So V ote

Context: House Hansard - 283 - Feb/15/24

Feb/15/24 1:53:57 p.m.
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Mr. Speaker, first of all, we are not talking about advance directives. That has already been settled. We are talking about advance requests. Second of all, in my speech this morning—because this is a reply to the speech I made this morning—I never said that not enough work had been done. The Bloc Québécois's position is that one year is enough and that we will see after one year, immediately after royal assent, whether we can start to work on the mental illness issue. The member should have sat on the committee from the get-go. He has been an MP from Quebec since 2015. It is a bit strange for him to be so uninformed on the issue of MAID. Since June 2023, the government could have included advance requests in the bill, taking into consideration any recommendation of the Special Joint Committee on Medical Assistance in Dying. We never said that not enough work had been done. We said that the government was dragging its feet when it comes to committee work. The Special Joint Committee on Medical Assistance in Dying was always convened at the last minute. Does the member think that three meetings on an issue such as this were enough?

214 words

Feb/15/24 11:36:24 a.m.
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Re: Bill C-7 Bill C-62 Bill C-39

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 10:06:15 p.m.
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Mr. Speaker, we need to move quickly to save people. I am all in favour of implementing social programs to save people, but does the member have a different point of view from the Conservatives right now? If we invest in social programs, will people all of a sudden get relief after 30 years of suffering and inadequate treatment? The accessibility of frontline services is another debate. How can we shut down debate today by claiming that, if ever we move forward with expanding MAID eligibility to people with mental disorders, then that would be an affront to people's integrity, when the fact is that MAID is voluntary? What is more, there are people who are going to examine the request and, if a person is suicidal or receiving care for the first time, then they will not have access to medical assistance in dying. I am trying hard to make people understand that just because a person makes a request does not mean that they will be eligible. When the member says things like that, how does she think that her point of view differs from what we have been hearing from the Conservatives today?

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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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Feb/13/24 6:39:06 p.m.
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Madam Speaker, I am having a hard time understanding what my colleague is saying. He knows very well that structural vulnerabilities, such as poverty, have an impact on overall health. Is he saying that we need to deal with that before we can allow people who are mentally ill to get relief from their irremediable suffering? That is what I am getting from his speech, when recommendations 5 and 6 of the panel's report indicate that, if there is any doubt whatsoever as to structural vulnerabilities, then medical assistance in dying will not be made available.

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Feb/13/24 2:38:21 p.m.
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Mr. Speaker, medical assistance in dying is about freedom of choice. The role of the state is not to decide for the person who is suffering; it is to guarantee the conditions under which people can make a free and informed choice. If someone does not want medical assistance in dying, they can simply not ask for it. The National Assembly is unanimous: Quebec is ready. It has its own legislation. Will the federal government amend the Criminal Code to allow for advance requests for people who are suffering?

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Feb/13/24 1:05:42 p.m.
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Madam Speaker, I am sure my colleague's intention is not to exploit the pain of people who have been enduring irremediable suffering for decades. However, she is repeating an argument that we have heard often in this debate and that I feel is something completely separate. The issue of access to primary mental health care has nothing to do with the decision we must make on whether to expand medical assistance in dying since, with regard to access to care, these people would not qualify under the criteria and guidelines of the expert report. I do want us to advocate for better care. I wholeheartedly agree with that, but that is another debate. However, there are people who have been receiving care for decades and who are suffering, and the government wants to tell them to keep suffering for three years.

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Feb/12/24 1:51:34 p.m.
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Madam Speaker, since 2015, every time we have addressed medical assistance in dying in the House, it has been blocked by the Conservatives. I understand that my colleague is not happy about it. He tells me that everyone has a right to their own opinion. The Conservatives' opinion is very much based on the views of religious right-wing voters.

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Feb/12/24 1:45:26 p.m.
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Madam Speaker, perhaps the interpretation was not accurate, because what I said is that the suicidal state is reversible and that all experts agree on this, whether they are for or against expanding medical assistance in dying to cover mental disorders. It is reversible. People need to stop fearmongering. I was also saying that if we expand MAID to cover things like mental disorders, it could have a preventive effect. Some people who have suicidal ideation today are going to commit suicide, and they will never have received treatment in the system. Sometimes no one sees it coming. I am not saying that my colleague's quote does not exist. I am saying that some people suffering today will commit suicide and no one will see it coming. I am more thorough than that. He knows that very well. He does not have to insult me to ask me questions.

151 words

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 - 279 - Feb/9/24

Feb/12/24 1:20:09 p.m.
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Madam Speaker, it would have been good if my colleague could have sat with us on the Special Joint Committee on Medical Assistance in Dying. I think she is confusing two things. Just because a person requests MAID does not mean that they will be eligible to receive it, and all of the experts, whether they are in favour of MAID or not, have said that a suicidal state is reversible. I am not sure what she was talking about, but it is important not to engage in fearmongering. No one who has just been taken into care will be given that option because, first of all, it is not an option that is offered to people. People have to make a request. I would invite my colleague to read the panel's recommendations on that.

