- Member of Parliament
- Member of the Joint Interparliamentary Council
- Conservative
- St. Albert—Edmonton
- Alberta
- Voting Attendance: 67%
- Expenses Last Quarter: $119,185.60
- Government Page
Madam Speaker, here we are again, just as we were last February. We are faced with an arbitrary deadline set by the Liberals for their radical plan to expand MAID for mental illness. The Liberal government is completely unprepared and, therefore, needs to bring in eleventh hour legislation to extend the implementation deadline that it set in the first place.
I cannot think of another time or another issue in which a government has effectively had to bring in emergency legislation twice to extend a deadline for the implementation of its own law. It is truly shambolic. How did we get into this mess, thanks to the Liberals? Very simply, what we have across the way is a radical and reckless government that put blind ideology ahead of evidence-based decision-making. That has been the consistent pattern, in terms of decisions the government has made with respect to this planned expansion. This started with David Lametti, the former justice minister, who accepted a radical Senate amendment back in 2021 to implement MAID for mental illness and then set an arbitrary two-year timeline for implementation.
It should be noted that the charter statement for the bill in which Lametti accepted that radical Senate amendment provided a rationale for excluding MAID in cases of mental illness. The minister said at the time that he and the government were against MAID for mental illness because there were inherent risks and challenges. Indeed, he was right, but then he suddenly flip-flopped and rammed the amendment through with very little debate, one and a half days of debate. There was no parliamentary study, no consultation with experts and affected groups, and no evidence that MAID for mental illness can be implemented safely and appropriately.
The Liberals got it completely backwards. Instead of studying the issue first to determine whether this could be implemented safely, they decided to move full steam ahead and study the issue after the fact. Had they approached this matter responsibly, they would have learned very early on that there are significant clinical, legal and ethical problems with expanding MAID in cases of mental illness.
Among those problems are two fundamental clinical issues. The first is the difficulty of predicting irremediability. In other words, it is difficult to predict whether someone with an underlying mental health condition will get better. That is problematic in two major ways.
One is from the standpoint of the law. Under the Criminal Code, in order to qualify for MAID, a person must have an irremediable condition. More specifically, an irremediable condition is defined as one in which a person has an incurable disease or illness and is in an irreversible state of decline. If it is not possible to accurately determine that someone with a mental illness is in an irreversible state of decline and will not get better, then how can MAID for mental illness be carried out within the law? It cannot.
More significantly, from an ethical standpoint, if it is difficult to predict whether someone will get better, what that means with certainty is that persons who could get better will have their lives prematurely ended. Such persons could go on to lead a healthy and productive life. This was underscored by evidence heard by the special joint committee on MAID, during both its initial study two years ago and its more recent study this past fall. The special joint committee heard evidence that clinicians can get the prediction around irremediability wrong 50% of the time. In other words, it is like flipping a coin with people's lives. Is that a risk that members of the House are prepared to take?
When I posed that question to the minister responsible for mental health, she essentially answered in the affirmative. She doubled down on her support for an expansion of MAID for mental illness in three short years. Flipping a coin, gambling with people's lives, is what MAID for mental illness will result in.
A second fundamental problem is difficulty on the part of clinicians in distinguishing a rational request for MAID from one motivated by suicidal ideation. That is underscored by the fact that, in 90% of suicide deaths, persons suffer from a diagnosable mental disorder, not to mention that suicidal thoughts are often a symptom of mental disorders. This is why psychiatrists who appeared before the special joint committee said that it is not possible to distinguish MAID for mental illness from suicide. At the very least, MAID for mental illness significantly blurs the line between suicide prevention and suicide facilitation. It fundamentally changes the character of MAID and transforms it into something akin to state-facilitated suicide. This demonstrates just how far down the slippery slope we have gone under the Liberals.
To paraphrase the minister, she said that there are robust safeguards in place in that persons with a mental illness would only be able to qualify after years of receiving treatments and not getting better. However, that is simply not accurate; no such safeguards are found in any legislation put forward by the Liberals. In fact, the expert panel that the Liberals appointed, incredibly, recommended that there be no additional safeguards. Therefore, under the MAID expansion, it is simply not accurate that one must go through treatments or that one must be suffering over an extended period of time in order to qualify. In fact, the Liberals expressly rejected such additional safeguards.
