- Member of Parliament
- Member of Parliament
- Bloc Québécois
- Montcalm
- Quebec
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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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- Feb/15/24 3:40:49 p.m.
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- Re: Bill C-7
Mr. Speaker, I have two comments.
First, my colleague says that we could have contested Justice Baudoin's ruling. However, Justice Beaudoin was referring to the Carter decision, which demonstrated in a way that people with a degenerative disease, like Ms. Gladu and Mr. Truchon, should have ended their lives. The right to life is certainly not about allowing people to commit suicide before reaching the tolerance threshold. That is the issue.
How can the Conservatives denounce suicide on one hand and say that we must be careful when it comes to suicide and all that, which I agree with, and on the other hand not understand that the only alternative for these people is to end their life? The Baudoin decision was relevant in that regard, because Bill C‑7 allowed these people to not end their life.
Second, as for the example that the member gave, I would like to say to him that the conclusion he came to himself is found in the expert panel on MAID and mental illness' sixth recommendation. I will read an excerpt:
...the Panel recommends that ‘community services’ in Track 2 Safeguard 241.2(3.1)(g) should be interpreted as including housing and income supports as means available to relieve suffering and should be offered to MAiD requesters...
If his party ever comes to power, will his government increase health transfers? We did not hear a peep from that side when the stingy Liberal government did not put anything on the table that could help us take care of the people he is talking about today.
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Madam Speaker, I will start with an assertion whose veracity will become clear. With Bill C-62, the cowardly Liberal government brought forth a mouse.
If we are talking about Bill C‑62 today, it is because Bill C‑7 created the Special Joint Committee on Medical Assistance in Dying when it passed. The committee's mandate was to review the medical assistance in dying legislation, in particular as regards the issue of advance requests. Because we knew that the problem was more difficult in cases of mental illness, the government set up an expert panel to help MPs do their job. The panel was to issue a report to the special joint committee.
The expert panel was indeed set up. The problem is that, instead of putting everything in place following the adoption of Bill C‑7, the government decided to call an election in 2021. That delayed the process.
Immediately after the useless election, we would have expected the special joint committee to sit but, no, we had to wait. They took their sweet time. The committee was finally convened, but it had a huge mandate. Its mandate was so huge that Bill C‑39 on mental illness had to be introduced, delaying the committee's recommendation.
Since February 2023, the committee has been very clear on the issue of advance requests. In fact, that was its most widely held recommendation. During the entire debate on Bill C‑62 in the House, the government said that we needed to be cautious and proceed slowly. That is fine, but when caution involves making patients suffer, I cannot agree. I think we need to be diligent.
The government took its sweet time. Here we are in 2024, and it introduced legislation seeking to postpone the issue of mental illness. Fine, but what is happening with the main recommendation the committee made in February 2023? The government knew very well that Quebec was laying the groundwork on the issue of advance requests. It knew very well that Quebec would bring in its own law. Instead of taking inspiration from that and seeing what measures could be included in the regulation accompanying Canada's MAID legislation, it did nothing.
I have stood in the House many times to ask the Minister of Justice and the Minister of Health why the government did nothing. Why does the bill not include a component on advance requests, which should have been prepared over the past year? After all, the government introduced legislation enacting the special joint committee's February 2023 recommendation on mental illness. On the issue of advance requests, however, it did nothing, despite the majority recommendation.
Yesterday, I got my answer. The Minister of Health demonstrated in front of the whole committee that he was unfamiliar with the Quebec law, yet he rises in the House and says he has enormous respect for Quebec's process. The Liberals do not even know what they are talking about. The minister told me that the issue of advance requests is more difficult than the issue of mental illness because, for example, there might be family quarrels at the patient's bedside.
I realized that the minister had not read section 29.6 of the Quebec law, which stipulates that, as soon as patient is diagnosed, they can appoint a third party. The third party will not determine when the person can access medical assistance in dying, but will advocate for their wishes, which will be included in the advance request, or the person's criteria.
People in my riding have told me that, when they become incontinent and can no longer control their bowels, when they have reached the point where they no longer have any appetite and it becomes a chore for their caregivers to feed them, although they are well compensated for their troubles, when they are no longer able to recognize their friends and family members and when they can no longer maintain relationships, they would like to have access to medical assistance in dying. The third party in whom they have placed their trust will then ask the care team—because patients are indeed cared for by entire teams—to evaluate whether they are meeting the criteria, if they are there yet.
If people make advance requests, it is because they want to avoid shortening their life. They want to live as long as possible. We could be good to them and take care of them until they cross their tolerance threshold.
