- Member of Parliament
- Caucus Chair
- NDP
- Cowichan—Malahat—Langford
- British Columbia
- Voting Attendance: 66%
- Expenses Last Quarter: $140,733.69
- Government Page
Mr. Speaker, it seems to me that we have gotten ourselves into trouble with the use of arbitrary timelines. The Senate amendment to Bill C-7 kicked the can down the road two years. Last year's Bill C-39 added a year, and now Bill C-62 would add three years.
I just want the member to put that into the context of the fact that the health ministers of seven out of 10 provinces and all three territories have asked for an indefinite pause. The special joint committee, likewise, was very careful not to put a timeline in its recommendation for a pause.
How does the member reconcile this three-year pause with the fact that those institutions, those provincial governments, would rather put more of a qualitative benchmark than a timeline on it?
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Mr. Speaker, on the situation we find ourselves in this week, and last year with Bill C-39, we can draw a direct line back to the Senate amendment that was placed on Bill C-7. The government did a complete 180. It came out with a charter statement explaining why it was excluding mental disorders, and it then went and accepted the Senate amendment.
Bill C-39 last year had to punt the ball down the road by a year. Now we have Bill C-62 trying to do that by another three years. It feels like everything we have been doing has been trying to play catch-up to that change in the law. The law was changed before we had done the work.
Does my hon. colleague regret voting for that Senate amendment, given all he knows now and all of the catch-up we have been trying to do on this very important and sensitive issue?
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Madam Speaker, I would like to inform the you that I will be splitting my time.
Today, we are not debating Bill C-62; we are actually debating Motion No. 34, which is a programming motion to get the bill through the House of Commons. We are having to resort to a tactic that I do not often like to use, but time is forcing us to do this.
If the House of Commons, the Senate and Governor General do not act and we do not have this bill into royal assent by March 17, the law is going to change. Essentially, many experts have expressed an extreme amount of discomfort with that. There is a lot of professional discomfort. We have seen also from our provinces and territories that they are very uncomfortable with the pace of change that is going on.
What Bill C-62 would do is delay the implementation of MAID for persons who are suffering from a mental disorder as a sole underlying condition. The bill would further kick that can down the road until 2027. It also has a legislative requirement that the Special Joint Committee on Medical Assistance in Dying be reconvened in advance of that date. Hopefully, that committee would have the time necessary.
As parliamentarians, we have to step up to the moment. I am particularly saying this for my hon. colleagues in the House of Commons. There is plenty of blame to be assigned to the Liberals, and, trust me, I have given my fair share. We are in this situation because of an ill-advised 11th hour amendment to Bill C-7 in the previous Parliament, a bill that the government's original charter statement had presented as a reasonable argument against the expansion of MAID to people who had mental disorders. Then that bill went to the Senate and it inexplicably accepted a consequential amendment that brought us to where we are today.
Last year, we had to quickly pass Bill C-39, because, again, we were not ready for the deadline then. That kicked the can further down the road by one year. Now we find ourselves in the exact same position. I am suffering déjà vu, like a lot of my hon. colleagues are, where we now have to force this legislation to kick the can down the road another three years. I feel like I am caught between two forces right now: the ineptitude of the governing Liberals for putting us in this position and a Conservative Party that seems to just want to cause chaos in this final week.
This is a moment when the adults in the room need to step up to the plate. There is plenty of blame to be assigned, but we cannot work around the deadline and the fact that we have only two sitting weeks left to us. We are still at the second reading stage of this bill, and that is why this programming motion is necessary. That is why we need to step up to the plate and ensure that Bill C-62 is through the House of Commons by the end of this week. It still has to run the gauntlet in the Senate, and who knows what is going to happen in the red chamber. That is something for the government members to figure out.
One thing that is really good about this motion is that there is a requirement that the Standing Committee on Health be convened on Wednesday. That will allow members of that committee to question either the Minister of Health or the Minister of Justice and also have two hours to speak to witnesses. Honestly, we need to come together as a Parliament and ensure that we get this through.
It is further bolstered by the fact that seven out of 10 provinces and all three territories sent a letter to the federal government asking for an indefinite delay. These are signatures of ministers of health and ministers responsible for mental health and addiction, which are essentially the departments that are responsible for oversight of the whole medical assistance in dying regime. We have to listen to those incredibly important voices. We have to listen to their expertise. We have to honour what they are requesting in this letter.
I ask my hon. colleagues to step up to the plate and be the adults in the room. Let us get Bill C-62 passed through the House of Commons this week.
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Madam Speaker, this is obviously a week when the House of Commons as a whole has to step up to the plate because we really only have two sitting weeks left on the parliamentary schedule until the March 17 deadline.
