SoVote

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

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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The Deputy Speaker

Feb/15/24 5:06:04 p.m.
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We have a point of order from the hon. member for Barrie—Innisfil.

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Mr. John Brassard

Feb/15/24 5:06:08 p.m.
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Mr. Speaker, I know that the member for Kingston and the Islands operates in a way that he accuses other members of heckling him as part of his schtick, but I did not heckle him. He was telling a heartfelt story about his father-in-law who had a brain tumour, and I ask that he retract that accusation.

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The Deputy Speaker

Feb/15/24 5:06:25 p.m.
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We are descending into debate. We will continue debate with the hon. member for Lambton—Kent—Middlesex.

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Ms. Lianne Rood (Lambton—Kent—Middlesex, CPC)

Feb/15/24 5:06:36 p.m.
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Re: Bill C-7 Bill C-62 Bill C-314

Mr. Speaker, I rise today to address a question of paramount importance and profound concern to many of my constituents in Lambton—Kent—Middlesex: Will Canada cross the Rubicon and expand access to assisted suicide for otherwise healthy individuals whose mental disorder is the sole underlying medical condition, or do we have enough common sense and moral clarity to stop this radical and dangerous expansion of MAID to mental health cases? The issue at hand stands at the juncture of ethics, medicine and our societal values. This is not merely a policy decision. It is a profound moral question that strikes at the heart of who we are and how we value life and respond to suffering. The core concern here is the difficulty, if not the impossibility, of determining with certainty that mental disorders are irreversibly incurable. Unlike many physical ailments, the trajectory of mental illness is often unpredictable and can respond to treatment over time. The NDP-Liberal government's push toward expansion, despite substantial opposition from medical professionals and the public, raises serious questions. It reflects a troubling trend of policy-making that seems to prioritize ideological considerations over careful, evidence-based deliberation. How can we, in good conscience, move forward with a policy that many experts in psychiatry and mental health view with significant trepidation? The opposition from the medical community, particularly from mental health professionals, is not just significant but deeply insightful. The expert panel on MAID and mental illness, the very panel established by the government to study this issue, acknowledged the complexities involved. It noted the difficulty in predicting the long-term prognosis of mental disorders, underscoring the near impossibility of determining with certainty whether a mental disorder is truly incurable. Leading psychiatrists across Canada have expressed reservations. The Association of Chairs of Psychiatry in Canada, which includes the heads of the psychiatry departments of all 17 medical schools in the country, called for a delay in implementing MAID for patients with mental disorders as the only underlying medical condition. Its concerns centre on the challenges in assessing incurability and differentiating genuine MAID requests from suicidal ideation rooted in treatable mental health conditions. Surveys conducted within the psychiatric community reflect this opposition. For instance, a significant majority of Manitoba psychiatrists have indicated that Canada is not ready for the implementation of assisted suicide for patients with mental disorder as the sole underlying medical condition. A similar sentiment was echoed in a survey conducted by the Ontario Medical Association, where a two-to-one majority of respondents opposed the availability of MAID for such cases. These results are in line with public opinion, which has consistently shown discomfort with this expansion. In fact, I have heard from hundreds of residents of Lambton—Kent—Middlesex who are opposed to this expansion, and polls such as those conducted by Angus Reid reveal substantial public reservations about MAID for mental illness. If we ignore experts' warnings and the public sentiment and proceed with this expansion, we risk making irreversible decisions in cases where there might be potential for recovery and improvement with the appropriate treatment. The ethical implications of such a scenario are profound and disturbing. In our examination of this issue, we must not overlook the societal context in which decisions about MAID are being made. The CEO of Food Banks Mississauga recently issued a stark warning that the inability to afford basic necessities is pushing people towards considering MAID. This is a harrowing indication that, for some, the choice to pursue assisted dying may be influenced more by socio-economic despair rather than by unimaginable physical or mental health conditions. This revelation is deeply troubling. It compels us to question whether we are addressing the root causes of such despair or merely offering a tragic and irreversible solution to what are fundamentally social and economic problems. This is particularly concerning in