44th Parl. 1st Sess.
February 15, 2024 10:00AM
- Feb/15/24 1:12:32 p.m.
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Mr. Speaker, I want to thank the member for sharing his experiences. I am a big fan of the Yiddish proverbs that he says, so maybe he has one he can share in addition to the one he shared already.
Getting back to the subject at hand, I worry most that there was an amendment put to the legislation that would basically allow for an expansion of medical assistance in dying to persons with mental disorders. The government had a choice where it could just simply say no to that amendment and just leave things as they are until, at the very least, the provinces which run the health care systems, and the mental health professionals could say “we are ready”. Does the member believe that the government really made a mistake and that this does have a bit of “the dog ate my homework” kind of approach to it? The government is simply relegislating over and over and making the same mistake.
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Mr. Speaker, I will be sharing my time today with the member for Lac-Saint-Louis.
I am very pleased to have the opportunity to speak in this House today in support of Bill C-62, particularly after listening to some of the debate this morning and hearing some of the language used in this House today.
For example, the member for Abbotsford, throughout his speech today continually used the words “the mentally disorded” I believe in reference to people who are suffering from mental illness. A little later in the day, we then heard from the member for Leeds—Grenville—Thousand Islands and Rideau Lakes, who continually referred to people as “addicts” throughout his speech.
In this House, we are leaders. Our words are important and we should not be furthering the stigmatization of people who suffer mental illness. I would caution my colleagues across the way to be careful in their language and to please not further marginalize people who are already suffering.
I will turn back to Bill C-62. As the Minister of Health and the Minister of Justice have emphasized, the government believes an extension of three years is necessary to provide individual clinicians as well as provinces and territories the time they need to prepare for this change.
I also believe a three-year extension of the period of ineligibility to receive MAID on the basis of a mental illness alone is necessary. Although significant progress has been made, more time is needed to ensure the safe assessment and provision of MAID in these circumstances. I have heard from psychiatrists in my riding of Hamilton Mountain who have said these very things. They need more time to get the system ready.
My remarks today will focus on the progress that has been made in preparing the health care system, and also what more needs to be done.
In 2021, as required by former Bill C-7, an expert panel examined the issue of permitting MAID where the sole underlying condition is a mental illness. It concluded that the existing legal framework of eligibility criteria and safeguards is sufficient, providing that MAID assessors apply the existing framework appropriately with guidance, through the development of MAID practice standards and specialized training.
Our government understood the importance of the panel's findings. To that end, we have been working in collaboration with the provinces and territories and other health care partners to implement consistent standards across the country and support a highly trained workforce to undertake these complex assessments.
For example, we supported the development of a model practice standard for MAID by individuals with clinical, regulatory and legal expertise. A model practice standard for MAID was released in March 2023 and has been adopted, or is in the process of being adopted, by most regulators across the country as a basis for assessment for clinical decision-making. The standard also provides guidance for MAID clinicians as they navigate more complex MAID requests.
We also supported the development of the first national, fully accredited bilingual MAID curriculum, which was launched in August 2023. The curriculum consists of seven training modules addressing various topics related to the assessment and provision of MAID, including how to do a MAID assessment, how to assess capacity and vulnerability, how to manage complex chronic situations and how to assess requests involving a mental illness. Over 1,100 clinicians have registered for the curriculum since August of last year.
This progress is the result of leadership and collaboration among health system partners, including federal, provincial and territorial governments, health professional organizations, regulatory bodies, clinicians and organizations like the Canadian Association of MAID Assessors and Providers. This collaboration and progress will continue to make improvements in approaches to safety and quality in assessments and provisions of MAID.
In terms of the future, I want to briefly speak to the Regulations for the Monitoring of Medical Assistance in Dying, which outline the reporting requirements relating to MAID requests. These regulations came into force in November 2018, but were recently revised to facilitate enhanced data collection and reporting on MAID activity. Most notably, the regulations now allow for the collection of data based on race, indigenous identity and the self-reported presence of a disability, where a person consents to provide this information.
The revised regulations came into force on January 1, 2023, and information on MAID activity in 2023 will be released in Health Canada’s annual MAID report this year, in 2024. This information will provide valuable insight into who is requesting and receiving MAID, including those under track 2, whose natural death is not reasonably foreseeable.
Despite all this work, we have heard that the provinces and territories are at various stages of readiness for the lifting of the exclusion of eligibility and that they need more time to prepare their health care systems.
I know that the suffering caused by a mental illness can be just as severe as that caused by a physical illness, but I strongly believe that this extension is necessary to ensure that MAID can be safely assessed and provided on the basis of a mental illness alone. This extension does not question the capacity of people with mental illness to make health care decisions. It is about giving the health care system more time to adopt or implement some of these key resources to ensure that MAID practitioners are properly equipped to assess these complex requests, and that the provinces and territories have the necessary mechanisms in place to support them.
For example, both the expert panel that I referred to earlier and the special joint committee on MAID have emphasized the importance of case review and oversight of MAID, both to educate practitioners and to support accountability and public trust in the law. While the majority of cases of MAID, 90%, take place in provinces with formal oversight processes, other provinces do not have formal MAID case review and oversight processes in place beyond those already undertaken by professional regulatory bodies.
