So V ote

Feb/15/24 4:13:36 p.m.
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Re: Bill C-7 Bill C-14

Mr. Speaker, we have heard that a lot in this debate. We all want to be on the side of the angels. We all want to improve socio-economic conditions. The expert report does take structural vulnerabilities into account, and no assessor is authorized to grant a request for medical assistance in dying if there is any possibility that the request came about because of a structural vulnerability. I paid close attention to my colleague's speech. Judging from the examples he gave, I gather he was in favour of Bill C‑14 for cases involving reasonably foreseeable death, but that he is against Bill C‑7 for people suffering from an incurable degenerative disease who are forced to cut their life short by suicide because their suffering has become intolerable. If Bill C‑7 is implemented, those people will be able to live until they reach the threshold of what they feel is tolerable. Did I understand correctly that my colleague is against Bill C‑7 as it relates to degenerative diseases? I am curious, and I would like him to answer this question. He talked about it in his speech.

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Mr. Tom Kmiec (Calgary Shepard, CPC)

Feb/15/24 12:58:20 p.m.
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Re: Bill C-7 Bill C-62 Bill C-14

Madam Speaker, I am glad to be joining debate on Bill C-62. Off the top, I will mention that I will be voting for it. Like the shadow minister for justice on the Conservative side said, this is about protecting the vulnerable. Though the federal government has dropped the ball in this latest iteration of its legislation, these three years, I hope, will be taken to basically fix the mistakes that were made all the way back to Bill C-14. I want to talk a little about what brought us to this moment, and then refer to some constituents of mine who have emailed me over the last few months on the issue of assisted suicide. I will also mention that I am sharing my time with the member for Mission—Matsqui—Fraser Canyon. I am sure he will add more to this debate. To go back to the beginning, not too far to the beginning because I could get into Genesis, the Carter decision is what kicked off multiple debates that I have now been a part of. I have now seen this debate go from Bill C-14 to Bill C-7 to Bill C-62, and the attempts by my hon. colleague from Abbotsford, who, I think, tried to do right by vulnerable Canadians all across Canada to make sure that we would not see an expansion of the MAID provisions to those who are still suffering with mental health conditions. The great thing about Hansard is that I was able to go all the way back and review what I had said on Bill C-14. I spent quite a bit of time complaining that the reasonably foreseeable clause would be knocked down by a court. It was knocked down by a court in the Truchon decision, because all our deaths are reasonably foreseeable; that is what living is all about. At the time, I had said that all of us who are born are born with one foot in our grave. One is assured one will die; one does not know just what it is, but it is reasonably foreseeable. I am just repeating it now. I know that it is morbid, but it is the truth. A lot of what we are dealing with here are issues of life and death and how one's death will happen. Therefore, at the time, this reasonably foreseeable clause would get knocked down, and it was knocked down in the Truchon decision. My issues, just generally, are that, in a perfect world, this would not be necessary because people would not suffer. However, because this world is not perfect, people do suffer. People suffer in deep and different ways. Members know that I had a disabled daughter who passed away a few years ago. Had she lived longer, and I know at least one little girl in Calgary who has lived much longer with the same conditions my daughter had, she would be one of those vulnerable Canadians who would be facing the possibility that her physician, her specialist, might push for and might offer MAID. I say “offer MAID”, but it seems so weird to say “offer MAID”, to offer something that I do not consider to be a medical service and to rush one's death sooner. Although we all die, as I said many Parliaments ago, the act of dying is not one that one does alone; it is done as a family, as a group of friends and with those loved ones around. It is not something that happens in solitude. There are others who will miss one when one is gone. I know that it is difficult in a moment of suffering and a moment of great pain, or chronic pain, to believe it, to know it. A lot of the emails, the correspondence and the meetings I have had were with people who are worried about the assisted suicide MAID provisions, which the government has ineffectually dealt with through successive pieces of legislation. I think it was a grave error not to appeal the Truchon decision. I really do. I think it was a mistake. I said it to constituents at the time. I have a Yiddish proverb, because I always do. They are great proverbs, and everybody should live by them and should know more of them. I just wish I could pronounce them in Yiddish: The truth never dies, but it is made to live as a beggar. This legislation is a beggar. This legislation should have been a permanent fix to the issues. I think that Conservatives have suggested, both in committee and outside of committee, what some of those fixes would be. Although I disagree with an acronym, I will use RFND, reasonably foreseeable natural death. It should be limited to those who are terminally ill, where their death is foreseeable within the next six months, where there is a prognosis from a medical professional saying that one will indeed pass away. For those most terrible conditions, I am thinking of a lot of cancers. My grandfather passed away from brain cancer in Canada, which brought my family to Canada. His death was very much reasonably foreseeable when it was terminal. There are others who have mental health conditions, which are caused by a physical condition. The mental health condition alone should not be the reason to seek assisted suicide. Different Conservatives have mentioned, and I very much agree with this, that patients should be the ones requesting it. These are all things the government could have legislated into law. These are things that experts have said, and I want to read some of what the experts said in different committees. Professor Trudo Lemmens and Mary Shariff persuasively rebutted a bunch of arguments that were made in Truchon. They noted again that reasonably foreseeable natural death applied to “all” persons, “not only to persons with disabilities”. “The judge in Truchon failed to appreciate how such a restriction reflects a constitutional duty to protect the equal value of the lives of all Canadians.” I have read the Carter decision twice now. As many in the House know, this is something I take pride in saying that I am not a lawyer. I am not burdened with a legal education. I know the member for Fundy Royal is disappointed and that the member for St. Albert—Edmonton will be disappointed too, so I come to this as a layperson. Even the Carter decision did not say he had a right to die. It goes back to this idea, like I have said, that all of our deaths are reasonably foreseeable. It will happen; it is unavoidable in life. These two experts said that the judge in Truchon made a mistake. This concept, this expertise, was then repeated in observations made by 72 disability rights organizations that penned a letter to the then justice minister. They said that reasonably foreseeable natural deaths are the ones where there is terminal illness that is coming up very quickly, and that this idea is an equalizing effect, guaranteeing a common thread among persons accessing MAID, assisted suicide, namely that they are dying within a very short time window. That is how I think this legislation should work. I am not saying there should be no MAID. The Carter decision stands as a Supreme Court decision in Canada, so there has to be a provision of it in a method. It should be rare and should be restricted to the very few people for whom it was originally intended. I feel that Bill C-14 to Bill C-7 to the situation we are in today do not address that. That is why we have this legislation that is a beggar. It is not in the original form that it should be. The truth lies in abiding by what Carter decided. Another one reads, “From a disability rights perspective, there is a grave concern that, if assisted dying is made available...regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.” That is a terrible message to send to persons with disabilities. I am thinking of my daughter, had she lived. That would have been a terrible message to send to her. All three of my living kids have a chronic kidney condition. My boys will likely need a kidney transplants. What a terrible thing to tell them, that they are a burden on the medical situation and that maybe they should seek faster death. Is that what specialists are going to tell them when they are adults? I will not be in the room, but they will be in the room. Will that be pushed onto them? For those who are on dialysis, it is hard on their bodies to go three to four days a week to get dialysis in a hospital setting. I am not speaking of peritoneal dialysis that can be done in the home. There have been lots of experts. The member for Fundy Royal explained a lot of what has been said on the issue. The government keeps erring in the wrong direction with more expansive legislation to allow more people to access something that was not the original intention of Carter. We should abide by Carter, as I mentioned before. I have had constituents write to me. I just want to make sure that I read some of their thoughts into the record. Leanna wrote, “Please Halt the expansion of MAID to include those facing mental illness.” Catherine wrote, “As a parent who has seen my own children experience mental health challenges while in their teen years and early twenties, I am writing to express my deep concern about people with mental illness alone becoming eligible for medical assistance in dying. The move towards this will put countless vulnerable people at risk.” Joe, in my riding, is a regular writer. I respond to most of his emails. I will send this to Joe just to make sure he knows I read his emails. His second and third points read, “By offering MAID for mental illness governments may put less money into treating mental illness.... Canadians may wish for MAID because of despair. They have not have been offered treatment for their mental illness.” Cameron talked about a friend of his who is a nurse working in a mental health unit in Calgary. Mental health for him is all about seeing the intrinsic value of every human being, as celebrating the person not for what they contribute but for the beauty of their existence. He feels that once we stop seeing the dignity of one person, we will doubt our own worth and validity. I know my time is running short, so I will not belabour this. I have heard comments from some members of the House who have tried to impugn a person's faith, religion or philosophical affiliations with whatever beliefs; although, all of us come to the House with our different beliefs. Some of them are sacred. Some of them are secular. It really does not matter where they come from, but all of us try to ascribe value to life, what that life is and what autonomy should be like. To those members, I note that I did abstain from one vote that was specifically on advance directives because I have a constituent, Jim, who communicated with me over email that he and his spouse saw the experience of his mother, who passed away from Alzheimer's, and how terrible it was. In situations like that, it is incumbent upon the government to find a way to meet the requirements of the original Carter decision so that Jim and his spouse, when that time comes, can have their wishes met.

