- Member of Parliament
- Member of Parliament
- Liberal
- Thunder Bay—Rainy River
- Ontario
- Voting Attendance: 64%
- Expenses Last Quarter: $144,359.62
- Government Page
- Feb/15/24 4:03:00 p.m.
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Mr. Speaker, let me start by apologizing to the four or five people who might have listened to my last speech and who are here listening again today, because this is going to sound a little repetitive.
I certainly support the legislation, and I know there are a lot of people out there who are really worried about allowing MAID for mental illness. There are people who are worried about their friends. There are people who are worried about their parents. I am most sympathetic to people who are worried about their children. I have six children, and I know that they are going to, at some point in their life, go through difficult times. I would certainly be a little worried for them if we were to allow MAID for mental illness to be implemented with the current safeguards.
I know that there are also many psychiatrists who are worried about and/or oppose the legislation. In fact, the latest statistic I heard was from a survey that showed that about 75% of psychiatrists were against it. They are worried that their patients who would otherwise get better would instead resort to MAID.
Let me take a step back and look at the arguments coming from the other side. People are going to say, “Why not? Is it not a matter of personal autonomy? Is it not my body and my choice?”. This is not about the state's dictating to the individual what they can do with their own body. It does not criminalize trying to commit suicide or committing suicide. This is about what role, if any, the state should have in assisting people to commit suicide.
I am going to come back to the issue of whether MAID for mental illness is the same as assisting suicide.
The question of whether the state ought to take a role in assisting people in ending their lives is, I think, a little like the question of whether the state should try to prevent people from killing themselves. This is a topic I know something about, having worked a lot of years as an emergency room physician. In that role, my job, if somebody came before me and was suicidal, was to keep them in the hospital, even against their will, to prevent their suicide from happening.
Occasionally people would ask why I should I have that power, saying, “ Is it not my body, and my decision to make?” I think that there are two legitimate reasons for the state to try to prevent people from killing themselves. One is to protect someone from themself. When one is in the depths of depression, they cannot realize that things will get better; that is partly why someone is so depressed and wants to kill themself. The reality for most people is that they do in fact get better.
The other legitimate reason for the state's intervention is to protect the family. The person who commits suicide is dead. The rest of the family lives on and lives with the pain, but it is not only that; they are constantly haunted by whether the death was because of something they did or did not do.
Some people are going to say that, no, MAID for mental illness is not the same as assisted suicide, that we are talking about a small group of people who have intense, prolonged suffering and have tried every form of treatment but nothing has worked, and that it is cruel and unconstitutional to not allow those people access to MAID. I disagree. The Canadian law is far more permissive than, for example, the Dutch law. There is absolutely no requirement that all forms of treatment have been tried and been unsuccessful. Our law does not even require patients to have tried any treatment at all; it requires only that the patient have no other treatment that is acceptable to them. There are going to be people who refuse all forms of treatment altogether.
I know that there are people who support MAID for mental illness who will say that the safeguards are going to come from the medical profession, that they are going to require someone to have tried all forms of treatment beforehand. Unfortunately, I do not have the same sort of faith in the medical profession's doing that. Why do I not? If we look at what has happened with the MAID regime for people with physical illnesses, we see that there are a lot of MAID practitioners who are very zealous about its being all about one's personal autonomy and saying it is not for them to question someone's suffering, and who are quick to approve people.
Let me give some examples from the media. The Fifth Estate aired a program that said that a 23-year-old diabetic going blind in one eye was granted MAID. Another person, a 54-year-old man, had back problems, but his main problem seemed to be that he was worried about losing his housing and ending up on the street. He too was granted MAID.
CTV published a couple of relevant articles. A 51-year-old woman was actually granted and got MAID for multiple chemical sensitivities. Again, from CTV, a 31-year-old woman who seemed to use a wheelchair from time to time and had multiple environmental allergies, applied and was approved for MAID; again, however, her main problem seemed to be that she could not find suitable housing.
