SoVote

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

Mr. Francis Scarpaleggia (Lac-Saint-Louis, Lib.)

Feb/15/24 12:13:37 p.m.
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Madam Speaker, as always, I appreciate the member's interventions, his insights and all that he brings to the table. I would agree with the member in that one of the sticking points for me in this process is the fact that the agenda, and this is undeniable, has been driven by the Senate. There is a big difference between government legislation and Senate legislation, and we are talking about a Senate amendment. The government has all kinds of resources. It has access to all kinds of experts to consult. It has access to legal experts, it does charter analysis and everything else. However, the Senate side does not have those same resources. Therefore, how could the Senate approach this with such a degree of certainty and, in some cases, one might say, a sense of infallibility when it does not really have the resources that the government has? The government, with all those resources, never intended to go ahead. I would like the member's comment on that.

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Mr. Charlie Angus

Feb/15/24 12:14:46 p.m.
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Madam Speaker, if people are not elected and cannot be fired, it does not just give them a sense of infallibility; it gives them a sense of absolute arrogance, because they can do whatever they want, for better or worse for Canadians. I was certainly appalled. I had the honour to sit in for my colleague for Nanaimo—Ladysmith for one of the meetings, and I was super careful asking questions, even for the people with whom I did not agree. I wanted to get this right. However, I felt this sense of lazy arrogance. Senator Kutcher so much as said that they had already agreed they would not hear all the witnesses, that they had already agreed they would just push ahead. The Senate blew this. It did not do the due diligence. Senators were not even interested in hearing the witnesses. We should never have been put in a situation to let that lot make a decision as profound as this.

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Mr. Kevin Waugh (Saskatoon—Grasswood, CPC)

Feb/15/24 12:15:43 p.m.
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Re: Bill C-234

Madam Speaker, that was a passionate speech by the member. He spoke in particular about northern Canada, where maybe the resources are not the same as those Canadians enjoy in metro areas. He also brought up the Senate situation. I think we are seeing in the House of Commons these days that we are having issues with the Senate, in particular with Bill C-234, which we have brought back several times here, and the MAID legislation. This is a concern. As the member said, they are not elected. They are appointed. It has caused some strain on families, not only with the MAID legislation but also for the agriculture sectors with Bill C-234. I just wanted to point that out and have the member comment on the issues we are having with the Senate. It looks like we could have these issues for a number of years with the Senate, compared to the House of Commons.

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Mr. Charlie Angus

Feb/15/24 12:16:46 p.m.
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Madam Speaker, we certainly know that the Conservative record on the Senate is pretty dismal too. I mean, they put Mike Duffy, the Come-From-Away senator, in there. Why was that? Was it because he was a hack who raised money for Stephen Harper? Pamela Wallin and Patrick Brazeau can be included in a rogue's gallery of people who are not accountable. The issue today is that we now have, as a Parliament, a democratic body, the obligation to fix something very profound. I would love to debate and talk about how we deal with that unelected, unaccountable lot where it seems that, if they flipped pancakes for the Liberal or Conservative parties, they get a job for life. There has to be a better way of running a democracy.

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Ms. Christine Normandin (Saint-Jean, BQ)

Feb/15/24 12:17:36 p.m.
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Madam Speaker, a few weeks ago, I attended the funeral of a friend's mother who had decided to avail herself of MAID. In her farewell speech to her mother, my friend said the following: Mom, when you told us about your decision, I did not agree because it was going to deprive me of a mother, but I had no choice but to respect your decision, because it was yours to make. I thought it was a testament to her generosity of spirit. In his speech, the member for Timmins—James Bay talked about respect. Since he is so knowledgeable on the subject, I would like to ask him a question that I did not have the opportunity to ask earlier. Although it is not necessarily the subject we are debating today, I would like to know why he decided to vote against the amendment to allow Quebec to offer advance requests. The purpose of this amendment was to allow the Government of Quebec to proceed with the safeguards we have in place, and this request did not require a specific provision for Quebec in the Criminal Code. The purpose was to ensure that all provinces could use the program if they wanted to. I would like to hear why the member for Timmins—James Bay—

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The Assistant Deputy Speaker (Mrs. Carol Hughes)

Feb/15/24 12:18:50 p.m.
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The hon. member for Timmins—James Bay.