2009 words

Feb/15/24 10:46:51 a.m.
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Re: Bill C-14

Madam Speaker, we just witnessed a great NDP-Conservative coalition. The member is reiterating the Conservatives' argument to the effect that the ruling in Gladu and Truchon was not challenged before the Supreme Court. However, the reason why it was not challenged before the Supreme Court is that people were suffering and Ms. Gladu and Mr. Truchon deserved to have relief. This was based on the Carter decision. However, the NDP voted against Bill C-14, which did not go far enough. I do not know why the member is being so inconsistent today. I would like to know whether the member is aware that, basically, his party is trying hard not to say that it lacks courage, that it is backing down when it comes to mental illness and that it is throwing the ball back into the court of the Conservatives who, as they announced, are going to do away with all of this.

159 words

Mr. Yasir Naqvi (Parliamentary Secretary to the Minister of Health, Lib.)

Feb/15/24 10:29:51 a.m.
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Re: Bill C-7 Bill C-62 Bill C-39 Bill C-14

Mr. Speaker, I am thankful for the opportunity to speak about Bill C-62 and the extremely important issue of medical assistance in dying, or MAID, and mental illness. I think all members can agree that this is a highly complex, quite sensitive and emotional issue, that raises divergent and deeply held views from the medical community, experts and the public at large. The questions of whether, how and when to expand eligibility for MAID to persons whose sole underlying medical condition is a mental illness are difficult; they do not have easy answers. The federal government believes that eligibility for MAID should be expanded to such persons. However, such an expansion should not be rushed and should not occur before the health care system is ready to safely provide MAID in all cases where it is requested on mental illness grounds. This is why we have introduced Bill C-62, which proposes to extend the temporary mental illness exclusion by three years, until March 17, 2027. The bill also includes a provision requiring a parliamentary review prior to that date. As members will recall, in 2015, the Supreme Court of Canada concluded in the Carter case that the Criminal Code’s absolute prohibition on physician-assisted death was unconstitutional. The Supreme Court held that physician-assisted dying must be permitted in some circumstances, namely, for competent adults who clearly consent to the termination of life and who have a grievous and irremediable medical condition. This decision led to the legalization of MAID in Canada one year later, in 2016, through Parliament’s enactment of former Bill C-14. Our original MAID law limited eligibility for MAID to competent adults with an eligible medical condition whose natural death was reasonably foreseeable. Our MAID framework was added to the Criminal Code and was made up of a stringent set of eligibility criteria, as well as procedural safeguards to prevent error and abuse in the provision of MAID. A few years later, the “reasonable foreseeability of natural death” eligibility criterion was challenged in Quebec; in 2019, it was declared to be unconstitutional by the Superior Court of Quebec in the Truchon decision. As this was a trial-level decision, it was only applicable in Quebec. Nevertheless, the Attorney General of Canada did not appeal the decision; instead, the federal government made the policy decision to expand eligibility for MAID. This led to Parliament’s enactment of former Bill C-7 in 2021, which expanded eligibility for MAID to persons whose natural death is not reasonably foreseeable. This resulted in the removal of the eligibility criterion that a person’s death be reasonably foreseeable and the creation of two sets of procedural safeguards for the lawful provision of MAID. The first track of safeguards applies to persons whose natural death is reasonably foreseeable; the second, more robust, track applies to persons whose natural death is not reasonably foreseeable. This second set of safeguards was created in recognition of the fact that requests for MAID by persons who are not at end of life are more complex. This is why a minimum of 90 days must be taken to assess a person for eligibility for MAID when their natural death is not reasonably foreseeable. This is not a reflection period; it is a minimum assessment period. This safeguard aims to respond to the additional challenges and concerns that may arise in the context of MAID assessments for persons whose natural death is not reasonably foreseeable. This includes whether the person’s suffering is caused by factors other than their medical condition, as well as whether there are ways of addressing their suffering other than through MAID. This second set of safeguards also requires that two practitioners be satisfied that the person meets all the eligibility criteria, and if neither of them has expertise in the medical condition causing the person suffering, one of them must consult with a practitioner who does. Involving a practitioner with the relevant expertise aims to ensure that all treatment options are identified and explored. Practitioners are also required to inform the person of available counselling services, mental health and disability support services, community services and palliative care; to offer them consultations with the relevant professionals; and to ensure that the person has given serious consideration to such alternative means to alleviate their suffering. Although this does not require a person to undertake treatments that may be unacceptable to them, it requires that they fully explore and weigh the risks and benefits of available treatment options. Former Bill C-7, as originally introduced, permanently excluded eligibility for MAID on the basis of a mental illness alone. This was not because of the incorrect and harmful assumption that individuals who have a mental illness lack decision-making capacity or because of a failure to appreciate the severity of the suffering a mental illness can cause. Rather, this was done because of concerns about the inherent risks and complexities of permitting MAID for individuals who suffer solely from mental illness. During its consideration of the bill, the Senate made an amendment that added a sunset provision that would repeal the mental illness exclusion 18 months later. The House of Commons accepted the amendment in principle, but changed the date of repeal to two years; in other words, the provision of MAID based on a mental illness alone was set to become lawful on March 17, 2023. The decision to temporarily maintain the exclusion of eligibility was based on the recognition that additional study would be required to address the risks and complexities of permitting MAID in these circumstances. This is why the former bill also included a requirement for an independent expert review respecting recommended protocols, guidance and safeguards to apply to such requests for MAID. Former Bill C-7 also required the creation of a joint parliamentary committee tasked with conducting a comprehensive review of the Criminal Code's MAID provisions and other MAID-related issues, including MAID and mental illness. The committee undertook this important work, and its interim report, which focused on MAID and mental illness, was tabled in June 2022. It urged the federal government to collaborate with regulators, professional associations, institutional committees and the provinces and territories to ensure that the recommendations of the expert panel were implemented in a timely manner. The committee's second report was tabled in February 2023. The majority view expressed was that eligibility for MAID on the basis of a mental illness alone should be permitted. However, the final report also raised a key concern that more time was needed for standards to be developed and training to be undertaken before the law should permit a mental illness to ground a request for MAID. The federal government recognized the significant progress that had been made by the provinces and territories, stakeholders and the medical community in preparing for the expansion. However, it ultimately concluded more time was needed. This is why we introduced Bill C-39, and Parliament enacted it. It extended the exclusion by one year, until March 17, 2024. This extension aimed to provide additional time for the dissemination and uptake of key resources by the medical and nursing communities. We thought it essential to prepare for the safe assessment and provision of MAID in all cases where a mental illness grounds a request for MAID. The committee expressed support for the extension in its second report. I want to take a moment to recognize the work that the federal government has done during this extension to support the fulfillment of some of the expert panel’s recommendations. For instance, we amended the regulations for the monitoring of MAID last year to ensure comprehensive data collection and reporting. Such changes allow for data collection related to race, indigenous identity and disability of persons requesting MAID. These changes came into force in January 2023, and the first set of data will be captured in Health Canada’s 2024 annual report on MAID. Moreover, Health Canada convened an independent MAID practice standards task group to develop a practice standard for MAID. In March 2023, the model MAID practice standard and supporting documents that provide guidance to support complex MAID assessments were released. Finally, Health Canada supported the Canadian Association of MAiD Assessors and Providers in the development of a Canadian MAID curriculum, which was launched in September 2023. In Canada, certain aspects of MAID fall under federal jurisdiction and others fall under provincial and territorial jurisdiction. The federal government is responsible for the criminal law aspect, whereas the provinces and territories are responsible for the implementation of MAID within their health care delivery systems. Impressive progress has been made in preparing for the expansion by the March 2024 deadline. However, the provinces and territories have all expressed that they are not yet ready. For this reason, we are proposing to extend the temporary mental illness exclusion for another three years, until March 17, 2027. The extension would allow more time for the provinces and territories, and their partners, to prepare their health care systems by implementing regulatory guidance and developing additional resources for their medical and nurse practitioners. It would also provide more time for medical and nurse practitioners to become familiar with the available training and supports. Our ultimate goal is to help ensure that the necessary protections are in place to protect the interests of individuals who may seek MAID on the basis of a mental illness alone. We believe that this issue should not be rushed. Eligibility for MAID should not be expanded until the health care system is ready to safely provide MAID in these complex circumstances. I urge all members to support the bill so our partners can get this right.