The minister does not even know what I am talking about right now. Do members think it is normal that people say they respect Quebec, that they have great admiration for Quebec's progress on this issue, but that they do not even know what is in Quebec's law?
It is no surprise that they come out with a bill like Bill C‑62, that does not address this at all. Then they have the gall to say that Quebec has made good progress, but that not all Canadians are ready for that, so they have to wait and watch their patients suffer. Quebec is not the only province that supports advance requests. According to an Ipsos survey, 85% of Canadians from coast to coast support advance requests.
The Conservatives claim that they want to do good, they want to take care of Canada's most vulnerable. I, too, want to take care of the most vulnerable, but who is more vulnerable than a patient who is about to cross their tolerance threshold, who is suffering and who is being told no by the government?
Some claim that there could be abuses, as if the Criminal Code did not provide for punishment of abuses. They seem to believe the medical system to be inherently evil. I heard my Conservative colleague earlier. Listening to the Conservatives, one would think everyone working in the health system wants vulnerable people euthanized. I heard another Conservative member say there is an opioid crisis, there are people in the streets, and we are going to euthanize them. That is absolutely false. It is really far-fetched. That kind of rhetoric is meant to scare people; it amounts to spreading misinformation on a crucial topic.
When we care, we do not infringe on individual autonomy. The role of the state is not to decide matters so personal as how someone wishes to cross their threshold of tolerance. It is not to tell patients what is right for them. It is to provide the conditions so they can make a free and informed choice.
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- Feb/13/24 11:59:53 a.m.
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- Re: Bill C-7
Mr. Speaker, my colleague participated in all three sessions on the issue. When Quebec tabled its report and when we voted on Bill C-7 in 2021, I was very reluctant to consider opening up MAID to mental disorders. However, I worked my way through the experts' report and I invite my colleague to read it again.
My colleague says there is nothing in the legislation. However, it does not have to be in the legislation. The regulations can set out the “how to”. Recommendations 10 and 16 are important safeguards.
Let us assume I am not questioning anything in my colleague's speech; the fact remains that, today, as I speak, there are people who are suffering irreversibly and intolerably.
What solution does my colleague have for those people?
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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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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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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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- Feb/7/24 6:28:44 p.m.
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- Re: Bill C-7
Madam Speaker, that is an interesting question.
I would like to point out to my colleague that the committee had very little time to assess whether the system was ready. We had two or three meetings to determine that and the deadline was ridiculous. However, many people came and told us that the system was ready.
The Quebec National Assembly took a stand in 2021. Bill C‑7 was passed after that, after a lot of work had been done and brought to a halt in Quebec. The Quebec college of physicians said that it still needed a little more time. However, there is a big difference between needing a little more time to ensure that everything is done safely and properly and putting off indefinitely the need to deal with the suffering of people with serious mental disorders.
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Madam Speaker, I never thought I would end up debating medical assistance in dying in the House again, or reliving what we went through when we passed Bill C‑14, a bad law. I never expected that the Liberals would again be in the same position, or show the same lack of courage they did with Bill C‑14, which was prescribed by the Carter-Taylor decision.
Quebec passed its legislation on end-of-life care before the Carter decision. In the Carter decision, the court ruled that Quebec had to revise its legislation to include more than end-of-life issues only. The Parliament of Canada, which had never considered this before, was also told that it had to address not only end-of-life issues, but also degenerative diseases like those afflicting Ms. Carter and Ms. Taylor. Ms. Carter had spinal stenosis and Ms. Taylor had amyotrophic lateral sclerosis. In its decision, the court ruled that Parliament had to legislate because both women's right to life was being infringed.
Why was their right to life being infringed? The right to life is not a minor right. This should be of interest to the Conservatives, who are pro-life. I am too, in that sense. The right to life was being infringed because these people had to shorten their lives when they would have liked to live until their suffering became intolerable.
As members of Parliament, as representatives of the state and the people, our duty is not to decide what the patient needs when it comes to an issue as personal as their death. The role of the state is to ensure the conditions needed for them to exercise free will, so that they can make a free and informed decision. That is the role of the state. Otherwise, we get into government paternalism.
I invite my Conservative colleague to do some reading in clinical ethics and not to limit himself to what psychiatrists in Ontario are saying. We know that psychiatrists are divided on the issue. In fact, if there is one discipline in which medical paternalism continues to reign, it is psychiatry. We would never have seen the progress that we have seen in clinical ethics if medical paternalism in general still ruled supreme.