That being said, I think it is worth it for us to remember why we are here. We have to go back to Bill C-7 and the Liberal government's 11th hour, inexplicable decision to accept a very consequential Senate amendment to it, which got us into this mess in the first place. The Senate changed the law without having done the proper research and consultations. Ever since, it feels like we have been playing a game of catch-up. That is why Bill C-39 was necessary last year, and why we have found ourselves in the same situation with Bill C-62.
Is the parliamentary secretary prepared to accept some responsibility on behalf of his government and issue an apology for setting that arbitrary deadline and getting us into the mess we now find ourselves in?
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Madam Speaker, I am pleased to be standing in the House today to join debate on Bill C-62. Forgive me if I am feeling a bit of déjà vu right now, because it was precisely one year ago, in February 2023, that the House was in a similar position with the earlier bill, Bill C-39.
That bill, of course, extended the delay of the implementation of the acceptance of mental disorders as a sole underlying medical condition to access MAID. That bill kicked the can down the road by one year. As a result, we find ourselves in a position where we are now approaching the deadline of March 17, 2024.
To go into a bit of detail on what Bill C-62 contains, it is not a very complex bill. It should be clear that the bill itself is not relitigating the issue that was first brought in by Bill C-7. I will get into Bill C-7 in a moment. This bill is seeking to further delay the implementation of MAID for mental disorders as a sole underlying medical condition until March 17, 2027, essentially three years down the road from now.
I also think an important part of the bill is that it inserts a legislative requirement that the Special Joint Committee on Medical Assistance in Dying be reconvened in advance of that change, so that a committee of parliamentarians made up of members of Parliament and senators can review our country's readiness and make a determination in advance of that date.
I have been a member of the special joint committee from the beginning, all the way back in the 43rd Parliament, and, speaking for myself, I am very glad to see that we do have that legislative requirement in Bill C-62 and that, more importantly, the committee is actually being given the time it should have had to study this very complex and sensitive issue in advance of its implementation. That is something we could have been much better served by in previous iterations of this legislation.
I think it is important that we explore a little of the history of how we got to this moment. As a member of this special joint committee, I personally have felt that we have been playing a game of catch-up to the change in law that was made in advance of any serious inquiry into this matter.
Bill C-7, in the 43rd Parliament, was, of course, the Government of Canada's response to the Truchon decision. It specifically created a separate track in the Criminal Code for people whose death was not naturally foreseeable. Previous to that, one had to have a medical condition in which one's natural death was foreseeable, so essentially it was for people who were suffering terminal stage cancer, who were going through a great deal of suffering and so on.
It is important to note, though, that when the government first brought Bill C-7 in, there were already questions at that time, in advance of the legislation, about what we do with people who are suffering from mental illness, who have suffered, in some cases, as my colleague pointed out, for decades, for whom treatments have not worked. What were we to do with that?
In the original version of the legislation, by law, the government was required to have the bill accompanied by a charter statement, but mental disorders were specifically excluded from the original version of Bill C-7. The government provided what I thought at the time was a fairly well-reasoned charter statement. It was understood that by excluding this, one could potentially engage two prominent sections of the Charter of Rights and Freedoms, namely section 7, which is the security of the person, the fact that everyone essentially has the right to make a decision about what happens to their own body, and section 15, the equality clause, that the law has to treat everyone equally. With reference, those two sections may potentially be engaged by an exclusion.
The government identified the following in its charter statement:
First, evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error, in relation to persons who suffer from a mental illness serious enough to ground a request for MAID. Second, mental illness is generally less predictable than physical illness in terms of the course the illness will take over time. Finally, recent experience in the few countries that permit MAID for people whose sole medical condition is a mental illness (Belgium, Netherlands and Luxembourg) has raised concerns.
That is what the government's original position on Bill C-7 was.
The House passed Bill C-7 and it went off to the Senate. There, for reasons that remain shrouded in mystery to me to this day, the government decided to accept a Senate amendment, essentially at the eleventh hour, which had significant repercussions for the bill. Essentially, the Senate was reversing the government's original position on whether mental disorders qualified for MAID.
The government accepted that Senate amendment. Of course, Bill C-7, because it had been amended, had to come back to the House, and the government managed to cobble enough votes together to get it passed.
Therefore, we, as parliamentarians, were left with a law that had been changed in advance of the hard work being done to properly consult, research and discuss the issue with expert witnesses and with the health systems that have primary responsibility for the oversight of the change in law.
Yes, an expert panel was convened. The special joint committee was convened. Of course, its work was interrupted by the unnecessary calling of an election in the summer of 2021. Some very valuable time was lost there, because, of course, we then had to reconvene in the 44th Parliament, and a considerable amount of time was lost due to that.