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Mr. Charlie Angus

Feb/15/24 12:18:53 p.m.
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Madam Speaker, I thank my colleague for her thoughtful question. Parliament needs to put a process in place to examine all these issues. Personally, I think it is an important issue, and members of Parliament need to work together to make the necessary changes to this bill.

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Ms. Lori Idlout (Nunavut, NDP)

Feb/15/24 12:19:18 p.m.
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Re: Bill C-62

Uqaqtittiji, the member highlighted the ravages of what colonial systems continue to do to indigenous peoples, but I wanted to ask specifically about Bill C-62 and the amendment that has been inserted about the creation of a joint committee of both houses of Parliament designated for determining eligibility. What does the member think about that amendment, which would require discussions on ensuring the eligibility of a person whose sole underlying medical condition is mental illness? Does he think that is an urgent task that needs to happen after Bill C-62 is passed?

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Mr. Charlie Angus

Feb/15/24 12:20:11 p.m.
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Madam Speaker, we know that a joint committee was struck, and we heard a lot of testimony, in particular, that the process in place to make this work is not there. We need the legislation to say that the right of someone to die because there are no other options out there for them is not good enough. We need to close this loophole. We need a committee to be struck, I think, to examine how MAID is rolling out to make sure that it protects rights. Also, I think we need a conversation about proper mental health services, which are being denied to people across the country.

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Ms. Marilyn Gladu (Sarnia—Lambton, CPC)

Feb/15/24 12:21:00 p.m.
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Madam Speaker, I acknowledge the member's work with his palliative care motion, which led to my bringing the palliative care bill to Parliament. He may be aware that the five-year review shows an increase in people who have accessed palliative care from 30% to 58%. There is still a long way to go. My question for the member has to do with the Truchon decision, which he talked about. I agree that it should have been appealed to the Supreme Court, but the government today can still ask the Supreme Court to weigh in on it. I think that is what the government should do. Does the member agree?

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Mr. Charlie Angus

Feb/15/24 12:21:35 p.m.
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Madam Speaker, the problem was that the government accepted the decision and changed the law. Now we are dealing with it. My message to government is that, from here on in, we cannot be cavalier about this. We cannot just allow unelected bodies, or even a superior court, to make a decision on something so profound. Our duty as parliamentarians is to test the law, check the law and make sure that any changes from here on in are done within a broader framework of rights, dignity and the protection of the vulnerable.

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Ms. Laurel Collins (Victoria, NDP)

Feb/15/24 12:22:15 p.m.
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Madam Speaker, I thank the member for his advocacy on this issue. I have heard from constituents who have given up hope, who are struggling with the housing crisis and the high cost of living and feel like that they have been legislated into poverty. They are worried about the expansion of MAID and what that means for them and the people they love who are in the same situation. I am wondering if the member can talk about the responsibility of successive Liberal and Conservative governments in putting people in this dire situation.

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Mr. Charlie Angus

Feb/15/24 12:22:51 p.m.
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Madam Speaker, I have spent my career believing in the great hope of Canada and the fundamental goodness of Canada, but as a nation, we are failing people. We are failing people in a time of growing climate uncertainty and international uncertainty. People are afraid. They need to know that what we do in the House brings their concerns forward and tries to put reasonable solutions in place because people cannot be left feeling hopeless and uncertain at this time.

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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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Ms. Lori Idlout (Nunavut, NDP)

Feb/15/24 12:33:34 p.m.
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Uqaqtittiji, I think that we all know that indigenous peoples have the fewest mental health resources. A huge part of that is because of Canada's colonial history. One of the efforts we have been making is trying to get more indigenous healers and indigenous care workers incorporated into the non-insured health benefit system so they can be paid similarly to professionally or academically certified educated mental health professionals. I wonder whether the member agrees that making sure these workers are being funded as well would be a way of alleviating some of the pressures, and one of the better ways to make sure indigenous peoples are getting the mental health services they need.

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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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Mr. Michael Cooper (St. Albert—Edmonton, CPC)

Feb/15/24 12:35:32 p.m.
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Madam Speaker, I served on the special joint committee on MAID, and the overwhelming evidence from experts, including leading psychiatrists, is that there are fundamental political problems with MAID in cases where mental illness is the sole underlying condition. This includes the difficulty in predicting irremediability and in distinguishing a request that is rational from one motivated by suicidal ideation. What evidence can the member cite to indicate that these fundamental political problems will be resolved in three short years?

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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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Mr. Michael Cooper

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

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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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