Bill C-314

An Act to amend the Criminal Code (medical assistance in dying)

This enactment amends the Criminal Code to provide that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.

Justice

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, once again, we hear reports of Canadians crying out for help with their mental health, but being offered assisted death instead.

The government refused to listen to mental health experts, to veterans, to disabled people and to indigenous Canadians. It did not listen to the family whose mother begged for help, but instead was euthanized before her kids could even say goodbye.

Canadians overwhelmingly oppose this overreach on assisted suicide. Tomorrow, we can end this madness by passing Bill C-314.

Will the government give Liberal MPs a free vote? This is for the whip, yes or no?

Criminal Code

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Mr. Speaker, I would first like to pay my respects to my colleague, whose personal accounts were very moving. Our hearts go out to Anton's family.

As we know, Bill C-314 amends the Criminal Code to provide that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying. The Bloc Québécois supports access to medical assistance in dying when a mental disorder is the sole underlying medical condition. We agree with the expert panel that the safeguards currently in place in the Criminal Code are sufficient. We think the exclusion should be maintained for one more year in order to give health care professionals a chance to develop standards of practice for cases of medical assistance in dying related to mental illness and to become familiar with those standards.

I would remind the House that the Bloc Québécois's position on medical assistance in dying has always been to uphold the consensus in Quebec, which came about following five years of consultations, specifically that medical assistance in dying is a right. Everyone has the right to die with dignity, of their own free will and with as little suffering as possible.

The Bloc Québécois is of the opinion that it is wrong to draw false analogies between the different problems in society and the specific issue of access to medical assistance in dying when a mental disorder is the sole underlying medical condition. We are of the opinion that it is possible to defend the right to self-determination, which is what medical assistance in dying is, while contributing to improving our health care systems, especially our mental health services. On that note, the Bloc Québécois would remind the House that the government has not substantially increased health transfers. That is affecting the system.

I would like remind the House that, in this debate, it is not a matter of offering people euthanasia as an answer to society's ills, contrary to what the Conservatives are saying. It is frankly irresponsible to suggest that the government's actions are causing people to become depressed and that the government's solution is to offer them medical assistance in dying.

It is also important to remember that the Conservative leader spread disinformation by failing to mention the context, when he stated in his communications that the government decriminalized dangerous drugs. The context is that Ottawa authorized a three-year pilot project in British Columbia to decriminalize the possession of small quantities of drugs. It is a pilot project based on practices used in Portugal with the explicit goal of curbing the overdose epidemic that is happening in British Columbia. The hope is that this pilot project will set a course to help Canadians and Quebeckers with addictions.

What is more, it is misleading to say that the governments will be providing medical assistance in dying in less than a year. That suggests that people will have their request for medical assistance in dying approved in less than a year, when that is not at all the case. As the experts on the Special Joint Committee on Medical Assistance in Dying pointed out, it will take at least a decade, maybe several decades, before a person can get medical assistance in dying for a mental disorder. It will have to be established that decades of therapy using multiple approaches have done nothing to treat the patient's mental health condition. In short, that is the complete opposite of what is being said by the Conservative leader, who is suggesting that a temporary depression is sufficient grounds to access medical assistance in dying.

In the Truchon and Gladu ruling, the courts had determined that the criteria were too restrictive, hence the evolution of this legislation. At the end of a press conference, a journalist asked the Conservative leader if he was prepared to use the notwithstanding clause to block access to medical assistance in dying. The Conservative leader skilfully dodged the question by mentioning that it is not currently before the courts. The Bloc Québécois is curious to hear what his colleagues think of this.

It should also be noted that the expert panel did not recommend deferring the exclusion measure. This is a request by professional associations. Although the expert report is entitled “Final Report of the Expert Panel on MAiD and Mental Illness”, the experts recommend changing the terminology to “mental disorder” because “mental illness” does not have a standardized definition. The panel finds that its recommendations on safeguards, protocols and directives should apply to all clinical situations in which several or all of these important concerns are present, namely incurability, irreversibility and capacity. The expert panel considers that the safeguards currently included in the Criminal Code are adequate for cases of medical assistance in dying when a mental disorder is the sole underlying medical condition.

As my colleague from Repentigny said earlier, the panel made 19 recommendations to proceed with requests for medical assistance in dying when a mental disorder is the sole underlying medical condition. They fall into five broad categories: the development of practice standards for medical assistance in dying; the interpretation of the term “grievous and irremediable medical condition”; vulnerabilities; the assessment process; and implementation.

Briefly, the panel recommends that practice standards be developed and shared with professional associations so they can adapt and adopt them. It should be noted that the government set up a task group to address this and that these practice standards were published in early 2023.

When it comes to interpreting the expression “grievous and irremediable medical condition”, the criteria of incurability, irreversibility and enduring and intolerable suffering, which are currently contained in the Criminal Code, must be duly established. They must be appropriately interpreted in applications for MAID when a mental disorder is the sole underlying medical condition. Although the expert panel acknowledges that it is impossible to establish fixed rules surrounding treatments, their duration, number and variations, they must nonetheless be part of the considerations for accessing medical assistance in dying. Simply put, for someone to have access to MAID when a mental disorder is the sole underlying medical condition, that person must have a significant history of treatments and therapies.

With regard to vulnerability, this involves ensuring that applicants have access to sufficient resources—housing, pain management, community support—so that their choice to access medical assistance in dying is not based on an adverse social circumstances. Again, the Bloc Québécois reiterates that increasing health transfers and funding the construction of social housing must be permanent priorities for the federal government.

As for the recommendations regarding the assessment process, the key recommendation is that the Criminal Code requirement, in this case consulting a specialist, involve a psychiatrist.

