SoVote

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

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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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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Ms. Lisa Hepfner

Feb/15/24 1:40:28 p.m.
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Mr. Speaker, I, too, enjoy working with my colleague at the Standing Committee on the Status of Women. To be clear, conversations with the Province of Quebec are very important. We need to pass Bill C‑62 now to ensure that we have a program in place. This is not the end. We will keep talking with the Government of Quebec. We will keep learning from the Government of Quebec. I very much appreciate my colleague's comments.

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

Feb/15/24 1:41:18 p.m.
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Mr. Speaker, we are about 32 days away from a legal deadline that was arbitrarily thrown at us by the unelected, unaccountable Senate, forcing us to allow people who are depressed, people who are isolated and alone, to die through medical assistance in dying. Now my colleagues are saying to give them a couple of years and they will make it all work. What I found profoundly disturbing was that my colleague said they would support this. They figure that if they have another year or two, if they can meet just a few more people and just tick all the boxes at consultation, then people who are depressed and alone should be allowed to die. I find that an appalling position of the government. The government put us in this position through its cavalier approach to MAID, and its refusal to look at the issues and hear that this is really not a road we want to go down, that this is a line in the sand with respect to the human community. If the member thinks that in three years she will have consulted enough people, but, at the end of the day, she will support people dying because they have no support, then the government has very poor vision and it needs to explain that to the Canadian people.

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Ms. Lisa Hepfner

Feb/15/24 1:42:34 p.m.
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Mr. Speaker, I do not think consultation is simply checking boxes. It is extremely important, particularly when we are talking about our vulnerable and about our medical system. As I mentioned, I have personally consulted with psychiatrists in Hamilton. These people study and work at some of the best institutions in Canada. They are the experts. They have told me that, while the idea behind MAID for mental illness is a sound one, we are just not ready yet. We need to have all the proper safeguards in place before we move forward with this legislation. I think that is fair and I think it is reasonable.

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

Feb/15/24 1:43:34 p.m.
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Re: Bill C-62

Mr. Speaker, I am rising for the second time this week to speak to this issue. As I said at the beginning of my speech at second reading, I was so interested in this issue that I offered to sit on the Special Joint Committee on Medical Assistance in Dying when it dealt with the question of mental illness. I felt it was my duty to take part in a debate that is so important for our society. This is a crucial and extremely complex social debate. As a legislator, I wanted to learn more about this hot-button public policy issue that is so important to my constituents. Many of them have written to me about this. I attended much of the debate on the issue this week, and I was very impressed by the tone. It is true that emotions can sometimes get the better of us, but that is to be expected when we are debating such a crucial matter, a matter of life and death. I must say that I was impressed that the debate was conducted in a respectful manner. That is impressive, and we should adopt that same tone when we discuss the many other issues addressed here in the House. I heard arguments that I do not want to call fallacious, because that is a pejorative term and I do not want to criticize anyone, but let us just say that I heard a few contradictions during certain speeches. First, someone claimed that we could have simply amended Bill C-62 to include advance requests. I do not think we are ready to make a hasty amendment to open the door to something as complex—if not more—as medical assistance in dying, namely, medical assistance in dying for persons with a mental illness. It took much effort, much debate, much discussion and several committee meetings for us to be able to talk about medical assistance in dying for patients with a mental illness. Moreover, the idea that we can move an amendment in committee is wrong, because such an amendment would certainly be ruled out of order, since the scope of the bill is not that broad. The bill deals with a specific question, namely, medical assistance in dying for persons with a mental illness. People claim we are taking too much time to debate this issue, that it has already been three years and that we should end the debate. We are not talking about policies like affordability or the need to build housing as quickly as possible. We are talking about something very serious. We really are going beyond the more practical issues, and I think it will take the time it takes because there is no consensus among the experts. If there is no consensus, we cannot force the issue, suddenly demand consensus and insist we move forward because time is running out. The issue of how long it will take to reach a good conclusion is unfortunately not a problem for me. As I was saying, this is not simply a technical medical issue, it is a moral and ethical issue for society, certainly. The matter of caution was also raised. Some claim that the government is too cautious, too timid, on this issue, that it is not acting as quickly as people would like, that it has not addressed the issue fast enough or lacks political will. It does in fact lack political will because there are too many uncertainties. In this case, it is not a bad thing to lack political will in order to forge ahead as soon as possible. However, on this idea of being too cautious, I would say that this is true even for the Bloc Québécois, because it has accepted the framework we have established. For the moment, we are not implementing this framework. Nevertheless, under the framework, not everyone who requests medical assistance in dying on the grounds of a mental illness will receive it. We are talking about a mere 5% acceptance rate. Even if we went ahead, we would do so with a lot of caution, given the 95% of people who would request medical assistance in dying on those grounds. We should then not talk as if caution were not an issue. Caution is an issue, even if we agree to move forward. I would like to ask my colleagues who keep disparaging the government for its caution whether it would be too cautious to require that, in these cases, a psychiatrist be involved in assessing the person's request. Right now, it is not necessary for a psychiatrist to be involved in the assessment. In the Netherlands, where medical assistance in dying is legal, a psychiatrist must give an opinion on the request. There is caution built into the process, but it is not unreasonable. I would say that my colleagues in the Bloc Québécois agree that some caution is required. There is also talk about freedom. Some say that this is a matter of freedom, as if they were talking about absolute freedom. It is not a matter of absolute freedom, because 95% of those requesting medical assistance in dying would not have access to it on the grounds of a mental illness. We need to make things clear and add nuance to this debate to avoid giving the impression we are talking about absolute concepts. Then they bring up the issue of the Quebec nation. I listened carefully to my friend, the hon. member from Joliette, with whom I enjoyed working on election reform. He is a seasoned parliamentarian who makes excellent speeches in the House. He said that there were many nations in Canada. Indeed, there is the Quebec nation, but there are also indigenous nations. There are indigenous nations within the Quebec nation as well. What I understand is that indigenous nations are not too keen to move this issue forward at this time. They say that they have not been consulted enough. They have concerns about the systemic racism that exists in health care systems across the country. Among other things, they are afraid that not enough thought will be put into processing the requests. We should not focus too much on the idea of community when it comes to medical assistance in dying. When people get to that point, when they are on their death bed, I do not think they dwell too much on the community. Each person is a soul facing infinity alone. That is why we should not talk too much about nations when we are discussing medical assistance in dying. It is not a matter of being part of a community. I agree that it is a matter of individual rights. That is where it gets complicated, because we do not want people to suffer. However, we do not want people to do things that have not been assessed with the utmost caution, because it is a matter of life and death. I will stop here and await my colleagues' questions.

