SoVote

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

Feb/15/24 4:43:45 p.m.
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Mr. Speaker, on a point of order, I would like to correct my hon. colleague. I note, in his zest for this intervention, he misread the number. It is not 811; it is 988.

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The Deputy Speaker

Feb/15/24 4:44:02 p.m.
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It is not a point of order, but it was a good clarification.

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Mrs. Cheryl Gallant (Renfrew—Nipissing—Pembroke, CPC)

Feb/15/24 4:44:09 p.m.
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Mr. Speaker, it was not that long ago that “made in Canada” was a phrase we were proud of. We have teenagers who, sometimes for the very first time in their lives, are encountering adversity. It is a psychological crisis to them. They react in such a way that they are actually trying to commit suicide. It is often said that an attempt at suicide is a cry for help. They end up in the hospital for a time. We have seen, with veterans, how some of them who seem to be near the end of life have been encouraged to use MAID. Is there anything in this legislation that would explicitly prevent medical workers from suggesting MAID to people who attempt suicide but thankfully are not deceased as a consequence of it?

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Mr. Marc Dalton

Feb/15/24 4:45:16 p.m.
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Mr. Speaker, it is quite unfortunate, but even under the old regime, there were many people who were not facing imminent death but still received MAID. I believe the Liberal member for Thunder Bay actually talked about some of the zealous doctors who prescribe it. I am aware that this has happened, so to the member's question, there is nothing that I am aware of that would prevent this. The member talked about youth. I have family members who have gone through drug issues and mental health issues and have come out the other side and now are supporting people in a similar situation.

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Mr. Randall Garrison (Esquimalt—Saanich—Sooke, NDP)

Feb/15/24 4:46:10 p.m.
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Mr. Speaker, I have had the same question through the whole debate today, and that is, as I have said before, that we all know that access to mental health supports varies by one's residence, by one's income and by one's ethnicity. People have trouble accessing mental health services. Would the hon. member support making mental health services fully part of the Canada Health Act, so that we can equalize access to mental health services in the country?

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Mr. Marc Dalton

Feb/15/24 4:46:38 p.m.
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Mr. Speaker, we do not have the supports we need for people with mental health challenges. The member mentioned ethnicities. I am indigenous. I am Métis. I know that a lot of indigenous, first nations and Métis groups are very concerned, because the number of suicide attempts among adults is at least double the rate in the rest of Canada's population. Among youth, it is six times higher. It is a very vulnerable population, and this is a concern, especially for indigenous Canadians.

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Mr. Marty Morantz (Charleswood—St. James—Assiniboia—Headingley, CPC)

Feb/15/24 4:47:16 p.m.
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Mr. Speaker, this amendment was brought in by the Senate, the other place, in the first place. It was not in the original legislation. It came back here; the Liberals decided it was a good idea, and it got put through the House without any time limit. It was supposed to be law, and then they extended it for a year. They are now trying to extend it for three years. They are relying on the same people who brought in this idea of MAID for mental illness to postpone it for three years. Does the member think that this is going to be an easy ride through the Senate, or are the senators who brought this in in the first place going to give it a hard ride?

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Mr. Marc Dalton

Feb/15/24 4:47:58 p.m.
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Mr. Speaker, that is a real concern, especially because we have a deadline in March to get it passed here and then through the Senate.

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Mr. Daniel Blaikie (Elmwood—Transcona, NDP)

Feb/15/24 4:48:12 p.m.
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Mr. Speaker, given the March deadline and the potential for trouble in getting this expeditiously through the Senate, is the member glad that we are wrapping up debate in the House of Commons so quickly, so that we have time to try to get it done before the deadline?

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Mr. Marc Dalton

Feb/15/24 4:48:26 p.m.
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Mr. Speaker, I think it is an extremely important discussion. I know it is moving forward. It does need to go to the other chamber.

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The Deputy Speaker

Feb/15/24 4:48:33 p.m.
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It is my duty, pursuant to Standing Order 38, to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Calgary Rocky Ridge, Automotive Industry; the hon. member for St. Albert—Edmonton, Public Services and Procurement; and the hon. member for Calgary Nose Hill, Carbon Pricing.

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Ms. Annie Koutrakis (Parliamentary Secretary to the Minister of Tourism and Minister responsible for the Economic Development Agency of Canada for the Regions of Quebec, Lib.)