Finally, the recommendations for implementation can be broken down into three areas: consultation with stakeholders, training, and data collection for monitoring purposes.

As my hon. colleague and friend, the Bloc Québécois member for Repentigny, explained, this is a serious subject. We must set partisanship aside and work with the expert panels.

[Len Webber, Conservative, Calgary Confederation, AB]

Mr. Speaker, today I rise to speak to Bill C-314, an act that would amend the Criminal Code in regard to medical assistance in dying.

This enactment would amend the Criminal Code to provide that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.

This is not the first time I have risen in this House to speak on the issue of medical assistance in dying, MAID, and I thank the hon. member for Abbotsford for the opportunity to speak to his bill.

As we know, MAID is an extremely complex issue that has generated some strong opinions on both sides. In May 2016, when I rose here to speak in support of the MAID legislation, I stated that, “when it comes to something as personal and sensitive as death, it is better to have options available, even if we do not like them, even if we do not believe in them. It is better to have some legal framework [in place] than none at all.”

I quoted from many letters I received from constituents in my speech back then and read letters from Ken, Connie, Valerie, Debra Lee, Catherine, Tracey, Doug and David. They all shared their personal perspectives with me, and it was extremely helpful in my own personal deliberations.

In the years since MAID was legalized, I have come to have known a number of people who have found comfort, personally and for their families, in the MAID process. Their death was foreseeable, there was no chance of recovery and when the dying process appeared to be both prolonged and cruel, it was an option they took advantage of. Their death was dignified, it was planned and it was peaceful. It allowed them to say their goodbyes to their loved ones, to their friends, when they could.

However, that being said, I am a very big proponent of hospice and palliative care, which must always be a viable and an available option to someone contemplating MAID. In the strongest of terms, MAID cannot be seen as a substitute for good palliative care, and it should never be.

Through my family’s volunteer experience with Hospice Calgary, and later with my wife’s final days with breast cancer at the Agape Manor Hospice care facility, I saw first-hand how critical it is we have a proper, well-funded palliative care system here in Canada. I saw then how underfunded this specialized care is within our health care system, and it is still that way today.

Canadians should have access to the support and care they need while living through one of the toughest times in their lives. We need to do better and we can do better, but we certainly have a long way to go.

However, today we are here to address the concerns of Canadians when it comes to the implementation of MAID with mental illness as the sole eligibility. This is the gist of Bill C-314. Should there be a permanent exclusion from MAID for people whose sole underlying condition is a mental disorder?

Back in 2016, during the original MAID debate, I had a meeting with a constituent, a young man named Anton. He came to my office, and Anton is the reason I am rising to speak today. He was a 25-year-old or 26-year-old, fit, good looking, articulate, intelligent and healthy young guy. When I say “healthy”, though, I mean in the physical sense only.

Anton came to my office to discuss his desire to have access to medical assistance in dying. He literally wanted to die. He shared with me his mental struggles and he said he was tired of living and he just wanted to die. It was something I just could not comprehend. This young guy seemed to have everything going for him and he wanted to die.

Anton felt the requirement in MAID that one’s death be foreseeable was unfair, a barrier and should not be in the legislation. He felt if one wanted to die, one should be allowed to through MAID, no questions asked. It should be as easy as going to get a haircut, he said.

I did ask him if he ever thought of taking his own life and why he would need MAID. He said he did not want to put a bullet in his head, jump off a chair with a noose around his neck or cut his wrists. That seemed too fearful for him, too painful and unfair for whomever would find him. We talked for what seemed like hours in my office.

I found it odd that he never once mentioned anything about a doctor, any treatments he was receiving or any medication he was on, so I asked him if he had seen a doctor. He had not spoken to a single health professional about his desire to end his life. I encouraged him to, and I said he needs to talk to somebody because I was certainly not the guy to talk to about suicidal tendencies. When he was leaving the office, he said he would seek some help. I gave him a hug, and I have had many sleepless nights since wondering if there was anything else I could have done.

About three months later, Anton requested another meeting with me. He told me that he had sought help and went to see a doctor. Whether it was a psychiatrist or psychologist, I do not know, but he told me of his horrific episode. The very doctor who Anton went to seek help from called the police, saying that Anton was a danger to himself and needed to be protected. Anton was taken away by the police and locked in a padded room for 14 hours without any food or water. He told me he only got out because he finally convinced authorities that he was fine, that he was normal and that things were good. He basically had to lie his way out. He said it was the worst experience of his life. He asked for help and had gotten none.

That is the problem. Many Canadians are just not getting the mental health assistance they need. Clearly, we need to put better supports in mental health and people's access to that help. We should be careful in asking police to be mental health professionals. We need to make sure we have the right people in the right place at the right time. I am pleased to hear that some police forces are now using health professionals in the field, but we still have a long way to go.

We need to put vulnerable Canadians back in control of their lives. We want to see them get the help they need and provide them with the social and mental health supports they need. We must never give up on them and allow them to prematurely choose MAID over access to mental health care.

Since 2016, I have heard nothing from Anton. I have often wondered whether he is still alive or dead. Before this speech, I tried to seek him out, and I went to social media. I had some assistance and found some information on Anton. I discovered that he had found love abroad. He is working to bring his new wife or girlfriend to Canada and is excited to start a new business. I know that if MAID legislation in 2016 had permitted mental health as a sole reason, it is quite possible that Anton would have ended his life without exploring all of his options. He never would have found the love and support that he has today.