However, it is important to realize that everything that has transpired since then has been as a result of that Senate amendment being accepted by the government. Again, I feel, and as a member of the special joint committee I think my feeling has some validity here, that we have been trying to play catch-up ever since that moment.
My time on the special joint committee has been difficult. It is not an easy subject for anyone to sit through, because the opinions of the people with lived experience and those who work in a professional capacity really are on all sides of the spectrum and everywhere in between. It can be quite difficult for a parliamentarian to work their way through that to try and understand the complex legal and medical arguments that exist behind this issue, but it is important.
I would say that, personally, my work on the committee has really been a struggle to find a balance between two concepts that sometimes seem to be in competition with each other. I am a firm believer in the Canadian Charter of Rights and Freedoms. I think it is a very important document in Canadian history, and I believe that we have to respect an individual's right to make decisions over their own body, but that belief system of mine was always struggling with another concept, which is that sometimes society finds itself in a position in which it is necessary for it to step in and protect its most vulnerable members. I think those two themes were echoed, not only for me but for many of the witnesses who appeared before our committee and in the many briefs we received.
I also want to note that our special joint committee has existed twice in this Parliament. We tabled our second report in February last year, in advance of Bill C-39. The committee's mandate at that time was guided by five themes that we had to look at, and mental disorder as the sole underlying medical condition was one of those. Of course, we were reconvened after the passage of Bill C-39, but as my colleague from Montcalm pointed out, our runway was extremely short. It did not do justice to the amount of time that we actually needed and to the extreme complexity of this issue.
Just to give this clarity for people listening, I believe our first meeting as a committee was on October 31, and we had to conduct some committee business, and elect the chairs and vice chairs. We really had only three three-hour meetings with witnesses, so nine hours of testimony. We excluded, by necessity, a lot of people who I would dearly liked to have heard from, namely administrators of our public health system, elected officials of provincial governments and so on.
Because of the short timeline, we did not even have enough time to properly translate all the submissions that were sent to our committee because, of course, before they can be distributed to committee members, they have to be translated into French and English. That is a requirement that honours the fact that we are a bilingual country. We, as committee members, did not even have the opportunity to review important submissions, and those submissions came from people who had lived experience, who were dealing with the situation at home, but they also came from many professionals whose practice is involved in this specific area.
I have taken a position on this. The member for Abbotsford, in the fall, had introduced Bill C-314, and I did vote for that, so my vote on this matter is quite clear. I have been informed by the fact that at our committee, there has been a significant amount of professional discomfort expressed by people who practice medicine in this area, psychiatrists and psychologists. Sure, some of them may be acting in a paternalistic way, but I do not think that can be applied equally to everyone. I think for some of them, we have to review their opinions. We have to take them in the context in which they are given. I think we have to afford them a measure of respect, given the fact that these are their lifelong career choices and, in many cases, we can measure their experiences in decades.
I want to take a little time to read from some of the testimony we received from witnesses. We did hear from Dr. Jitender Sareen from the department of psychiatry at the University of Manitoba, who was there also on behalf of psychiatry departmental chairs at the Northern Ontario School of Medicine, McMaster, McGill, Memorial University, the University of Ottawa and Queen's University. His testimony was that they strongly recommended “an extended pause on expanding MAID to include mental disorders...because we're simply not ready.” He was quite emphatic on the point that we are not going to be ready in another year.
Dr. Trudo Lemmens, who is a professor of health law and policy in the faculty of law at the University of Toronto, was there to clarify some constitutional arguments. He was really trying to underline the fact that we have to keep the section 7 and section 15 rights in balance with section 1 and that this issue has not actually been decided by the courts, contrary to what we heard from some witnesses. Previous speakers on tonight's debate have also pointed out that the Truchon decision did not include any reference to mental disorders. That is an important point we have to make.
Dr. Sonu Gaind, who is the chief of the department of psychiatry at the Sunnybrook Health Sciences Centre, pointed out that:
MAID is for irremediable medical conditions. These are ones we can predict won't improve. Worldwide evidence shows we cannot predict irremediability in cases of mental illness, meaning that the primary safeguard underpinning MAID is already being bypassed, with evidence showing such predictions are wrong over half the time.
Scientific evidence shows we cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests, with overlapping characteristics suggesting there may be no distinction to make.
He also commented on the fact that the curriculum used does not teach assessors to distinguish between suicidality and psychiatric MAID requests, and so on.