Work is being planned to explore best practices through a federal-provincial-territorial working group, with a view to encouraging more consistent and robust mechanisms across the country.
The expert panel and the special joint committee also identified engagement with indigenous partners as a priority. The Government of Canada has launched a two-year engagement process on MAID to hear the perspectives of first nations, Inuit and Métis, including urban indigenous people, indigenous people living off-reserve with or without status, indigenous people living with disabilities, and two-spirit, LGBTQQIA+ and gender-diverse indigenous people.
The proposed extension under Bill C-62 would provide the necessary time to have these discussions with indigenous partners. It is an essential process to appropriately inform implementation as well as guidance and training material for clinicians to support enhanced integration of cultural safety in MAID practices.
Health Canada will provide its first official update to Parliament on this work in March 2024, just next month.
In conclusion, the Government of Canada remains committed to ensuring that laws reflect the needs of people in Canada, protect those who may be vulnerable, and support autonomy and freedom of choice. While we have made significant progress in the study of MAID and mental illness, and in the development and dissemination of key resources, we are not yet ready. We need to act prudently and not rush this change without the necessary resources in place.
This decision is not an easy one, but I want to assure the House that we will continue to work collaboratively with our partners to improve the mental health of Canadians.
I thank all members for the opportunity to speak today as we debate this important bill.
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- Feb/15/24 3:27:45 p.m.
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Mr. Speaker, it is very clear that there is a class, racial and geographic aspect to being able to access mental health services. We have a problem for people in rural and remote communities. We have a problem in indigenous communities. We also have a problem for those who cannot pay for their services.
As a way of also attacking this problem, would the member support making mental health services fully a part of the Canada health care plan?
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- Feb/15/24 3:28:20 p.m.
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Mr. Speaker, as a rural member of Parliament, I have long fought for, and will continue to fight for, ensuring that rural Canada has access to the mental health services that it needs, whether that is east central Alberta, which I am proud to represent, or rural and remote communities across Canada or in our north.
From my early days in the nomination to become the Conservative candidate prior to the 2019 election, I have long said that mental health is, in fact, health. That is why I was so proud to stand in support of, and continued to call for, the 988 suicide help line. That is why, in the last election, I was proud to support a platform that had significant mental health investments.
The idea that mental health is health is that basis of ensuring that every Canadian has dignity and every opportunity to succeed, and the chance to get better. We cannot forget that there is always hope.
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Mr. Speaker, I will be splitting my time with the member for Pitt Meadows—Maple Ridge.
Bill C-62, no. 2, suggests that we pause the expansion of medical assistance in dying, known as MAID, to people suffering from mental illness. The Liberals have shown time and again that they consistently pass legislation without the careful consideration needed for such significant changes to our society. This discussion is not just legislative; it is about how we value human life and the impact of the government's choices on all Canadians. In thinking about extending MAID to include mental illness, there is a need for a deep understanding of the complexities and uncertainties in diagnosing and predicting mental health outcomes.
Evidence to the Special Joint Committee on Medical Assistance in Dying showed a worrying truth: Clinicians often struggle to predict whether mental health conditions are irremediable, and they have a 50% chance of being wrong. This alarming fact points to a big problem with the proposed expansion; this is the chance of making permanent choices based on uncertain medical opinions. Mental health involves biological, psychological and social elements. Recovery is not always straightforward, and what seems irremediable at one point may improve with treatment.
Basing MAID on the idea that a mental illness cannot be cured shows a misunderstanding of the changing nature of mental health recovery. As the member for St. Albert—Edmonton put it, it is like flipping a coin on matters of life and death, a practice that is ethically troubling and goes against the idea of patient-focused care. Moreover, we cannot discuss MAID and mental illness without considering the wider issues of access to quality mental health care in Canada.
When people such as Canadian Paralympian and veteran Christine Gauthier are offered MAID from the government when simply requesting help with a wheelchair lift, it shows a worrying trend of suggesting MAID as a fix for systemic failures to providing proper care and support for those with disabilities and chronic conditions. This is not just one case. It reflects a larger problem, wherein essential services and supports are lacking; this drives people to consider MAID not because they want to but because they feel neglected by the Liberal government.
The risks of broadening MAID to include mental illness alone are complex, going beyond clinical doubts to wider social and ethical issues. It makes us question our dedication to mental health care, the value we place on lives touched by mental illness, and the kind of society we want to have. Do we face challenges with empathy, support and a commitment to better care, or do we settle for solutions that ignore the struggles Canadians face?
The Liberal government's approach to expanding MAID shows a wider trend of hasty law-making that leads to policies being introduced, then pulled back or changed after facing reality and public criticism. From errors in firearms legislation to heated debates on the carbon tax, the government often acts first and thinks later. This not only damages our law-making process but also lowers public trust in our ability to govern wisely and carefully.
The rush to include mental illness in MAID, without proper evidence or full discussions with mental health experts, ethicists and affected groups, shows a lack of regard for the careful and expert-led discussions that such a major policy change requires. The need to pause and rethink this expansion, via the bill, is an admission that the government's actions have been rash and poorly thought out.