I am very grateful for the perspective that Anton has given me on this issue, as it has profoundly convinced me that those whose sole condition is a mental disorder should not have access to medical assistance in dying. That is why I support the hon. member for Abbotsford's private member's bill, Bill C-314.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, in March 2023, legislation to extend by one year the temporary exclusion of eligibility for MAID where a person's sole medical condition is a mental illness received royal assent and immediately came into force. This means that persons suffering solely from a mental illness will be eligible for MAID as of March 17, 2024. Bill C-314, the bill before the House today, would remove this eligibility at least until we have satisfactory answers and guardrails to ensure that we can extend this profoundly permanent step with confidence. In my view, we do not have that necessary confidence today, and I think the majority of Canadians and health professionals, and the data, concur.

Data released in September 2023 from the Angus Reid Institute found that a majority of Canadians, 52%, worry that treating mental health will not be a priority when MAID eligibility is expanded to include individuals whose sole condition is mental illness. A vast majority of Canadians, 80%, are concerned with the mental health care resources available in this country, namely that they are not sufficient. Overall, one in five Canadians says they have looked for treatment from a professional for a mental health issue in the last 12 months, and in that group, two in five say they faced barriers to receiving the treatment they wanted. These obstacles appear to be more of an issue for women, among whom 45% of those who sought treatment say it was difficult to receive, and young Canadian adults aged 18 to 34.

A majority of Canadians support the previous rules governing MAID, first passed in 2016 and then updated in 2021, but there was more hesitation when it comes to this next step. Three in 10 say they support allowing those whose sole condition is mental illness to seek MAID, while half are opposed.

I will turn to some of what the professionals are telling us, starting with the Centre for Addiction and Mental Health. A survey recently of CAMH physicians found a lack of agreement on whether or not mental illness could be considered “grievous and irremediable” for the purposes of MAID and what criteria could be used to determine whether a person is suffering from an irremediable mental illness. The survey also found significant disagreement among physicians on whether or not a request for MAID can be differentiated from suicidal intent. These physicians also highlighted the concerns they had about access to mental health care in the context of expanded eligibility for MAID.

Canada's mental health care system has experienced chronic underfunding, leading to a significant shortage of community- and hospital-based mental health care across the country. Between one-third and one-half of Canadians with mental illness were not getting their mental health needs met before the COVID–19 pandemic exacerbated the mental health crisis and increased the burden on our mental health system and therefore on Canadians. The results of that survey replicate the findings from the Canadian Psychiatric Association's member consultations in 2020 and the conclusion of the Council of Canadian Academies' expert panel working group report in 2018.

Let me turn to the Canadian Mental Health Association, Canada's premier organization dealing with mental health:

CMHA's position, first articulated in a national policy paper in August 2017, and later, in testimony to the Senate in November of 2020, is that until the health care system adequately responds to the mental health needs of Canadians, assisted dying should not be an option....

First, it is not possible to determine whether any particular case of mental illness represents “an advanced state of decline in capabilities that cannot be reversed.”

Second, we know that cases of severe and persistent mental illness that are initially resistant to treatment can, in fact, show significant recovery over time. Mental illness is very often episodic. Death, on the other hand, is not reversible. In Dutch and Belgian studies, a high proportion of people who were seeking MAID for psychiatric reasons, but did not get it, later changed their minds.

Third is the issue of whether this distinction for mental illness vis-à-vis all other types of illness is inherently discriminatory. Denying access to MAID for mental health reasons alone does not [necessarily] mean that those with mental illness suffer less than people afflicted with critical physical ailments.

That is true. The statement continues, saying, “What is different about mental illness specifically, is the likelihood [or not] that symptoms of the illness will resolve over time.”

We do not have the benefit of appropriate guidance from the Supreme Court of Canada on this issue, and that is something we need to take into account.

It is also noteworthy that with only 7.2% of Canada's health budget dedicated to mental health care, Canada spends the lowest proportion of funds on mental health among all G7 countries. For example, in the U.K., the National Health Service spends 13% of its budget on mental health care. According to the OECD's recent analysis of spending on mental health worldwide, it concluded that even that is too low, given that mental illness represents as much as 23% of the disease burden. The historical underfunding of mental health has been most pronounced in community-based mental health services and I think that ought to be taken into account.

According to the Canadian Psychiatric Association, perhaps Canada's foremost experts on mental health diagnosis and treatment, its members are profoundly split on this issue. The CPA's most recent member consultations in 2020 found that 41% of respondents agree that persons whose sole underlying medical condition is a mental disorder should be considered for eligibility for MAID, 39% disagree or strongly disagree, and 20% were undecided.

According to CPA president, Dr. Grainne Neilson:

Balancing the commitment of psychiatrists to provide treatment, care and hope for recovery with a person's lived experience of suffering and right to enact personal choice in health-care decisions, including MAiD, is a fundamental challenge, particularly where death is not naturally reasonably foreseeable.

Equitable access to clinical services for all patients is an essential safeguard to ensure that people do not request MAiD due to a lack of available treatments, supports or services. Poor access to care is particularly relevant for people of low-socioeconomic status, those in rural or remote areas, or members of racialized or marginalized communities.

The Canadian Psychological Association, another very important group in this matter, states the following:

Many mental disorders are managed, not cured. Medications for mental disorders are largely palliative. While it is possible that medications and psychotherapy may successfully treat an episode which then doesn’t recur, it is often the case that mental disorders require management across a lifetime.

In assessing whether a condition is incurable and irreversible, consideration must be given to equity of access to interventions. Wait lists for publicly funded services are long. Services, like psychotherapy offered in communities by psychologists, are not funded by Medicare. Needed services are not always available in rural or remote communities. To fully address whether a condition is resistant to intervention, that intervention must be accessible.

It is not.

