SoVote

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

Feb/15/24 12:57:16 p.m.
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Re: Bill C-7 Bill C-62

Madam Speaker, my colleague is quite right. With Bill C-7, but for the passage of Bill C-62, the impact would be profound on our health care system, on individuals suffering with mental illness and on the message we send Canadians suffering with mental illness. I can say only that the government has moved forward in this dangerous direction while ignoring at every turn the advice of experts, including, as I quoted extensively, the Society of Canadian Psychiatry, medical experts and legal experts, about the merits of moving forward. It is our job to debate these things, to consider them and to hear from experts. Unfortunately, because the government dropped the ball, it is up to us to pass the legislation before us to protect Canadians suffering with mental illness.

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Mr. Tom Kmiec (Calgary Shepard, CPC)

Feb/15/24 12:58:20 p.m.
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Re: Bill C-7 Bill C-62 Bill C-14

Madam Speaker, I am glad to be joining debate on Bill C-62. Off the top, I will mention that I will be voting for it. Like the shadow minister for justice on the Conservative side said, this is about protecting the vulnerable. Though the federal government has dropped the ball in this latest iteration of its legislation, these three years, I hope, will be taken to basically fix the mistakes that were made all the way back to Bill C-14. I want to talk a little about what brought us to this moment, and then refer to some constituents of mine who have emailed me over the last few months on the issue of assisted suicide. I will also mention that I am sharing my time with the member for Mission—Matsqui—Fraser Canyon. I am sure he will add more to this debate. To go back to the beginning, not too far to the beginning because I could get into Genesis, the Carter decision is what kicked off multiple debates that I have now been a part of. I have now seen this debate go from Bill C-14 to Bill C-7 to Bill C-62, and the attempts by my hon. colleague from Abbotsford, who, I think, tried to do right by vulnerable Canadians all across Canada to make sure that we would not see an expansion of the MAID provisions to those who are still suffering with mental health conditions. The great thing about Hansard is that I was able to go all the way back and review what I had said on Bill C-14. I spent quite a bit of time complaining that the reasonably foreseeable clause would be knocked down by a court. It was knocked down by a court in the Truchon decision, because all our deaths are reasonably foreseeable; that is what living is all about. At the time, I had said that all of us who are born are born with one foot in our grave. One is assured one will die; one does not know just what it is, but it is reasonably foreseeable. I am just repeating it now. I know that it is morbid, but it is the truth. A lot of what we are dealing with here are issues of life and death and how one's death will happen. Therefore, at the time, this reasonably foreseeable clause would get knocked down, and it was knocked down in the Truchon decision. My issues, just generally, are that, in a perfect world, this would not be necessary because people would not suffer. However, because this world is not perfect, people do suffer. People suffer in deep and different ways. Members know that I had a disabled daughter who passed away a few years ago. Had she lived longer, and I know at least one little girl in Calgary who has lived much longer with the same conditions my daughter had, she would be one of those vulnerable Canadians who would be facing the possibility that her physician, her specialist, might push for and might offer MAID. I say “offer MAID”, but it seems so weird to say “offer MAID”, to offer something that I do not consider to be a medical service and to rush one's death sooner. Although we all die, as I said many Parliaments ago, the act of dying is not one that one does alone; it is done as a family, as a group of friends and with those loved ones around. It is not something that happens in solitude. There are others who will miss one when one is gone. I know that it is difficult in a moment of suffering and a moment of great pain, or chronic pain, to believe it, to know it. A lot of the emails, the correspondence and the meetings I have had were with people who are worried about the assisted suicide MAID provisions, which the government has ineffectually dealt with through successive pieces of legislation. I think it was a grave error not to appeal the Truchon decision. I really do. I think it was a mistake. I said it to constituents at the time. I have a Yiddish proverb, because I always do. They are great proverbs, and everybody should live by them and should know more of them. I just wish I could pronounce them in Yiddish: The truth never dies, but it is made to live as a beggar. This legislation is a beggar. This legislation should have been a permanent fix to the issues. I think that Conservatives have suggested, both in committee and outside of committee, what some of those fixes would be. Although I disagree with an acronym, I will use RFND, reasonably foreseeable natural death. It should be limited to those who are terminally ill, where their death is foreseeable within the next six months, where there is a prognosis from a medical professional saying that one will indeed pass away. For those most terrible conditions, I am thinking of a lot of cancers. My grandfather passed away from brain cancer in Canada, which brought my family to Canada. His death was very much reasonably foreseeable when it was terminal. There are others who have mental health conditions, which are caused by a physical condition. The mental health condition alone