Feb/15/24 4:49:07 p.m.
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Re: Bill C-62

Mr. Speaker, I would like to inform you that I will be sharing my time with the member for Lambton—Kent—Middlesex. I am pleased to rise in the House today in support of Bill C‑62. The bill proposes to extend the temporary exclusion of mental illness as a an eligibility criteria for medical assistance in dying for three years, until March 17, 2027. Today, I will speak to the importance of allowing some time before lifting this exclusion so that the provinces, territories and their health care partners can use it to better prepare for this critical stage in the evolution of medical assistance in dying, or MAID, as we call it in Canada. The current legal framework for MAID is set out in the federal Criminal Code. However, the provinces and territories are responsible for delivering health care, which includes implementing MAID. Even before the original legislation authorizing MAID was added to the Criminal Code in 2016, we were working closely with the provinces and territories to support MAID's safe implementation. These important relationships are all built around the mutual goal of ensuring quality health care for Canadians. The expert panel on MAID and mental illness and the Special Joint Committee on Medical Assistance in Dying both emphasized the importance of clear standards of practice and consistent implementation of guidelines across the country, training doctors and nurse practitioners, case review, vigilance in supporting best practices and confidence in the appropriate application of the law. The provincial and territorial governments and their stakeholders, such as health professional organizations, regulatory bodies and practitioners, are actively planning to make people whose sole underlying medical condition is mental illness eligible for MAID. As it has been recognized in all areas, significant progress has been made in that regard. However, the provinces and territories are dealing with different challenges within their jurisdictions. They are also at different stages when it comes to implementing these key elements and, consequently, in how prepared they are for the lifting of the exclusion. For example, an independent task force of clinical, regulatory and legal experts has developed a model practice standard that physician and nursing regulatory bodies can adopt or adapt as part of the development or ongoing review of MAID standards. In addition to the model standard, the task force has also published a companion document entitled “Advice to the Profession”. Practice standards are developed and adopted by bodies responsible for ensuring that specific groups of health care professionals operate within the highest standards of clinical practice and medical ethics. While some provincial and territorial regulatory bodies have successfully included MAID practice standards in their guidance documents for clinicians, others are still in the process of reviewing and updating their existing standards. To facilitate the safe implementation of the MAID framework, Health Canada helped develop a nationally accredited bilingual maid curriculum to support a standardized pan-Canadian approach to care. The Canadian Association of MAID Assessors and Providers, known as CAMAP, has created a training program that has been recognized and accredited by the appropriate professional bodies. The MAID curriculum uses a series of training modules to advise and support clinicians in assessing persons who request MAID, including those with mental illness or complex chronic conditions or who are impacted by any vulnerability. To assist in the practical application of the legislative framework for medical assistance in dying, the curriculum will help achieve a safe and consistent approach to care across Canada. This will ensure that health care professionals have access to high-quality training on medical assistance in dying. To date, more than 1,100 clinicians have registered for the program, which is impressive given that the program was only launched in August 2023. However, that is only a portion of the workforce. More time will make it possible for more doctors and nurse practitioners to sign up for and participate in the training so they can absorb the theory and put it into practice as professionals. Let us talk a bit about the medical assistance in dying review and case study. In Canada, the medical and nursing professions have a self-regulating process. The above-mentioned provincial and territorial regulatory bodies are tasked with protecting the public with respect to all health care, and medical assistance in dying is no exception. In addition to the existing health care practitioners' regulatory governing bodies, several provinces have established formal oversight mechanisms specific to MAID. In Ontario, for example, the chief coroner reviews every case of medical assistance in dying, as does Quebec's commission on end-of-life care. Both organizations have strict policies on when and what information must be provided by clinicians, and the Quebec commission publishes annual reports. While provinces with formal MAID oversight processes account for over 90% of all MAID cases in Canada, other provinces do not have a formal MAID quality assurance and oversight process to complement the existing complaint-based oversight processes put in place by professional regulatory bodies. Work is planned to explore case review models to ensure oversight and best practices through a federal-provincial-territorial working group to support consistency across jurisdictions. All the provinces and territories were united in their call to extend the exclusion in order to have more time to prepare their clinicians and their health care systems that also manage the requests having to do with mental illness, which also deserves having the necessary support measures implemented. The provincial and territorial governments need to ensure not only that the practitioners are trained in providing medical assistance in dying safely, but also that the necessary supports are accessible to clinicians and their patients throughout the entire assessment process. The Special Joint Committee on Medical Assistance in Dying and the expert panel both underscored the importance of interdisciplinary engagement and knowledge of the available resources and treatments. Specialists and practitioners also expressed the need to bring in support mechanisms for providers conducting the assessments and the people who request medical assistance in dying, regardless of their eligibility. Although some administrations have strong coordination services to manage requests and provide auxiliary services, others are taking a decentralized approach, which can result in less coordination between services and disciplines. The availability of the support services necessary for practitioners and patients also varies by region. For example, we heard about difficulties accessing health care services in general in rural and remote areas of the country. The additional delay will make it possible to better support the patients and clinicians involved in medical assistance in dying. This government is committed to supporting and protecting Canadians with mental illness who may be vulnerable, while respecting their autonomy and personal choices. We think that the three-year extension proposed in Bill C‑62 will give the time needed to work on these important aspects so that this can be implemented in a safe and secure way.