The mental functions required to give consent to MAiD are the very ones sometimes impaired with a serious mental disorder, despite the grievous and irremediable suffering the disorder imposes. Consideration must be given to how to assess capacity despite the impairment in thinking that can accompany serious mental disorders.

I believe that we must act cautiously and prudently, and we must take a phased approach in this area. As has been noted by all parliamentarians, this is an intensely sensitive issue with grave moral and consequential concerns.

Adequate time, in my view, is needed to facilitate a comprehensive national conversation about acceptable safeguards and the availability of medically assisted dying for those suffering from psychological or mental health conditions alone, so that we minimize negative impacts on people living with mental health problems and illnesses when they are most vulnerable, and on their caregivers and health professionals.

I think holding that national conversation must involve people living with mental health problems and illnesses, and their experiences because they play a central role. We must get their input into what mechanisms must be there to minimize the risk of wrongful death.

It is going to be my position to support this bill and I think we must move very cautiously. I do not think that we can say that we can never move into this area, but I think we can say with confidence that now is not the prudent time.

[Monique Pauzé, Bloc, Repentigny, QC]

Mr. Speaker, I am going to address the subject of Bill C‑314; that goes without saying. However, I feel especially compelled to condemn the excessive and inappropriate nature of this initiative from the hon. member for Abbotsford. His bill is being tabled in reaction to an important, sensitive social issue, namely medical assistance in dying.

The fact that my colleague from Abbotsford wants to amend the Criminal Code to include the notion that mental disorders should not be considered grievous and irremediable medical conditions for access to medical assistance in dying is a proposal that does not even need to be made. Mental illness is an extremely complex issue, even a controversial one in medical circles. There are many reasons for that. To begin with, it would be imprudent and dangerous to rush the process of providing access to medical assistance in dying when the sole underlying medical condition is a mental disorder. However, that is not what is happening right now. The Criminal Code will be revised in due course, if necessary. On this point, experts feel that the current provisions of the Criminal Code are adequate to allow for further work on medical assistance in dying.

What I want to speak out against today is what I see as the official opposition's blatant politicization of this issue. Everything looks normal, or almost, when one reads Bill C-314 objectively, but it is the whole message surrounding the introduction of this bill in the House that I want to condemn. I would like to be able to say that some members just do not understand, but I cannot even use that explanation as an excuse for their behaviour.

Although I agree that being unable to afford a home and dealing with inflation and rising grocery prices are not pleasant experiences, associating them with medical assistance in dying for mental disorders is the worst kind of populism. This just shows an appalling ignorance of the many realities experienced by people living with with mental illness or just plain ignorance in general. This is a position of contempt toward people who are working on many fronts to lead a somewhat normal life, despite the suffering caused by their mental condition. With Bill C-314, the Conservatives are putting on their agenda generalizations and falsehoods that they think will win them votes, and I do not see anything good about that.

This debate is a societal debate. When the official opposition claims that the work that will be done next spring is to allow Canadians who are “losing hope”, the phrase used by the leader of the official opposition, to access medical assistance in dying, I think that is completely irresponsible. There is a difference between a request and the acceptance of the request. That is the first thing the member should take into consideration. Just because a request is made does not mean it will automatically be accepted. I want to come back to the fact that the Conservatives are driven by purely vote-seeking motivations and that these statements are false. At press conferences, they tell Canadians that the intention is to provide medical assistance in dying to people whose only condition is depression or other mental health problems. Come on. Depression is reversible. Suicidal ideation is also reversible. They need to stop for a minute and think. In my opinion, it is completely irresponsible to say such things. However, it gets worse. In March, the leader of the official opposition went so far as to include the following generalizations in his preamble:

Those going to The Mississauga Food Bank [are] seeking help with medical assistance in dying, not because they are sick but because they are hungry...

Here is another quote:

...1.5 million are eating at food banks, and some are asking for help with medical assistance in dying because they cannot afford to eat, heat or house themselves.

Honestly, my colleagues cannot be serious. There are plenty of other passages from Hansard I could quote. In any case, if the Conservatives seriously believe that not being able to afford a house or dealing with the challenge of finding a place to live during post-secondary studies are two factors that lead people to want to end their lives, then I would say that things are an absolute mess.

We expect the official opposition to put an end to its demagoguery and simplistic approach, and instead take a more collegial approach where real discussion can take place and where all opinions can be expressed to allow a full understanding of what is at stake. The Bloc Québécois believes that the strategies and messages coming from the official opposition on such an important and sensitive issue do nothing to advance everyone's understanding of the issue.

The subject we are studying deserves serious consideration. We have a duty to Quebeckers and Canadians, and it is certainly not to tell them a bunch of nonsense, as the opposition leader did last March in the quotes I cited earlier. Medical assistance in dying is not a form of treatment for people with depression or suicidal ideation. It is the last resort, after decades of care, interventions and numerous therapies have all failed, when suffering is never-ending and the disease is incurable. I cannot emphasize that enough.

We believe that suffering is not exclusive to people who have a degenerative disease or who are at the end of their life. There is no need to rush this work, since the outcome has not yet been decided, contrary to what the Conservatives would have everyone believe with their message and their populist election strategy.

In its report, the Expert Panel on MAID and Mental Illness made 19 recommendations and proposed more stringent safeguards. For example, in recommendation 10, the panel proposed that a psychiatrist independent from the treating team and an independent assessor be consulted. Recommendation 16 involves the implementation of prospective oversight. There are other recommendations.

Under no circumstances would the Bloc Québécois condone providing access to medical assistance in dying in this medical context without the following: a thorough analysis of the practices and standards being considered; discussion with civil society groups, patients' rights representatives, professional associations and other stakeholders; a clear interpretation of the criteria regarding incurability, irreversibility and enduring and intolerable suffering; and the establishment of all of the safeguards and legal processes related to the ability to consent.