should not be the reason to seek assisted suicide. Different Conservatives have mentioned, and I very much agree with this, that patients should be the ones requesting it. These are all things the government could have legislated into law. These are things that experts have said, and I want to read some of what the experts said in different committees. Professor Trudo Lemmens and Mary Shariff persuasively rebutted a bunch of arguments that were made in Truchon. They noted again that reasonably foreseeable natural death applied to “all” persons, “not only to persons with disabilities”. “The judge in Truchon failed to appreciate how such a restriction reflects a constitutional duty to protect the equal value of the lives of all Canadians.” I have read the Carter decision twice now. As many in the House know, this is something I take pride in saying that I am not a lawyer. I am not burdened with a legal education. I know the member for Fundy Royal is disappointed and that the member for St. Albert—Edmonton will be disappointed too, so I come to this as a layperson. Even the Carter decision did not say he had a right to die. It goes back to this idea, like I have said, that all of our deaths are reasonably foreseeable. It will happen; it is unavoidable in life. These two experts said that the judge in Truchon made a mistake. This concept, this expertise, was then repeated in observations made by 72 disability rights organizations that penned a letter to the then justice minister. They said that reasonably foreseeable natural deaths are the ones where there is terminal illness that is coming up very quickly, and that this idea is an equalizing effect, guaranteeing a common thread among persons accessing MAID, assisted suicide, namely that they are dying within a very short time window. That is how I think this legislation should work. I am not saying there should be no MAID. The Carter decision stands as a Supreme Court decision in Canada, so there has to be a provision of it in a method. It should be rare and should be restricted to the very few people for whom it was originally intended. I feel that Bill C-14 to Bill C-7 to the situation we are in today do not address that. That is why we have this legislation that is a beggar. It is not in the original form that it should be. The truth lies in abiding by what Carter decided. Another one reads, “From a disability rights perspective, there is a grave concern that, if assisted dying is made available...regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.” That is a terrible message to send to persons with disabilities. I am thinking of my daughter, had she lived. That would have been a terrible message to send to her. All three of my living kids have a chronic kidney condition. My boys will likely need a kidney transplants. What a terrible thing to tell them, that they are a burden on the medical situation and that maybe they should seek faster death. Is that what specialists are going to tell them when they are adults? I will not be in the room, but they will be in the room. Will that be pushed onto them? For those who are on dialysis, it is hard on their bodies to go three to four days a week to get dialysis in a hospital setting. I am not speaking of peritoneal dialysis that can be done in the home. There have been lots of experts. The member for Fundy Royal explained a lot of what has been said on the issue. The government keeps erring in the wrong direction with more expansive legislation to allow more people to access something that was not the original intention of Carter. We should abide by Carter, as I mentioned before. I have had constituents write to me. I just want to make sure that I read some of their thoughts into the record. Leanna wrote, “Please Halt the expansion of MAID to include those facing mental illness.” Catherine wrote, “As a parent who has seen my own children experience mental health challenges while in their teen years and early twenties, I am writing to express my deep concern about people with mental illness alone becoming eligible for medical assistance in dying. The move towards this will put countless vulnerable people at risk.” Joe, in my riding, is a regular writer. I respond to most of his emails. I will send this to Joe just to make sure he knows I read his emails. His second and third points read, “By offering MAID for mental illness governments may put less money into treating mental illness.... Canadians may wish for MAID because of despair. They have not have been offered treatment for their mental illness.” Cameron talked about a friend of his who is a nurse working in a mental health unit in Calgary. Mental health for him is all about seeing the intrinsic value of every human being, as celebrating the person not for what they contribute but for the beauty of their existence. He feels that once we stop seeing the dignity of one person, we will doubt our own worth and validity. I know my time is running short, so I will not belabour this. I have heard comments from some members of the House who have tried to impugn a person's faith, religion or philosophical affiliations with whatever beliefs; although, all of us come to the House with our different beliefs. Some of them are sacred. Some of them are secular. It really does not matter where they come from, but all of us try to ascribe value to life, what that life is and what autonomy should be like. To those members, I note that I did abstain from one vote that was specifically on advance directives because I have a constituent, Jim, who communicated with me over email that he and his spouse saw the experience of his mother, who passed away from Alzheimer's, and how terrible it was. In situations like that, it is incumbent upon the government to find a way to meet the requirements of the original Carter decision so that Jim and his spouse, when that time comes, can have their wishes met.

