Senator Miville-Dechêne: The United Kingdom, France, Germany and the European Union have adopted age verification laws to access online porn. They have safeguards to ensure privacy of data, like Bill S-210. Why not look at these examples instead of deciding to allow children to freely access the porn sites?

Senator Miville-Dechêne: Yes.

Senator Miville-Dechêne: Honestly, no, I wasn’t aware of that. That was in one of the briefs submitted to Quebec’s commission on end-of-life care. They discuss the situation in Belgium and in the Netherlands. It’s a bit different. All right, then, I’ll take you at your word.

But there is certainly more than one expert who’s uncertain about the irremediability of psychiatric disorders. It’s a difficult debate. You mention evidence and the fact that it’s beyond dispute, but I think that the Council of Canadian Academies, a respected scientific organization, also reached similar findings on the issue of irremediability. These are professionals, but not physicians only. From what I understand, they are also scientists from various backgrounds. That, too, is not insignificant. It is a social debate. Yes, physicians are very important, but I think the debate is broader than that.

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Senator Miville-Dechêne: That’s a difficult question. I don’t think politics is a perfect science. I think we’re all trying to find the right way forward in dealing with the very difficult issue that is MAID, broadly speaking.

I think there are specific criteria for psychiatric illnesses that make irremediable consequences generally more difficult to establish than for physical illnesses. I’m not saying, Senator Kutcher, that this is absolute. I’m saying that, based on what I’ve read and on the discussions I’ve had, this is part of the difficulty.

I also think that the safeguards need to be robust. I understand that it is difficult and, as you know, our opinions on this issue differ. I understand that there are people who are waiting for this help and who are suffering, but I believe that what happened in Belgium and the Netherlands shows us that once we open MAID up to those with psychiatric problems... When 1,150 people are requesting MAID in a country that is smaller than Canada, that’s a lot of people. You often talk about people you know who have indeed had illnesses for a very long time, who have tried every treatment, but once that door is open, how will it work? Unlike you, I don’t have absolute confidence in all doctors, all medications and all treatments. I think there are abuses. The fact that there have been 16 cases of MAID in Quebec where tough questions are being asked because it appears the law was not followed shows that these questions are far from easy.

I don’t have a definite answer. I wonder, I have doubts and I think you do, too. However, we have fairly opposite points of view on this issue.

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Hon. Julie Miville-Dechêne: Senator Gold, a year ago, during the study of Bill C-11, you said this about my age verification amendment:

. . . The Government of Canada is looking to introduce legislation to address potential online harms with the goal of keeping all Canadians safe online, including being safe from the kind of harm that this amendment would propose. In the government’s view, this would be the most appropriate forum, in the context of that legislation, to discuss this important issue. . . .

In other words, the government said, “We’ll take care of the issue in our online safety bill.”

Today, the government finally introduced its long-awaited bill, and there’s no age verification to prevent children from accessing online porn. So my question is this: What happened to that clear commitment?

Hon. Julie Miville-Dechêne: Honourable senators, I rise in support of Bill C-62, which proposes a three-year extension to the temporary exclusion of medical assistance in dying eligibility for persons suffering solely from mental illness. In the interest of full disclosure, and specifically for the benefit of our recently arrived colleagues, I’d like to remind you that three years ago, I voted against the Senate amendment that extended MAID to psychiatric patients. At the time, there was no consensus among experts on this social issue, and that is still the case today.

Although defending minority rights is at the heart of our mandate, the Senate is not a court of law. While some may argue that denying access to MAID violates the constitutional rights of those with mental illness, this conclusion is far from clear. In its Charter statement, the Department of Justice spells out the competing rights and values at stake, including the autonomy of individuals versus the protection of vulnerable people from any incentive to end their lives. The Department of Justice adds:

 . . . feelings of hopelessness and the wish to die are common symptoms of some mental illnesses, which can make it difficult for even experienced practitioners to distinguish between a wish to die that is fully autonomous and well considered and one that is a symptom of a person’s illness.

After analyzing international science-based evidence for a year and a half, the Council of Canadian Academies’ expert panel found no evidence that the irremediability of mental illness could be predicted. Some mental disorders may even impair a person’s decision making and increase their risk of incapacity.

The fact that provincial governments aren’t ready is another compelling argument. We mustn’t forget that the provinces deliver medical care and have jurisdiction in this area. It would be a mistake to equate their serious concerns with an ideological objection to MAID in every case. Take Quebec, for example, a place I know better than others: It was a frontrunner in expanding medical assistance in dying and even holds the world record for this practice. Last year, MAID accounted for 5,200 or 6.8% of deaths in Quebec, a 42% increase in a single year. Of that number, a disturbing 16 cases failed to meet all the criteria specified in the act.

Last June, Quebec amended its Act Respecting End-of-Life Care to legalize advance requests related to cognitive illness leading to incapacity, but it excluded patients who exclusively suffer from a mental disorder. This decision was based on a report by Quebec’s end-of-life care commission, published in December 2021, which concluded, and I quote:

Medical aid in dying is care of last resort for persons whose illness cannot be cured and whose decline in capability is irreversible. Given the lack of consensus in the medical community on the incurability and irreversibility of mental disorders, a strong doubt remains as to whether medical aid in dying is appropriate care. In this context, the risk that this gesture be premature appears very real to us. We are faced here with the grim prospect of individuals obtaining medical aid in dying rather than appropriate medical follow-up that would favour a fully satisfying life.

I share those very same concerns. Some have argued the following — and I’m quoting the report of the Special Joint Committee on Medical Assistance in Dying:

 . . . there is no consensus on many existing medical practices, and that this is not generally considered a justification for prohibition.

I think that it’s inappropriate to equate MAID with a simple medical practice, as though this were about a hormone treatment or taking antibiotics. We have to have the honesty or lucidity to come to grips with this. This is about helping a person to die. It is irremediable.

Another sensitive aspect is the fact that, in the report of the Special Joint Committee on Medical Assistance in Dying, witnesses observed that the eligibility criteria for MAID didn’t require people with mental disorders to have exhausted all reasonable treatment options. Bill C-7 only required that the patient be informed of treatment options. In theory, this would mean that the patient could receive MAID even if he or she hasn’t had access to adequate care. This is particularly worrying in a country like ours, where the shortage of psychiatric care is an established fact.

In Belgium and the Netherlands, where psychiatric patients have access to MAID, more robust safeguards exist.

According to the submission of Professor Scott Kim from the University of Michigan, 1,150 applications for MAID were made in the Netherlands in 2022, which is quite a lot. However, only 5% to 10% were granted. Belgian and Dutch laws require doctors to agree with the fact that there are no options other than MAID in each case, so MAID really is a last resort. I’m aware that the right to refuse all treatment is well established in our country, and it is a paramount right, but it seems to me that the exercise of this right, combined with a life-ending medical intervention, is a sensitive issue that warrants further consideration.

Bill C-62 will do just that. It will allow time for such careful consideration of the state of our knowledge and the scientific and ethical grey areas.

Obviously, I’m aware that there is intolerable mental suffering that is as great if not greater than the suffering associated with physical illnesses, but we can’t expand access to MAID any further until we’re able to confidently assess the applicant’s incurability, the irremediability of their condition, their capacity and their suicidal tendencies.

The severe shortage of psychiatric care and services must be at the heart of this reflection on the health care systems’ state of readiness, or at least that’s what I think. We can’t focus solely on the fact that there are protocols for administering MAID. That is not enough.

Finally, the precautionary principle applies when lives are at stake. Thank you.

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