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Ms. Marilyn Gladu (Sarnia—Lambton, CPC)

Feb/13/24 7:56:12 p.m.
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Re: Bill C-234 Bill C-14

Madam Speaker, here we are again at the eleventh hour. The government has waited on something that it has to put in place; otherwise, on March 17, people whose only condition is a mental illness will be able to apply for medical assistance in dying. The Liberals are not virgins in the parliamentary process. They understand very well that, typically, for a bill to go through three readings in the House and through committee meetings, and then go to the red chamber, where a similar number of readings and committee meetings take place, takes about 18 months. If there is goodwill among all parties and we agree, it may be six months. It is ludicrous to me that less than two months before the deadline, the government put forward this legislation. It is really putting a gun to the head of opposition members, because if we decide not to pass the bill, on March 17 people who suffer only from a mental illness will be able to receive medical assistance in dying. I have a lot of compassion for people suffering from mental illness. In many cases, they have suicidal thoughts and are not full of hope for the future, so it is easy for them to say in despair that there is no way out. However, a lot of people get better and go on to live full lives. They are not in a place where they can really take that decision. It is not the first time the government has waited until the last minute. I remember when the medical assistance in dying legislation in Bill C-14 was introduced, there was a lot of pressure for us to get along and pass the bill. I would have more confidence if it were not for the fact that the government continually brings forward legislation that is unconstitutional. Then it goes through the courts to the Supreme Court and, like Bill C-69, is declared unconstitutional. The bill for the welfare of indigenous children was also declared unconstitutional. It is our job to give due process to bills and to make sure they are a good idea, rather than just rubber-stamping them and passing them along. I do not want to have the consequence that people who are mentally ill would receive MAID if we do not pass this legislation in time, but we have no guarantee that the Senate is not going to delay the bill. There was a question for the member who gave the last speech about how the Senate may choose to block the bill. That would delay it even further and we would not make the timeline. It is not a sure thing that the bill is going to get across the line. We have to look back to the Carter decision. We spent a lot of time talking about what the response would be, and it was the court's order that the criteria be an irremediable condition with imminent death. That is the path we started on. I was very concerned at the time because every recommendation from the special committee that studied this said that without good-quality palliative care, one really does not have a choice. At that point in time, I found out that only 30% of Canadians had access to palliative care. That is what prompted me to bring forward my private member's bill to get consistent access to palliative care for all Canadians. That bill unanimously passed in the House. Since then, we have doubled access, from 30% to almost 60%, which is a great thing, but there is more to go. If people do not have good-quality palliative care, they really do not have a real choice. The government needs to refocus itself. I saw in the report that after five years of progress on palliative care, there are still identified gaps. The government needs to pursue that with passion and aggressiveness because that is the answer. If people have good-quality palliative care, they do not choose medical assistance in dying, and that applies everywhere. I met today with some of the representatives from palliative care, and they informed me that when people go to hospice, nine out of 10 of them are asking for medical assistance in dying, but very few of them actually take advantage of it once they experience palliative care. Why are nine out of 10 of them asking for medical assistance in dying? It is because the doctors are recommending it, and I do not have any confidence that the safeguards that were supposed to be in place are actually being adhered to. A doctor from the Liberal Party who spoke before me cited five examples that he is aware of where clearly people did not meet the conditions but were given medical assistance in dying. Canada is on a very slippery slope. If we look at the history of countries that have implemented medical assistance in dying, the Netherlands was sort of at the forefront, and it took a while for it to experience a rise in the percentage of people who were dying from medical assistance in dying. However, last year in Canada, 4% of people who died did so by medical assistance in dying. We set a world record. We are top of the charts on killing people with medical assistance in dying. I think this is absolutely the wrong direction, so to broaden medical assistance in dying to include people who are mentally ill is absolutely ill-informed, at the very least. I would say, without being insensitive, that people who are mentally ill are actually able to kill themselves. Sadly, in their despair, many of them are taking their lives every day. They do not need the government to enable them. The Conservatives warned the government, when this ill-advised amendment came from the Senate, that this would happen. Instead of realizing the mistake and backing off, the Liberal government is kicking the can down the road for another three years, where the next government will deal with it, instead of recognizing that this is not a good idea. Doctors are saying that 50% of the time they cannot even identify whether somebody's condition, when they suffer from mental illness, is irremediable. If that is the case, then half of the time, they are going to kill someone who might have gotten better. This is a totally bad idea. The government should stand up, say it realizes the mistake it has made and that it should have introduced legislation to eliminate that mistake. However, that is not where we are today. Today, here we are: If we do not make a decision and pass the bill in a hurry, people with mental illness are going to start dying from MAID on March 17. I would say that there is a lot scope creep that has been suggested. Where do we stop? There has been a suggestion that if we approve those with mental illness, maybe minors should be added, or maybe the option of advance directive should be added. It looks like the solution to all of these things is death. We hear that homeless people are requesting medical assistance in dying. We hear that veterans are being advised to take medical assistance in dying. This is just scope creep and broadening who is dying in this way, without having proper controls in place. I do not think that is acceptable. One of the things that has been totally ignored is the conscience rights of doctors. The federal government will always say it did not preclude that in its bill, but the fact is that provinces are forcing medical doctors and nurses to participate, even if it is against their religion and their conscience rights, and the federal government has done nothing to correct that situation. That is a problem. The other thing I would say is that in the creep that is happening, they have created an express lane for the disabled. It is disgusting to the disabled community and disgusting to me that they would say that if someone is disabled, they should go to the front of the line. For the vulnerable, the mentally ill and the disabled, we need to protect those people; we need to stand up for their rights and know that we can give them hope. I do not agree with the way this was brought forward. I think the government should have appealed the Truchon decision. When Quebec decided this needed to happen, the government should have said no, that it had thought about it, studied it and spent a long time on it. It should have said it was going to appeal that decision, because what it brought in at the beginning was at least better than the scope creep we are seeing now. I have talked about the many examples of things that are not good with the legislation. Obviously, I do not want to see anymore people die. I will definitely work with the government to see the legislation pass as speedily as possible, and I encourage it to use the same leverage it used on Bill C-234 to help its Liberal-appointed senators do what it wants. I hope it does the same on this bill and that it receives speedy passage, and that we do not have people with mental illness being killed by the government.

1579 words

Mr. Pat Kelly

Feb/13/24 7:38:44 p.m.
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Re: Bill C-7 Bill C-14

Madam Speaker, it is possible that my colleague misunderstood me. What I said in my speech was that I voted for Bill C-14 because it was a reasonable response to what had to be addressed, which was the Carter decision. The reasonable foreseeability of death was a problem clause, and I thought so at the time. I thought it was awkward and perhaps not the best way to put it, so it was not a shock to me that it ended up being challenged on that basis. I think my colleague may have been overestimating my enthusiasm for Bill C-14, but I did support it, because something had to be done. However, this reckless expansion that came after the Senate amendments to Bill C-7 goes way beyond this. No court was calling upon Parliament or forcing Parliament to expand the eligibility of MAID to those whose sole underlying health condition is mental illness.

