SoVote

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

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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Hon. Rob Moore (Fundy Royal, CPC)

Feb/15/24 12:38:22 p.m.
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Re: Bill C-7 Bill C-62 Bill C-39

Madam Speaker, Canadians would be forgiven for thinking they have seen this movie before, because they have. It was only last year that we debated Bill C-39, which provided an extension of the coming into force of this dangerous legislation. Now we are debating Bill C-62, which was introduced two weeks ago thanks to consistent pressure from Conservatives, advocates, experts, organizations and individuals from across the country who want to help individuals live with mental illness, not help them end their lives. How did we get here? We got here because we have a justice minister, a Prime Minister and a government that have ignored the science, the legal experts, the courts and the pleas of the most vulnerable. They have ignored Canadians. They have plowed ahead with legislation to expand medical assistance in dying to Canadians who deserve help, Canadians who are suffering from mental illness. I do not need to tell the House about some of the shocking headlines we have seen over the last year. Veterans suffering with PTSD are being told by employees of Veterans Affairs that they could consider MAID. Individuals without housing are considering MAID for economic reasons. Individuals, as we heard at our justice committee when we studied Bill C-7, who did not wish to have MAID were consistently pressured to considered it. On this side of the aisle, Conservatives have chosen the path of hope rather than harm, and we will continue to do so, but across the way, just this week, we heard a government minister say it is not a matter of if this expansion takes place; it is a matter of when. I mentioned ignoring the law. When we were at the justice committee studying Bill C-7, we consistently heard the government say that we have to do this because the courts told us we have to. Nothing could be further from the truth. First of all, there was a court decision, which the government did not appeal. That decision in no way directed the full expansion of accessibility to MAID to those suffering from mental illness. In fact, it was not in the original legislation. What happened with Bill C-7, which we studied at justice committee, in no way, shape or form involved expansion of MAID to those suffering from mental illness. However, when the bill got to the unelected Senate, it was amended to include this provision, which we had not even studied. The minister at the time assured us his bill was charter-compliant. The previous justice minister was at committee. I am holding today a letter signed by 32 leading experts on the law, professors from faculties of law around the country. The letter says, “We disagree as law professors that providing access to MAID for persons whose sole underlying medical condition is mental illness,” which is what we are talking about today, “is constitutionally required, and that Carter...created or confirmed a constitutional right to suicide, as [the Minister of Justice] has repeatedly stated. Our Supreme Court has never confirmed that there is a broad constitutional right to obtain help with suicide via health-care provider ending-of-life.” Those are powerful words. If I had time, I would read the names of the 32 professors who signed the letter. People would recognize many of them. They would certainly recognize the different universities they represent. With the letter in hand, I said to the minister of justice, “Minister, you have come here saying that, constitutionally, you have to do this, but these 32 experts are saying you do not. Who is right, you or these experts?". The minister said, “I'm right.” That is the attitude we have seen consistently with the government as it has plowed ahead in spite of the evidence, in spite of the concerns and in spite of the pleas from disability groups, mental health experts and psychiatrists. I have a brief from the Society of Canadian Psychiatry, which makes a number of conclusions. I do not have time to read them all, but I want to touch on a couple of the conclusions: At this time, it is impossible to predict in any legitimate way that mental illness in individual cases is irremediable. A significant number of individuals receiving MAID for sole mental illness would have improved and recovered. This is a finding of the Society of Canadian Psychiatry. I have already spoken about this a bit, but even they can see this. They go on to say: The political process leading to the planned expansion of MAID for mental illness has not followed a robust and fulsome process, has not reflected the range of opinions and evidence-based concerns on the issue, and has been selectively guided by expansion activists. If that does not send a shiver down one's spine, I do not know what would. When we are talking about Canadians at their most vulnerable place, they should be able to count on us. How many of us participate in, for example, Bell Let's Talk Day every year? We say to people, if they are suffering with mental illness, to reach out, that we are here to help and that they should talk to someone they trust and access mental health support. Now, in spite of all this, we have psychiatrists saying the government is moving in the wrong direction. I turn to their recommendations: The Board of the Society of Canadian Psychiatry recommends that the planned 2024 MAID for mental illness expansion be paused— It's not for a year, not for three years and not for five years, but: —indefinitely, without qualification and presupposition that such implementation can safely be introduced at any arbitrary pre-determined date. What are we led to believe when a government will not listen to legal experts when it comes to the criminal law and will not listen to psychiatrists when it comes to mental illness? It begs the question of who it is listening to and why. This is the second time, and Conservatives have warned all along that there would be a dangerous, slippery slope. Canada has leapt ahead of all other nations. Some nations were ahead of the curve on this compared to Canada. Now they look at us and ask what happened that we would even be discussing providing assisted death to someone who comes to Veterans Affairs or to one of the number of hospitals across our country, looking for help, and instead is offered medical assistance in dying. I want to set the record straight that the Liberal government has not, in any way, been bound by the courts to expand MAID to those whose sole underlying condition is mental illness. This was a path it chose to take. We need to take this time to reflect on that path, to turn back and to give people hope. We all know individuals who have been touched by mental illness in the health care system. We know the wait times can be extraordinary for people to get help. We also know the government has contributed to those wait times. After eight years, people are suffering. I would urge members to support this bill and then to look at ways to provide support for those suffering with mental illness, not to offer them assistance in death. I move: That the question be now put.

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The Assistant Deputy Speaker (Mrs. Carol Hughes)

Feb/15/24 12:49:01 p.m.
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The motion is in order. Questions and comments, the hon. member for Timmins—James Bay.

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Mr. Charlie Angus (Timmins—James Bay, NDP)

Feb/15/24 12:49:17 p.m.
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Madam Speaker, I want to follow up on something my colleague pointed out that people in Canada really need to understand. Because the federal government failed to challenge the Truchon decision, the legislation came back to the House. Parliament went through it, and it was to be approved in the Senate, yet unaccountable, unelected people in the Senate who did no due diligence decided arbitrarily that they would expand MAID to include people who were desperate, isolated and alone with mental illness. They threw it back to the House without any work being done, and the Liberals accepted it. Now we are scrambling, 30 days away from the deadline. I would ask my hon. colleague what it says about the fundamental failings of democracy that unelected, unaccountable people in the Senate, who cannot even be fired, could make such a profound change in legislation that would affect so many lives without any oversight, due to a failure of the government to say they are way over the line, this is not their purview and this is the work that Parliament does.

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The Assistant Deputy Speaker (Mrs. Carol Hughes)

Feb/15/24 12:50:25 p.m.
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It has happened a couple of times today that members of the Senate have been mentioned or adjectives have been used regarding the Senate. I want to remind members that the House rules say that no member shall use offensive words against either House or any member thereof. Members should be careful with the words they are using and not mention members from the other House directly, because they are not here to defend themselves.

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