Members can count on the member for Montcalm, the Bloc Québécois critic on this file, to do a very thorough job.

I invite all members of Parliament, especially the members of the official opposition who might be tempted to repeat their dangerous generalizations and falsehoods, to read all of the recommendations. There are recommendations that have to do with the assessment process. The Criminal Code requires consultation with a specialist, and the key recommendation is for that specialist to be a psychiatrist. There is also the prospective oversight that I was talking about earlier.

The recommendations relating to implementation fall into three categories: consultation, training and data collection. Simply put, in order to access medical assistance in dying when a mental disorder is the sole underlying condition, there must be a significant history of treatment and therapy. Nothing is taken lightly.

In closing, we have to consider our capacity to pay for the health needs of the patients in question. We have to provide care to these people with irreversible illnesses. As a compassionate and empathetic society, we must take care of patients who meet the eligibility criteria for medical assistance in dying and provide them with a gentle and dignified death. Let us allow this work to continue early next spring without polarization or disinformation.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Mr. Speaker, it is a pleasure to rise and speak on an issue that has been fairly extensively debated over the last number of years. Members will recall that the reason we are having today's debate goes back to 2015, when a Supreme Court of Canada decision ultimately obligated parliamentarians here in the House to develop and pass a law that took into consideration the ruling made by the Supreme Court, with the necessity for the government to provide a framework.

It was not a very easy challenge when that decision was ultimately made. I do not know how best to put it, but the Government of Canada, at the time run by Stephen Harper, ultimately sat on the issue until there was an election. That election saw a change in government, and it was one of the first orders of business that the Government of Canada, under the current Prime Minister, had to deal with.

Over the years, I have been engaged in many different types of debates on all forms of legislation. When I am talking to young people who are trying to get a sense of what we do here in Parliament, I talk about legislation, and I will often make reference to Bill C-7. For Bill C-7, a very passionate debate took place on the floor of the House of Commons back in Centre Block. I can recall it vividly because of all the different emotions that were being expressed on the floor and all the discussions that took place.

It was not taken lightly. If we take a look over the years at the number of Canadians who have been consulted in one form or another with regard to medical assistance in dying, we are not talking about tens of thousands. We are talking about hundreds of thousands of Canadians from coast to coast to coast, in many different forms. They came together to voice opinions and concerns. In fact, we had a standing committee that did an incredible number of consultations, not only with individuals in our communities but with many different stakeholders.

In the debates that I have seen, I do not think we referenced our health care professionals and the important role they played in the debates. I want to start off by talking about that, because I think it is really important that, as Bill C-314 will ultimately be voted on, we understand and appreciate the number of discussions and the amount of effort that took place for the current legislation we have, which was amended.

As we saw, there were some issues that ultimately came out of Bill C-7, which caused another government bill to come to the floor. Again, a lot of repeat discussions took place and it ultimately passed. I think that is why the member has made the decision to propose his private member's bill. The changes that were made in what I think was Bill C-39, although I am not 100% sure and the member can correct me if I am wrong in his closing comments, are what might have brought forward this particular piece of legislation.

To be clear on what Bill C-314 does, it proposes to permanently exclude the eligibility to receive medical assistance in dying on the basis of a mental disorder alone. Wording is really important. I know that in the original debates with all the different stakeholders, and I made reference in particular to our health care professionals, the quality of the presentations and the understanding of the serious nature of the issue were, I would suggest, second to no other out of the debates I have witnessed, in particular given some of the things we heard coming out of committees.

As I reflect on that debate, I think that, in good part throughout the process, we saw many members of Parliament put their party position to the side and reflect in terms of what each believed as a parliamentarian. Maybe it was a crossover of personal beliefs versus the canvassing that many people no doubt had in terms of their constituents and wanting to reflect the general will of their constituents.

At the end of the day, when we think of medical assistance in dying and the issue of a mental disorder, I do not think that we want to try to simplify the message. As we all know, I am not a medical professional, but I have an immense amount of respect for what our medical professionals have to go through in order to be put into a position, because it is not just any and every doctor or nurse practitioner; there is a whole lot more that is involved. Towards the end of the debate, particularly on the second piece of legislation dealing with this particular issue, we had members who stood up and said, “Well, just put in your order”, almost as if someone were going through a drive-through and then it is done. We all know that is, by far, not the case.

I will fall back on the fine work that our standing committees have done. I am going to fall back on the issues and how they were explained, in good part, by the different stakeholders. I am going to stand by what the health care professionals brought forward to us. I will look at the information that was provided and ultimately reflect on what I believe in this particular situation and what a vast majority of the constituents I represent would want me to say on this particular issue. I will do this with very much a sympathetic heart, understanding the difficult situation that, unfortunately, far too many people have to face.

We can have as much sympathy as we want for those individuals who are looking at the possibility of getting medical assistance in dying, but it is one thing to sympathize and it is another thing to empathize. Based on everything I have looked at and listened to over the last number of years, I have not been convinced that this is, in fact, the direction that we should be going with regard to Bill C-314. I am just not convinced.

I think that what we ultimately need to do is continue to monitor and look at ways in which we can ensure that there is no abuse of the MAID legislation. We need to continue to show compassion in every way we can. We need to continue to listen to what the experts, individuals and stakeholders are telling us and try to build more value to the legislation so there is a higher sense of comfort in the broader community, which I believe there is today. The mechanisms are there, and there are opportunities to continue to be able to review.