We also heard from Dr. Tarek Rajji; he is the chair of the medical advisory committee at the Centre for Addiction and Mental Health. He stated:
CAMH's concern is that the health care system is not ready for March 2024. The clinical guidelines, resources and processes are not in place to assess, determine eligibility for and support or deliver MAID when eligibility is confirmed to people whose sole underlying medical condition is mental illness.
These provide a snapshot of the widespread professional discomfort that exists out there, and I do not think we can discount those voices.
I would agree that there were also a number of professionals on the other side who did feel we were ready, and that is what makes this such an incredibly complex and sensitive subject to try to navigate as a parliamentarian. Again, we as a committee should have been afforded the time and space to really delve into these issues and to greatly expand our witness list to make sure we were in fact ready.
Members will note that our recent committee report had only one recommendation in it. I recognize that the recommendation was a result of the majority of the committee members. There were some dissenting opinions, notably from the senators who were part of the committee. However, the committee did recognize that Canada is not prepared for medical assistance in dying where mental disorder is the sole underlying medical condition, and we did not attach an arbitrary timeline to the recommendation. Our specific call was that MAID should not be made available in Canada until the minister of health and the minister of justice are satisfied, based on recommendations from their respective departments and in consultation with their provincial and territorial counterparts and with indigenous peoples, that it can be safely and adequately provided.
We keep getting ourselves into trouble by setting arbitrary deadlines for ourselves. Setting up an arbitrary timeline is not an adequate replacement for the qualitative work that needs to be done by these departments. I would much prefer that we satisfy the qualitative requirement in the recommendation, where departments, experts and our provincial and territorial colleagues are in fact saying that they are going to be okay with that.
The recommendation and my reference to the provinces and territories is a great segue to the fact that there was also a letter sent to the Minister of Health. It was signed by seven out of 10 provinces and all three territories. The signatures include those of all the ministers of health and ministers responsible for mental health and addictions in those provinces, including Adrian Dix and Jennifer Whiteside from my own province of British Columbia. They quite clearly say:
The current March 17, 2024, deadline does not provide sufficient time to fully and appropriately prepare all provinces and territories across Canada....
We encourage you and [the] federal Justice Minister...to indefinitely pause the implementation of the expanded MAID eligibility criteria to enable further collaboration between provinces, territories and the federal government.
I will wrap up by saying that this is a very sensitive issue. I do think we should pass Bill C-62 and honour the calls we are hearing from the professions intimately involved in this issue and the calls coming from the provinces and territories. We need to step up to the plate and make sure we have a fully ready system in advance of the changing of any laws.
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Madam Speaker, when we were looking at Bill C-14 two Parliaments ago, there was a statutory requirement for a review. The government went ahead and introduced Bill C-7 before we ever did that review. It accepted the Senate amendment to its bill before it established the special joint committee, of which I was a member, both in the previous Parliament and in this one. We struggled with many of the issues the member highlighted in his speech. Two of the themes we were grappling with as a committee were respect for individual autonomy versus protection of the vulnerable.
I share the member's concerns with this. How, in his mind, do we try to rectify those two concepts, so that we are respecting a person's autonomy to make decisions that are in their own interest but also making sure that we as a society are protecting the most vulnerable?
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Madam Speaker, today we are revisiting a subject that never seems to leave me in this place, which is medical assistance in dying. It has come up repeatedly: in the 42nd Parliament, in the 43rd Parliament and again in the 44th Parliament. I think it underlines the gravity of the nature of this subject matter.
I want to thank the member for Abbotsford for bringing forward this bill and for giving us as parliamentarians an opportunity to discuss this incredibly important subject.
What Bill C-314 is essentially going to do, for the constituents of Cowichan—Malahat—Langford who are watching this debate, is amend the Criminal Code to reverse what was done with Bill C-7 and specify that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.
It is important to mention Bill C-7, because it is an important part of why we are here today. Bill C-7 was originally introduced in the 43rd Parliament. The government is, of course, required by law to issue a charter statement with its main pieces of legislation. In that charter statement, the Minister of Justice went to lengths to make people understand why the government had specifically excluded in the first draft of the bill why a person with a mental disorder as a sole underlying medical condition could not be eligible to receive medical assistance in dying.
The charter statement did say that the exclusion was not “based on a failure to appreciate the severity of the suffering that mental illness can produce”. Rather, as the statement took pains to say, it was “based on the inherent risks and complexity that the availability of MAID would present for individuals who suffer solely from mental illness.” It is important to understand we are not using the term “mental illness” anymore. Every text is now recommending that we use the term “mental disorder”.
There were three primary reasons given in the charter statement at that time. First, the charter statement said, “evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error”.