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

Feb/15/24 1:08:46 p.m.
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Mr. Speaker, in issues like this, there is always this tension between the right of the individual and the impacts that individual has on the “culture”, for lack of a better word, and on others in the society when exercising that right. This was brought up by one of the psychiatrists who appeared before the committee when he said that one of the concerns he has with MDSUMC is a possible contagion effect. I do not know if courts would actually consider this because it is so difficult to prove. Anyway, it is just something I think about a lot, and I wonder whether the member has any thoughts on that.

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Mr. Tom Kmiec

Feb/15/24 1:09:37 p.m.
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Mr. Speaker, it is something that I also think about. The member mentioned courts, and sometimes, I feel that these court decisions should apply for six months to the judge who makes them before they apply to the rest of the public. I sometimes wonder, when they think these things through, that it goes back to too much legal information that clouds their judgment at times. This is where I worry that it is exactly that contagion effect. Does it then become permissible, broadly, that suicide and suicidal ideation are the go-to? Is that the type of society we want to, I do not think “encourage” is the right term, but do we want an acceptance of it? We have companies that promote things like Bell Let's Talk. What is the point of doing that when we have MAID provisions being expanded consistently through a series of legislation and court decisions?

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Mrs. Tracy Gray (Kelowna—Lake Country, CPC)

Feb/15/24 1:10:28 p.m.
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Mr. Speaker, we have heard from a lot of people in the disability community, advocacy groups, who advocate for persons with disabilities. They have come out very strongly against expanding MAID for people where the sole underlying condition is mental illness. I wonder if the member can speak to that, if he has heard that as well, and also to the concept that it should not be easier to get MAID than it is to access mental health and addiction treatment.

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Mr. Tom Kmiec

Feb/15/24 1:11:11 p.m.
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Mr. Speaker, the member raises a great point. There are a lot of vulnerable, disabled Canadians who have expressed themselves through not only their associations but also as individuals by communicating to their elected representatives that they do not want to see this expansion because they are worried. It comes from their experience when they go into a clinical setting or into a hospital setting, where the law says that because it does not have to be patient-initiated, medical professionals can give up on their patients. As someone who has been in a lot of hospitals with my children, both living and those who have passed, I can say that, sometimes, ER doctors and specialist nurses and physicians, who are at the end of their wits and are tired, take on a lot of patients. They have a lot going on and have complex patients with complex needs. It is easy to see how it could lead to a situation where they are maybe not giving the best advice and are looking for a path that requires less care in the long term. That is the worry that a person with a disability has. That is the worry every parent has when they have children with a disability. When they are adults, will they be able to advocate for themselves? How will the medical system stream them, and where will it stream them? As a parent, I worry about that.