What happened for patients to be given back control over their end of life? We find the answer to that question in the bioethics literature. In the past, some doctors who had cancer said they did not want treatment. Now, we have good medical practices, whereas in the past, aggressive treatment was the standard. The doctors said that they wanted to live the two years they had left without undergoing treatment that would leave them bedridden. They claimed that they wanted to spend quality time with their loved ones. It took doctors with cancer demanding that option for patients to be able to discuss these sorts of things with their own doctor. In the 1960s, there were patients who only found out that they were dying of an incurable disease and were in fact at the end of their life when the priest came to their room to administer the last rites. They were not even told that they were terminally ill. That was medical paternalism.
Over time, the right to die was granted. Patients were granted the right to die and the opportunity to refuse aggressive treatment. That is when we began providing the palliative care that is so important to my Conservative friends. Before that, palliative care was called passive euthanasia, and it was not allowed.
Medical paternalism has been gradually set aside. What has this led to?
It has led to the right to refuse life-saving treatment, to stop treatment. These are all rights we have today.
We have before us a bill that perpetuates suffering indefinitely for people with a severe mental disorder who have been unable to relieve their suffering through treatment. That is no mean feat. They have spent 10, 20, 30 years suffering, trying multiple treatments and being stigmatized by the society in which they live.
We are able to establish the decision-making capacity of people living with a severe mental disorder. For those capable of making decisions, the court told us that it would be discriminatory and stigmatizing if, just because they have a severe mental disorder causing suffering that psychiatry is unable to properly change or relieve, they were told what was best for them and that they should continue to suffer forever, while psychiatry need only provide a palliative care option until the end. That is what we are discussing today.
I will calm down. It is just that I heard some nonsense earlier.
Then what happens? There was Bill C‑7, which was rather cautious. It set a two-year deadline for creating an expert panel. Who read the report of the expert panel in the House? Who read it before voting? This is the second vote we are having on this subject. We have to read the report of the expert panel. Indeed, the irremediable aspect is something that is hard to implement. Admittedly, there is an additional difficulty, but the expert report does set out guidelines. That is what this is about.
Then the Liberals show up today with a clause they added that says we are going to work with an expert panel for two years and create a joint committee. The problem is that the joint committees have always been set up at the last minute, too close to the deadline.
When we submitted our report the last time, we were forced to admit that, before moving forward with the issue of mental disorders, we needed to assess the situation in the field. Even though I think the group that was supposed to work on it had developed important guidelines and standards of practice, it was obvious to me that there was still not quite enough time. Everyone told us so, including the Collège des médecins du Québec—I will have more to say later about its criteria and guidelines for proceeding that I find useful.
How is it that, a year ago, the government gave itself a one-year deadline and thought that would be enough time? A lot of work has been done in that year, yet the government is saying we should put it off until 2027.
We heard what the Conservatives just said. We can forget about MAID if they form government; they will put it off indefinitely. That means that people will continue to suffer indefinitely, and that suffering will be intolerable because psychiatry is unable to provide relief other than by rendering them virtually incapacitated. Somehow, people find that morally acceptable. I honestly do not know where the morality lies in that. Some people have very flexible morals. In any case, it has nothing to do with suffering.
When people claim that someone living with depression could have access to medical assistance in dying, it is simply not true. Just because someone applies for MAID does not mean they will be able to access it. The assessors will do their job. Stefanie Green was saying that a person in a suicidal crisis is not eligible for medical assistance in dying. Someone who raises their hand and says that they want MAID simply because we allow mental disorders to be eligible grounds for MAID would not have access to it because they have not received proper care.
However, there would be an opportunity for prevention, because we could provide treatment at that time. It is wrong to say that 90% of people who have suicidal ideation and commit suicide received proper care. No, they did not receive proper care. Very often, when people commit suicide, no one saw it coming at all.
What are we going to do? What are the Conservatives going to to with people who are desperate and suffering and who currently still have hope that we are going to consider their suffering and find a solution so that things are done properly and by the law? What do they think those individuals are going to do in their despair? Is suicide morally acceptable? Suicide attests to the failure of our system and our society. I will never, ever accept suicide. That is why, when we talk about medical assistance in dying, we are not in the same page at all.
A person who is feeling suicidal is not eligible. Someone who has just been taken into care and diagnosed is not eligible. Applications take structural vulnerabilities into account. Just because someone is poor and does not have access to care does not mean that they will be eligible for medical assistance in dying. They would not be eligible, because they would have to have tried every possible treatment. Someone who unjustifiably refuses treatment that could improve their condition will not be eligible. If accessible and effective treatments are available and the person refuses them, they are ineligible. If the assessors cannot agree that the criteria have been met, the person is not eligible either.
The Collège des médecins du Québec told us that it remains at the discussion stage, that it has established its guidelines and it still needs time in order to eventually get there. Personally, I think one year would have been enough, otherwise we might give up. We could end up being hypocritical and leave it to chance. We might as well flip a coin.