156 words

Feb/13/24 7:37:46 p.m.
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Re: Bill C-14

Madam Speaker, my colleague is claiming that Bill C-14 resulted in good legislation with its reasonably foreseeable natural death criterion. However, that did not even address the Carter ruling, since Ms. Carter did not have a condition that made her terminally ill. The Supreme Court ordered Parliament to regulate situations like those of Ms. Carter and Ms. Taylor. Limiting medical assistance in dying to people who are terminally ill completely ignores people like Ms. Gladu and Mr. Truchon, who had to go to court to assert their constitutional right. People have had to go on hunger strikes to meet the reasonably foreseeable natural death criterion. Is that what my colleague calls compassion?

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Ms. Andréanne Larouche (Shefford, BQ)

Feb/13/24 4:49:20 p.m.
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Re: Bill C-7 Bill C-62 Bill C-14

Mr. Speaker, the member for Salaberry—Suroît is a tough act to follow. This is not easy, because we all have someone in mind when we talk about this. We have all lost loved ones over the past few months and years. We all have gone through different experiences. Some people request medical assistance in dying, others do not, but one thing is certain: this is a very sensitive topic. It is with great humility and sensitivity that I rise today to speak to Bill C-62, an act to amend An Act to amend the Criminal Code (medical assistance in dying), no. 2, something we have been talking about for a long time. We must act by considering the fact that, currently, the Government of Quebec's Bill 11 does not include non-neurocognitive mental disorders as being eligible for medical assistance in dying and that Quebec wants to fill the administrative void surrounding the federal government's position on the subject of mental disorders relative to neurocognitive disorders. Therefore, I am not here to repeat my whip's testimony. I am here to provide some background and talk about Quebec's specificities. I will close by going into more detail about the Bloc's position. First, in 2014, Quebec passed the Act Respecting End-of-Life care after five years of consultations and of working together across party lines. I want to emphasize that the work was non-partisan. In 2015, the Supreme Court ruling in Carter indicated that some provisions of the Criminal Code that prohibited medical assistance in dying contravened the Canadian Charter of Rights and Freedoms. In 2016, the Liberal government passed Bill C-14, in response to Carter. In 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, who claimed that excluding people whose death was not reasonably foreseeable from eligibility for medical assistance in dying was discriminatory. As a result, the court ordered that federal and provincial laws be amended before December 18, 2020. In 2021, after a pandemic-related delay, Parliament passed Bill C‑7, which created two pathways to medical assistance in dying: One for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable. Quebec simply chose to drop the end-of-life criterion. Bill C‑7 required that an expert panel be created to review MAID and mental illness. The Expert Panel on MAID and Mental Illness was formed in August 2021 and produced a final report containing 19 recommendations. Recognizing that the legislation was flawed and that issues related to medical assistance in dying remained unresolved, Bill C-7 created the Special Joint Committee on Medical Assistance in Dying, composed of members of the Senate and members of the House of Commons, which had a five-part mandate. The joint committee tabled an interim report on June 22, 2022. There was not much time between the tabling of the joint committee's report, which was initially expected in 2022, and the March 17, 2023, deadline for excluding people from MAID for mental illness, so members postponed eligibility for one year to allow the committee to finish its work. The goal was to give the professions involved more time to develop standards of practice. At last, in February 2024, the joint committee produced its final report. The report contains only one recommendation. Bill C‑62 implements the report's recommendation by postponing eligibility for MAID MD-SUMC, for mental disorders, for three years and by forcing the creation of a joint committee one year before the report. Sections 241.1 to 241.4 of the Criminal Code govern medical assistance in dying in Canada. What is more, under the law, the government is required to oversee the use of medical assistance in dying via the Regulations for the Monitoring of Medical Assistance in Dying. I am providing all of this background to illustrate that the government could have and should have taken action a long time ago. Second, in Quebec, medical assistance in dying is governed by the Act Respecting End-of-Life Care. The activities surrounding medical assistance in dying are supervised by the select committee on end-of-life care. In June 2023, the National Assembly of Quebec passed Bill 11 to expand access to medical assistance in dying in Quebec and harmonize Quebec's legislation with the Criminal Code. There are some notable changes to Quebec's legislation. Minister Sonia Bélanger and her colleagues Roberge and Jolin‑Barette held a press conference on February 7 calling on the government to include a provision in the Criminal Code that would allow Quebec to move forward with advance requests, because, even though Quebec's legislation allows it, the Criminal Code does not. Although doctors who choose to go ahead with advance requests are unlikely to be prosecuted by Quebec's attorney general, the risk of a civil lawsuit is still there, and that will make many doctors think twice about granting advance requests. Quebec's National Assembly has passed a unanimous motion demanding that the federal government legislate on the issue. Third, the Bloc Québécois will vote for the bill on the condition that the postponement is for one year, not three. The Bloc Québécois believes that eligibility for people suffering from mental disorders must be postponed so that Quebec, the provinces and professional bodies can create a framework for their MAID practices. However, it should not be postponed indefinitely. The Bloc Québécois believes that postponing eligibility by three years will prolong the suffering of individuals who could be eligible for MAID and is contrary to their rights as guaranteed by the charters. The Bloc Québécois wishes to point out that the report of the Expert Panel on MAID and Mental Illness, as well as the Collège des médecins du Québec, emphasized that the safeguards—namely irremediability, severe physical or mental suffering, and free and informed consent—currently provided for in the Criminal Code are sufficient to allow access to MAID where mental disorder is the only underlying condition. In our supplementary opinion attached to the report of the Special Joint Committee on Medical Assistance in Dying, the Bloc Québécois points out that, even though preparations on the ground for medical assistance in dying when a mental disorder is the sole underlying medical condition are not yet complete across Canada, this does not change the fact that several professional associations, including the Collège des médecins du Québec and the Association des médecins psychiatres du Québec, would still like it to be made available in the future. The Bloc Québécois also acknowledges the requests made by several provinces to postpone eligibility. It should be noted that many countries have adopted policies on medical assistance in dying specifically for mental disorders. The Bloc Québécois deplores the government's failure to be proactive and the Conservatives' obstruction on the issue of medical assistance in dying when a mental disorder is the sole underlying medical condition and on the issue of advance requests. We fear for the patients who will have to turn to the courts to assert their rights while also bearing the burden of their illness. Finally, the Bloc Québécois condemns the fact that this bill does not distinguish between mental disorders and neurodegenerative diseases, such as Alzheimer's and Parkinson's. Quebec's law makes that distinction. It would allow people suffering from the latter category to access medical assistance in dying, as advocated by the Quebec government. In the Bloc's opinion, the social consensus on these illnesses is stronger, and it would have liked to see the Criminal Code brought into line with Quebec's end-of-life care law by allowing advance requests. In his supplementary opinion on MAID, the member for Montcalm, whom I would like to congratulate for all his work on this issue, went into great detail on the reasons that justify MAID when a mental disorder is the sole underlying condition. The position of the Collège des médecins du Québec perfectly sums up the importance of allowing advance requests for medical assistance in dying, as well as medical assistance in dying when a mental disorder is the sole underlying condition. While admitting it needs more time to ensure its members are ready, the Collège des médecins du Québec has established five guidelines for assessing eligibility for medical assistance in dying. In conclusion, the Bloc Québécois has a humanist view of medical assistance in dying that is grounded in philosophical principles and ethical arguments that reflect the evolution of Quebec society. Medical assistance in dying recognizes the right of individuals to choose for themselves, to determine the conditions for a healthy and dignified life. Medical advances allow us to sustain life, but that does not preclude the need and right of the individual to define what is an acceptable life. Section 1 of the Quebec Charter of Human Rights and Freedoms states that every human being has a “right to life, and to personal security, inviolability and freedom”. Quebec society believes that the right to life includes the right to die. In that context, we need to see medical assistance in dying as a right that gives the individual the option of avoiding terminal suffering and medical paternalism in order to maintain their dignity. By allowing medical assistance in dying, we allow people to choose how, when and where they want to pass away. Medical assistance in dying only makes sense if the person's free and informed consent is respected. The word “free” means voluntary and without constraint, and the word “informed” means with all the information needed to make such a decision. Meeting this condition is necessary for accessing medical assistance in dying. The principles we stand for concerning medical assistance in dying are equally valid in cases of mental illness. Let us not forget that the possibility of access to MAID does not mean automatic eligibility. However, when the Quebec select committee was doing its work, it made a distinction between mental disorders and neurodegenerative diseases. The commission concluded that although there was no consensus on mental disorders, there was a consensus on neurodegenerative diseases. With that in mind, the Quebec government opened the door to advance requests. Advance requests allow an individual to determine the conditions under which MAID should be administered when they have lost the capacity to consent because of their illness. In its second report, the Special Joint Committee on Medical Assistance in Dying expressed its support for advance requests. All parties, except the Conservatives, who are against any form of medical assistance in dying, voted in favour of the recommendations. As a final point, the federal government therefore has no reason to drag its feet or to deny Quebec's request.

