- Member of Parliament
- Member of Parliament
- Bloc Québécois
- Montcalm
- Quebec
- Voting Attendance: 65%
- Expenses Last Quarter: $126,025.95
- Government Page
- Feb/15/24 4:29:34 p.m.
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Mr. Speaker, we often hear the argument that investments must be made in mental health to prevent mental illness and severe mental disorders.
I did not hear his leader say that he was going to put more on the table in terms of health transfers. Will the Conservatives propose a substantial increase in health transfers?
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- 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?
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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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Madam Speaker, as I often say in the House, everyone wants to do the right thing. Everyone has the best of intentions and wants to look out for people's best interests. However, being compassionate does not square with undermining human dignity or a person's capacity for self-determination in a decision as personal as deciding one's death.
In his bill, my colleague is telling us that mental illnesses are not considered to be grievous and irremediable medical conditions. However, according to the DSM‑5 definition, a mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning.
Can we really say that is not serious?
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Madam Speaker, my colleague from Thunder Bay—Rainy River is well aware of my great respect for him. However, in listening to his speech, I found it riddled with confusion.
I wondered whether he read the expert panel's report on mental illness as the sole underlying medical condition. I believe that our thinking may not be quite so different. I think that his practice has shown him the need to take care in adopting such an approach. However, in reading the report, he will see that there are many precautions in place and very specific guidelines.
Indeed, just because there are not very many mentally ill people experiencing tremendous suffering does not mean we must not move forward. One person experiencing unimaginable and intolerable suffering is, in my opinion, one too many.
I would like to know my colleague's thoughts on this.
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Mr. Speaker, I want to start by saying that before I dove into this subject, read the expert panel's report multiple times and asked endless questions, I was among the unconvinced.
Second, because we cannot cut corners on this issue, the entire community of professionals in mental health care, mental wellness and mental illness needs to be informed and trained. It will require an adequate number of service providers and assessors. It will require guidelines. Each of the regulatory bodies from coast to coast will need to establish standards of practice for their members, so as to ensure safe, effective and adequate implementation.
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Mr. Speaker, I would like to begin by providing some background on Bill C-39, which is not rocket science, when it comes down to it. Then I would like to talk about the philosophical foundation for dying with dignity, as well as the context and whether or not medical assistance in dying should be extended to patients whose sole underlying medical condition is a mental disorder. I would also like to talk about mental illness generally in our societies and the experts' report before finally concluding my speech.
The context is rather simple. This is not about rehashing the entire debate. We are studying Bill C-39, which simply defers the provision in Bill C-7 that would have ended the two-year exclusion for mental disorders on March 17, 2023.
Following consultations, the government has decided to extend this exclusion clause for one year, which means that on March 17, 2024, mental disorders, or rather individuals whose sole underlying medical condition is a mental disorder, would be eligible for MAID, subject to the conditions, limits, guidelines, standards of practice, safeguards and precautionary principles outlined in the expert report.
Before voting, I invite all parliamentarians in the House to read the report of the expert panel. It contains precautionary principles that do not lend credence to last week's comments by, for example, the leader of the official opposition. It really puts into perspective the ideology underlying the comments by my colleague from St. Albert—Edmonton. Let me dive right into this matter.
Why is there such a delay? The reason is that we believe things should be done properly by the medical world. When a mental disorder is the sole basis for a request for MAID, how prepared are those working in this field across the country to ensure that MAID is adequately and safely delivered in light of the safeguards?
More providers and seasoned assessors will be needed. I should note that the experts did say that assessing whether a person with a mental disorder has the capacity to choose MAID is something they are already doing. Often a person may have cancer and also suffer from a mental disorder. It is not the sole underlying medical condition, and they still need to establish the person's capacity to decide for themselves. Again, in response to the oversimplification by my colleague from St. Albert—Edmonton, first a person needs to want MAID, and then they need to meet the criteria.
As far as mental disorders are concerned, to meet the criteria, this is not going to happen overnight or anytime soon. It is going to take decades before anyone can have access. It is going to take time for the whole range of necessary treatments and possible therapies to be tested without the condition that the person demonstrate that they cannot bear any more and that their pain cannot be relieved. That is a long way from people living in poverty, who are depressed and who might have access to medical assistance in dying. We are far from it.
That being said, what are we talking about? When we talk about medical assistance in dying, I know that everyone in the House wants to do the right thing. Everyone has the best of intentions and wants to look after the best interests of patients and people who are suffering. However, being compassionate does not square with undermining human dignity. Human dignity is grounded in the capacity for self-determination.
Those are the philosophical premises. The law grants any individual with a biomedical condition the right to self-determination. Nothing can be done without the patient's free and informed consent. To that end, the role of the state is not to decide what that patient, who is the one suffering, needs. Rather, the state must ensure the conditions needed for them to exercise free will, so that patients can make a free and informed decision.