The Liberals need to work hard if they want to win the election. If not, they are going to be leaving the fate of those who are suffering in the hands of people who just told us today that this will not happen on their watch, that they support suffering for life everlasting, and that they know what is moral and right for these people.
The Quebec college of physicians said, and I quote, “the decision to grant MAID to someone with a mental disorder should not be viewed solely as an episode of care. Rather, the decision should be made following a fair and comprehensive assessment of the patient's situation.” We are talking about taking the time to establish the chronicity of the condition.
The college of physicians also set out a second condition. It said, and I quote, “the patient must not exhibit suicidal ideation, as with major depressive disorders”. It might be a good idea for the members of the Special Joint Committee on Medical Assistance in Dying to hear that, although they are on the same committee as I am and that was said in committee.
That is a far cry from the grandstanding Leader of the Opposition who stands up in the House and asks the Prime Minister, in prime time, whether medical assistance in dying is the only thing he has to offer those who are depressed and having a hard time making ends meet. That is a bit much.
The third criterion laid out by the college of physicians states that the patient must “experience intense and prolonged psychological suffering, as confirmed by severe symptoms and overall functional impairment, over a long period of time, leaving them with no hope that the weight of their situation will ease. This prevents them from being fulfilled and causes them to see their existence as devoid of meaning.”
The experts tell us that they cannot apply irremediability and suffering metrics to mental health, and that prevents them from creating a category as a grounds for MAID. It has to be done on a case-by-case basis. All questions of clinical ethics, in terms of clinical assessment, are examined on a case-by-case basis. Some seem to think that going on a case-by-case basis is hell and that it is not a rigorous process. It is very rigorous.
The fourth condition states, “the patient must have been receiving care and appropriate follow-up over an extensive period of time.” Access to care must have been available. Otherwise, no access to medical assistance in dying will be provided for mental disorders. It seems to me that we heard the same thing in committee. We heard the same criteria.
At some point, we have to have the courage of our convictions. I believe that we have to offer relief to people experiencing intolerable suffering, who have reached their limit. I also believe that we must not make decisions about their life or quality of life for them. They alone can decide what is tolerable or intolerable.
When people talk to me about a slippery slope, they seem to be working on the assumption that all health care workers are evil. However, people who work in health care need to be kind. As far as I know, gaining admission to medical school is not easy. I imagine that the selection criteria are quite strict and challenging. The same goes for nursing.
The fifth condition states, “requests [from social workers] must undergo a multidisciplinary assessment, including by the physician or specialized nurse practitioner in the field of mental health who has treated the individual”. This is in the case of a follow-up assessment, not in the midst an episode. A person cannot get medical assistance in dying simply by saying that their life no longer has any meaning. Making a request does not mean one is eligible.
The Collège des médecins du Québec concluded by saying, “Under these conditions, it would be possible, in the CMQ's view, to provide individuals suffering from a grievous and irreversible mental disorder with access to MAID. It is important to prevent situations where individuals opt for MAID out of desperation, because they do not have access to proper care or do not consider the care available to be acceptable, such as an extended stay in a facility without the prospect of gaining more autonomy.”
That is the exact opposite of the nonsense we heard earlier. We were told that this was like a house of horrors, that we were dealing with experts and doctors who simply wanted to harm people's physical integrity. We have to be careful.
To access MAID, the individual must first make a request, which is then followed by informed consent. When it comes to mental disorders, doctors currently perform a daily assessment of a person's decision-making capacity if they have a mental disorder and a comorbidity, an additional illness that is hastening their death. Everyone agrees that these people are capable of choosing and consenting to medical assistance in dying. MAID practitioners have long been determining the decision-making capacity of people with a mental disorder. Just because someone has a mental disorder does not mean that their right to self-determination and to make decisions should be violated. That is discrimination and stigmatization.
When people tell me they want to protect the vulnerable, I wonder who could be more vulnerable than someone who has suffered for decades with a mental disorder and has tried every treatment. Who could be more vulnerable than someone grappling with a paternalistic psychiatrist—I am choosing my words carefully—who thinks he knows better than his patient what treatment they need, then chains them to a palliative care pathway and throws away the key because he cannot bring himself to admit that he is unable to provide relief to his patient?
At committee, I put the question to some psychiatrists who told us we were on the wrong track. They admitted that, in 25 or 30 years of practice, they had seen some patients fall through the cracks. Indeed, it is for this small group of people who fall through the cracks in psychiatry that this expansion is necessary. We need to show a little humanity here in the House.