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Feb/13/24 12:51:49 p.m.
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Re: Bill C-7 Bill C-14

Madam Speaker, I appreciate the opportunity to speak to this. Having been in this place for all the debates we have had, I have been trying to figure out the best way to explain to Canadians, if there is an argument here, why it is not between Liberals and Conservatives, or between Greens and NDP and Conservatives and the Bloc. It has actually been, from the very beginning, a struggle for Parliament to actually deal with an issue we have been kicking down the road for too long. I mentioned earlier in debate, as the member for Saanich—Gulf Islands, the quiet and extraordinary courage of a single woman, Sue Rodriguez, who took her irremediable medical condition of suffering all the way to the Supreme Court of Canada and was denied the opportunity for what is generally called death with dignity. She had the procedure illegally. Those who were with her at the time would have been subject to criminal penalty as well, including my friend Svend Robinson, who at the time was member of Parliament in a different party from a different place. It was a very fraught time, and the issue of medical assistance in dying kept coming back to me from constituents who were heartbroken that their parents or loved ones had to go through suffering. Quite often people would say to me they would not let a family pet go through this kind of suffering so why do we allow our moms and our dads to go through this when there is no prospect they are going to recover. This finally went back to the Supreme Court of Canada for a different decision that came out of the Carter case. The Carter case, back in 2015, said that refusing to allow someone the legal option to seek medical assistance from their doctor in a situation where their illness is terminal is really a violation of section 7 charter rights. I only mention this because that was also with a deadline. We have to take action on this; we cannot just leave the matter. The Supreme Court of Canada has said that this provision of the Criminal Code is actually a charter violation. That means one cannot let it just sit there anymore. It would take too much time, and my colleagues will be relieved to know I will not go through this chapter and verse, but it is a tough, tough issue for parliamentarians. At the time, as we started debating the first iteration of allowing for death with dignity, in Bill C-14, our first Minister of Justice to deal with this was the very honourable Jody Wilson-Raybould. She had to struggle with this. Our Minister of Health at the time, also very honourable, Jane Philpott, was struggling with this. It occurred to me as the debate went on that what we had in Canada on this issue was essentially a professional dispute. The lawyers in Canada wanted to make sure that the charter was respected. The doctors in Canada said they did not want to be asked to figure out what “irremediable” meant and were not exactly ready for that. Therefore, subsequent revisions kept happening because, after all, in our first attempt to get medical assistance in dying right, we did not allow for advance directives. Therefore, we had subsequent court cases where people who had terminal cancer could not access MAID because they decided they better ask for it now, which was maybe months before death would occur naturally and months before a doctor could say, “Okay, you're ready now. Nod.” One had to be able to physically sign; the day of, one had to confirm one's procedure. Again, I better not go back through all of this, but essentially the professional views of doctors pleading with parliamentarians outweighed the lawyers dealing with parliamentarians to say that we were probably still going to have charter violations, but it is better that we listen to the doctors and that they are ready. All of this ended up taking us back to fixing medical assistance in dying again to try to make it more humane, to try to respond to the concerns of Canadians from coast to coast that they wanted to be able to access an advance directive in a situation that fit the MAID template. This brought us to Bill C-7. To some of the comments that were made in this place earlier today, the government and Parliament were under a deadline that was court imposed, not politically imposed, to oblige ourselves, as parliamentarians, to meet what the Supreme Court of Canada said the charter required us to do. We had a very tight timeline, and then the Senate did something I do not think anyone in the House expected. Again, we had a professional dispute going on here. Doctors were saying they were not ready to extend this to people whose sole irremediable condition is mental illness. Public health professionals in addiction and mental health were saying they were not ready. However, with strong pressure and strong professional advice from the psychiatric community, the Senate decided we should extend MAID to those with an underlying condition that is only, and I do not say “only” as if it is a marginal or trivial matter, a crushingly painful and life-ending threat from mental illness. We are walking this fine line. The line is even finer when we start realizing who is more likely to not be able to access mental health supports; they are the marginalized and the poor. Who is more likely to not be able to imagine continuing on in life with a crushing mental illness? It is again the marginalized communities. The disability community spoke with a loud voice saying not to extend MAID as they were worried enough that it was a slippery slope when Bill C-14 first came in, and now Bill C-7. Here we are again with a court-imposed deadline. Let us be clear to Canadians watching today. Certainly, the provinces and many doctors and mental health professionals have spoken with one voice. If we do not act quickly to pass this legislation and if the Senate does not act quickly to get it to royal assent come March 17, then as a matter of reality, we are up against March 17, and medical assistance in dying would become available to people where mental illness is the sole underlying condition. Is it irremediable? We are told by the experts that no one really knows how to answer that question. Yes, some of the psychiatric community says the safeguards are there and if three psychiatrists say that it is irremediable, then that is enough. However, we are all asking where the mental health supports are, particularly for those who are marginalized. Where is the access? This is one that particularly perturbs me. I have had many people come to me from a community that has experience with using psilocybin, conventionally known as magic mushrooms, as a way to alleviate a mental health condition, which might otherwise be irremediable, with remarkable results. We know that Health Canada is currently accelerating trials on psilocybin. It strikes me as beyond a catch-22 that the authorities would say to those people and to their doctors, who think psilocybin could help them, when the alternative is that they are more likely to commit suicide, or if we do not act by March 17, they will have access to legal medical assistance in dying, and it would be too dangerous to let them try psilocybin, but the alternative is death. It seems to me that any medical risks from psilocybin pale in comparison to the irreversible reality of death. How can we let this happen? We cannot. I think we need to discuss another thing in this place, which is societal assistance in living. We know what medical assistance in dying looks like, but what does societal assistance in living look like? It means ending poverty and bringing in a guaranteed livable income for all. It means access to mental health services in this country. It means a compassionate and caring approach that says to every Canadian, whether in the disability community, the indigenous communities or the youth who are struggling with addictions, that we hear them and will not fail them. That means, no matter how members feel about it, we have to pass this legislation expeditiously.

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Feb/13/24 12:34:44 p.m.
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Re: Bill C-14

Madam Speaker, my friend, the member for Kelowna—Lake Country, and I share many of the concerns expressed today. This is one of those issues on which I would beg everyone in this place not to seek partisan advantage. The divide we have here is really the most non-partisan thing of all: the structure of our Parliament, the Westminister system, whereby we still have the equivalent of the House of Lords; that is, the Senate. The Senate put in Bill C-14 that medical assistance in dying be available to those whose underlying medical condition is a mental health condition only. Everyone here, regardless of partisanship, is struggling to make sure Canadians do not seek access to medical assistance in dying if there is another option that allows them to continue to live. It is not partisan. I would like comments from my hon. friend.

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Feb/13/24 12:04:25 p.m.
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Re: Bill C-14

Madam Speaker, this has become an issue, because it was inserted in the legislation at Bill C-14 by the Senate. Does the hon. member have any knowledge of what attitude the Senate is going to take? We are operating under the gun here. We have to do something before March 17. Do we have any indication of whether the Senate will, once the House dispatches this matter, take it up quickly?

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Mr. Luc Thériault

Feb/13/24 10:35:07 a.m.
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Re: Bill C-62 Bill C-14

Mr. Speaker, the minister did not answer one aspect of my question. Why the double standard? The minister had a full year to implement the recommendation of the Special Joint Committee on Medical Assistance in Dying concerning advance requests. An Ipsos poll of 3,500 people showed 85% support across Canada. If the minister does not know that, he is not staying on top of his file. As far as postponement is concerned, the minister has implemented the recommendation to the letter. Three years is too long. He knows that. However, he could have added another dimension to Bill C‑62. He had a year to do it. Will he introduce legislation on advance requests, yes or no? Bill C‑14 is bad legislation. The minister says that he worked carefully. People have been forced to go on hunger strikes to meet the reasonably foreseeable natural death criterion. Is that what he means by protecting vulnerable people?