The charter statement went on to say, secondly, “mental illness is generally less predictable than physical illness in terms of the course the illness will take over time.” I think a lot of people can understand that. Someone may receive a diagnosis for a physical illness like cancer, which is particularly well known. We know a lot about cancer these days, and based on what part of the body it strikes, we can predict with a fairly certain amount of accuracy what a person's ability to survive it is based on how far it has progressed and so on. It is the same with other physical ailments. With mental disorders, on the other hand, there still are, indeed, a lot of unknowns.
Finally, that same charter statement went on to explain that the recent experience in the few countries that do allow it, and it did mention Belgium, Netherlands and Luxembourg, “has raised concerns”.
That was the charter statement at the time with the first draft of Bill C-7. Of course, When Bill C-7 went to the Senate, the Senate amended that part of the bill to allow a person with a mental disorder as a sole underlying medical condition to access MAID. There was some back-and-forth between the government and the Senate to establish a sunset clause so that it would not come into effect until March 17 of this year.
At the time, the New Democrats decided to vote against the Senate amendment because the requirements of the earlier Bill C-14 had not yet been met. We had not yet had a parliamentary committee to delve into these issues, and we felt that, despite the government having gone to all those lengths through its charter statement to explain its position, accepting an eleventh-hour Senate amendment without having done that important work was very much akin to putting the cart before the horse.
There was also Bill C-39, which was introduced earlier this year because we found that more time was needed. Whatever anyone's feelings are in this House with regard to people with mental disorders being able to access MAID, there was agreement that more time was needed. Therefore, Bill C-39 was passed in very short order in both Houses, and that delayed the implementation of it until March 17, 2024. That is the timeline we are on now.
I am rising to speak to this particular bill because of my experience with this file. Both in the 43rd Parliament and in this Parliament, I was the New Democratic member on the Special Joint Committee on Medical Assistance in Dying.
It was not an easy committee to be on. Let me just say that. For me personally, I constantly wrestled with two concepts: How do we as parliamentarians, with the power we have to change Canada's laws, find a way to honour the personal rights, capacity and autonomy of the individual versus the need of society to step up and protect the most vulnerable? Those were two great themes that were constantly a struggle for me personally when listening to all of the witnesses who came before the special joint committee on the five thematic areas we were charged with by this House and the Senate.
I would encourage people, if they have not done so already, to look at the good work done by the special joint committee, both the interim report, which specifically focused on this area, and the final report, which was tabled earlier this year and completed the committee's mandate. I also want to draw people's attention to the executive summary of the final report of the expert panel on medical assistance in dying and mental illness because there was some incredibly good work done in that as well. We did recognize the authors of that report. The report states:
That MAiD requests may mask profound unmet needs or conversely, that such requests may not be received with the seriousness they deserve, has been raised with respect to several historically marginalized populations (e.g., racialized groups, Indigenous peoples, persons living with disabilities, and sexual orientation and gender minorities). 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.
That is the warning sign that I think much of the medical community is struggling with.
People with mental disorders qualifying for MAID will be under track two of the MAID regime, because death is not a naturally foreseeable outcome. I would remind people that track two has safeguards in place:
request for MAID must be made in writing....
two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met....
the person must be informed that they can withdraw their request at any time....
the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care....
I want to underline that last point. They have to be informed of the available and appropriate means, but we know that for a lot of marginalized populations, those are not always available.
I want to recognize my colleague from Courtenay—Alberni, who has called on the government to urgently fulfill its promise to establish a Canada mental health transfer. This is a very great need in our country. We can see it from coast to coast to coast. I can see it in my community of Cowichan—Malahat—Langford.
The question of Bill C-314 and the state of mental health care in Canada are two things weighing on me quite a bit. I am certainly going to take a lot of time to think about which way I want to go with this bill, but I appreciate the member for Abbotsford for bringing it forward and giving parliamentarians an opportunity to read the report and consider what this bill seeks to do.
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Mr. Speaker, I share my colleague's concerns. That is why I voted against the Senate amendment to Bill C-7 in the previous Parliament. I have been a member of the special joint committee on medical assistance in dying. It is very clear that Bill C-39 is necessary. We do need to have that delay in place.
The concepts we were struggling with at committee were individual autonomy versus protection of the vulnerable. I would like to get my colleague's thoughts on those concepts. What is his understanding of the capacity of a person who may have a mental disorder to make an informed consent decision and their own internal understanding of what they are going through?
This is a genuine question. I am genuinely curious as to what the member thinks about it because this is a really important debate that our country is having.