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Mr. Dan Albas (Central Okanagan—Similkameen—Nicola, CPC)

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. Tom Kmiec

Feb/15/24 1:13:39 p.m.
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Re: Bill C-314

Mr. Speaker, I obviously agree with the member. The dog that ate the government's homework has been fattened up over the last nine years, because it had a lot of homework to eat that the government has not done or pretends not to have done. However, we had an opportunity to close the door completely with the bill from the member for Abbotsford, Bill C-314. I think it was a grave mistake of the House not to have voted in favour of it. There would have been no expansion of MAID to those with mental illnesses. The House and future Parliaments could have reviewed the situation and redecided on the matter in five, 10, 15 or 20 years. Then, there would be more data and more people looking at how the system had been used, what the demand was like, and whether there had been advances in the psychiatric and mental health services provided to Canadians. If we do not provide the service at the front end, so that a person could choose to get healing and have the ability to live a fulsome life the way they want to live it, then we cannot really be pushing MAID on the other side as the only path available to those who are vulnerable or suffering from mental illness.

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Mr. Brad Vis (Mission—Matsqui—Fraser Canyon, CPC)

Feb/15/24 1:14:51 p.m.
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Re: Bill C-62 Bill C-314

Mr. Speaker, I rise today to speak to Bill C-62 which seeks to delay the expansion of medically assisted death to individuals whose sole condition is a mental illness until March 2027. Yesterday, in anticipation of these remarks, I sent an email to about 10,000 constituents, and I heard back from 95 of them on the subject we are debating today, medical assistance in dying, or MAID. I heard from parents who have lost children, as well as those who have suffered from depression and were able to overcome their illness with treatment. The majority of respondents agreed with the position I am about to outline, but there were some who did not. Many of those who disagreed with my stance came from Mission—Matsqui—Fraser Canyon's very large and diverse Dutch community. Given its history in, and our connections to, the Netherlands, people in the Dutch community have a deep understanding of this issue. I appreciated hearing their thoughtful comments. Among those who disagreed, the most common concerns raised were about access and advance requests for those suffering from dementia. Concerns were also raised about the challenges many Canadians face in accessing mental health supports and treatment, which can leave some feeling hopeless. In fact, it nearly brought me to tears, hearing from constituents who asked, “How dare you try to take away the right for me to access MAID when I am suffering from mental illness?” They did not see a pathway out for the circumstances in their life. That is a horrible position to be in. One thing, however, was unanimous: Our health care system is failing to meet the needs of Canadians suffering from mental health challenges. This must be addressed. I am grateful to everyone who took the time to share their thoughts and concerns in a compassionate and respectful way. Almost a year ago, I stood before my colleagues in this House and expressed my concerns about the Liberal government's decision to extend medically assisted death to individuals suffering solely from mental illness. I highlighted the stark contradiction between our efforts to promote mental health awareness and services and those to offer death as an option to those struggling with mental health challenges. Mental health affects every family in our country, and it pains me to see the government contemplating the provision of death as an option to individuals who are at their lowest point. I shared the heartbreaking story of a member of my community of Abbotsford, who received medically assisted death without her daughters being informed, despite her documented mental health condition. Regrettably, such stories are becoming too common under our existing MAID regime. Retired corporal Christine Gauthier, who represented Canada at the Paralympic Games, testified before the Special Joint Committee on Medical Assistance in Dying that she had tried for five years to get a wheelchair ramp installed in her home through Veterans Affairs Canada. Instead, she was offered MAID by a VAC caseworker. A week before her testimony, the Minister of Veterans Affairs confirmed that at least four other veterans had been offered MAID as well. Now, after eight years of the Liberal government and with the cost of living soaring, some Canadians are seeking MAID in fear of homelessness. Most recently, a member of my community from the Family Support Institute of BC raised deep concerns about the expansion of MAID. They stated that, even with the current