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Context: House Hansard - 280 - Feb/12/24

Feb/13/24 10:16:13 a.m.
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Re: Bill C-14

Mr. Speaker, I thank hon. Minister of Justice for sharing these comments with other members of the cabinet, particularly the Minister of Health. This is perhaps the most difficult issue any of us will ever deal with as members of Parliament. Strangely enough, I will just add that, had she been alive when I was a member of Parliament, Sue Rodriguez, who went all the way to the Supreme Court of Canada for the right to die with dignity, would have been my constituent. She lived in North Saanich. There is tremendous public support in my area for medical assistance in dying being available to Canadians. However, I have to say, when it came to Bill C-14 and extending it to where mental illness was the only underlying cause, I voted for that bill only because there was a time delay, and we should be ready before it comes into effect. I support what the Minister of Justice just said. We know the provinces have spoken with one voice. I am very concerned that access to treatments for mental health are still not available and might push people toward seeking MAID because they cannot get access to something like psilocybin that could deal with their underlying causes. I very much object to using time allocation. I do not think I have ever voted for time allocation in this place, but now I must because the court deadline is approaching; March 17 is soon. We need to make sure that we do not leave Canadians in this awful gap where we do not have anything in place, as a Parliament, to deal with the current crisis. I offer those comments just to say that I will be voting differently from the way I typically have, but I still vigorously object to time allocation being used routinely.

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Context: House Hansard - 280 - Feb/12/24

Feb/12/24 1:23:10 p.m.
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Re: Bill C-7 Bill C-62 Bill C-14

Madam Speaker, let us try to calm down a bit. In this debate, the government is basing itself on the Special Joint Committee on Medical Assistance in Dying for its amendment to Bill C‑62. The Bloc Québécois would have liked to lend its support. The problem is that we believe that we should not indefinitely delay the possibility of medical assistance in dying for people with an irremediable mental disorder, when no psychiatrist worth their salt has been able to treat them or relieve their suffering. After 10, 20 or 30 years of suffering, the decision whether or not to request MAID should not lie with this person, who is supposed to determine whether the patient is eligible. We asked for an amendment to the bill. Why take three years when, last year, we were told that it would take a year to make sure that MAID for people with mental disorders could be set up in a safe and appropriate manner? The main issue we have is that, in 2015, there was an election, but there was also the Carter decision. The government and this Parliament passed terrible legislation, similar to the one Quebec adopted a year earlier. Quebec passed a law that only covers end-of-life cases, people who are terminally ill. I want to reiterate that, in the terminal phase of life, the process of dying has begun and is irreversible. People can be well taken care of in palliative care. Good palliative care, as described by Cicely Saunders at the time, is full, comprehensive, holistic support for people as they are dying. It involves adequately managing the person's pain and suffering, both physical and emotional, and supporting their family. All of this should be done in an environment that resembles a normal environment as much as possible. However, it is possible that, all of a sudden, in the midst of this process, the patient, who is slowly dying, will request MAID because, one day, they are feeling at peace and ready to let go. That is not a failure, in my opinion. It can be seen as successful palliative care. When my colleagues are about to depart this life, I hope that they will be calm and at peace. That is what I would wish for everyone. So Quebec had taken those steps. Then in Parliament came the Carter decision, which stated that Ms. Carter was not at the end of her life, but she was suffering a great deal. It was therefore decided that depriving her of medical assistance in dying impinged on her right to life. Why? She was being forced to end her life prematurely, when the fact is that letting her decide what happened next would empower her. It was up to her to define when her suffering became intolerable. It was a bad law. Bill C‑7 had to be introduced. When we began studying Bill C‑7, there was another factor that had to be considered; that was in 2021. The Carter decision states that there cannot be an absolute prohibition on MAID simply because people belong to a particular group, one that is vulnerable. It must be assessed on a case-by-case basis. The reality is that people can and do struggle with irremediable mental disorders. Irremediability is established through a rigorous process. During that process, practitioners must be certain that the person has never refused treatment that we know would have absolutely improved their situation. There are indeed people whose mental disorders cause intolerable suffering, and psychiatry does not help them. If anyone here wants to claim otherwise, I would say that they lack intellectual integrity. Psychiatrists cannot cure everyone; it is impossible. That said, psychiatry is rife with medical paternalism. That being said, what we wanted was for the government, whose Bill C‑62 is based on the work of the Special Joint Committee on Medical Assistance in Dying, to plan ahead for when it might have to introduce Bill C‑62 and include another key recommendation of the special joint committee in the bill. That recommendation was presented a year ago and was the subject of a consensus. One Conservative member even joined the majority. There is a consensus in favour of advance requests. Why was that not included in the bill? It should have been anticipated. The government knew that the date would have to be pushed back. It had a year to introduce a measure in the House that would have also covered people suffering from dementia and Alzheimer's. Why did the government not do that? We asked the government why it was not doing so when it had the chance. Quebec drafted its own legislation. It is structured, rigorous and unanimously supported in Quebec. An Ipsos poll shows that 85% of the Canadian population supports advance requests. In British Columbia, 84% supports advance requests. In Alberta, it is 84%; in Saskatchewan and Manitoba, it is 81%; in Ontario, it is 84%, in Quebec, it is 87%; in Atlantic Canada, it is 81%. I could go on. There are other figures. They vary. The results are based on a sample of 3,500 people. That is not nothing. When will the government take action? Why has it not heard this request? Why has it not spoken with Quebec, who has worked on this issue? Why did it not hear the unanimous will of the National Assembly, just last week? Why is it afraid of its own shadow? Why do the Liberals lack courage so? The last time they lacked courage, we ended up with Bill C‑14. What is the problem with Bill C‑14? The real problem with Bill C‑14 is not a legal problem. The problem is for a patient who is suffering, who, to satisfy the reasonably foreseeable natural death criterion, has to go on a hunger strike. We have seen that. The problem is for people who, like Ms. Gladu and Mr. Truchon, have to fight for their constitutional rights in court. When I say there is a lack of courage, that is what I mean. My only viewpoint is the viewpoint of patients who are suffering. The only thing I am standing for here is the suffering patients' right to self-determination. Patients had to fight an uphill battle against medical paternalism when it comes to MAID. As I mentioned last week, there was a time when the palliative care that is so dear to the heart of my Conservative friends and that I personally consider to be very important was called passive euthanasia. Doctors obstinately used aggressive life-support measures because their duty was to save their patients. As we know, every doctor thought that they could save every patient back then. It was actually doctors suffering from cancer who started to assert their right to refuse treatment. Today, cessation and refusal of treatment are part of what are considered to be good medical practices. Why are we not studying the bill today? The government is imposing a gag order. We will not be overly critical of this decision. I understand that this has to be done before March 17. We are not getting too worked up about this, but still, we have not consented and will not consent to this. Why not? It is because we wanted a bill that was based on the recommendations from the Special Joint Committee on Medical Assistance in Dying. I want answers from the government in that regard. Why the delay in expanding medical assistance in dying to people with mental health issues? We did what the committee asked. Bill C‑62 even provides for the Special Joint Committee on Medical Assistance in Dying to reconvene in order to determine whether the groundwork has been laid. That is what we are doing. We basically took the recommendation and inserted it into the bill. Then, there is the issue of advance requests. There is a consensus on that across the country, but the government lacks the courage of its convictions. The Liberals are afraid of demagoguery because there has been a lot of it on this issue. They are lumping everything together. However, at some point, they need to be consistent in their approach. The Liberals are well aware that the state's role is not to decide for the patient what is best for them when it comes to a decision as personal as one's own death. The state or the patient's neighbour is not the one who is going to die. The state's role is to determine the proper conditions and ensure that they are put in place so that patients can make a free and informed choice. If people are worried about abuse or the slippery slope when it comes to advance requests, then they should look at Quebec's law, which is a model to follow. The government could have easily inserted elements of the Quebec law into its regulations. It is all well and good to say that the law is a little vague, but the amendment we are making to the medical assistance in dying legislation, expanding section 241 of the Criminal Code, is followed by a procedure, regulations on enforcing regulations. That is where the various safeguards are put in place. There are standards of practice when it comes to mental disorders. A year ago, a committee began looking at standards of practice, and they will be sent to the regulatory bodies in each province, namely the colleges of physicians. Once we have clear guidelines and standards of practice and the criteria I was talking about earlier are met, someone in a suicidal crisis will not have access to medical assistance in dying. It bears repeating, because I am hearing a lot of confusion over this. A suicidal person is not eligible for medical assistance in dying, even if they suffer from a mental disorder and are in suicidal crisis, and even if they have recently been admitted to care and diagnosed. I have often asked psychiatrists if they thought that giving access to medical assistance in dying to people with mental disorders could also provide an opportunity for prevention. Some people commit suicide and no one sees it coming. No one knows those individuals today, no physician took them on. For example, knowing that MAID is an option, a person might come forward because they are suffering and want to exercise that option. Well, that person would not qualify. However, they would then be taken care of and get the treatment they need, since suicidal ideation is reversible. There is no question about that. However, it is not about those patients. When we asked the chair of the expert panel, psychiatrist Mona Gupta, how many patients in her practice would have been eligible, she told us of two or three patients over her entire practice. Still, these are people who are suffering. When people talk about the fact that the resources are not there—the resources in terms of someone to assess capacity, for an independent psychiatrist to look at a case—I would point out that right now, the decision-making capacity of a person struggling with a mental disorder, but who has cancer, for example, is verified. Psychiatrists are currently assessing the decision-making capacity of people with a mental disorder and a comorbidity. Depending on their condition, practitioners are able to determine the decision-making capacity of these people who have a mental disorder. The Supreme Court was clear: Not allowing these people to access MAID creates stigma. Not only does it stigmatize them, it discriminates against them. Why infantilize and weaponize people who have a mental disorder and who, in their entire existence, have not found treatment that can alleviate their suffering? I rather like having discussions and debating with my Conservative colleagues. They have a sense of conviction, but there are some Conservatives who use scare tactics and conflate everything. It is not enough to repeat some 20 times that someone came to say that irremediability is hard to address. Everyone agrees. Even the expert panel starts with that. They did not hide that fact. In fact, they say that because irremediability is hard to establish there must be safeguards and precautionary principles put in place. I therefore move the following amendment: That the motion be amended in subparagraph (b)(ii): (a) by adding after the words “be deemed referred to a committee of the whole,” the words “that an instruction be deemed to have been given to the committee granting it the power to expand the scope of the bill so as to take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care,”; (b) by replacing the words “deemed reported without amendment” with the following: “deemed reported with the following amendments: That the bill be amended by adding the following new section 241.21 to the Criminal Code: New section 241.21 Medical assistance in dying eligibility criteria for advance requests “241.21 The government of a province may establish a medical assistance in dying framework for advance requests from persons who have an illness that could deprive them of the capacity to consent to care, in accordance with the laws of that province.””; and (c) by replacing the words “deemed concurred in at report stage” with the following: “deemed concurred in at report stage, as amended”.

