44th Parl. 1st Sess.
February 15, 2024 10:00AM
- Feb/15/24 12:17:36 p.m.
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Madam Speaker, a few weeks ago, I attended the funeral of a friend's mother who had decided to avail herself of MAID. In her farewell speech to her mother, my friend said the following: Mom, when you told us about your decision, I did not agree because it was going to deprive me of a mother, but I had no choice but to respect your decision, because it was yours to make.
I thought it was a testament to her generosity of spirit.
In his speech, the member for Timmins—James Bay talked about respect. Since he is so knowledgeable on the subject, I would like to ask him a question that I did not have the opportunity to ask earlier. Although it is not necessarily the subject we are debating today, I would like to know why he decided to vote against the amendment to allow Quebec to offer advance requests. The purpose of this amendment was to allow the Government of Quebec to proceed with the safeguards we have in place, and this request did not require a specific provision for Quebec in the Criminal Code. The purpose was to ensure that all provinces could use the program if they wanted to. I would like to hear why the member for Timmins—James Bay—
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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. 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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- Feb/15/24 3:56:03 p.m.
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Mr. Speaker, I have spoken and shared, probably a little too much at times, in this House, regarding my own family's struggles and my own struggle with suicide, and why I fight so passionately on this issue and others. I want to say a heartfelt “thank you” to my colleague across the way. I have only known him for eight and a half years, but for me that is perhaps the most profound speech or intervention that he has made.
I do want to offer this. From the testimony we have heard from the medical community, we know that seven provinces and three territories have asked the Liberal government, not for a three-year pause but, for an indefinite pause.
How does our colleague feel about that? Is that something we should look at?
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