restrictions, our most vulnerable populations are gaining access to MAID without adequate precautions, social services, expertise, professional supports and wraparound social networks to consistently represent their interests and voices. Despite our repeated calls to protect the most vulnerable, I believe the Liberal government has failed to act responsibly on this point. Around this time last year, instead of cancelling the expansion of MAID for mental illness, the Liberals introduced last-minute legislation to impose a temporary one-year pause. Now, a year later, I am here again to see that the government wants to add another pause of three years to the mental illness expansion, delaying it until March 2027. This past fall, the Liberals had an opportunity to get rid of this expansion altogether. In February, my colleague, the hon. member for Abbotsford tabled Bill C-314, which would have cancelled the expansion of MAID to those with mental illness as the sole condition. When the bill came up for a second reading vote in October, most Liberals, along with the Bloc Québécois, defeated it. The government is seemingly only choosing to delay the expansion again after the significant backlash it has received from mental health experts, doctors and advocates across Canada. It seems that the government wants to recklessly push aside this issue instead of listening to what Canadians and, indeed, our mental health professionals want. For many years we have heard about the fast expansion of assisted suicide in Europe. Now, Canada has infamously become a global leader with its progressive euthanasia policy. The Netherlands was the first country in the world to legalize euthanasia, and it took the country over 14 years to reach 4% of the total population's death from assisted suicide. Other countries with similar policies, such as Switzerland and Belgium, have not even reached the 4% mark. Canada's MAID regime has only been around for six years and has outpaced these countries with euthanasia, accounting for 4% of total deaths in 2022. Health Canada reported that 13,241 Canadians received assisted suicide just in the past year. That is more than a 30% increase from 2021 deaths. Belgium allows euthanasia to children of any age. Most recently, the Netherlands expanded its euthanasia policies to include terminally ill children. The Liberals have met with the largest pro-MAID lobbying group, Dying with Dignity, many times. This group is advocating for assisted suicide to be expanded to mature minors. If the government continues to take us down this slippery slope, will it lead us to a path that expands euthanasia to all children? Youth in this country are already falling through the cracks, with suicide being the second leading cause of death for youth and young adults. How can youth struggling with mental illness even think of having a better future if they become eligible for MAID and it is normalized? The Liberals, in my opinion, are inadvertently creating a culture of death. Delaying the expansion of MAID for mental illness is not enough. The government must immediately and permanently halt the expansion of MAID to those with mental illness. The reports from the committee echo what Conservatives have been advocating for years, which is that expanding assisted suicide to those suffering from mental illness will lead to the premature death of individuals who could have recovered with proper support and treatment. The government is taking an ideological stance, and it is not listening to the experts working in the field. Last year, the country's largest psychiatric teaching hospital, the Centre for Addiction and Mental Health, said that it is not ready for this expansion and emphasized the need for more mental health resources. The chief of the psychiatry department at Sunnybrook Health Sciences Centre in Toronto, Dr. Sonu Gaind, has said that it is irresponsible for us to provide “death to someone who isn't dying before we ensure that they've had access and opportunity for standard and best care to try to help alleviate their suffering.” We cannot overlook the inherent dignity and value of human life, especially when individuals are at their most vulnerable. It is our duty as lawmakers to prioritize the well-being and protection of everyone in Canada, particularly those facing mental health challenges. As the member of Parliament for Mission—Matsqui—Fraser Canyon, I believe in upholding the principles of compassion and support for those struggling with mental illness. Yes, I also acknowledge that we need to do a lot more; efforts to date have not been sufficient, whether in terms of the government response or the societal response. Delaying the expansion of MAID for mental illness is not the solution; it merely postpones the inevitable reckoning of the profound ethical and moral implications of such legislation and the broader implications we are faced with here today. Those struggling with their mental health deserve support and treatment, not death. We know that recovery is possible when treatments are more readily available.