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Context: House Hansard - 280 - Feb/12/24

Feb/12/24 12:42:41 p.m.
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Re: Bill C-14

Madam Speaker, when it comes to MAID, this government is not exactly a shining example of proactivity. After the Carter decision, it took a long time for the government to table a half-decent bill. Bill C‑14 was pretty worthless. It was a poor imitation of the Quebec legislation and was far from addressing the crux of the Carter decision. That being said, the issue of proactivity is still relevant. Regarding MAID for people with mental health conditions, a three-year delay was unnecessary; one year would have been enough. The government has been aware of that for a year, since it is basing its decision to kick it down the road on the consensus recommendations of the Special Joint Committee on Medical Assistance in Dying. Why has the government not done anything on advance requests for the past year? Why is it dragging its feet? Why is it not basing its decision to go ahead with this on the joint committee's key recommendation?

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

Feb/12/24 12:04:27 p.m.
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Re: Bill C-62 Bill C-14

Mr. Speaker, it is a pleasure to rise to speak to a very important issue. This is a deeply personal and complex issue, one that has had a great deal of debate in the House for number of years now. We are not directly speaking to that. Rather, we are speaking to the motion that would enable the government to get the MAID issue resolved for the next few years. The motion would ensure that the legislation actually passes. I will give a little background on that. There is a time limit for us to ultimately get Bill C-62 passed in order to fulfill our commitment to the court. Obviously, we want to keep the law validated, appropriately. The motion we have brought forward today would allow for the House, while providing some time for the Senate, to pass and give royal assent to the bill before the House breaks in March for a couple of weeks. In essence, it allows for a little more debate this week, when it will ultimately pass. It would then afford the Senate, in the week following the break, the ability to deal with the legislation and hopefully pass it without amendment. This is very important, as that would then enable the legislation to receive royal assent before the deadline. I know some members may be a little uncomfortable with respect to this programming motion before us today, the limitations that it puts on members and the importance of the subject matter itself. As some members may recall, last week I stood in my place and asked for unanimous consent to sit late in the evening. That way, members would have had more opportunity to have debate on this issue. Unfortunately, we did not get unanimous consent. As a direct result, we have to work within the time frame of when the House allows us to sit. As a result, in order to meet the deadline, we have brought in a programming motion. I made reference to the very beginning, about when we started to talk about the issue of medical assistance in dying. It came up in 2015. A Supreme Court of Canada decision, Carter v. Canada, made it very clear that we, as a government, and Canadians, through the Charter of Rights, needed MAID legislation. That was decided midway through 2015, but no action was taken, knowing full well that we had to bring in a law to address what the Supreme Court had put in place. We all know that an election took place. Shortly after that election, it was made very clear that as a government we needed to bring in the legislation. An approach was made to the Supreme Court to take into consideration what had taken place over the last number of months following its decision, including an election. The Supreme Court ultimately provided grace to the House of Commons so that we could, in fact, get the necessary legislation brought forward to the chamber and ultimately passed. We did have to ask for yet another extension back then. I do not think that surprised anyone. From the day we can recall, in 2015, there was a great deal of discussion that had taken place. In fact, I suspect, if one were to take a look at the different pieces of legislation, today, we call it Bill C-62, and the original legislation was Bill C-14. We have had legislation in between those bills, which the government had to bring into the House. On occasion, when the government brings in legislation for debate, there is fairly extensive debate not only in the chamber but also in committees. I can remember, quite vividly, a lot of the debate, the issue for which the special committee was put together to deal with the issue and to provide some thoughts, recommendations and ideas to the chamber and the members who were directly involved. There is no lack of interest or input from the many different stakeholders, of all different natures, in every region of the country. Everyone had an opinion on the issue. In the end, the amount of dialogue that went into the legislation and the creation of MAID, was probably greater than 90% of all other forms of legislation that come to the House. We saw that in the passion of the debates presented at the time by members of Parliament on all sides of the House. It was not just Liberals, New Democrats, Conservatives or the Bloc, or even the leader of the Green Party at the time, where one could see the emotional toll of the debate. That is why I talk about it being of a very deep, personal nature. There are complex choices and decisions that have to be made on this. When I reflect on that debate, there were tears inside the chamber. There were all sorts of emotions as members tried, in the best way they could, to explain why they were taking their positions on it. Different members voted for different reasons and so forth. In the end, Bill C-14 ultimately passed, after many hours of debate inside and outside. When I say outside, I go even further than outside of standing committees. There were emails, correspondence and discussions that I had on this issue, and it was fairly intense. People wanted to know how I felt about it. I am sure all members of Parliament were questioned about what they had to say on the legislation. I do have differing opinions from members across the way and maybe even, quite possibly, within my own caucus. I genuinely believe that the need for MAID is there. There is no question about that. However, where I fall on the side that it seems to be acceptable, at least for a good percentage of people I represent, is to have trust and confidence in our system of health care professionals, social workers and support people whom family members go to when the time comes to make difficult decisions, such as another family member, a local pastor or anyone else. Having that confidence has allowed me to feel comfortable as we have gone through this legislation, virtually from day one. There was a need for changes. To bring in substantive legislation for the first time that so profoundly impacts the lives of Canadians and to expect that the legislation would be perfect and would not require change is somewhat naive. That is in fact what took place. There was a need to make some changes to the legislation. That is why, ultimately, we had the second go-round of the legislation. There was a fairly wide discussion on that second attempt and, through amendments, something that is now very challenging was brought in, which deals with mental health as a sole condition for MAID. I know that has stirred the emotions of a lot of members and, ultimately, when the legislation passed to allow it, there was a lot more resistance to it than there was to Bill C-14. It did not surprise me, because of the delicacy of the issue. Again, I fell back to what I believe a vast majority of my constituents are comfortable with, which are the health care professionals and others, because I am not a medical doctor. I do not understand the issue to the same depth as do the different professionals. As a direct result, I feel more comfortable taking the same position as the government took on the issue. However, we also need to recognize the reality that other jurisdictions are very concerned about the implementation and about the degree to which we are ready to implement the legislation that was passed. That is really the crux of it. Therefore, we have Bill C-62 today, which would allow for that ongoing exemption to continue. That would enable the system, which is large and complex, to ensure that everything is ready. Then, if the legislation takes effect, people would not be let down, and we would still be able to meet the constitutional requirements. Let us remember that the amendment to the original legislation, in part, came from an appeal court in the province of Quebec, which obligated members of the House to bring forward other legislation. I know my friend opposite, from the Conservative Party, says that we had a choice and that we could have appealed that decision to the Supreme Court of Canada. As a number of them said, we could have attempted to kick the can down the road. Ultimately, it was a decision made and supported by a majority of members of Parliament in the House. Even though the Liberal government had a majority, when it came