SoVote

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

Feb/15/24 10:46:08 a.m.
Watch

Madam Speaker, I will take exception to the member's comment because a tremendous amount of work has been done to create the appropriate safeguards. Not only are there legislative safeguards in place in the Criminal Code, which I alluded to in my remarks, but there are also safeguards being developed within the medical profession. We need to make sure we listen to our health care providers, those who deliver health care at the provincial and territorial level, and extend the date for the change in eligibility criteria for three years so MAID could be administered with all the appropriate safeguards in place.

103 words

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

Mr. Yasir Naqvi

Feb/15/24 10:49:41 a.m.
Watch

Madam Speaker, our number one job is to protect people's rights. Given that the various decisions of the courts have said that it is a person's right to determine their end of life, we need to make sure that right is protected. Of course we need to ensure that they get all of the care they need in order to be able to recover, but as the courts have said, if their suffering is irremediable, they should have that option available because it is a matter of their rights. That is why we are working so hard, along with our provincial and territorial partners, to ensure that all the right safeguards and all of the right training are in place before MAID is extended to people whose sole underlying condition is mental illness.

135 words

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

Mr. Michael Cooper

Feb/15/24 12:37:00 p.m.
Watch

Madam Speaker, a survey released two weeks ago from the Ontario Psychiatric Association indicates that 78% of Ontario's psychiatrists oppose the expansion and do not believe that there are sufficient safeguards. Can the hon. member speak to the government's decision not to add additional safeguards, and would he support additional legislative safeguards pursuant to the Criminal Code if in fact we move ahead with this in three years?

70 words

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

Ms. Lisa Hepfner

Feb/15/24 1:42:34 p.m.
Watch

Mr. Speaker, I do not think consultation is simply checking boxes. It is extremely important, particularly when we are talking about our vulnerable and about our medical system. As I mentioned, I have personally consulted with psychiatrists in Hamilton. These people study and work at some of the best institutions in Canada. They are the experts. They have told me that, while the idea behind MAID for mental illness is a sound one, we are just not ready yet. We need to have all the proper safeguards in place before we move forward with this legislation. I think that is fair and I think it is reasonable.

107 words

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

Mr. Marcus Powlowski (Thunder Bay—Rainy River, Lib.)