There are those who have such faith in my fellow doctors to come up with the system and all the safeguards, but I do not share the same sort of faith. I, as someone with a lot of children, realize it is inevitable that at times in their life they are going to go through a hard time, the breakup of a relationship or financial hard times. I am really worried that they would walk through the door of a zealous practitioner who will tell them it is all about personal autonomy and is their decision to make, because who is the doctor to question their suffering. There is not any requirement in the current legislation that the MAID practitioner talk to the family or the previous treating practitioner to find out whether in fact the depression was motivated by, for example, the breakup of a relationship.
I also want to talk about what I think is a really fundamental and perhaps fatal flaw in the current regime with allowing MAID for mental illness, which is the problem, the impossibility, of determining irremediability: Who is not actually going to get better? I have spoken previously about the inability of suicidal individuals to appreciate the fact that they are going to get better. Some people would ask whether there are people who are not going to get better, who are irremediable. That is in fact the requirement of the legislation. The problem is that doctors do not have a crystal ball. They are not really good at being able to determine who really is irremediable.
In fact, a recently published study looking at the ability of clinicians to determine irremediability for treatment-resistant depression concluded:
Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard of irremediability cannot be met....
Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of [MAID] assessments.
For me, as a long-time medical doctor, it is absolutely mind-boggling that there are medical practitioners and psychiatrists who are not particularly bothered by the fact that they really cannot say whether the illness is irremediable, and would grant MAID. If we allow MAID for one such person who would actually get better, to me it would seem tantamount to the same sort of tragedy as the state's hanging someone who later turned out to be innocent. We in this place cannot let that happen.
Last, let me address the assertion of proponents of MAID who say that it is inevitable that the Supreme Court would find not allowing MAID for mental illness unconstitutional because it is allowed for physical illness. I think that, yes, there would be a finding that such a provision would violate section 15 or section 7, but as always, the question comes down to the section 1 analysis and whether the state's actions constitute a reasonable limitation as prescribed by law that “can be demonstrably justified in a free and democratic society.” I do not think the answer to that is clear. It is not just me; there was a letter written by 32 law professors who came to the same conclusion: it was not clear whether it would be found unconstitutional.
I am not going to say that we should never allow MAID for mental illness; in fact, I know personally of a case where this might have been the ethical thing to do, but I think we are a long way now from being in a situation where we should start to allow it. I would prefer the pause be indefinite, but so be it. We have what we have. Let us look at it in two years and see what has changed. I doubt very much will have changed.
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- Feb/13/24 7:41:34 p.m.
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Madam Speaker, let me start by saying that I am sharing my time with the member for Sarnia—Lambton, which, I have to say, is a little bizarre.
I support this legislation, a further three-year hold on allowing MAID for mental illness, and, in addition, imposing a requirement in two years' time to reform the MAID committee to re-examine this question.
I know there are a lot of people out there who are worried about MAID for mental illness. People are worried about their parents. People are worried about their siblings, and I can most appreciate that people are worried about their children. I have six kids and I, frankly, would be worried if we were to implement this legislation as is, because I do not think there are adequate safeguards. Everyone who is a parent realizes that our children will inevitably, at some time, go through difficult times.
I also know that there are many psychiatrists out there who are worried about this, and the majority of psychiatrists are against this. They are worried that their patients, who would otherwise probably get better, would instead resort to MAID. To all these people, I think their concerns are totally justified. I do not think there are adequate safeguards in place at the moment.
Let me step back a bit and look at the approach of those who are advocating for MAID for mental illness to start right now. For them, it is all about personal autonomy: “It is my body, my choice. Who are you to second-guess whether I want to live or not?” This is not the state dictating to people what to do with their own bodies. It is not criminalizing either suicide or attempted suicide. This is a question of what role, if any, the state should have in assisting people to commit suicide.
I am going to get back to the question: Is MAID for mental illness really the same as suicide? The question of whether the state should be assisting people in committing suicide is closely akin to the question of whether the state should help to prevent people from committing suicide. This is something that I have a bit of experience with, because for a lot of years, as an emergency room doctor, I would see people who were suicidal, and it would be my role, if I thought they were suicidal, to keep them in the hospital, even against their will. People would ask me why I should have this power. They would ask, “Is it not my right to decide what to do with my own body?”