to Bill C-14, members know full well there were members from all sides who supported it. Today we have a minority situation, and the only way we can pass legislation through to have the support of other political entities inside the chamber. I would like to think that what we learned through this process has enabled us to look at other things we have been able to do directly. During many hours of the debates, people talked about palliative care, hospice care and about the lack of that type of care being provided to the people of Canada. It has been a genuine concern for many years, probably a good 20-plus years, where we needed to see more invested in hospice and in palliative care. Far too often we see individuals who are panelled in our hospitals because there is no place for them to go outside of the hospital. If we look at what took place during the pandemic, we saw that care facilities had to close the doors to people from outside to protect those on the inside. Those on the inside were often dying prematurely, and we know that as fact. Organizations like the Canadian Forces or the Red Cross were involved. If we take a look at the bigger holistic picture, are we collectively, and contrary to what some might say, it is not just Ottawa, doing enough to be able to deal with these social issues that Canadians have a high standard for? They want politicians of all political stripes and of all levels of government to invest more resources. I am talking about not only money, but also time and debate. There are probably better ways in which we could spend some of the money that is spent in areas such as health care, social services and so forth. One could take a look at the process for someone who might, first, end up in a hospital situation, and while in the hospital, they find out that things are not good and that their life is going to come to an end in a relatively short time. One of the things that happen is that hospitals can provide only so much in terms of treatment. There is no consistency within a province, let alone the nation, as to which individuals are being kept in the hospital. Because there are not enough supports in a home atmosphere and there is no other place for an individual to go, far too often they become panelled in a hospital facility in one form or another. I believe the debates we have seen on MAID amplify that. These are the types of discussions and debates that we should be having, not only here in Ottawa but also in our communities and at the different legislatures. Quite frankly, there are some fairly significant stakeholders out there who also have to play a role, like non-profit organizations. That is what I recall about some of the discussions we have been having over the years in regard to MAID legislation. Unfortunately, as I pointed out, the original thoughts in regard to MAID and the need for us to bring in legislation and the types of debates that we saw then are in contrast to today, as it is becoming more of a politicized issue. Politics seems to be more important than the issue itself in some ways. That is why at the very beginning I referred to the fact that it is not a good thing that we had to bring in a programming motion, but it is important that we do it today, because we were not successful at getting the consensus required to be able to sit longer to allow for a consensus to emerge as to how the legislation could pass through the system. However, we still have an opportunity. The motion talks about going to the Standing Committee on Health as the subject matter. When this motion passes, it will enable the Standing Committee on Health, as its first priority in terms of the resources of the House, to meet. A minister will in fact be there for a good hour. There will be an opportunity to have a few other witnesses. It will ultimately have to go through the committee. If we can get this motion passed, after this legislation goes through committee it will come back here to the House of Commons for third reading later this week, before being dealt with in the Senate in the last week of February to March 1. That time frame will enable it to ultimately get the necessary royal assent in order for it to be enacted into law. Based on what the legislation would actually do, I would think that the Conservatives, in particular, would support it. The essence of the legislation is to put in a three-year extension. It provides for particular provinces and jurisdictions to be able to get things in a better state of readiness, so that, at the end of that period of time, we are able to provide the types of services that are necessary. This means, in good part, that there will be ample time for us to continue to have that dialogue and debate, and if there is a need to do and bring forward other things, whether it is through private members' business or government business, that there are opportunities. However, I suspect, by passing Bill C-62, that a sound majority of the House will be content with the modernization, if I can put it that way, of the legislation. In one part, it reminds me of the issue of the suicide crisis helpline, and I say that for two reasons. One reason is that some members often will make reference to how the legislation as a whole is enabling individuals to virtually have suicide upon request, which is just not the case. We know that is not the case, and the members who say it know that is not the case but unfortunately we still see some members give that false impression. I find that to be somewhat unfortunate, because it is definitely misleading and does a disservice in terms of the legislation and the thorough process that we have gone through. I cannot imagine the number of hours, and we are talking three digits and more of hours of different types of discussions in many different forums. To try to simplify it by calling it “suicide on demand” does a great disservice to the legislation and to the law that we currently have in place. The reason I bring up the suicide helpline is that someone indicated to me that there are people who, at times in their lives, give it thought. When they heard about the MAID legislation, they made inquiries, and because of those inquiries they were able to get the type of assistance that made things better for them. In other words, MAID legislation, on occasion, I would ultimately argue, has actually even saved lives. An hon. member: Oh, oh! Mr. Kevin Lamoureux: Madam Speaker, a doctor in the House laughs at that. I do not believe it is a laughing matter. I think the member should reflect in terms of all the debates and discussions—

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Context: House Hansard - 277 - Feb/7/24

Context: House Hansard - 277 - Feb/7/24

Feb/7/24 6:58:15 p.m.
Watch
Re: Bill C-7 Bill C-14

Madam Speaker, I appreciate the comments of my colleague, who always speaks very calmly and moderately. It is a pleasure to serve with him. The NDP voted against Bill C‑14, which did not address the Carter decision's requirements at all. Bill C‑7 met the Carter decision's requirements with additional changes that required hard work, to clarify the issue. Is the NDP saying no to the idea of one day moving forward on mental disorders, or would it rather put the subject off indefinitely? We could start working on this tomorrow morning, and I am convinced that within a year, we could come up with something very promising.

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Mr. Luc Thériault

Feb/7/24 6:31:26 p.m.
Watch
Re: Bill C-7 Bill C-14

Madam Speaker, that is an excellent question. In the supplementary report that I tabled, I note that, if we had had more time, we could have engaged with these people. By engaging with these people, we could have understood exactly what their concerns were. A certain number of associations did tell us that everything was ready for us to do this. The member knows that. For example, the Association of Medical Assistance in Dying Assessors and Providers came and told us after Bill C‑14 and Bill C‑7 were introduced that not all doctors were trained to be MAID providers. There was only a small number and they would be able to meet the demand. When it comes to mental disorders, we are talking about an even smaller number still. The people from this association felt that they were able to do this safely. There was also the Canadian Psychiatric Association, the Canadian Bar Association, the Association des médecins psychiatres du Québec, the Federation of Medical Regulatory Authorities of Canada, the Nova Scotia department of health, and so on. It comes down to the way people followed the debate and the way they debated within the governments because they sometimes have other concerns. I would have liked to hear them. The government did not call on us as soon as Parliament returned so that we could do a review and ask all of the questions we had. We could have even gone out into the community to see what was missing, but we were unable to. Here is what I think: We could do it right now, in the next year. We need to work together, get out there and explain it, see what is going on, and share the guidelines. Then, if we need another year, we can take it. Waiting until 2027 to do this is definitely not a progressive way of going about it.

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Context: House Hansard - 277 - Feb/7/24