The House resumed from May 17 consideration of the motion that Bill C-314, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, it is a privilege to engage in this debate on Bill C-295, and I want to commend the member for Vancouver Centre for bringing forward this bill. I am not sure we will be supporting it, and I will explain why in a moment, but she has brought forward a bill that addresses what is perhaps one of the most existential challenges facing not only Canada but western developed societies, which is the aging of our population.

A huge demographic challenge facing our country of course is the aging of our population. There are more and more Canadians who are becoming seniors. There are more and more Canadians who are moving out of the workforce, which is creating significant workforce shortages, and we are experiencing those today. At the same time, these seniors are requiring more and more care, which of course imposes a burden on taxpayers.

I would not for a moment suggest we should not be providing for the seniors who built our country. We owe it to them to do that.

However, the COVID pandemic, the first pandemic of its kind in over 100 years, left virtually every government around the world unprepared to meet that challenge. Here in Canada, that challenge manifested itself, among other things, by creating significant shortages of competent workforce members within our hospitals to address the increasing numbers of patients coming in suffering from the COVID virus. This became an acute problem for hospitals across our country.

There was not a province or territory that was not impacted by the fact that our hospitals could not provide the care needed. Beyond that, our long-term care facilities suddenly found themselves faced with this incredible challenge of having vulnerable seniors they were in charge of who had now contracted the COVID virus and trying to put into place protocols that were going to protect those vulnerable residents of those homes.

This bill seeks to address that by criminalizing the failure to provide the necessary care in those homes. More specifically, this enactment, Bill C-295, would amend the Criminal Code to create an offence for long-term care facilities, their owners and their managers who fail to provide the necessities of life to residents of their facilities.

I think all of us can agree that is a worthy undertaking to make sure our long-term care facilities have the kinds of services and protective protocols that would protect the residents of those facilities. The problem is we have significant labour shortages in our country. Until we have actually addressed those labour challenges, it would be imprudent to impose on these facilities criminal sanctions that effectively mean these homes could not provide the kind of care the Criminal Code would require but that our labour challenges cannot address adequately.

My challenge with this legislation is we are trying to do two things. We are trying to provide those facilities with the labour force they need to adequately protect residents and patients, but at the same time we are trying to criminalize the activities of these facilities when in fact they are in no position to comply with the law.

I would raise one other point. The proponent of this bill, the member for Vancouver Centre, has said that this is all about protecting the most vulnerable within our society. I commend her for standing up and defending the rights and the welfare of our seniors, the ones who find themselves in extremely vulnerable positions.

However, there are other seniors and other Canadians who are also in vulnerable positions who call out for protection and those are our mentally ill, the mentally disordered in our society, who are now finding themselves caught under Canada's medical assistance in dying regime, Canada's assisted suicide regime, which is being extended by this government to the mentally disordered within our society, including those suffering from depression.

I do not know how we square that, on the one hand, advocating for the protection and welfare of seniors in our homes, but, at the same time, saying that we are going to also advocate for assisted suicide to be extended and expanded to include the mentally ill.

There is something wrong with that picture. It troubles me deeply that we have found ourselves in this place where competing ideologies are taking place right here in the House of Commons.

I earlier asked the proponent of this bill if she would support Bill C-314, which seeks to extract and remove the mentally ill from Canada's MAID regime. She hummed and she hawed and she explained this way and that way.

At the end, all we could conclude was that, no, she was not prepared to protect the mentally ill against medically assisted dying but, at the same time, would be advocating for the seniors in our homes and the residents of our long-term care homes who find themselves vulnerable and could see their lives and their health impaired by another pandemic.

We can see that I am quite frustrated to be placed in the position of having to judge the member for Vancouver Centre's bill based on her inability to understand that there has to be consistency when we bring forward legislation.

When we promote an ideology that is supposed to protect the most vulnerable in our society, that does not mean we can pick and choose between different vulnerable groups. We need to address their needs in a wholesome way, in a holistic way, and we have to be consistent in how we apply our ideology.

Unfortunately, that is not taking place here. Quite frankly, I lament that our country is moving down this road, where some of our most vulnerable are going to find themselves at great risk because of the life and death policies that this government is adopting, which have not been properly thought out.

I am going to ask the member for Vancouver Centre to reconsider her position on Bill C-314, as I will reconsider my position on her bill, Bill C-295. We both have objectives to protect and defend the rights of the vulnerable.

I call for one thing: consistency. All those who are vulnerable in our society are worthy of our protection.

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I want to thank my hon. colleague for her care and concern for the most vulnerable adults in our society.

There is another bill coming through the House very shortly, Bill C-314, which is about medical assistance in dying and protecting the mentally ill against the scope and expansion of medical assistance in dying. I was wondering, given the fact that the member has concern for the vulnerable adults in our society, if we could expect her to also support that bill?

Medical Assistance in Dying

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, next year, the government will expose the most vulnerable Canadians to medical assistance in dying. Assisted suicide will be available to those who suffer from mental illness, including depression. This is profoundly wrong and unprecedented.

There is no consensus in the mental health community that MAID can be safely and ethically administered to the mentally ill. Issues of suicidality, irremediability and competency are far from being resolved. There is growing fear among persons with disabilities over the slippery slope our country finds itself on.

Who is next? The veteran suffering from PTSD? The poor who have no escape from poverty? The addicted on our streets with no hope of accessing timely treatment? That is why I have tabled Bill C-314, the mental health protection act. It repeals the portion of Canada's MAID laws that captures the mentally disordered, while preserving the remaining elements of the government's MAID regime.