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Mr. Luc Thériault (Montcalm, BQ)

Feb/15/24 1:53:57 p.m.
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Mr. Speaker, first of all, we are not talking about advance directives. That has already been settled. We are talking about advance requests. Second of all, in my speech this morning—because this is a reply to the speech I made this morning—I never said that not enough work had been done. The Bloc Québécois's position is that one year is enough and that we will see after one year, immediately after royal assent, whether we can start to work on the mental illness issue. The member should have sat on the committee from the get-go. He has been an MP from Quebec since 2015. It is a bit strange for him to be so uninformed on the issue of MAID. Since June 2023, the government could have included advance requests in the bill, taking into consideration any recommendation of the Special Joint Committee on Medical Assistance in Dying. We never said that not enough work had been done. We said that the government was dragging its feet when it comes to committee work. The Special Joint Committee on Medical Assistance in Dying was always convened at the last minute. Does the member think that three meetings on an issue such as this were enough?

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Mr. Francis Scarpaleggia

Feb/15/24 1:55:18 p.m.
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Mr. Speaker, indeed, I should have used the correct term, “advance requests”, instead of “advance directives”. It seems to me that, during question period, the leader of the Bloc Québécois was just asking for an amendment to allow advance requests all of a sudden. Regardless of the government's timeline, I do not think the House is really ready to vote on this. Some members of the Special Joint Committee on Medical Assistance in Dying may be. However, as I told him earlier, this is not something as straightforward as the Standing Committee on Finance studying a budget. In that case, the members of a given party recommend that all their fellow party members vote in favour of it because they have studied it and the party trusts them. Everyone wants to make the right decision, so this requires a much more thorough debate. As the member himself said, Quebec did not put medical assistance in dying due to mental disorders in its legislation. The member said it was because Quebec had not studied it at the time. If Quebec is so sure, it can amend its legislation to include it.

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Mr. Garnett Genuis (Sherwood Park—Fort Saskatchewan, CPC)

Feb/15/24 1:56:36 p.m.
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Mr. Speaker, I am struck with how, during this debate, we have heard so much technical and bureaucratic language from the government. It masks what is fundamentally an ethical and moral issue, that is, the just way to treat the most vulnerable within our society. This discourse about maybe we are not ready or maybe we will be ready masks the more important underlying question of whether we should ever have the state involved in facilitating the suicide of those with mental health challenges. On this side of the House, we say a firm no, not now, not ever. I want to ask the member if he is concerned about the dramatic growth in the rates of those opting for MAID in Canada, opting for it perhaps under pressure or in other circumstances. We have seen, since this practice started in Canada, dramatic increases every single year. Is the member concerned about that, or is he totally fine with this idea of exponential growth in the rates?

