SoVote

Context: House Hansard - 283 - Feb/15/24

Feb/15/24 11:17:19 a.m.
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Madam Speaker, as an advanced democratic country, Canada sometimes brings in legislation on issues that have never been dealt with before. Sometimes Canada is one of the first countries in the world to deal with these types of issues. When we bring in legislation that fundamentally affects every single Canadian, sometimes we have to look at it again to see how we can serve Canadians, whether we are stepping on the toes of the fundamental rights of Canadians. Earlier the hon. member for Abbotsford said that there was no national consensus. I would like to ask the member whether he agrees with me that due to the different religious beliefs, different religious faiths and philosophies, we cannot have national unanimity on issues like this.

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Context: House Hansard - 283 - Feb/15/24

Mr. Chandra Arya (Nepean, Lib.)

Feb/15/24 11:30:51 a.m.
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Madam Speaker, Canada is one of the most advanced democracies in the world. That is why we bring in legislation, some of which is quite unique. In Canadian history, over all 155 years, this is the first time legislation like this has been brought forward. Whenever we bring forward legislation that fundamentally affects every single Canadian's life, is it not important that we relook at it, modify it if required, take a pause, check to make sure everything is okay and patiently advance it instead of rushing it through? I would like the hon. member's views on that.

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Context: House Hansard - 283 - Feb/15/24

Mr. Chandra Arya (Nepean, Lib.)

Feb/15/24 12:23:24 p.m.
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Re: Bill C-62

Madam Speaker, I will be sharing my time with the member for Fundy Royal. I am pleased to have the opportunity to speak in the House today in support of Bill C-62, the bill that proposes to extend the temporary exclusion of mental illness as an eligible condition for medical assistance in dying by three years, until March 17, 2027. I will speak today about the importance of a delay before lifting this exclusion to provide more time for the provinces, territories and their health care partners to prepare for this critical juncture in the evolution of medical assistance in dying, which we refer to as MAID in Canada. The legal framework for MAID is set out in the federal Criminal Code. However, it is the provinces and territories who have the responsibility for health care delivery, including MAID implementation. We have been working in close collaboration with the provinces and territories to support the safe implementation of MAID since before the original legislation permitting MAID was enacted in the Criminal Code in 2016. This is an important relationship built on the mutual goal of ensuring quality health care for the people of Canada. Both the expert panel on MAID and mental illness and the Special Joint Committee on Medical Assistance in Dying emphasized the importance of clear practice standards and consistent implementation of guidelines across the country, training for physicians and nurse practitioners, and case review and oversight to support best practices and trust in the appropriate application of the law. Provincial and territorial governments and their stakeholders, such as health care professional organizations, regulatory bodies and practitioners, have been actively planning for eligibility for MAID for persons whose sole medical condition is a mental illness. As has been recognized across the board, critical progress has been made in this regard. However, the provinces and territories face different challenges within their jurisdictions and are at varying stages of work in implementing these key elements and consequently their readiness for the lifting of the exclusion. For example, a model practice standard for MAID was developed by an independent task force group made up of clinical, regulatory and legal experts as a resource for physician and nursing regulatory authorities to adopt or adapt in their development or ongoing revision of MAID standards. In addition to the model standard, the task group also released a companion document entitled “Advice to the Profession”. Practice standards are developed and adopted by regulatory bodies responsible for ensuring that specific groups of health professionals operate within the highest standard of clinical practice and medical ethics. While some provincial and territorial regulatory bodies have successfully implemented MAID practice standards into their guidance documents for clinicians, others are still in the process of reviewing and updating their existing standards. To support the safe implementation of the MAID framework, health Canada supported the development of a nationally accredited bilingual MAID curriculum to support a standardized approach to care across the country. The Canadian Association of MAiD Assessors and Providers has created and is now delivering a training program that has been recognized and accredited by the appropriate professional bodies. The MAID curriculum includes a series of training modules to advise and support clinicians in assessing persons who request MAID, including those with mental illness and complex chronic conditions, or who are impacted by structural vulnerability, as well as help with the practical application of the MAID legislative framework. The curriculum will help achieve a safe and consistent approach to care across Canada and ensure access to high-quality MAID training for health practitioners. So far, more than 1,100 clinicians have registered for the training, which is impressive given the curriculum was just launched in August 2023. This is only a portion of the workforce. More time would allow additional physicians and nurse practitioners to register and participate in the training, and to internalize these learnings and put them into professional practice. Now let me turn to case review and oversight of MAID. In Canada there is a process of self-regulation within the medical and nursing professions. The provincial and territorial regulatory bodies, which I spoke of earlier, have a mandate to protect the public for all health care, and MAID is no exception. In addition to the presence of health professional regulatory bodies, several provinces have implemented formal oversight mechanisms specific to MAID. For example, in Ontario, the Chief Coroner reviews every MAID provision, as does Quebec’s end-of-life commission. Both of these bodies have strict policies regarding the timing and type of information to be reported by clinicians, and the Quebec commission issues annual reports. While the provinces with formal MAID oversight processes represent over 90% of all MAID provisions in Canada, other provinces do not have formal MAID quality assurance and oversight processes in place to complement existing complaint-based oversight processes undertaken by professional regulatory bodies. Work is being planned to explore case review and oversight models, and best practices, through a federal-provincial-territorial working group, with a view to supporting consistency across jurisdictions. All provinces and territories were united in their request to delay the lifting of the exclusion in order to have more time to prepare their clinicians and health care systems to manage requests where mental illness is the sole underlying condition, and to put the necessary supports in place. Provincial and territorial governments must ensure not only that practitioners are trained to provide MAID safely but also that the necessary supports are available to clinicians and their patients through the assessment process. Both the expert panel and the special joint committee on MAID emphasized the importance of interdisciplinary engagement and the knowledge of available resources and treatments. Experts and practitioner communities have also expressed the need for support mechanisms to be in place for providers undertaking assessments and persons who request MAID, irrespective of their eligibility. While some jurisdictions have robust coordination services to manage requests and provide ancillary services, other jurisdictions take a decentralized approach, which can result in less coordination across services and disciplines. The availability of necessary support services for both practitioners and patients is also variable, depending on the region. For example, we have heard about the challenges of accessing health care services generally in rural and remote areas of the country. Additional time would allow more work to be done to support patients and clinicians involved in MAID. The Liberal government is committed to supporting and protecting Canadians with a mental illness who may be vulnerable, while respecting personal autonomy and choice. The provinces and territories are ultimately responsible for the organization and delivery of MAID and supporting health services. Given their responsibility for how MAID is delivered, moving forward before provinces and territories are ready would not be the responsible course of action. We believe that the extension of three years proposed in Bill C-62 would provide the time necessary to work on these important elements for the safe and consistent application of MAID for persons suffering solely from a mental illness.