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Mr. Speaker, as I clearly outlined in my speech, the safeguards are very clearly laid out, not only in the Criminal Code, but also in what we believe the standards of practice should be, and that is going to apply to the medical community. That being said, the medical community has indicated it does need more time, hence the need for Bill C-39. I would just remind the hon. member that many stakeholders in the field of mental health have underlined the fact that the Liberal government needs to step up to the plate and increase the funding and the resources to appropriately address this major crisis happening from coast to coast to coast.
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Mr. Speaker, it is an honour to stand to give my thoughts on Bill C-39. For those who are watching the debate today, this is the bill to amend the Criminal Code to delay, until March 17 of next year, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition is a mental illness.
It has to be stated very clearly, because of the timeline with which we are dealing, that if this bill is not passed, the original sunset clause that was put in place by the old Bill C-7 will come into effect on March 17, which is just over a month away. It is for that reason that I will support the bill and will work with all parties to get the bill passed quickly.
Today's conversation has to happen within the context of the mental health crisis in Canada. We know and have heard, and this is not just from members of Parliament, from many advocates and stakeholders that there is an extreme lack of funding and resources. Clearly, there absolutely must be parity between physical and mental health in funding.
The Minister of Mental Health and Addictions has stated in the House that Canadians should have access to timely evidence-based, culturally appropriate and trauma-informed mental health and substance use services to support their well-being. With that I agree wholeheartedly, but words are not enough. We need to see the requisite resources and funding to follow through those words.
We know that beyond the Canada mental health transfer many advocates have long been calling for legislation to enshrine in law parity between mental and physical health. I am very glad today that I am giving my speech beside the hon. member for Courtenay—Alberni, who is our mental health and addictions critic and who has himself tabled Motion No. 67, which calls on the government to develop that legislation and to urgently fulfill its promise to establish that Canada mental health transfer.
In my own riding of Cowichan—Malahat—Langford, many of my fellow citizens are going through extreme struggles with the opioid crisis. They are dealing with trauma. They are dealing with underlying mental health challenges that are simply not being addressed. That is an extreme gap and the cause of an extreme amount of shame for a country as wealthy as Canada to be still having these conversations about the resources that need to be brought to bear in communities like mine.
I have been a member in the House since 2015, so this is now my third Parliament. I have been here for the entirety of the legislative journey of medical assistance in dying. I can remember Bill C-14 and the sometimes difficult debates we had in the House. That legislation was in response to the Carter decision in the Supreme Court, which basically said that to deny people this right was contrary to our charter. It therefore gave the government a timeline to address it with the appropriate legislation.
What is not often talked about with Bill C-14 is that there was a legislative requirement in that act when it received royal assent. There was a five-year statutory review of medical assistance in dying. Unfortunately, that never occurred before the government went ahead in the previous Parliament and introduced Bill C-7, which established a second track for people whose death was not reasonably foreseeable.
The context of today's speech and C-39 is the fact that we have a story here of the government in several instances putting the cart before the horse. It not only introduced Bill C-7 before a statutory review occurred, which was a requirement of Bill C-14, but it then went ahead and accepted a Senate amendment to the bill that ran contrary to its own charter statement. It did that pretty massive expansion to the law without establishing a special joint committee that was a requirement of Bill C-7.
I am intimately familiar with what this process has been because I have not only been a member of the House since 2015, I have not only participated in debate on Bill C-14 and on Bill C-7, but I have also been a member of the special joint committee, both in the previous Parliament and in this Parliament.
The message all along has been that this kind of a review should have occurred before we were dealing with a timeline crunch. It became quite obvious during the special joint committee that too many Canadians, too many professionals in our country had apprehension about mental disorders as the sole underlying medical condition for being able to access medical assistance in dying as early as next month. Hence, we have Bill C-39.
I want to go back to the original charter statement that the government released as a part of Bill C-7. That includes a number of important statements as to why the government felt, originally, that mental disorders should be excluded from accessing MAID. It did say in that charter statement that the exclusion was not based on the assumption that individuals who suffered from mental illness lacked decision-making capacity. It also said that the exclusion was also not based on a failure to appreciate the severity of the suffering that mental illness could produce. Rather, it was based on the inherent risks and complexity that the availability of MAID would present to those individuals.
First, that charter statement identified that the evidence suggested that screening for decision-making capacity was particularly difficult. It could be subject to a high degree of error. Second, the statement identified that mental illness was generally less predictable than physical illness with respect to the course that the illness may take over time. Finally, it highlighted the experience that a few of the countries that permitted MAID, namely Belgium, the Netherlands and Luxembourg, for the sole underlying medical condition of mental illness had and some of the concerns relating to the increasing number of these cases and the wide range of mental illnesses in respect to which MAID could be provided.