In thinking about it, I thought, well, the state has two legitimate interests in trying to prevent people from killing themselves. One is to protect people from themselves, because when they are in the depths of depression they do not realize that things will get better. That is partly why they are so depressed and why they want to kill themselves. However, the vast majority of people do get better.
The other legitimate reason for the state to intervene is to protect the loved ones. The person who dies is dead; they are not suffering any more pain. The people who continue to feel the pain are those who have lost their loved one. In addition, they often spend the rest of their lives thinking about whether this had anything to do with something they could or could not have done.
I know there are people who are going to say this is different: MAID for mental illness is different from assisting suicide, and the people they are talking about with respect to MAID for mental illness are people who are chronically, desperately ill, who have tried all forms of treatment and for whom nothing has been effective. They say that it is really cruel and unconstitutional not to help those people. I disagree.
First of all, the Canadian law, unlike the Dutch law, is very permissive as to who meets the requirements. There is absolutely no requirement that the person has tried all forms of therapy and they have failed. In fact, they do not have to have tried any form of treatment at all, because the legislation would require only that there are no other treatments acceptable to the patient. I know, from being a doctor, that people are going to refuse all treatment. They are going to refuse medications. I know those who support MAID for mental illness are going to say, “Okay, it is not in the legislation, but it is up to the medical profession, the doctors, to impose these requirements, like trying all forms of treatment, even if the law does not.”
I hate to say it, but as a doctor I do not have the same faith in my own medical profession, and the reason for that is that we ought to have learned from what has happened with MAID for other forms of physical disability. There are a lot of zealous MAID practitioners out there who absolutely believe that personal autonomy is paramount and do not think we ought to be questioning why somebody decides to take their own life.
Let me give some examples from the media. The Fifth Estate, a very good show, talked about a 23-year-old diabetic person who was losing sight in one eye, who applied for and was granted MAID. Another story was of a 54-year-old man with back problems, but his real problem seemed to be that he was afraid of losing his apartment and ending up on the street. He too applied for and was granted MAID.
CTV documented the story of a 51-year-old woman, who applied for and actually received MAID for multiple chemical sensitivities. Another story was of a 31-year-old woman approved for MAID for needing a wheelchair. I do not think she actually really needed it, but she usually used a wheelchair and had multiple environmental allergies. Again, her problem was mostly that she could not find adequate housing. Again, this person was approved for MAID.
To those who have such faith in the medical profession that they say we are going to create the safeguards, they are perhaps a little naive. I would sincerely worry if we were to implement this legislation with the safeguards in it right now. I have six children, and I know, almost inevitably, that life is such that they are going to go through difficult times, such as the breakup of a relationship or hard financial times. I would be worried they would see one of these zealous practitioners who believe in personal autonomy, who would say, “Who am I to question your suffering?”
Part of the problem is that the current legislation would not require the MAID practitioner to talk either to the family or to the treating doctor, so they are not going to find out that the depression was the result of the breakup of a relationship or the person's not taking their medication.
I also want to briefly talk about the problem with allowing MAID for mental illness and the question of irremediability. Part of the problem with allowing it for people who are depressed is the fact they cannot see that things are going to get better, but people are going to say that surely there are people out there who are not going to get better, which is the requirement of the legislation: One needs to have an irremediable illness.
The problem, though, is that doctors are not really good at predicting who is not going to get better, especially with respect to mental illness. With things like cancer, it is different.
A recently published study that looked at clinicians' ability to determine irremediability for treatment-resistant depression concluded, “Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard for irremediability cannot be met”.
Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of MAID assessment.
For me, as a long-time doctor, it is almost mind-boggling that there are practitioners out there, psychiatrists, who are not particularly bothered by the fact that they cannot be sure somebody's condition is irremediable. It would be absolutely terrible to take someone's life when they could actually get better.