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Context: House Hansard - 283 - Feb/15/24

Mr. Chandra Arya

Feb/15/24 12:34:39 p.m.
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Madam Speaker, I agree with the hon. member that rural and remote communities, including indigenous peoples, have difficulty accessing the quality health care that many of us in urban centres take for granted. I also agree with the member that we need to look beyond the formal structure that is currently available in identifying the people with knowledge who can provide health care services. We should see whether we can bring people with the knowledge and expertise in traditional medicine or the various other knowledge systems available around the world into the system, where their knowledge and experience would be available not only to indigenous peoples but to all Canadians.

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Context: House Hansard - 283 - Feb/15/24

Mr. Chandra Arya

Feb/15/24 12:36:11 p.m.
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Madam Speaker, especially on issues on which highly qualified experts and professionals are giving their opinions, sometimes it may not be possible for everyone in the room to agree on the right answer. That is why the government has invested in consultation. The bill did not come up on its own. It is not just an outcome of the thought process of some bureaucrats sitting in a government building here; it also includes a lot of consultations with Canadians, health care professionals and other experts. Their inputs have also been taken into consideration when formulating the legislation.

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Context: House Hansard - 283 - Feb/15/24

Mr. Chandra Arya

Feb/15/24 12:37:43 p.m.
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Madam Speaker, the short answer would be what I always say, which is that whenever we bring in legislation that fundamentally affects all Canadians, especially the kind of legislation that has never been thought of during the last 155 years, we need to take a real look at it, modify it and change it if required. I am sure there will be a time in the future when we can have a real look at the whole MAID legislation to see whether we can tweak it to better serve Canadians.

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Context: House Hansard - 283 - Feb/15/24

Mr. Chandra Arya (Nepean, Lib.)

Feb/15/24 1:24:03 p.m.
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Mr. Speaker, in his speech, the hon. member mentioned the 31% increase in the number of Canadians using the assistance of this MAID legislation. I know this number of a 31% jump, when seen in isolation, is big. However, does the member agree that, because the legislation is fairly new, all the people who had been waiting and suffering for such a long time started utilizing these MAID legislation provisions? Does he agree that, going forward, when these MAID provisions are normalized, the rate of growth he quoted will not be so huge in the future?

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