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Madam Speaker, I heard the member for Abbotsford say right out of the gate that his bill seeks to reaffirm the dignity and worth of each and every human life. Who could be against that?
The dignity of every human life, as I was trying to say to him earlier, depends on autonomy and respect for a person's self-determination. We may have good intentions, but if we claim to know what is good for a so-called vulnerable person because we think we know better than they do about what is good for them, because we mistake sympathy for compassion, if we decide through some sort of state or medical paternalism what is supposedly good for them, without considering the person's suffering at all, if we take away a person's self-determination, then we undermine their dignity. That is what I wanted to say, but my colleague did not understand.
That is the very foundation of our position. It is called ethical and political philosophy, not theology or any sort of religious ideology.
The preamble to the bill sets out its intentions: “Whereas Parliament considers it a priority to ensure that adequate supports are in place for the mental health of Canadians”. Who could be against that?
I see no problem with that, but it has nothing to do with the purpose of the bill. This can be done without saying that the mental disorder considered as a serious and irremediable medical condition is excluded. I will come back to that.
The second paragraph of the preamble states, “Whereas Parliament considers that vulnerable Canadians should receive suicide prevention counselling rather than access medical assistance in dying”. This really shows a lack of rigour.
All the experts spoke about this and we can even read it in the literature. It is a little twisted to associate suicide with medical assistance in dying. I heard the leader of the opposition make that link a few times during oral question period, but conceptually that is false. Medical assistance in dying is initiated when an individual expresses that that is what they want. It is not imposed. Above all, it is for situations where the person's condition is irreversible. As far as I know, no witness at committee told us that a suicidal state is not reversible. Furthermore, witnesses also told us that we should not conflate the two. This is not getting off to a good start.
When a request for medical assistance in dying cites a mental disorder as the reason, the first step is to establish whether the person suffering has been struggling with the mental disorder for 10, 20 or 30 years of their life. In the experts' report, which I hope my colleague has read, it says that a person exhibiting suicidal ideation would not be eligible. It is one thing to want or to request medical assistance in dying, and another to meet the eligibility criteria. This is essential.
A person who is depressed or in crisis will not necessarily receive medical assistance in dying. Moreover, the experts say that an assessor would never consider a request for medical assistance in dying from a person in a state of crisis. The patient would have to first exhaust all available treatments for alleviating their suffering, without refusing a single treatment capable of restoring their health.
As Dr. Black said, “One study estimated suicidal thinking as an 8% lifetime risk for adults in the Netherlands, yet 65 or 0.0004% of adults in the Netherlands have died of MAID in any given year due to psychiatric reasons.”
Now we have members talking about a potential slippery slope, citing Bill C-14 and ignoring the obligation given to us by the courts to proceed with passing Bill C-7. Bill C‑14 was a bad bill that confused the public. Is it respectful of human dignity to force people to go on a hunger strike to reach the standard of likely and reasonably foreseeable natural death? I think there is something a bit inhumane about that.
In order to reach a criterion that was unworkable for some, people had to actually go on a hunger strike. Others, like Ms. Gladu and Mr. Truchon, had to assert their rights in court. Members say they want to protect the vulnerable. They should start by not treating these people like children and not exploiting them for any purpose. They should instead think about their well-being.
Who is more vulnerable than someone who is suffering intolerably and is close to their tolerance threshold? Who are we to decide for them what their tolerance threshold should be? That is essentially what this is all about.
People want to live as long as possible. The court determined that these individuals' right to life was being infringed upon. I am sure the Conservatives have a lot to say about the right to life. The court found that by denying these individuals the right to medical assistance in dying, their ability to live as long as possible is being taken away. This prevents them from living until they reach their tolerance threshold. That is when we could provide care to them and proceed.
Without this assurance, what do many of these individuals do? They commit suicide prematurely, and this infringes on their right to life. This is indisputable, and it could not be considered reasonable in a free and democratic society, even if it went to the Supreme Court.
Some people always want to go to court. However, right now, people are suffering. While we are procrastinating, people are suffering. We have to put things into perspective.
The committee that considered the issue of mental illness as the sole underlying medical condition made a recommendation. That is why I think that Bill C-314 is premature, at the very least, if not irrelevant at this time.
I will read the committee's recommendation. It states, and I quote: “That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate.”
At the very least, I would have expected a debate to take place following the work of that committee. That is the least that could have been done. I invite my colleague from Abbotsford to read the report of the Special Joint Committee on Medical Assistance in Dying and especially the expert panel's report. The recommendations set out in the expert panel's report include criteria and guidelines that do not exist for other forms of MAID practice. He should feel reassured after reading those recommendations, and I am sure he will never talk about a slippery slope again.
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