Historically, it was difficult to fight medical paternalism. At one time, people who had reached the terminal phase of an incurable disease did not have the right to die. The right to die was acquired, and it was called palliative care. Life was artificially prolonged, and people died from clinical trials or new therapies rather than dying a peaceful death in palliative care. However, palliative care is not a substitute for medical assistance in dying.
I find it strange that my colleague thinks it is unacceptable to grant access to medical assistance in dying to someone whose soul is suffering, and that he even opposes any form of medical assistance in dying, even when people are at the end of their life. He is opposed. At some point, if people are opposed, they need to explain why.
Why does the law recognize people's right to bodily autonomy throughout their lifetime but take it away from them at the most intimate moment of their lives? The government or our neighbour is not the one dying, so on what basis is the government giving itself the authority to decide for us at the most intimate moment of our lives?
These are the ethical and philosophical grounds and principles behind our position. Just because someone has a mental disorder does not mean that they should also be subject to social discrimination and stigma. Even though mental illness is now considered to be an actual illness, mental health is still not on the same footing as physical health. Mental illness results in discrimination and stigma.
Should we be telling people who have to deal with such discrimination and stigma that they will also never be given the right to MAID, even if they have been suffering from a mental illness and have had schizophrenia, for example, for 25 or 30 years? On what grounds are we refusing them that right? That is the basis of the expert panel's report. Do we give that right to someone with a mental disorder who is suffering, who has tried everything, whose problems are far from over and who says that they cannot go on?
There are people out there who have an ache in their soul, and unfortunately, we lose them when they attempt suicide. It is really no better. We absolutely must fight against suicide because it is one decision that cannot be undone.
In the report, the experts set out several precautionary measures. They talk about structural vulnerabilities like poverty. On page 11 of the report, the experts state the following: “In the course of assessing a request for MAiD—regardless of the requester's diagnoses—a clinician must carefully consider whether the person's circumstances are a function of systemic inequality”, and, if so, this should be addressed.
With respect to suicidal ideation, experts offer us another precautionary measure. It is not enough for a person to request MAID to have access to it.
The report states: “In any situation where suicidality is a concern, the clinician must adopt three complementary perspectives: consider a person's capacity to give informed consent or refusal of care, determine whether suicide prevention interventions—including involuntary ones—should be activated, and offer other types of interventions which may be helpful to the person”.
What is this claim about people who are depressed being able to request MAID? Members need to stop talking nonsense. That is not what the expert panel's report says. It says that incurability can be established over the course of several years. The patient must have exhausted all available therapies and treatments. However, that does not include overly aggressive therapy.
What does the member for St. Albert—Edmonton think should happen? When a person with a psychiatric disorder says that they reached their breaking point years ago, should psychiatric science insist that there is a treatment out there and that it is going to find it? That is what I mean by overly aggressive therapy.
Overly aggressive treatment may exist for all types of illness. Who gets to decide when it is too much? The Supreme Court and the Superior Court of Quebec have told us that it is up to the patient to decide. That is important, because the member for St. Albert—Edmonton keeps saying that we are cutting lives short, ending lives prematurely.
In reality, the opposite is true. Everyone wants to live as long as possible. People who are on what we call the second track, whose natural death is not reasonably foreseeable, want to live as long as possible. What they do not want is to be denied help when they reach their breaking point. If we do not give them access to MAID, they will find their own way to avoid ending up in that situation, because it is currently illegal for them, and they will end their lives prematurely. They will commit suicide.
The ruling that some contend should have been appealed to the Supreme Court states that there is an infringement on the right to life. The Conservatives' position infringes on the right to life because it forces people to end their lives prematurely rather than waiting for the moment of death, which sometimes is in one or two years. As proof, there is the case of Ms. Gladu. She did not go ahead with MAID, but she was relieved to know that she had that option. She did not commit suicide; she died naturally.
However, if her suffering became intolerable, she knew that she could access MAID because our compassionate and empathetic society would take care of her and ensure that she had a peaceful and dignified death. This meant that she could have the death that she did. Many people say that they choose to end their lives because they are not certain that they will be taken care of.
Is there anything more devastating than a suicide? That is a societal failure. We cannot be complacent about suicide attempts, about people feeling suicidal. In the health care system, mental illness, which is an illness like any other, absolutely must have all the necessary resources.
