44th Parl. 1st Sess.
February 13, 2024 10:00AM
- Feb/13/24 10:13:27 a.m.
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Mr. Speaker, when I reflect on this, the whole discussion and debate that has taken place over the last number of years has been fairly extensive.
Going back to the Supreme Court of Canada's Carter decision of 2015 and to the amount of committee and House of Commons' time, there has been a great of deal of discussion, justifiably so. It is important to recognize that medical assistance in dying is not necessarily a new issue. It has been well discussed in many different forms, even the issue of mental health well-being.
I wonder if the minister could provide his thoughts on the journey taken to bring us to this point today and on why it is so critically important that it pass by the end of this week.
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- Feb/13/24 10:26:27 a.m.
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Mr. Speaker, I appreciate my colleague's remarks and his hard work on the special joint committee.
I have several points to raise. The first one is that the bill addresses mental illness as the sole condition. The act requires that we deal with the issue before March 17, 2024.
I have a lot of respect for my colleague across the aisle. He mentioned that Canadians from coast to coast agree on the issue of advance requests. Although Quebec has expressed its willingness, I do not believe that all Canadians agree; that is the second point.
Obviously, if we want to extend medical assistance in dying to advance requests, we need to do so responsibly and with caution, as we did with all of the other issues, in other words, with all of the health experts, namely health ministers, psychiatrists, doctors and nurses. We need to proceed with caution, making sure to respect individual rights. We also need to strike a balance between individual rights and the protection of vulnerable persons. That is how we have been doing things since 2016, and that is how we will continue in the future.
Once again, it is important to note that the Criminal Code applies to the entire country. It is important to have clear information for all Canadians, so that everyone understands their rights and the criminal rules that apply across Canada. Criminal law must be consistent from one province to another.
That said, political discussions with Quebec are ongoing because this conversation needs to be had. However, we need to proceed carefully, cautiously and prudently.
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Mr. Speaker, in the previous Parliament, I was the NDP's representative on the medical assistance in dying committee. I do support medical assistance in dying, but it was the most difficult issue I have ever dealt with, and I agree with my colleague from Saanich—Gulf Islands that it was probably the most difficult issue most of us have ever dealt with in the House. For that reason, I agree with the minister that we have to proceed very cautiously and very deliberately in any expansion to medical assistance in dying.
Today I would rather be talking about removing mental illness as the sole underlying condition, but Parliament dealt with that question with the private member's bill from the member for Abbotsford, Bill C-314, so we cannot do that today. We are placed in the awkward position where the Senate added the provision to the original medical assistance in dying legislation, which I think was very ill-advised.
However, we have no choice at this point, I believe, but to support the closure motion to try to get this done so we can prevent the provision from coming into force, when we know clearly we are not ready and when we know some of us have very clear moral reservations about the expansion.
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- Feb/13/24 10:36:17 a.m.
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Mr. Speaker, what I can add to the conversation I just had with my colleague across the way is that we created expert panels to study several aspects of expanding medical assistance in dying. Experts conducted a study on advance requests. They found that it is extremely complex when we talk in the present about articulating a desire to seek medical assistance in dying, added to the fact that a person might submit a request 30 or 40 years ahead of time. Given the context, their situation, condition and wishes could change.
This said, Quebec has already addressed the issue, and a bill has been introduced in the province. We are well aware of this, and we are starting a discussion with Quebec. Discussions will be held.
We have a Criminal Code that applies across the country. Consequently, the question has to be approached the same way we dealt with the other aspects, meaning nationally. This is what we did when we prudently undertook consultations while taking the necessary precautions.
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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 11:36:17 a.m.
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Mr. Speaker, in the process of debating this, I would draw attention to the case back in 2016 of E.F., a woman in Alberta. There is media coverage on it and it is worth a good read. The reason I bring it up is because E.F. did get access to medical assistance in dying. She had nothing but a mental condition but it was horrific.
If this next step in medical assistance in dying is put on hold, would the member want to consider some mechanism by which a person like E.F. could get the relief from a life that simply was agonizing and not worth living?
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- Feb/13/24 11:37:11 a.m.
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Mr. Speaker, first and foremost, we want to ensure that we have a system of care in place to ensure that E.F. can actually get access to supports if she is suffering. However, that is not in place anywhere in the country, not in all 10 provinces and three territories. We know that. We are falling far below our OECD partners. Provinces and territories spend between 5% and 7% of their health care budgets on mental health compared to France and Britain that are at 12% and 14% respectively.
As New Democrats, we want to see a medical assistance in dying response where guardrails are in place to protect the most vulnerable. We want to ensure that safe and adequate delivery of medical assistance in dying is in place, but that there still is bodily autonomy and end-of-life choice. We need to have a system in place that the experts support, one that actually responds to medical assistance in dying, that ensures we have the training and that we have addressed all the recommendations of AMAD committee. We have not done that. I know the government is working toward that, but we are very far away from it.
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- Feb/13/24 12:33:42 p.m.