Feb/15/24 4:03:00 p.m.
Watch

Mr. Speaker, let me start by apologizing to the four or five people who might have listened to my last speech and who are here listening again today, because this is going to sound a little repetitive. I certainly support the legislation, and I know there are a lot of people out there who are really worried about allowing MAID for mental illness. There are people who are worried about their friends. There are people who are worried about their parents. I am most sympathetic to people who are worried about their children. I have six children, and I know that they are going to, at some point in their life, go through difficult times. I would certainly be a little worried for them if we were to allow MAID for mental illness to be implemented with the current safeguards. I know that there are also many psychiatrists who are worried about and/or oppose the legislation. In fact, the latest statistic I heard was from a survey that showed that about 75% of psychiatrists were against it. They are worried that their patients who would otherwise get better would instead resort to MAID. Let me take a step back and look at the arguments coming from the other side. People are going to say, “Why not? Is it not a matter of personal autonomy? Is it not my body and my choice?”. This is not about the state's dictating to the individual what they can do with their own body. It does not criminalize trying to commit suicide or committing suicide. This is about what role, if any, the state should have in assisting people to commit suicide. I am going to come back to the issue of whether MAID for mental illness is the same as assisting suicide. The question of whether the state ought to take a role in assisting people in ending their lives is, I think, a little like the question of whether the state should try to prevent people from killing themselves. This is a topic I know something about, having worked a lot of years as an emergency room physician. In that role, my job, if somebody came before me and was suicidal, was to keep them in the hospital, even against their will, to prevent their suicide from happening. Occasionally people would ask why I should I have that power, saying, “ Is it not my body, and my decision to make?” I think that there are two legitimate reasons for the state to try to prevent people from killing themselves. One is to protect someone from themself. When one is in the depths of depression, they cannot realize that things will get better; that is partly why someone is so depressed and wants to kill themself. The reality for most people is that they do in fact get better. The other legitimate reason for the state's intervention is to protect the family. The person who commits suicide is dead. The rest of the family lives on and lives with the pain, but it is not only that; they are constantly haunted by whether the death was because of something they did or did not do. Some people are going to say that, no, MAID for mental illness is not the same as assisted suicide, that we are talking about a small group of people who have intense, prolonged suffering and have tried every form of treatment but nothing has worked, and that it is cruel and unconstitutional to not allow those people access to MAID. I disagree. The Canadian law is far more permissive than, for example, the Dutch law. There is absolutely no requirement that all forms of treatment have been tried and been unsuccessful. Our law does not even require patients to have tried any treatment at all; it requires only that the patient have no other treatment that is acceptable to them. There are going to be people who refuse all forms of treatment altogether. I know that there are people who support MAID for mental illness who will say that the safeguards are going to come from the medical profession, that they are going to require someone to have tried all forms of treatment beforehand. Unfortunately, I do not have the same sort of faith in the medical profession's doing that. Why do I not? If we look at what has happened with the MAID regime for people with physical illnesses, we see that there are a lot of MAID practitioners who are very zealous about its being all about one's personal autonomy and saying it is not for them to question someone's suffering, and who are quick to approve people. Let me give some examples from the media. The Fifth Estate aired a program that said that a 23-year-old diabetic going blind in one eye was granted MAID. Another person, a 54-year-old man, had back problems, but his main problem seemed to be that he was worried about losing his housing and ending up on the street. He too was granted MAID. CTV published a couple of relevant articles. A 51-year-old woman was actually granted and got MAID for multiple chemical sensitivities. Again, from CTV, a 31-year-old woman who seemed to use a wheelchair from time to time and had multiple environmental allergies, applied and was approved for MAID; again, however, her main problem seemed to be that she could not find suitable housing. There are those who have such faith in my fellow doctors to come up with the system and all the safeguards, but I do not share the same sort of faith. I, as someone with a lot of children, realize it is inevitable that at times in their life they are going to go through a hard time, the breakup of a relationship or financial hard times. I am really worried that they would walk through the door of a zealous practitioner who will tell them it is all about personal autonomy and is their decision to make, because who is the doctor to question their suffering. There is not any requirement in the current legislation that the MAID practitioner talk to the family or the previous treating practitioner to find out whether in fact the depression was motivated by, for example, the breakup of a relationship. I also want to talk about what I think is a really fundamental and perhaps fatal flaw in the current regime with allowing MAID for mental illness, which is the problem, the impossibility, of determining irremediability: Who is not actually going to get better? I have spoken previously about the inability of suicidal individuals to appreciate the fact that they are going to get better. Some people would ask whether there are people who are not going to get better, who are irremediable. That is in fact the requirement of the legislation. The problem is that doctors do not have a crystal ball. They are not really good at being able to determine who really is irremediable. In fact, a recently published study looking at the ability of clinicians to determine irremediability for treatment-resistant depression concluded: Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard of irremediability cannot be met.... Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of [MAID] assessments. For me, as a long-time medical doctor, it is absolutely mind-boggling that there are medical practitioners and psychiatrists who are not particularly bothered by the fact that they really cannot say whether the illness is irremediable, and would grant MAID. If we allow MAID for one such person who would actually get better, to me it would seem tantamount to the same sort of tragedy as the state's hanging someone who later turned out to be innocent. We in this place cannot let that happen. Last, let me address the assertion of proponents of MAID who say that it is inevitable that the Supreme Court would find not allowing MAID for mental illness unconstitutional because it is allowed for physical illness. I think that, yes, there would be a finding that such a provision would violate section 15 or section 7, but as always, the question comes down to the section 1 analysis and whether the state's actions constitute a reasonable limitation as prescribed by law that “can be demonstrably justified in a free and democratic society.” I do not think the answer to that is clear. It is not just me; there was a letter written by 32 law professors who came to the same conclusion: it was not clear whether it would be found unconstitutional. I am not going to say that we should never allow MAID for mental illness; in fact, I know personally of a case where this might have been the ethical thing to do, but I think we are a long way now from being in a situation where we should start to allow it. I would prefer the pause be indefinite, but so be it. We have what we have. Let us look at it in two years and see what has changed. I doubt very much will have changed.

1583 words