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Context: House Hansard - 161 - Feb/15/23

Feb/9/24 11:39:16 a.m.
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Mr. Speaker, medical assistance in dying is a matter of freedom of choice. The Liberals should understand that. The role of the state is to guarantee the conditions for exercising a free and informed choice. Those who do not want medical assistance in dying do not need to apply for it. It is as simple as that. The National Assembly is unanimous. Quebec is ready. It has its own legislation. Will the federal government amend the Criminal Code to allow advance requests for people who are suffering?

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Feb/15/23 4:30:26 p.m.
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Re: Bill C-39

Mr. Speaker, my colleague said that people should not be induced to turn to medical assistance in dying in moments of weakness. I do not know where he is getting that from, but I just want to say that the expert panel's report on mental disorder makes no mention of that. When it comes to socio-economic determinants, which my colleague raised, the experts say that they need to be taken into account but that they are not part of the criteria for having access to medical assistance in dying. I am not sure what he is talking about, but one thing is certain. Members need to stop using scare tactics all the time. Basically, the Conservatives are against medical assistance in dying in every situation, not just in the case of mental disorder. Many of them are even opposed to it when a person is terminally ill and already dying. I would like to say to my colleague that, if he knows of any cases where a person has been induced to seek medical assistance in dying, then he must report them. The Criminal Code would apply, the police would intervene and those people would be brought to justice.

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Feb/13/23 5:06:24 p.m.
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Re: Bill C-39

Madam Speaker, I thank my colleague for his effort. That said, if Bill C-39 were withdrawn, on March 17, mental disorders would not be excluded from medical assistance in dying. It is important to know what we are talking about. Also, I do not know on what authority my colleague can claim that he would have had access to medical assistance in dying, given that the expert report clearly states that no expert on the planet considers suicidal ideation to be irreversible. Therefore, even if he was thinking about suicide, he would not have had access to medical assistance in dying. What makes him say that he would have had access to MAID?

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Feb/13/23 1:31:17 p.m.
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Re: Bill C-39

Mr. Speaker, all the data we have shows that people who are at the end of life have received palliative care. However, there are palliative care units that refuse to take someone into that unit because they allegedly requested medical assistance in dying. I find that unacceptable. I feel that palliative care is a stepping stone to dying with dignity. As part of the process, someone may request medical assistance in dying. That must be respected. Not everyone can manage to endure their pain and live an existence that makes them suffer to the end. I do not think the choice is ours; it belongs to the person. There is no reason why the government should not accept a patient's decision, their free choice. They must make an informed decision that is not subject to change, as we heard from some witnesses in committee. We were told that when some physicians had a patient before them requesting medical assistance in dying, they would force them to change their mind so that they would not ask for it and receive only palliative care. Imagine the opposite scenario. That would make the news everywhere for months.

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Feb/13/23 1:26:57 p.m.
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Re: Bill C-39

Mr. Speaker, I do not want to get into petty politics. I am not saying that my colleague's question is at that level, but I do not want to get into that. What I want to say, however, is that we can see the shortcut that my Conservative colleagues sometimes take when they speak. They act like MAID is the only choice, but that is not true. A person can die a natural death without any problems. MAID is only morally acceptable if, and only if, it is voluntary, period. I want all my colleagues to feel well supported in dying, because that is what palliative care actually is: support for people who are dying. I hope that as each of them lies on their deathbed, they are able to wake up one morning and feel completely at peace and ready to go, rather than lingering in agony. I hope they will be able to benefit from MAID. That is the best we can hope for for any human being: to depart this life in peace.

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Context: House Hansard - 62 - May/2/22

Feb/13/23 12:54:44 p.m.
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Re: Bill C-39

Mr. Speaker, as a Conservative, my colleague from St. Albert—Edmonton has never made so many references to science. I understand that he is passionate about this, but he is claiming that the report of the expert panel says things that it does not, particularly with regard to ending one's life prematurely in the case of mental illness. The only way for a person to end their life prematurely is by attempting or committing suicide. A person who is suicidal will never be given medical assistance in dying based on the assessment of one or even two experts. Feeling suicidal is a reversible condition. A suicidal state is reversible, and the condition for obtaining medical assistance in dying is the irreversibility of the mental disorder. The expert panel report states on page 13 that “the incurability of a mental disorder cannot be established in the absence of multiple attempts at interventions with therapeutic aims.” A person who attempts suicide and comes under pediatric care as a result will have to be monitored. They will probably never have access to medical assistance in dying on the grounds of a suicidal disorder. Eligibility must be established over a period of years, not in a crisis situation. The individual will also have to prove that they have tried every form of treatment and have never refused treatment that could have treated the condition. This is a sensitive subject, so people should be careful what they say. I hope my colleague will see reason. Those across the aisle are not the only ones vulnerable to blinding ideology

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