In the face of those political challenges, Conservatives called on the Liberals to put an indefinite pause on this expansion. Likewise, in the lead up to the March 2023 deadline for implementation, the arbitrary deadline set by the Liberals, the chairs of psychiatry at all 17 medical schools called on the Liberals to pause this expansion.
What did the Liberals do? Essentially, they kicked the can down the road. They introduced Bill C-39, which merely extended the deadline for implementation from March 2023 to March 2024. In other words, once again, the Liberals put ideology ahead of evidence-based decision-making, making what amounted to a political decision with a new arbitrary deadline.
Nearly a year has passed, and with respect to resolving the fundamental issues and problems regarding safely implementing MAID for mental illness, where are we today? No progress has been made.
Indeed, when the special joint committee heard from psychiatrists, the message was loud and clear that we should not move ahead with this. It is not safe, and it cannot be implemented appropriately. The responsible course for the government to take is to acknowledge that it simply got it wrong and put an indefinite pause on the expansion.
It is no surprise that, in the face of these challenges, there is a professional consensus against the expansion. We saw that last week, when a survey from the Ontario Psychiatric Association was released. It indicated that a full 80% of Ontario's psychiatrists do not believe the health care system in Canada can safely implement MAID for mental illness. Last week, seven of the 10 provincial health ministers, plus the health ministers from all three territories, called on the Liberals to put an indefinite pause on this expansion.
What did the Liberals do in response? Once again, they kicked the can down the road with Bill C-62, which is before us. They defied experts, the provinces and territories, and common sense. This bill is basically the same bill we were debating a year ago. Instead of a one-year pause, it provides a three-year pause, with absolutely no evidence to indicate that fundamental clinical problems can be resolved. These problems include predicting irremediability and distinguishing between a suicidal request versus a rational request.
We have a government that is telling us to forget the evidence. The minister said it is not even up for debate, that the government does not want to talk about evidence as part of this issue. She basically said to forget about irremediability. The bottom line is that we have a Liberal government that is determined to implement this radical policy against a consensus among psychiatrists and other advocates.
Indeed, to get an insight into the mindset across the way, last week, in a press conference, the Minister of Health said that there is a moral imperative to get ready for MAID for mental illness. What is the moral imperative? Is it to give up on people who are struggling with mental illness? Is it to offer death through the provision of MAID to persons who are struggling with mental health issues?
That is what these Liberals characterize as a moral imperative? I say it speaks to the moral bankruptcy of these Liberals after eight years of the Prime Minister.
When the Liberals talk about MAID and mental illness, they are always very vague about what they mean. They know that if Canadians fully understood what MAID for mental for illness meant, most Canadians would be absolutely appalled. The model practice standard, which I believe the minister alluded to, that was prepared by the government's so-called task group of experts provides that a mental disorder would include anything in the DSM-5. Any condition listed in the DSM-5 is what these Liberals are contemplating as constituting a condition that would qualify someone for MAID in the case of mental illness.
What are the conditions listed in the DSM-5? They include personality disorders, depression, schizophrenia and issues when persons suffer from addictions challenges. That is what we are talking about when it comes to MAID and mental illness. It is truly repulsive, it is morally bankrupt to the core and it says everything Canadians need to know about the values of these Liberals.
There is only one piece of good news in all of this, which is that this legislation provides a three-year pause, and what will happen between now and the expiration of those three years is a federal election. Canadians will have a choice. They can choose between a Liberal government that wants to provide death to persons who are struggling with mental illness or they can choose a common-sense Conservative government that will not give up on anyone, will be committed to offering persons struggling with mental health issues hope and health, and will permanently scrap this radical Liberal experiment that gambles with the lives of vulnerable Canadians.
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- Dec/7/23 2:02:12 p.m.
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Mr. Speaker, on March 17, Canada is set to go down a very dangerous road when MAID will become available for persons suffering solely from mental illness.
Last year, the government delayed this expansion after leading medical professionals, including the chairs of psychiatry from all 17 medical schools, said that Canada was not ready. That is because it is impossible to predict whether someone with a mental illness will not get better. In other words, persons who could get better would have their lives prematurely ended.
Recently, the Special Joint Committee on MAID wrapped up its hearings and heard loud and clear from experts that Canada still is not ready.
I urge the government to follow the evidence, stop the madness and immediately introduce legislation to permanently scrap this dangerous expansion of MAID.