Again, it really highlighted the fact that precaution was the necessary mode that was required before we embarked on this path. However, the government in its wisdom decided to accept a late stage Senate amendment to the bill after the House, full of its duly elected members, had given a final vote on Bill C-7. As a member at that time, I could not bring myself to accept that Senate amendment. Therefore, I ended up voting against the final version of Bill C-7 because of that.
It also needs to be said, when we are going over the history, that the special joint committee that was a requirement of Bill C-7 got a very late start. It was first brought into being just before the summer recess in 2021. We only had a few meetings before the summer of 2021 and we had the unnecessary election, launched solely at the request of the Prime Minister, in August of that year. This completely wiped out anything that was happening during the 43rd Parliament. That Parliament ceased to exist, and all of the committees that were a part of it did as well.
The new Parliament, the 44th, reconvened later that year, but it was not until around April or May of 2022 that serious discussions started coming together and we could actually get the special joint committee reformed. Again, we have to put that in the context of the impending deadline of March 17, 2023.
An incredible amount of time was wasted, not only from an unnecessary election but also from the delays of getting that committee up and running. We had to twice request an extension of our mandate from both houses of Parliament because the timelines we had been given were completely unrealistic, not only in hearing from as wide a range as possible of witnesses but also in producing a report that would reflect the gravity of the subject matter with which we were entrusted. That has to be highlighted in the debate today on Bill C-39.
I also think it is important because there have been a few narratives around this legislation. It is important to go back to understand what the Criminal Code actually says, and also to put that in the context of the definition of irremediability.
It is important that, in order to be eligible for medical assistance in dying, a person has to meet all of the following criteria: they have to make sure that they are in fact eligible for health services in the province they reside in, they have to be at least 18 years of age and capable of making decisions with respect to their own health, they have to have a grievous and irremediable medical condition, and they have to have made a voluntary request. All these conditions must be satisfied. A person must also give informed consent to receive medical assistance in dying, after having been informed of the means available to relieve their suffering, including palliative care.
Now we get to the definition of a grievous and irremediable medical condition as outlined in the Criminal Code. A person has to meet the following criteria for that definition: it has to be a serious and incurable illness, disease or disability; they have to be in an advanced state of irreversible decline in capability; and that illness, disease or disability, or that state of decline, has to be causing them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.
Those are the definitions in the Criminal Code, so despite the narratives we hear out there, those conditions must be met or the person administering MAID will have committed a crime. They will be in violation of the Criminal Code of Canada and will get the appropriate punishment as a result.
One of the difficulties is the fact that the term “irremediable” is not a medical or scientific term. It is a term that finds its definition within the Criminal Code. If we go to scientific or medical literature, it is a difficult term to define, and that, I think, is why we are seeing a lot of the apprehension around accessing MAID for mental disorders where the sole underlying medical condition is a mental disorder.
Some witnesses who appeared before our committee expressed the opinion that this should not be permitted, because there cannot be any certainty with respect to the incurability of a mental disorder. However, other witnesses told us that certainty is not required and that there are ways to consider irremediability, for example by looking at the years of treatment that people have had and whether any responses of the patient have actually been positive.
We also have to understand that the respect for personal autonomy in all of this is paramount, and it is has to be a treatment that is acceptable to the individual receiving it. They not only have to express informed consent, but it has to be something acceptable to them as a person.
I now want to talk a little about the special joint committee, which I have had the honour of being a member of, as I previously mentioned.
I think it is important to underline that our committee has struggled with the question of how to balance individual autonomy with protections for the vulnerable. We were tasked with looking at five themes through the passage of Bill C-7 and the motion that guided our work from both the House of Commons and the Senate: how we institute protections for persons with disabilities; the state of palliative care in Canada; advance requests; mature minors; and, of course, the subject of today, mental disorders as a sole underlying medical condition and their eligibility with respect to applying for medical assistance in dying.
Our final report is due to be tabled in the House this Friday, February 17. We wrapped up our committee meetings last week and finally approved a draft report. That draft report, as I speak, is going to translation services so that it can be ready for tabling here in the House, and so we will be able to meet the deadline that was given to us.
Before we did that work, we had others who did some important work ahead of us. We had the expert panel that was established. They also wrestled with major concerns, such as incurability, irreversibility, capacity and suicidality, and of course the intersection between structural vulnerability, mental disorder and medical assistance in dying.
That panel report, an important precursor to our work as a special joint committee, did state that assessors in medical assistance in dying should be able to establish incurability and irreversibility with reference to treatment attempts made; the impacts of those treatments; and the severity of the illness, disease or disability. The incurability of a mental disorder cannot be established in the absence of extensive attempts at interventions with therapeutic aims.
