- Member of Parliament
- Member of Parliament
- Bloc Québécois
- Montcalm
- Quebec
- Voting Attendance: 65%
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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 11:51:05 a.m.
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Madam Speaker, first of all, we have to start from the premise that all health care workers are basically caring and compassionate people. The premise of MAID's opponents is based on their belief that certain fundamentally malevolent and evil people want to get rid of vulnerable members of our society.
It seems rather surprising that the Conservatives, as economic libertarians, believe that the state should get mixed up in such a personal decision as an individual's death. The reason is that other determinants are at play. I have asked them repeatedly why they think that they are in a better position to make that decision than the person who is suffering. Today, I will say the thing they lack the courage to admit: it is because of religious beliefs.
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- Feb/13/24 7:23:24 p.m.
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Madam Speaker, I have great deal of compassion for my colleague and want to thank him for so generously sharing his life experience. He says he speaks for those who have no voice, and he is living proof that suicidal ideation is reversible.
I wonder if he could dig a bit deeper and acknowledge that there are people who have no voice, who have yet to find a psychiatric treatment that eases their suffering and who struggle with mental disorders? What solutions does he have for them after 30 years of treatment?
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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/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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- Feb/13/24 11:41:30 a.m.
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Mr. Speaker, I would like to know whether my colleague thinks that, one day, it will be possible to alleviate the suffering of people struggling with an irremediable mental disorder.
I would also like to know whether he agrees that it would have been wiser for the government to implement the joint committee's leading recommendation regarding advance requests and to take advantage of the introduction of this bill to add that component.
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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.
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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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- Feb/7/24 6:35:01 p.m.
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Madam Speaker, briefly put, I would say they lack courage. In this place, courage and compassion are lacking, and action is based far too much on ideology.
As I said earlier, only the individual can compare their life in one condition to their life in another condition, and this does not mean comparing two different lives. In that sense, we cannot turn a deaf ear to suffering. We have to listen and we have to act to make sure that these people receive care, of course. That is our goal. However, no matter how difficult it may be to determine whether a condition is irremediable, it would be intellectually dishonest to claim today that psychiatric treatment can relieve the suffering of everyone with severe mental disorders. For those whose suffering cannot be relieved and who request MAID in a considered and coherent manner, with all the safeguards I mentioned earlier in place, we have a duty to listen to what they think and to legislate accordingly.
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- Feb/7/24 6:02:34 p.m.
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Madam Speaker, my colleague is always very eloquent when it comes to defending the “no” camp and the pro-life camp. Does his position represent the position of the Conservative party? Is that the official position of the Conservative Party?
I just want us to be able to understand what is at stake in this debate today. Essentially, to him, irremediability is something that can never be proven. That means that, under a Conservative government, people who are suffering intolerably, who are dealing with intolerable suffering because they are victims of a mental disorder, could never be relieved of their suffering.
What I am also hearing is that he claims that he can solve the problem of suffering and irremediable mental disorders by injecting a lot of money into the health care system to make access to health care something that can help these people put all their suffering behind them.
Is that what he is telling us?
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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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- Oct/20/22 7:35:39 p.m.
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Madam Chair, first of all, my colleague is a real humanitarian, and I commend his compassion. He has done some very interesting work on drug addiction. His bill was very interesting.
Now, on the subject of mental health, some experts who appeared before the Special Joint Committee on Medical Assistance in Dying talked about mental health and the chronic suffering associated with certain mental illnesses. Some people may be struggling with intolerable suffering that cannot be treated with therapy. The experts told us that it might be better to give these people autonomy and the right to decide what to do about their suffering, as well as extending MAID to these individuals, who are few in number, rather than leaving them to contemplate suicide.
I know my colleague is a great humanitarian. I wanted to hear his thoughts on this, because, in the long run, if we cannot do this, people will slip through the cracks. Not everyone with mental illness can be cured, because there are illnesses that are incurable and irremediable. I would like to hear his opinion on this.
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