light of the ongoing mental health crisis that was exacerbated by the COVID-19 pandemic and the government's divisive response. Additionally, we must also reflect on the alarming reports concerning our veterans. There have been stories of veterans being offered MAID. This raises profound concerns about the support and care that we provide to those who have served our country. These individuals, who have sacrificed so much, deserve better than an expedited path to assisted death. These stories underscore the need for robust mental health support and the dangers of expanding MAID without adequately addressing these needs first. When the Liberal government has such a cavalier attitude toward assisted suicide, with a one-way slope toward access expansions and safeguard removals, is it any surprise that, according to the latest available numbers, the annual growth rate of MAID between 2021 and 2022 was 31.2%? Between 2016 and the end of 2022, 44,958 people died by MAID. That is more than the number of Canadians who died in military service during World War II. My point is that Canada's current MAID access may already be the most discretionary in the world. That is before the proposed mental health expansion. We are the only country whose legal system does not see assisted suicide as a last resort. What can we expect to happen to the growth rate if the House enables the “treatment” of mental illness with assisted suicide? We would be past the slippery slope concern if that were to happen. Crossing the Rubicon here would put us closer to free fall. Why are we debating the radical expansion of assisted suicide? Just four months ago, the hon. member for Abbotsford's bill, Bill C-314, was in the House. Conservatives urged the House not to give up on Canadians living with mental illness. Nevertheless, the government voted against the bill, sticking to its original plan, as per Bill C-7, to expand access to MAID to Canadians who are healthy except for their mental disorder. If it were not for the Special Joint Committee on Medical Assistance in Dying's tabling, on January 29, 2024, its findings and recommendations, the unprecedented MAID expansion would have been implemented within two months. Thankfully the committee, after extensive consultations and a review of expert testimony, concluded that Canada is not ready for the expansion of MAID to include cases where a mental disorder is the sole underlying medical condition. The report highlights the unresolved issues in accurately assessing the irremediability of mental disorders and the challenges in distinguishing between genuine requests for MAID and those stemming from treatable mental health conditions. The report confirms what common-sense Conservatives have been saying for months: Expanding assisted suicide to those suffering from mental illness would result in the deaths of those who could have gotten better. That is why, just like last year when the government introduced eleventh-hour legislation to put a temporary one-year pause on expanding assisted suicide to those suffering with mental illness, we are once again here at the eleventh hour. There is no question that there is an urgent need to pass Bill C-62 to delay until 2027 the implementation of MAID in cases where a mental disorder is the sole underlying cause and condition. As highlighted by the report of the special joint committee and the voices of experts and Canadians alike, a mere delay may not suffice. What is required is a comprehensive re-evaluation of our approach to MAID, particularly in the context of mental health. The issues at stake are not just medical or legal but are deeply rooted in our societal values and the respect we need to afford the dignity of human life, especially in its most vulnerable forms.

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The Deputy Speaker

Feb/15/24 5:15:11 p.m.
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It being 5:15 p.m., pursuant to order made on Tuesday, February 13, it is my duty to interrupt the proceedings to put forthwith every question necessary to dispose of the third reading stage of the bill now before the House. The question is on the motion. If a member participating in person wishes that the motion be carried or carried on division, or if a member of a recognized party participating in person wishes to request a recorded division, I would invite them to rise and indicate it to the Chair.

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Mr. Luc Thériault

Feb/15/24 5:15:47 p.m.
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Mr. Speaker, I request a recorded vote.

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The Deputy Speaker

Feb/15/24 5:15:52 p.m.
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Call in the members.

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Call

The Deputy Speaker

Feb/15/24 5:58:37 p.m.
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I declare the motion carried.

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The Deputy Speaker

Feb/15/24 5:59:17 p.m.
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The next question is on the main motion. If a member participating in person wishes that the motion be carried or carried on division, or if a member of a recognized party participating in person wishes to request a recorded division, I would invite them to rise and indicate it to the Chair.

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