This means that someone who has not had access to adequate care would not be eligible for MAID. Therefore, MAID could never be used as a substitute for good psychiatric care. I think that is an important thing we have to realize. There will be safeguards in place, not only with the Criminal Code, but also, we hope, with the standards of practice.
For patients who are considering this, we want to make sure that there has been a long track record of attempts to deal with their illnesses. At the same time, we have heard very clearly that there are many Canadians and many professionals who feel that additional time is needed to make sure we get this right.
One of the witnesses before our special joint committee was the chair of the Government of Quebec's Select Committee on the Evolution of the Act respecting end-of-life care. She explained that Quebec had decided that MAID for mental disorders as a sole underlying medical condition should not be permitted at this time because of the challenges of determining irremediability, as well as the lack of social consensus. Another level of government, this time the Province of Quebec, is also underlining the concerns that many members of Parliament are expressing here today.
I mentioned the final report that will be tabled in the House, but our committee did release an interim report. That interim report was specifically on this subject matter. I will read from our conclusion. It states:
We must have standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight in place for the case of [medical assistance in dying for mental disorders as the sole underlying medical condition]. This task will require the efforts and collaboration of regulators, professional associations, institutional committees and all levels of governments and these actors need to be engaged and supported in this important work.
Although some work is already underway to implement the recommendations of the Expert panel, there is concern that more remains to be done to ensure that all necessary steps have been taken to be ready by the March 2023 deadline...
Again, in our interim report, our special joint committee was already, at that time, expressing concern with the upcoming deadline, and I think it is a smart move that we are moving ahead with Bill C-39. If we back that up with the testimony we heard at committee, we had a number of different witnesses who clearly expressed that they had troubles with this deadline and that those standards of practice were not yet ready.
It needs to be underlined again that, if Bill C-39 is not passed, the original sunset clause of March 17 will come into effect. My vote for this bill is occurring because of that very fact. This is aside from the broader conversation we need to have about medical assistance in dying in general. It is support for a bill that is going to extend the deadline by one year so we can make sure that we get these standards of practice right, so we have the necessary time to engage with the broader community.
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Mr. Speaker, let me just say from the outset what a pleasure it was to serve on the special joint committee with the member for Montcalm, both in the last Parliament and in this one. I always appreciated his very thoughtful interventions and I could tell that he always came to committee quite well prepared.
The member and I have been here since 2015. He will remember that in the original bill, Bill C-14, there was a statutory requirement for a five-year review. We know that Bill C-7 was introduced before that review happened and that the government decided to accept a Senate amendment before it had a chance to establish a special joint committee. That process, that timeline, underlines why Bill C-39 is necessary now.
I wonder if my hon. colleague would just reflect on what has led us to this point and why Bill C-39 is necessary, and for this House to pass it quickly, because of the impending deadline and the fact that we do need to have some space to make sure we are getting these standards right. It is extremely important.
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Mr. Speaker, I have served on the special joint committee both in the previous Parliament and in this one. It was a lengthy amount of work, and certainly there was some very difficult testimony to go through.
I do not want to cover the same ground that previous members have asked questions on, so maybe I will change tack.
My friend, the member for Courtenay—Alberni, is our mental health and addictions critic, and he has constantly asked the government to bring mental health care funding up to parity with physical health care, understanding that there is in fact a real crisis. When I look at the conditions in ridings like mine, where we see the opioid crisis and the way it has been ravaging communities, there is so much underlying trauma and so many undiagnosed mental health disorders that are not being addressed.
I would like to invite the member to comment on that. In the midst of this very difficult conversation, and I agree that Bill C-39 is a necessity, we have to take this opportunity in time to make sure that our system is appropriately resourced and funded so that we are getting to Canadians who are falling through the cracks.
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Mr. Speaker, like the minister, I have been here since 2015, so I have seen the entire legislative journey of medical assistance in dying, and I have also been the NDP's member on the special joint committee, both in the last Parliament and this one.
Back when Bill C-14 was passed, there was a requirement in that act for a statutory review of the legislation. We did have Bill C-7, and the government did accept the Senate amendment, even though it was contrary to its own charter statement on the matter. It was only after that that we established the special joint committee, which was then delayed by the 2021 election and did not get up and going until May of last year.
In the context of that, I think the Liberals have, in some instances, put the cart before the horse before we have had the appropriate review, but I would also like to hear his comments because there is a crisis in funding for mental health in this country. We have had the Canadian Mental Health Association talk about this. I would like to hear from the justice minister that his government can make a commitment to bring mental health care funding up on par with that of physical care. There is a real crisis, not only in my community, but also in communities from coast to coast to coast. I think that is going to be an important component of this conversation.
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