Lastly, let me address the assertion of some proponents of MAID that it is inevitable that if this was to go to the Supreme Court, it would find it to be unconstitutional, because it discriminates against people who have mental illness rather than physical illness. I do not think it is at all inevitable. Yes, a court would probably find this to be a violation of section 15 or section 7, but the real question, as in a lot of constitutional questions, is the section 1 analysis. Does it constitute a reasonable limitation “prescribed by law as can be demonstrably justified in a free and democratic society”?
I think that is highly questionable, but never mind my opinion. There was a letter written by 32 law professors to the relevant ministers a year ago, stating the same thing, which is that it was not clear this would be found unconstitutional.
I am not going to say I do not think we should ever allow MAID for mental illnesses. I, in fact, know someone to whom perhaps the only humane thing would have been to offer it. However, we are very far at the moment from being in a position in which I would be willing to advocate for MAID for mental illness.
Let us vote for this legislation. Let us re-examine it in two years' time.
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- Feb/13/24 12:32:30 p.m.
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Madam Speaker, the member mentioned people in the disabilities community. I too have heard from the disabilities community about its opposition to MAID within that community. I wonder whether she could comment on what she has heard from people with disabilities regarding MAID and whether she thinks perhaps we need to have more safeguards for MAID for people with other forms of physical disabilities.
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Madam Speaker, I have not in fact read the report. At the moment, the problem is that we have 10 provinces and three territories that are all expected to come up with the appropriate safeguards, and I do not think any of them have actually publicly come forward with those safeguards.
I would further suggest that it ought not be the colleges of physicians and surgeons that are put in the position to have to put those safeguards in. It is up to us, the elected representatives who are accountable to the people, who ought to be the ones making those decisions, not the colleges of physicians and surgeons.
I would agree with the member that one person who stays in suffering is too many; however, I would also suggest that one person whose life is taken prematurely because of an overly liberal approach to MAID and the pain that that causes, particularly to the family, ought to be something we consider before making any decision that would allow that to happen.
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Madam Speaker, I support this legislation putting a one-year hold on allowing MAID for mental illness.
We need to hold off on this until we have a broader consensus as to if and how we are going to do this. We need more safeguards in place. If we are going to do this, we need to make sure that we do it right. I do not think that we ought to have an automatic start date in one year as is planned.
To be clear, yes, I support this legislation in that MAID for mental illness will not be allowed beginning in March. However, from my perspective, we ought to make this hold indefinite. I know there are a lot of people out there who are really worried about this legislation because they have loved ones who are going through a hard time and they think, probably rightly, that some of those people will want to access MAID.
There are parents, siblings, partners, spouses and friends who are worried. Parents touch my heart the most because they are worried that the lives of their children could be affected. I can certainly sympathize with this because I have six children of my own. One does not have to be a parent to realize that almost everyone goes through a difficult time at some point in their life, hence our concern.
I know there are also a lot of psychiatrists out there who are really worried about this. There are psychiatrists who know that if their patients were to have more treatment, they would probably get better, but they are requesting MAID at this time.
Both these groups have legitimate concerns about this legislation. At the moment, I do not think the safeguards are in place, and if implemented now, the law would end up affecting a lot of people in a way that was not intended.
What is the intention of the law? I would submit that the intention of MAID for mental illness is that it should only apply to a very small group of hard-core cases. This seems to be the case in Holland, where only one in a thousand people, I am told, who apply for MAID for mental illness are actually granted it.
It is not intended for a 25-year-old who was abused as a child and has had intermittent depression ever since. It is not intended for the 30-something-year-old who remains depressed a couple years after the breakup of a marriage. It is not intended for somebody who is schizophrenic and is fine on their medication, but having stopped their medication, now wants to access MAID.
Some out there may say, “Why not? It should be the individual's choice”. As a teenager, I read Jean-Paul Sartre, and at the time, I agreed with him that the ultimate choice in life is being over nothingness. Perhaps I still agree with this. However, neither suicide nor attempted suicide is illegal in Canada. The question today is what role, if any, the state has in assisting suicide.