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

Feb/15/24 4:59:27 p.m.
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Mr. Speaker, I have a question for the government about its so-called “MAID policy”. Its members have said repeatedly, especially as it relates to mental health challenges, that their MAID policy would aim to exclude those who are suicidal, but I want to understand something from the government: Is not any person who requests MAID suicidal, simply by definition, since they are requesting MAID?

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Ms. Annie Koutrakis

Feb/15/24 4:59:58 p.m.
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Mr. Speaker, I think it is irresponsible and untrue, honestly, to claim that MAID has anything to do with suicide. The Government of Canada recognizes the importance for all Canadians to have access to critical mental health resources and suicide prevention services. I am a member of the special MAID committee, and not one witness I heard when I was there said that this is suicidal.

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Ms. Marie-Hélène Gaudreau (Laurentides—Labelle, BQ)

Feb/15/24 5:00:44 p.m.
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Mr. Speaker, we can see during the debate that each party has its own position. When I talk with members, I see the difference of opinion. There are many in the Liberal ranks who agree that we need stringent requirements and an implementation team charged with making sure that the requirements are met. If Quebec is ready, what does my colleague think of an accommodation that would allow Quebec to ease people's suffering immediately, as requested in the motion, and not in three years or more?

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Ms. Annie Koutrakis

Feb/15/24 5:01:29 p.m.
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Mr. Speaker, that is an important question. The Criminal Code applies across Canada. We cannot start adapting the law for every region of the country. We have to understand that it would be irresponsible to amend the Criminal Code to allow Quebec to change its own legislation. That is my opinion.

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Mr. Mark Gerretsen (Kingston and the Islands, Lib.)

Feb/15/24 5:02:11 p.m.
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Mr. Speaker, the member for Sherwood Park—Fort Saskatchewan just suggested that somebody like my father-in-law, who was laying in a hospital bed with a brain tumour bulging out of his head, knowing full well that it was only a matter of days before he died, and who wanted to die with some form of dignity while his family was around him— Some hon. members: Oh, oh! Mr. Mark Gerretsen: Can the Conservative member for Barrie—Innisfil please not heckle me just this one time, possibly? I am wondering if the member would agree that perhaps it is extremely inconsiderate to think that somebody who realizes what the future holds for them, and who wants to die with some dignity, and that perhaps they can be saved from a bit of the pain, is thinking about more than just committing suicide?

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Ms. Annie Koutrakis

Feb/15/24 5:03:10 p.m.
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Mr. Speaker, I think it is very important, in this country, that we speak from a place of empathy, sympathy, understanding and mutual respect. We cannot paint all situations with the same brush. Obviously, we have a Charter of Rights, and through the Charter of Rights, every person has equal rights. Personally, and I can only speak for myself, I believe that someone who has long-standing suffering with a mental health issue or a degenerative brain malady that we know of should have access to medical assistance in dying, because I think it is far better for that person to be surrounded by their loving family than to continue the suffering.

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Mr. Todd Doherty (Cariboo—Prince George, CPC)

Feb/15/24 5:04:18 p.m.
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Mr. Speaker, to our hon. colleague for Kingston and the Islands, our colleague for Sherwood Park—Fort Saskatchewan only said that when speaking of MAID for those with mental illness, how do we differentiate between suicidal ideation and MAID? Indeed, it is what we are hearing from the experts who said, “There is no evidence that shows we can predict irremediability in mental illness and it is vastly different, vastly different from other medical conditions and neurodegenerative diseases.... We have to remember what MAID is about. MAID is about predicting who will never get better, and we can't do that, and if we can't do that with mental illness, we would providing death under false pretenses.” This is completely different from what our hon. colleague talked about with this father-in-law, who was struggling with a brain tumour, choosing MAID and those who are struggling with mental illness, which has been associated with flipping a coin on who can get better and who cannot get better. I ask my hon. colleague this: Is she okay with flipping a coin when it comes to offering MAID to somebody who is wishing to die by suicide.

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Ms. Annie Koutrakis

Feb/15/24 5:05:39 p.m.
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Mr. Speaker, I do not believe in flipping a coin. However, the mere fact that in this country we are still having this conversation, this debate and not having consensus, then I think a three-year pause is the way to go about it. It would let the provinces and territories, together with all the professionals, get together and make sure that when this does become whatever the next step would be, we will be better for it as a country.

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