This legislative step back, marked by two delays in implementation, is not just a minor issue; it is a clear sign of the dangers of choosing political speed over solid, evidence-based policy-making. It raises serious doubts about the government's commitment to responsible governance, which includes the need to fully explore, understand and foresee the effects of laws before they are passed. In this critical discussion on MAID, we must also consider the perspective of those directly affected by such policies. The voices of individuals and families living with mental illness must be central to our legislative process.
Their experiences and insights can provide invaluable guidance as we navigate the complexities of this issue. By engaging with these communities, we can ensure that our laws reflect the realities of those they impact most and uphold the principles of empathy and inclusion. Furthermore, the debate on MAID expansion underscores the need for comprehensive mental health services.
The government must prioritize the enhancement of mental health care infrastructure, ensuring that all Canadians have access to the support and treatment they require. By strengthening our mental health care system, we can address the root causes of despair and hopelessness that lead individuals to consider MAID, thereby affirming our commitment to life and well-being.
This moment also calls for a re-evaluation of our societal values and the role of government in safeguarding the dignity of every citizen. As policymakers, we have a duty to foster a culture that values every life, provides hope through support and resources, and respects the autonomy of individuals while carefully considering the ethical implications of life-ending interventions. This approach would not only address the immediate concerns surrounding MAID but would also contribute to a more compassionate and just society.
As we think about what this pause means, we must consider the lessons learned and push for a more thoughtful, consultative and evidence-based approach to making laws. The stakes are too high, and the chance for unintended harm too great, to accept anything less. In MAID's case, where ethics, law and personal choice intersect delicately, our responsibility to be extremely careful and considerate cannot be overstated.
The proposal for a pause on MAID's expansion clearly shows that the Liberal government's policy-making has been quick and poorly thought out. While this pause is needed, it points to a bigger issue of governance, where major legislative changes are made without enough foresight, discussion or understanding of the deep ethical implications. This pause reminds us of the dangers of enacting laws that deeply affect Canadians' lives and well-being, especially the most vulnerable. It shows the current Liberal government's failure to engage in a careful, evidence-based legislative process, preferring instead policies that match ideological aims rather than the complex realities of issues such as MAID and mental health.
This should be more than a brief stop; it should be a crucial time to rethink how policies, especially those about life and death, are made and applied. It questions the government's commitment to maintaining the highest standards of care, empathy and respect for all Canadians' dignity. We must demand greater legislative care and ethical responsibility from the government.
The discussion on MAID and mental illness needs a comprehensive approach that puts individuals' well-being and rights ahead of quick political gains.
It is time for a move towards more responsible governance, where policies are made with great care, are based on wide consultation, and reflect our collective values and ethical standards. Sadly, the current Liberal government seems to lack concern for any of these values.
The way forward should be marked by a dedication to thorough research, wide involvement and a deep respect for life's sanctity. Only by such a comprehensive approach can we ensure our legislative actions truly serve all Canadians, embodying the justice, empathy and respect that define our nation.
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- Feb/15/24 4:28:42 p.m.
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Mr. Speaker, I have to admit that this has been one of my big things. Even when I was a mayor, I talked about the mental health of Canadians.
We can solve a lot of societal problems if we have a better handle on mental health. In order to do that, we have to fund appropriately and properly. One of the big challenges, when we start looking at mental health, is that it is probably going to take at least a 20-year period before we start seeing some real benefits to society. Unfortunately, governments are only elected every four years; therefore, they are not willing to put in the real money that is needed. They often use a band-aid approach.
We need to start looking at a long-range plan to enhance and assist our mental health in Canada.
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- Feb/15/24 4:29:34 p.m.
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Mr. Speaker, we often hear the argument that investments must be made in mental health to prevent mental illness and severe mental disorders.
I did not hear his leader say that he was going to put more on the table in terms of health transfers. Will the Conservatives propose a substantial increase in health transfers?
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- Feb/15/24 4:33:19 p.m.
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Mr. Speaker, there is a very big concern when we are dealing with mental health. How do we determine that someone who has a mental health condition is in a stable mental health state and make sure they understand everything they are doing? This is not like someone going to buy a vehicle who is not sure they really like the colour or whatever else. This is something that is irremediable.
Definitely, we need to reexamine this and make sure we have a logical approach to mental health.
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- Feb/15/24 4:46:10 p.m.
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Mr. Speaker, I have had the same question through the whole debate today, and that is, as I have said before, that we all know that access to mental health supports varies by one's residence, by one's income and by one's ethnicity. People have trouble accessing mental health services.
Would the hon. member support making mental health services fully part of the Canada Health Act, so that we can equalize access to mental health services in the country?
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- Feb/15/24 4:46:38 p.m.
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Mr. Speaker, we do not have the supports we need for people with mental health challenges.
The member mentioned ethnicities. I am indigenous. I am Métis. I know that a lot of indigenous, first nations and Métis groups are very concerned, because the number of suicide attempts among adults is at least double the rate in the rest of Canada's population. Among youth, it is six times higher.
It is a very vulnerable population, and this is a concern, especially for indigenous Canadians.
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