I just want to say a few words about the governments' ability to pay for the health care needs of the patients I am talking about, given the feds' post-pandemic offer. Governments have to deliver care to these people with irreversible illnesses, but they will not be getting money to do so. Over the next 10 years, they will barely be able to cover indexing on chronically insufficient funding. The federal government's share will go up from 22% to 24%. I hope government members are not too proud of that, especially considering that, during the third wave, people told us the system was in critical condition. The pandemic had destabilized it to the point that it would take 10 years to recover from the pandemic's side effects on patients without COVID. Right in the middle of the third wave, the Prime Minister said it would all be dealt with after the pandemic. We were told an agreement was imminent. I figured that they would come close to the $28 billion everyone expected, that they would give the governments of Quebec and the provinces the predictable funding they needed to rebuild their systems, take care of people over the next 10 years and finally recover from the pandemic.
I have heard the Conservatives say they will honour that small percentage. Of all the G7 countries, Canada still has the best borrowing capacity. If debt is unavoidable, what better justification for it than taking care of our people and restoring and rebuilding our health care systems?
I hear people say that individuals who have had an incurable mental disorder for years should not be given access to MAID on account of structural vulnerabilities. According to the expert report, however, two independent psychiatrists would have to be consulted. Not only would two independent psychiatrists be required, but we also have to consider recommendation 16. So far, I have been talking about recommendation 10, but my colleagues should hold on to their hats, because recommendation 16 states that, unlike for other kinds of MAID, when mental disorders are involved, there would be something called “prospective” oversight. This is different from retrospective oversight, as required by Quebec's commission on end-of-life care, which requires a justification every time MAID takes place. No, this does not happen after, but rather before, in real time.
This prospective oversight needs to be established in each jurisdiction, which is precisely what the delay will be used for. This additional safeguard needs to be established in controversial cases. According to the expert report, when an individual's capacity cannot be properly assessed, MAID is not provided, period. It is not complicated. There will be no slippery slope.
If there is a slippery slope, there is the Criminal Code, the courts, the police. Evil people do not belong in the health care system. They would be fired. If they do harm, they can be taken to court. To my knowledge, the provisions allow action to be taken.
My esteemed colleague seems to assume that everyone in health care is necessarily evil, which is absurd. The slippery slope is based solely on health care workers having evil intentions. However, to work in that field, people have to demonstrate skills proving the opposite. Consequently, all the precautionary measures and principles in this report are sufficient, in my opinion.
What needs to be done now is to ensure that people get training. Not all Quebec psychiatrists have read the report. If they listen to interviews given by the member for St. Albert—Edmonton, they will wonder what is happening with their profession.
We must be able to see things realistically and proportionately, provide training, and ensure that we implement a law that will be both accessible and equitable throughout the country. We must avoid situations where an institution that does not want to provide MAID prevents someone from accessing it, if it is their choice and they meet all the criteria.
This is still a dangerous situation. It is happening in Quebec, and the college of physicians warned last week that, in a simple case of MAID for a terminal patient, some doctors did not want to refer the patient to another doctor who was willing to provide it.
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- Oct/20/22 8:08:29 p.m.
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Madam Chair, although I do respect my colleague, he has some gall to have made that speech.
First, when parties were discussing the deadlines for the committee's work, it was the Conservatives who refused to have the committee continue its work past the date set at the outset. Then they accepted June 6. We finally agreed on February and today they are saying that we must take the time needed. Meanwhile, they were not open to immediately planning the work to be done up to that point.
Second, I listened to the same experts and read the same expert report. Even though at the beginning I was not at all convinced about accessibility when mental illness is the only reason given, that is not what the experts stated in this report. We will continue our work and our soul-searching.
My colleague says that the government is ideologically driven, but the government can speak for itself. I believe that my colleague's speech is very ideological because he cites just one part of the report. When we examine the set of criteria to be met for someone with a mental health issue to gain access, we see that it is available to a very small number of people. People with suicidal ideation do not fall into that category.
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- Oct/20/22 7:00:49 p.m.
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Madam Chair, I would like to begin with an aside because I was deeply touched by what my colleague said. If anyone in the House is keenly aware of mental health and illness issues, it is me.
My colleague talked about stigmatization. Michel Foucault's monumental work, A History of Insanity in the Age of Reason, made it clear that mental illness had to earn its legitimacy. In other words, mental illness had to be construed as a medical condition. Nowadays, we say “mental health” because we want to avoid the term “mental illness”, but mental illness is an illness like any other. Unfortunately, people with mental illness were locked up, excluded, exploited, put in circuses, put in cages of put on the Ship of Fools. They were dispersed all over the place, set adrift. Foucault's account of the history of madness and how those afflicted were treated paints a dismal picture of human beings.
I rise today to point out that it is not our concerns about mental health and mental illness that divide us. It seems to me that, if we really look at this properly, we would see that this is not the right legislature for taking effective action in this area.