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Mr. Speaker, I rise to speak on Bill C-39, a legislation that imposes a new arbitrary deadline of March 2024 in place of the Liberal government's arbitrary deadline of March 2023 whereby persons with a sole underlying mental health disorder would be eligible for MAID.
I support Bill C-39 only because it is better than the alternative, namely that in one short month from now, on March 17, MAID would be available to persons with a sole underlying mental health disorder. This would be an absolute disaster and certainly result in vulnerable persons prematurely ending their lives, when otherwise, they could have gone on to recover and lead healthy and happy lives.
Rather than imposing a new arbitrary deadline that is not grounded on science and evidence, what the Liberal government should be doing is abandoning this radical, reckless and dangerous expansion of MAID altogether. This is why I wholeheartedly support Bill C-314, which was introduced last Friday by my friend and colleague, the member for Abbotsford, and would do exactly that.
One would expect that before deciding to expand MAID in cases of mental illness, a responsible government would take the time to study the issue thoroughly and consult widely with experts. After all, we are talking about life and death. We are talking about a significant expansion that would impact a vulnerable group of Canadians.
However, the Liberal government is not responsible, and that is not what happened. This is why the government finds itself in the mess it is in today with this rushed, 11th-hour legislation to delay the expansion.
Instead, the Minister of Justice accepted a radical Senate amendment to Bill C-7, which established an arbitrary sunset clause. That set in motion this expansion of MAID in cases of mental illness, effective in March of 2023. To provide some context, Bill C-7 was a response to the Truchon decision; its purpose was to remove a critical safeguard, namely that death be reasonably foreseeable before someone is eligible for MAID. It was a terrible piece of legislation that the government should have appealed but did not.
As bad as the bill was, when it was studied at the justice committee, of which I was a member at the time, nowhere in the bill was there any mention of expanding MAID in cases of mental illness. The justice committee did not hear evidence on that point. Indeed, when the minister came to committee, he said that there were inherent risks and complexities with expanding MAID in cases of mental illness, and therefore, it would be inappropriate to do so.
The bill went over to the Senate, and all of a sudden, the minister unilaterally accepted the amendment. Then what did the Liberals do? After little more than a day of debate, they shut down debate on a bill that had drastically changed in scope and rammed through the legislation for this expansion of MAID in cases of mental illness.
There was no meaningful study and absolutely no consultation with experts, including psychiatrists; persons struggling with mental illness; or these person's advocates. There was nothing. In short, the justice minister made the decision to go ahead with this significant expansion and then said the issue would be studied later. Hence, there was the establishment of an expert panel that was appointed after the government had already made the decision to go ahead. One would think that if an expert panel were going to be appointed, it would be appointed before deciding. However, that is not what happened with the justice minister and Liberal government.
We saw a special joint committee established after the fact. Talk about getting it backward, putting blind ideology and hubris ahead of science and evidence, and showing a total disregard for the concerns and lives of Canadians struggling with mental illness. Had the Minister of Justice and the Liberal government done their homework at the outset, they would have learned very quickly that this expansion of MAID cannot be implemented safely.
I serve as a co-vice-chair on the Special Joint Committee on Medical Assistance in Dying. As early as the spring, the committee heard from multiple witnesses, including representatives of the mental health community, and most importantly with respect to some of the clinical issues, leading psychiatrists. The body of evidence showing that this cannot proceed safely was overwhelming. One of the key reasons cited for this was that in the case of mental illness, it is difficult, if not impossible, to predict irremediability. In other words, in the case of mental illness, it is difficult or impossible to determine whether someone can recover and become healthy. This is a serious problem.
Let us look at some of the evidence that was available to the minister in the spring. Dr. John Maher, a clinical psychiatrist and medical ethicist who appeared before the committee, said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”
Dr. Brian Mishara, a clinical psychiatrist and professor at the Université du Québec à Montréal, told the committee, “I'm a scientist. The latest Cochrane Review of research on the ability to find some indicator of the future course of a mental illness, either treated or untreated, concluded that we have no specific scientific ways of doing this.”
Even the government's expert panel conceded the difficulty in predicting irremediability. At page 9 of the expert panel report, the panel observed, “The evolution of many mental disorders, like some other chronic conditions, is difficult to predict for a given individual. There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.” The government's own expert panel said that it is difficult, if not impossible, to predict irremediability.