I encourage my colleagues to vote in favour of Bill C-314.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Madam Speaker, I am presenting a petition signed by a number of Canadian citizens, including those in my riding. They call on the Government of Canada to publicly and unequivocally support a private member's bill, Bill C-314. This bill is sponsored by my colleague from Abbotsford; it would clarify that MAID, medical assistance in dying, should not be available to those whose only underlying health condition is a mental illness.

The petitioners point out that there is no consensus among health experts regarding what constitutes the irremediability of mental illness. They also point to section 7 of the Canadian Charter of Rights and Freedoms, on the right to life, liberty and the security of the person, in support of a petition that mental health supports should be made available, particularly to vulnerable Canadians, to counsel against medical assistance in dying for those who are suffering with a mental illness.

Criminal Code

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Madam Speaker, as always, it is an honour and a great privilege to speak on behalf of my community of Peterborough—Kawartha.

Tonight, I am speaking on my colleague from Abbotsford's private member's bill, Bill C-314. I have explained this before, but I will do so again. A private member's bill is something a member puts forward for the House to decide on. This is an important private member's bill, as they all are, really, because they come from a place of passion, but this is Bill C-314, an act to amend the Criminal Code, medical assistance in dying, which many of us know as MAID.

The summary states, “This enactment amends the Criminal Code to provide that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.”

The preamble states:

Whereas Parliament considers it a priority to ensure that adequate supports are in place for the mental health of Canadians;

Whereas Parliament considers that vulnerable Canadians should receive suicide prevention counselling rather than access medical assistance in dying;

Whereas Parliament considers that Canada’s medical assistance in dying regime risks normalizing assisted dying as a solution

The fact that we need a private member's bill to say this feels outrageous. I have listened to other members in the House tonight, and I want to be very mindful of my tone. This is an interesting and emotional debate, but I really urge the members opposite who have said they are not going to support the bill to consider getting it to committee. There is so much more we need to study.

My question is how this is not already in legislation. I will tell members why. In December of 2021, the Senate added an amendment to Bill C-7, without any consultation, study or discussion, to add people with mental illness as eligible for MAID. This private member's bill is currently the only way we can protect those suffering from mental illness. It is the only way for us as parliamentarians to say to those watching that we believe their lives matter and that it is our job to ensure we fight for them. Today might be awful, but none of us know what tomorrow will bring, as no one knows what is out there for them.

The MAID committee was created after the amendment was added. How backward is that? It heard testimony from many experts, and I want everyone to listen to the following quote because it is the essence of this discussion.

Dr. John Maher, clinical psychiatrist and medical ethicist, stated, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.” Anyone who has dealt with somebody who has a mental illness or disorder knows that we have not even scratched the surface of what we know. We do not know.

I want to read this letter from a constituent who has been following the slippery slope of the Liberal government's extension of MAID into the record. I have her permission.

She writes:

“Dear Michelle...,

My name is Kayla...I am going to be sending this letter to several MPs, but as you are [my] MP...I thought I should send this to you first. I am very troubled by something that is going to be happening very soon in this country, and I hope you will listen to what I have to say.

“Overall, I am a very healthy individual. I have a mental health condition, but it is my sole medical condition. However, I was mortified to discover last month, that Medical Assistance in Dying (MAiD...) will be available to people whose sole health condition is a mental health condition as of March 17, 2023.”

We have since voted in the House and that date has been extended one year to March 17, 2024. However, this is still in place, and this letter is very pertinent. She goes on to say:

“Persons who suffer from mental health conditions suffer horribly. I know that. I have suffered with mine for nearly 12 years. Perhaps the most appalling things of all are that 'The law no longer requires a person's natural death to be reasonably foreseeable as an eligibility criterion for MAID,' (Government of Canada, 2021) and 'There is no obligation for a person or their healthcare practitioners to inform family members if that person has requested or received MAiD.' (CAMH, 2022)...

“I think you see this for what it is...I will be eligible to end my own life on the basis that I have an incurable mental illness.”

“Let me give you a bit more background: I have 2 university degrees in Biology and Environmental Science. I have a job that I love and have held since a little while after I graduated. I have NEVER failed to pay taxes, nor have I ever taken extended leave or gone on El due to my mental illness, no matter how hard it gets. I have a family and friends that I love dearly, and they love me too. And yet now my own government has deemed my life not worth living. This isn't just unfair. This is monstrous.

“But it gets worse. What about those people who are in the same boat that I am medically, but are much, much worse off. They cannot pay their taxes because they cannot work. They have a substance addiction. They are veterans with PTSD. They are homeless because they cannot seem to fight off their demons. These are some of the most vulnerable people in our society. To say nothing of the 'mature minors' (whatever on Earth that means) that will be able to access MAiD in the future if this doesn't stop. Make no mistake. This thing, that we dress up with the nice name MAiD, is euthanasia of our most vulnerable people because they cannot 'contribute to society' like others can. The fact that the government would offer to 'get them out of the way'...in this way, just because the systems that the government put in place are failing them is an unspeakable evil.”

She put in brackets, “convince them that they should die”. These are her words.

She continues, “I hope, Michelle, that you will do everything in your power as an MP as I will do everything in my power as a citizen, to abolish this law. I understand the federal government is seeking to push back the timing”, which it did, as I said. She says this is “likely because it has received so much criticism. I understand that it likely wasn't you that made any of the decisions for this law to go ahead. But I also understand that you are in more of a position to do something about it than many people are. I hope you will respond after reading this letter.

“Sincerely,

“Kayla.”

I did respond to Kayla and we had a very powerful conversation. She gave me permission to share this letter.

I think one letter like this is enough reasonable doubt that we need to take this private member's bill very seriously. It is everything we need to know to consider and urge everyone in the House. I have heard people say, on the Bloc side, that people should have the right to choose. The reality is that people who are in such a state of mental disorder do not have that capacity. We have to help them.