As I said earlier in the preamble to my question, I sometimes get the impression from the minister that we have to reinvent the wheel. Of course, this matter is of particular concern right now, especially because of the postpandemic situation. Mental health has always been the poor cousin of physical health, and there are challenges to be met. Moreover, mental health is one of the weak links in our health care systems, and this became abundantly clear as the pandemic crisis played out. However, none of this justifies the federal government's interfering in something that is none of its concern.
I want the well-being of anyone struggling with illness or mental health problems to be a priority. No one wants that more than I do. Ottawa has to be careful, however, because it is not doing any good or making things better when it meddles in action plans that are already in place. I do not know if the minister is familiar with the 2022-26 interdepartmental mental health plan that was recently adopted by Quebec.
At one point, I had a glimmer of hope. She talked about bilateral child care agreements. I thought that perhaps the minister would be willing to look at what Quebec is doing. Then she would see that the problem in Quebec is not the policies, the goals or the organizational structures, but the money. It is the financial resources that are lacking. There is a lack of resources to hire competent employees and to support certain frontline workers who care for people. I am thinking about employees in community organizations, to name just one sector. I will return to this later.
That was just an aside, and I will now go back to my speech. That said, there are issues there, and I sometimes get the impression that my colleagues are in the wrong legislature. The responsibilities were divided in 1867. It is clear that the federal government currently takes in much more money for its responsibilities than it offers in services. It seems to want to give in to a temptation that has been denounced by every premier who has served the people of Quebec, who form a nation.
That is why we often refer to Quebec's strategies as national strategies. It is not to insult Canada, which is officially recognized as a country. It is just that Quebec is a nation by virtue of its National Assembly, which put strategies in place. Do members know when the first national mental health strategy was implemented? It was in 1980, and it was the first national strategy in the world.
The people of the Quebec nation, through their National Assembly, have been trying to meet mental health needs since 1980. Over time, Quebec has developed its expertise and various national strategies and action plans with the help of many stakeholders, but what it is currently missing is financial resources. When we talk about the interdepartmental plan, that includes a large number of departments. With regard to the consultation that took place in the development of the most recent plan, or the new strategy, we spoke to community groups, researchers, stakeholders, and all segments of the population, including youth, adults, seniors, minority groups and indigenous peoples. We developed that plan in conjunction with many departments and many members of Quebec's interdepartmental working group on homelessness and mental health, including the director of criminal and penal prosecutions, which is important when it comes to Bill C‑5. When we say that we are not going to penalize or incarcerate people because they have addictions, then we need to make sure that part of our informed and comprehensive strategy on mental health involves making sure those individuals do not go to prison, because we know that addictions are often related to mental health. We need to help these people.
Other contributors included the ministry of education, the ministry of advanced education, the ministry of immigration, francization and integration, the ministry of culture and communications; the ministry of families, the ministry of justice, the ministry of public safety, the ministry of agriculture, fisheries and food, the ministry of municipal affairs and housing, the ministry of finance, the ministry of transport, the youth secretariat, the indigenous affairs secretariat, the ministry of labour, employment and social solidarity, the Office des personnes handicapées du Québec, the Régie de l'assurance maladie du Québec, the status of women secretariat, Quebec's treasury board secretariat and the Société d'habitation du Québec.
In Quebec, for the people of Quebec, for our nation, which speaks through its National Assembly, there are at least 10 departments involved in this action plan. We see mental health as an interdisciplinary challenge. Now along comes this government, no doubt well intentioned, with a mandate letter for a minister who wants to help the Quebec nation, the people of Quebec and all the stakeholders I talked about implement this action plan. I hope we will not have to wait long for the money to come through. We have been waiting for health transfers for too long. In my opinion, if the federal government had invested its fair share in health care over the past 30 years, then all of Quebec's existing action plans would probably have strengthened the weak link that was exposed during the pandemic. That is the issue. Our mental health initiatives have to complement one another.
That is why I am asking the minister to work in concert with Quebec rather than exploit mental health just to exert her spending power—
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- May/19/22 10:54:28 a.m.
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Mr. Speaker, I would like to thank my colleague for his speech.
We agree with several aspects of his analysis. However, when talking about a pandemic that caused many deaths, we must be responsible. Both sides must avoid politicizing—in the least noble sense of the word—a debate like this one.
I sat with my colleague on the Standing Committee on Health. Earlier, he said that we should go back to the way things were before the pandemic, but I would like to qualify that statement. We know that the world's population is far from fully vaccinated. As long as vaccination rates are low and people are travelling, there is the potential for a variant that could completely compromise the benefits of vaccines, particularly in terms of the possibility of developing a severe form of the illness. I am sure my colleague agrees with me on this. In any case, I hope he will mention that.
The tourism industry's GDP has dropped 50%. This is serious. We have been asking, but the government has yet to table a plan to lift the health measures to give some predictability to the tourism and airline industries and to the travelling public. How does my colleague explain that?
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