only a few weeks away. Thanks to the rallying cry of medical experts, those who struggle with a mental illness and concerned Canadians from far and wide, along with Conservative members of Parliament, the government has been forced into a position where they have actually had to hit the pause button. This is not permanent; it is only temporary, lasting for three years. We will then see this legislation back before the House, with the current government desiring to offer medical assistance in dying to those who struggle with a mental illness.
When considering whether a mental disorder is irremediable, Parliament has heard from clinicians, who stated that it is only predictable 50% of the time. In other words, 50% of the time, clinicians are able to say that the individual will not recover from the mental illness. The other 50% of the time, they actually get it wrong. It is not the same as a brain tumour, for example, that can be seen on a scan, where there is evidence that can be judged and physical circumstances that can be known. Mental illness does not operate that way. While doctors might be correct 50% of the time, this means that, with regard to a prognosis, they are also wrong 50% of the time. To be very frank, the toss of a coin feels like a rather sad, wrong way to make a life or death decision. That is really what we are talking about: the toss of a coin, where 50% of the time, they get heads, and 50% of the time, they get tails. That is how this decision would be made if we were to move forward with medical assistance in dying for those who have a mental illness. This is absolutely wrong. That Parliament would even consider it is deeply troubling.
Of course, we know that this has nothing to do with whether our physicians and our psychiatrists are functioning in an adequate manner. It has everything to do with the fact that mental illnesses are incredibly complex and difficult to understand.
It is important, as we engage in this debate, to consider what medical experts are saying. We heard from Physicians Together with Vulnerable Canadians, which reported, “Given that there is no medical evidence to reliably predict which patients with a mental illness will not get better, MAID for mental illness will end the lives of patients who would have recovered.”
The Canadian Centre for Suicide Prevention echoed this, reporting, “There is no consensus on the meaning of irremediability for any mental disorder.” Dr. Gaind, chief of psychiatry at Sunnybrook Hospital, raised the alarm; he said, we “cannot predict irremediability when it comes to mental illness”.
Dr. Zivot agreed, saying, “mental illness lacks a strict definition and therefore, by lack of definition, can never be grievous and irremediable”. He went on to say that “if MAID becomes a treatment option within mental health care, the bond of trust and the pledge between doctor and patient is destroyed”.
Those who live with a mental illness need hope, not death. They need us to believe in them when they are unable to believe in themselves.
It is incumbent upon us, as a society, to extend hope, to offer support and to give treatment, not death. When we consider extending medical assistance in dying to those who are suffering from mental illness, many Canadians are left extremely vulnerable. When an offer of death is extended to those who are struggling, we communicate a message that there is really no hope and no opportunity for recovery; we communicate that the best relief would be to exit this life. That lacks compassion. It is deeply troubling.
Laurel Walker has been very public about her story. She talks about her darkest days of living with a mental illness, about suicide being an ideation of hers, day after day. Then she talks about the fact that she had this glimmer of hope that somehow kept her alive. She warned Parliament that, if we were to go in this direction of legalizing medical assistance in dying for those who have a mental illness, we would be robbing them of that hope and sending this grave message that, really, death is their only option.
Dr. Sareen offered the same warning and shared that making MAID available for mental disorders would undermine suicide prevention efforts and lead to unnecessary deaths. He said:
When a society makes MAID available, the population believes it is a way to end suffering. In other jurisdictions that have had MAID available for mental disorders, not only are there deaths due to MAID, but there are also deaths related to non-MAID suicides.
In other words, we see an increase not only in medical assistance in dying rates but also in suicide in general. There is this lack of hope and this message conveyed by society that there is no future.
As Canadians, we can do better. I dare say we must do better. We cannot give up on people such as Laurel, who are fighting for their very lives. These folks are in desperate need of hope and help. They want treatment, not death.
Those struggling with their mental health deserve that element of support. Rather than looking to facilitate the deaths of fellow Canadians who are suffering, we must focus on how we can better provide the needed treatment. In an article, psychiatrist John Maher is quoted as expressing that “Mental illness is treatable, and death is not treatment.”
We know that the problem is rarely only mental illness. It is often within the larger context of social challenges as well, whether this is not having basic necessities, such as housing, or a social structural support that is not available to these folks. Again, we have a responsibility as a society to make sure that those things are available to these individuals. Death is not the answer.
To my fellow colleagues in this place, I would make the following plea: Let us not just simply push the temporary pause button, as if to say their life is worth something now but, in a few years, it may no longer be. It is as if to say that the flip of a coin might not be acceptable now, but maybe we will flip a coin in three years; that might be okay. Rather, let us commit to permanently valuing those who live with a mental illness, and let us make sure that they are forever offered the adequate health care supports that are needed. Death is not that.
Christie Pollock submitted testimony calling for great caution. She is a 30-year-old who has her own struggle. She talks about the hope that she is now able to offer, because she runs a support group. Then she talks about the fact that, if medical assistance in dying had been offered to her, she might not be here. She goes on to say that, sure, she has her struggles, and she is not healed, but she has found a mix of therapy and medication that is getting her through. Her days are filled with hope. It is not just hope for herself; she is also able to offer hope to others.
Madam Speaker and members of this House, this is where we should wish to land, where the people of this place offer hope to Canadians, not death.
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