I worked a lot of years as an emergency room doctor, and I saw many people who were suicidal. My job was to assess whether people were suicidal, and if they were, to bring them into the hospital even if it was against their will. The law gave me the power to do so.
Many people would ask what right I have to tell someone what to do with their body and say that it should be their own choice. My response to them is that I think there are two legitimate reasons for the state intervening to prevent suicide.
One is in order to protect people from themselves. When someone is in the depths of depression, they do not see a light at the end of the tunnel. They cannot contemplate the possibility, let alone the probability, that they are going to get better. That is the nature of depression. That is what makes someone suicidal. Most of us know that, eventually, with a change of circumstances and enough time, people actually do get better.
The other legitimate reason for the state to interfere is to protect loved ones. A person who commits suicide is dead; they feel no pain. However, the loved ones continue to live the rest of their lives with the anguish of losing someone, often haunted by feelings that perhaps it was because of something they did or did not do.
The suicidal individual's inability to appreciate the possibility that they might get better should certainly make us reluctant to allow MAID for people with mental illnesses. Some people would ask whether there are people who really will not get better and who are irremediable. That is the requirement of law: The illness has to be irremediable.
The problem with that is that doctors are not really good at determining who is irremediable. Doctors do not have a crystal ball that can predict the future. In fact, studies show that doctors are not good at determining who is irremediable.
A recently published study by Nicolini et al. looked at clinicians' ability to determine irremediability for treatment-resistant depression. It reviewed 14 different studies. I will cite its conclusion: “Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard for irremediability cannot be met”. Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of MAID assessments.
As a long-time doctor, I find it absolutely mind-boggling that there are practitioners out there who are willing to administer MAID to someone knowing that perhaps with a bit of extra time the person would have gotten better. Good doctors worry about making mistakes. Good doctors do not want to kill off their patients. It seems to me that if there is even one person who is administered MAID and who, if they had not been given MAID, would have gone on to a happy life, that is a horrific tragedy. I would say it is something akin to capital punishment when it turns out the person was actually not guilty of the crime. If this happens, it is certainly on the conscience of every one of us in this place.
The number of people we can confidently say are irremediable is probably small. Some would say no, but I would offer a few comments. One is that anyone under 40 should never be considered irremediable, and in fact anyone under 60, unless they have had ongoing years of illness. I would also suggest that somebody who has not tried every kind of treatment and has not seen a lot of doctors and therapists should not be considered irremediable. Who is left? Perhaps if there is some 75-year-old who has no family and who has undergone many years of illnesses, tried every sort of treatment available and seen numerous doctors and no one can help, then maybe, and I emphasize the “maybe”, they should be considered for this.
Do I believe that the law, as implemented now, would really be confined to that small number of cases? No, absolutely not. Like a lot of members, I have been paying attention to the media and have heard of the many cases where we are just left shaking our heads that somebody would allow MAID for that. The reality is that there are a lot of practitioners out there with a very liberal approach to allowing medical assistance in dying, who seem to be willing to base it on perhaps just a phone call, practitioners who do not think it is necessary to talk to the family, to get to know the patient, or to consult someone who knows the patient.
Some people will say that the decision about standards of care and safeguards should be left to the colleges of physicians and surgeons. As a 35-year member of the College of Physicians and Surgeons of Ontario, I totally disagree with that. This is not the kind of decision that is normally left to the colleges, nor should it be; this is the kind of decision that should be left to the elected representatives, who in turn are accountable to the people.
In summary, if we are going to allow medical assistance in dying for mental illness, it should be to an exceedingly limited number of people. If we were to implement the law as it is now, I think a lot of people would be getting it whom the law was not really intended for, nor do I think we are that close, so I think there should be no fixed date on which this law comes into effect. When are we going to know we are ready to do this? I would suggest it would be when there is some consensus from the psychiatric community. From all the surveys I have seen, the majority of psychiatrists are against this, which is certainly one indicator.
We need to take however much time is necessary to do this right. This is not like other decisions made by the House of Commons. If we mistakenly take a life, all of the politicians in this room, all of the bureaucrats in Ottawa and all of the Supreme Court justices cannot bring that life back.
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