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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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Mr. Brad Vis

Feb/15/24 1:24:55 p.m.
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Mr. Speaker, I would like to thank the member for Nepean for a very fair question and for some of the points he made. Are we simply catching up in Canada as it relates to the availability of MAID? Perhaps in some cases, but under the current legislation, there has to be a foreseeable death. I believe that the way information is exchanged, access to MAID, and the access to information that people have, has led to a rapid increase, yes. However, I will also note that there was an individual in my community of Abbotsford who accessed MAID because she did not feel she had a place to live. That story was well documented in Canada. She did not believe that she had the support she needed to live a life that was respectable. I believe that with the normalization of MAID, for people who do not feel they have a lot of hope in life, it has become a more readily available option. My message today is that all people should have hope.

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Mrs. Caroline Desbiens (Beauport—Côte-de-Beaupré—Île d'Orléans—Charlevoix, BQ)

Feb/15/24 1:26:02 p.m.
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Mr. Speaker, I am a little thrown off by my colleague's comments. I have a friend who had a second kidney transplant, and complications ensued. She was told to go home, that her days were numbered. She was told that they could not give her any more anti-rejection drugs for her kidney and that her kidney would waste away, and so would she. At that point, in a panic, she asked if she could at least have access to MAID. She was told that she could access it in due course and was told to call to schedule an assessment. As if by some miracle, she got an unbelievable break: The transplanted kidney continued to thrive without the anti-rejection drugs, which she had stopped taking. She is still with us today, and she is listening. She did not need MAID. She always said that she was able to be at peace because she knew that she would always have that option, no matter what happened. I cannot understand why members are referring to all kinds of nonsense today, using big words like “assisted suicide” and “euthanasia”, when we are not the experts. We are here simply to lay the groundwork so that experts can have their say in due course. That is what happened to my friend. I would like to know where our colleague is going with his speeches on euthanizing children. That is horrifying, and I do not understand his point. Can he explain it to me?

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Mr. Brad Vis

Feb/15/24 1:27:42 p.m.
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Mr. Speaker, I will try to answer the question in French. In this specific case, the person was eligible for MAID. More broadly, with respect to that question, I do not believe that the legislation before us today relates specifically to that issue. That was related to kidneys, and there was a foreseeable death, but, thankfully, that individual did not have to face that situation. The legislation we are debating here today relates solely to mental health and a government decision to expand MAID to those suffering from mental health illnesses for three years. The experts who appeared at the joint committee between the House and the other House outlined that we are not ready for that expansion. So, the Conservative Party is in fact listening to the experts and taking the position that we have today.

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The Deputy Speaker

Feb/15/24 1:28:46 p.m.
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The hon. member for Calgary Heritage is rising on a point of order.

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Mr. Shuvaloy Majumdar

Feb/15/24 1:29:17 p.m.
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Mr. Speaker, yesterday was Valentine's Day. I misspoke in the House, and I retract my comment.

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The Deputy Speaker

Feb/15/24 1:29:24 p.m.
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I appreciate that. Continuing debate, the hon. Parliamentary Secretary to the Minister for Women and Gender Equality and Youth.

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Ms. Lisa Hepfner (Parliamentary Secretary to the Minister for Women and Gender Equality and Youth, Lib.)

Feb/15/24 1:29:35 p.m.
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Re: Bill C-7 Bill C-62

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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Mr. Adam Chambers (Simcoe North, CPC)

Feb/15/24 1:38:14 p.m.
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Mr. Speaker, not every person who jumps off the Golden Gate Bridge actually dies, and in fact a study tracked down 29 individuals who survived. Some 98% of jumpers, by the way, do not survive the jump. A study of 29 individuals who survived their jump off the Golden Gate Bridge revealed that every single one of them regretted their decision to jump the moment they jumped. I was just wondering if my colleague could reflect on the fact that suicide is a permanent solution to a temporary problem.

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Ms. Lisa Hepfner

Feb/15/24 1:38:55 p.m.
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Mr. Speaker, I would like to, first of all, say that we cannot equate suicide with medical assistance in dying. They are two completely different issues. Second, I would say that yes, we absolutely need to take the time to make sure we get this right. That is why this legislation is so important. We need these three years to get our medical system up to the level where we can make sure that everyone who is granted the MAID provision truly is someone who has gone through the medical system, has taken all of the medical treatments that are available and has still reached this conclusion. We need more time, and that is why we need this legislation.

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Ms. Andréanne Larouche (Shefford, BQ)

Feb/15/24 1:39:42 p.m.
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Mr. Speaker, I have the pleasure of working with the member at the Standing Committee on the Status of Women, and I thank her for the question. We have many values in common, but, in this case, she is talking about consultation with various communities. She mentioned continuing the consultation process, but what does she make of Quebec's clear request for legislation and action now? Does she realize that this delay and her party's lack of political will will cause women like Sandra Demontigny to continue suffering?

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