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Mr. Francis Scarpaleggia

Feb/15/24 1:57:41 p.m.
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Mr. Speaker, I am concerned about it. I do not know what it means and there is much disagreement as to what it means. I would ask a question of the member, which I know he will not have to answer under the rules. Is he okay with track one MAID? A lot of the psychiatrists who went before the committee who were not in favour of MAID for mental disorders were in favour of track one and track two. I would like to know if the member accepts MAID under any circumstance or not at all. It is an important ethical and moral decision, I agree, but no one in the House wants people to suffer needlessly, and I think we are all grappling with this on moral and technical grounds. It may not be possible, I cannot say, but we want to separate out suicidal ideation. We want to be able to separate out psychosocial factors as motivating factors for requesting MAID in cases of mental illness, and we are not there yet. We want to study treatment fatigue to see, if somebody says they are done and cannot take it anymore, whether we can guide them to another treatment. We have looked at treatment fatigue when it comes to HIV and type 1 diabetes patients, but we have not looked at treatment fatigue when we talk about psychiatric illnesses.

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Ms. Anita Vandenbeld (Parliamentary Secretary to the Minister of International Development, Lib.)

Feb/15/24 1:59:20 p.m.
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Mr. Speaker, we know that medical assistance in dying is a deeply personal issue that is very difficult. I wonder if my hon. colleague could talk about the fact that we need to base this on principles of personal autonomy, dignity and choice.

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Mr. Francis Scarpaleggia

Feb/15/24 1:59:41 p.m.
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Mr. Speaker, that is a very difficult question. We all believe in personal autonomy and choice. However, as I said in my speech two days ago, sometimes I think that is becoming a bit of an ideology, where we do not recognize that, yes, we are individuals with free will and free choice, but we are born into families and communities. We are influenced not only by the opportunities that families and communities afford us, but also by the constraints they impose upon us. In some cases, society imposes more hardship on some than others. We do not seem to be able to separate out whether somebody is asking for medical assistance in dying because of the hardships that society has imposed on them, or whether it is really a clear-eyed decision. I am not a psychiatrist. I am not a doctor. I do not approach this with—

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The Deputy Speaker

Feb/15/24 2:00:39 p.m.
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I hate to shut the hon. member down, but we are out of time.

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Mr. Brendan Hanley (Yukon, Lib.)

Feb/15/24 2:00:54 p.m.
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Mr. Speaker, this year, CanNor celebrates 15 years of supporting job creation and economic growth in the territories. Project by project, CanNor's support empowers innovators in our territories. Because of CanNor, 12 indigenous businesswomen in Yukon were able to kick-start or grow their businesses through a microloan program. Thanks to CanNor, the Sakku Investments Corporation, an Inuit business, can build homes throughout the year in Nunavut in its modular home plant. Thanks to CanNor, businesses such as ColdAcre Food Systems and Sarah's Harvest were able to expand their operations to improve northern food security. Thanks to CanNor, Makerspace YK was able to renovate a commercial space and turn it into a collaboration centre for Northwest Territories entrepreneurs. Thanks to CanNor, community spaces such as the Yukon Theatre, Heart of Riverdale Community Centre and the Pine Lake trail in Haines Junction will receive upgrades for all Yukoners to enjoy. The work of CanNor is leaving a lasting legacy in the north, but there is more to do and our government will continue to be there to support northern businesses and innovation.

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Mr. Kyle Seeback (Dufferin—Caledon, CPC)

Feb/15/24 2:01:56 p.m.
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Mr. Speaker, on February 17, the Republic of Kosovo celebrates its 16th year of independence. Kosovo's path to independence was not easy. During its fight for freedom in 1999, tens of thousands of Kosovar Albanians were killed, and tens of thousands more became refugees. Their stories of tragedy and suffering are really hard to hear. However, the Republic of Kosovo has always had a friend in Canada. Canada was one of the first nations to recognize Kosovo's independence in 2008, and Canada welcomed over 7,000 Kosovar refugees into Canada, including my fiancée and her entire family. Twenty-five years later, those former refugees have built lives here in Canada. They have enriched Canada with their culture, their hard work and their love of Canada. To all Kosovar Canadians, I say urime Dita e Pavarësisë.

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Mr. Taleeb Noormohamed (Vancouver Granville, Lib.)

Feb/15/24 2:03:00 p.m.
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Mr. Speaker, PacifiCan plays a vital role in communities across British Columbia. It partnered with New Relationship Trust to work on the B.C. indigenous clean energy initiative and invest $4 million to support indigenous communities, create good and sustainable jobs, and move toward clean and reliable energy. This investment is also supporting over 100 projects by providing an additional $140 million in collaboration with various partners. These projects have created over 1,000 jobs and have reduced emissions by more than 400,000 times. This shows the important work that the federal government is doing in B.C. by working with people, indigenous communities and local businesses. Together, we are creating lasting economic benefits while advancing reconciliation and fighting climate change. The role that PacifiCan plays in the economy of British Columbia is important, and it must continue to have our support.

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