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Madam Speaker, while the member and I do not agree on a lot of things, this is a case in which we do stand together in our concerns about proceeding with allowing those with mental disorders as a sole underlying condition access to medical assistance in dying.
My question is this. Given that this is true for, I think, most of the Conservative members, why are the Conservatives not helping to advance this bill as quickly as possible? We are facing this deadline, and this will come into force if we do not take action. Why are Conservatives holding up this bill today?
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Madam Speaker, my friend, the member for Kelowna—Lake Country, and I share many of the concerns expressed today. This is one of those issues on which I would beg everyone in this place not to seek partisan advantage.
The divide we have here is really the most non-partisan thing of all: the structure of our Parliament, the Westminister system, whereby we still have the equivalent of the House of Lords; that is, the Senate. The Senate put in Bill C-14 that medical assistance in dying be available to those whose underlying medical condition is a mental health condition only. Everyone here, regardless of partisanship, is struggling to make sure Canadians do not seek access to medical assistance in dying if there is another option that allows them to continue to live. It is not partisan.
I would like comments from my hon. friend.
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Madam Speaker, I will be sharing my time with the member for Saanich—Gulf Islands.
It is a pleasure to speak today to Bill C-62. The bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID—
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- Feb/13/24 1:20:15 p.m.
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Madam Speaker, we have been debating this bill for several days, or several years, even. Sometimes, I get the impression that people are not seeking out the most up-to-date information so we can have an enlightened debate.
Earlier, I heard some stereotypes, perceptions and impressions that have no place in this debate. I would like to ask if my hon. colleague is aware that this is not about giving or offering medical assistance in dying to someone who is in a state of distress and contemplating suicide. She talked about this a lot in her speech, but this would not happen.
I wonder if she is aware of this and if she has read the report. Has she really done enough research to debate this issue in an intellectually rigorous and consistent manner?
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- Feb/13/24 1:22:50 p.m.
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Madam Speaker, I think society is going to a place where we are devaluing people. It is easier for somebody to suggest medical assistance in dying than to actually take the time to help. Sure, we can have a conversation on what the municipal and provincial roles in that are and the wraparound services. However, this comes down to treating humans with dignity and value, and giving them a hand up. It is not suggesting that their life is not really worth it, that everything is broken, and to just book them in at 2:00 p.m. on Friday to end it all. That is disgusting, and society needs to do better.
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- Feb/13/24 1:34:50 p.m.
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Madam Speaker, I believe the stories of folks who are struggling to such a point that they are even considering this. The fact that we are looking at making this an available option instead of treatment, instead of getting them the services they need, is so disappointing.
To the second part of your question, this started as medical assistance in dying. A Supreme Court decision forced Parliament to make a decision to set up a framework. We seem to have evolved to medical assistance in suicide. From my personal perspective, I want to fight for those who are facing real challenges and give them the hope they need so they can continue to live and improve their quality of life, not end it.
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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 2:26:27 p.m.
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Mr. Speaker, we all know that medical assistance in dying is a difficult, deeply personal choice that families and individuals are confronted with at extremely difficult moments in their lives.
We know that, as a government and a Parliament, we have a responsibility to ensure that vulnerable people are protected, but also to respect the choices and rights of people who want to use MAID.
We will keep having these conversations, including with the Government of Quebec, to find the right path to take for everyone.
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- Feb/13/24 2:38:21 p.m.
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Mr. Speaker, medical assistance in dying is about freedom of choice.
The role of the state is not to decide for the person who is suffering; it is to guarantee the conditions under which people can make a free and informed choice. If someone does not want medical assistance in dying, they can simply not ask for it.
The National Assembly is unanimous: Quebec is ready. It has its own legislation.
Will the federal government amend the Criminal Code to allow for advance requests for people who are suffering?
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- Feb/13/24 2:40:09 p.m.
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Mr. Speaker, medical assistance in dying is a deeply personal and complex choice. There is always a balance to be struck between an individual's autonomy and dignity, and the protection of the vulnerable.
We have taken a cautious approach from the beginning. We owe it to Canadians and Quebeckers to treat these issues thoughtfully and to proceed with caution.
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- Feb/13/24 3:26:42 p.m.
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Mr. Speaker, I would like to ask the member whether he could speak more specifically to the work of the special committee and how important it was for us to be non-partisan in approach. Medical assistance in dying is such an important and deeply personal issue. It was really the work of the committee that helped us arrive at the decision.
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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 4:16:03 p.m.
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Mr. Speaker, I would like to thank my colleague for his speech, and especially the bits in French.
However, I am still amazed to learn that during the course of this debate, which is not that old, the Special Joint Committee on Medical Assistance in Dying agreed on recommendations. These recommendations are found in the Bloc Québécois amendment we are debating today. I believe this amendment is very simple. It mentions that the bill “take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care”. I think this is just common sense.
Can we not vote on this amendment first and then make some progress so that people who need it can have access to medical assistance in dying in a free and informed manner?
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