If one cannot predict irremediability, persons who could go on to lead healthy and happy lives may have their lives prematurely ended. This is a problem that the government cannot avoid and that has not been resolved. Let me remind this House that, under the law, one must have an irremediable condition in order to be eligible for MAID. However, here we have leading experts and psychiatrists, including the government's expert panel, saying that it is difficult, if not impossible, to predict irremediability.
According to the psychiatrists who appeared before the special joint committee, what that means is that medical assessments in cases of mental illness for MAID are going to be decided on the basis of “hunches and guesswork that could be wildly inaccurate.” Those are the words of Dr. Mark Sinyor, a professor of psychiatry at the University of Toronto, who appeared before the special joint committee. These words were echoed by other psychiatrists who appeared before our committee.
The expert panel did not use such language, but it essentially conceded the point in its report because it was unable to come up with any objective standard by which to measure whether a patient's condition in the case of mental illness is irremediable. Instead, the expert panel ridiculously and recklessly said that it was going to wash its hands clean of this and that it was going to give a big green light and say it can all be done on a case-by-case basis. There would be no objective standard whatsoever; all would be guesswork and subjective assessment.
At the special joint committee on the issue of predicting irremediability in the context of mental illness, Dr. Mark Sinyor said that physicians undertaking a patient assessment “could be making an error 2% of the time or 95% of the time.” A 95% error rate is the risk on a matter of life and death, on a procedure that is irreversible and results in the termination of someone's life. For persons who are struggling with mental illness, this is the government's solution. The minister just stood in this place and said, “Damn the evidence. Damn the facts. We are going full steam ahead”.
I cannot think of a more reckless approach than the one the Liberal government has taken on an issue of profound importance to so many Canadians. It is not just the issue of irremediability, although given that this cannot be resolved, it should be the end of the matter. In addition, psychiatrists and other experts at the special joint committee emphasized that in the case of mental illness, it is very difficult to distinguish between a request motivated by suicidality versus one made rationally. In fact, suicidality is a symptom of mental illness, and indeed, 90% of persons who end their lives by suicide have a diagnosable mental disorder.
To illustrate how radical the government is, I note that when the Ontario Medical Association surveyed Ontario psychiatrists in 2021, 91% said they opposed the expansion of MAID for mental illness under Bill C-7. About 2% expressed support. Some 91% were against, 2% were in support and the reset were undecided. This speaks to how reckless, how radical, how extreme and how out of touch the government is on the question of expanding MAID in the case of mental illness.
In the face of the overwhelming evidence that we heard at committee, we issued an interim dissenting report calling on the Liberals to put a halt to this radical and reckless expansion. The minister ignored our interim dissenting report. He ignored the experts. He ignored the evidence. It appears he is so blinded by ideology that it is impossible for him to see what is in plain sight: This cannot be done safely.
In December, when it was evident that the minister was not listening, the Association of Chairs of Psychiatry in Canada, which includes the heads of psychiatry at all 17 medical schools, said to put a halt to this expansion. However, the minister still was not prepared to act. Indeed, it was not until the day after Parliament rose for Christmas that he had a late afternoon press conference where he made some vague commitment to introducing legislation in which there would be some type of extension. Then, with only 17 sitting days left before the expiration of the sunset clause, the minister finally saw fit to introduce this bill. I think this very clearly illustrates the shambolic approach with which the government has handled this issue.
We now have legislation, but what does this legislation do? As I noted at the outset of my speech, it provides for a new arbitrary deadline, even though issues of irremediability, suicidality and capacity to consent have remained unresolved for the past two years. There is absolutely no evidence that those issues are going to be resolved a year from now.
What we have is nothing more than an arbitrary deadline, and a year from now, we are going to find ourselves in exactly the same place. Let us be clear. When we speak about suicidality, irremediability and capacity to consent, these are not issues to be brushed under the rug. These are serious legal and political issues that are fundamental to determining whether this can go forward.
In closing, whether this expansion takes place a month from now or a year from now, it will be an absolute disaster and will result in persons struggling with mental illness having their lives wrongfully terminated. It is time for the government to get its head out of the sand, stop being blinded by extreme ideology, follow the science, follow the evidence and scrap this ill-conceived expansion.
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