I want to leave us with this. This woman's name is Elyse. She is a young university student. She said that she is so worried about this legislation to extend MAID to those with mental illness. She has struggled with mental illness, and she knows with certainty that, if someone had offered that to her during her times of illness, she would not be here today. She would not be getting her university degree. She would not be in a happy, healthy relationship, and she would not know that her life was worth living.

If one is watching at home, if one has a loved one suffering, if one is suffering, one's life matters and it is worth living. It is our job to study this to the depths to determine whether we can do this. This private member's bill is the only thing that would protect those with mental illness and mental disorder from accessing MAID. I urge every member in the House to at least pass it to committee.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

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.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I heard the member for Abbotsford say right out of the gate that his bill seeks to reaffirm the dignity and worth of each and every human life. Who could be against that?

The dignity of every human life, as I was trying to say to him earlier, depends on autonomy and respect for a person's self-determination. We may have good intentions, but if we claim to know what is good for a so-called vulnerable person because we think we know better than they do about what is good for them, because we mistake sympathy for compassion, if we decide through some sort of state or medical paternalism what is supposedly good for them, without considering the person's suffering at all, if we take away a person's self-determination, then we undermine their dignity. That is what I wanted to say, but my colleague did not understand.

That is the very foundation of our position. It is called ethical and political philosophy, not theology or any sort of religious ideology.

The preamble to the bill sets out its intentions: “Whereas Parliament considers it a priority to ensure that adequate supports are in place for the mental health of Canadians”. Who could be against that?

I see no problem with that, but it has nothing to do with the purpose of the bill. This can be done without saying that the mental disorder considered as a serious and irremediable medical condition is excluded. I will come back to that.

The second paragraph of the preamble states, “Whereas Parliament considers that vulnerable Canadians should receive suicide prevention counselling rather than access medical assistance in dying”. This really shows a lack of rigour.

All the experts spoke about this and we can even read it in the literature. It is a little twisted to associate suicide with medical assistance in dying. I heard the leader of the opposition make that link a few times during oral question period, but conceptually that is false. Medical assistance in dying is initiated when an individual expresses that that is what they want. It is not imposed. Above all, it is for situations where the person's condition is irreversible. As far as I know, no witness at committee told us that a suicidal state is not reversible. Furthermore, witnesses also told us that we should not conflate the two. This is not getting off to a good start.

When a request for medical assistance in dying cites a mental disorder as the reason, the first step is to establish whether the person suffering has been struggling with the mental disorder for 10, 20 or 30 years of their life. In the experts' report, which I hope my colleague has read, it says that a person exhibiting suicidal ideation would not be eligible. It is one thing to want or to request medical assistance in dying, and another to meet the eligibility criteria. This is essential.

A person who is depressed or in crisis will not necessarily receive medical assistance in dying. Moreover, the experts say that an assessor would never consider a request for medical assistance in dying from a person in a state of crisis. The patient would have to first exhaust all available treatments for alleviating their suffering, without refusing a single treatment capable of restoring their health.

As Dr. Black said, “One study estimated suicidal thinking as an 8% lifetime risk for adults in the Netherlands, yet 65 or 0.0004% of adults in the Netherlands have died of MAID in any given year due to psychiatric reasons.”

Now we have members talking about a potential slippery slope, citing Bill C-14 and ignoring the obligation given to us by the courts to proceed with passing Bill C-7. Bill C‑14 was a bad bill that confused the public. Is it respectful of human dignity to force people to go on a hunger strike to reach the standard of likely and reasonably foreseeable natural death? I think there is something a bit inhumane about that.

In order to reach a criterion that was unworkable for some, people had to actually go on a hunger strike. Others, like Ms. Gladu and Mr. Truchon, had to assert their rights in court. Members say they want to protect the vulnerable. They should start by not treating these people like children and not exploiting them for any purpose. They should instead think about their well-being.

Who is more vulnerable than someone who is suffering intolerably and is close to their tolerance threshold? Who are we to decide for them what their tolerance threshold should be? That is essentially what this is all about.

People want to live as long as possible. The court determined that these individuals' right to life was being infringed upon. I am sure the Conservatives have a lot to say about the right to life. The court found that by denying these individuals the right to medical assistance in dying, their ability to live as long as possible is being taken away. This prevents them from living until they reach their tolerance threshold. That is when we could provide care to them and proceed.

Without this assurance, what do many of these individuals do? They commit suicide prematurely, and this infringes on their right to life. This is indisputable, and it could not be considered reasonable in a free and democratic society, even if it went to the Supreme Court.

Some people always want to go to court. However, right now, people are suffering. While we are procrastinating, people are suffering. We have to put things into perspective.

The committee that considered the issue of mental illness as the sole underlying medical condition made a recommendation. That is why I think that Bill C-314 is premature, at the very least, if not irrelevant at this time.

I will read the committee's recommendation. It states, and I quote: “That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate.”

At the very least, I would have expected a debate to take place following the work of that committee. That is the least that could have been done. I invite my colleague from Abbotsford to read the report of the Special Joint Committee on Medical Assistance in Dying and especially the expert panel's report. The recommendations set out in the expert panel's report include criteria and guidelines that do not exist for other forms of MAID practice. He should feel reassured after reading those recommendations, and I am sure he will never talk about a slippery slope again.

[Gary Anandasangaree, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the member for Abbotsford for bringing forward Bill C-314, an act to amend the Criminal Code regarding medical assistance in dying.

I acknowledge that we are gathered on the traditional unceded lands of the Algonquin people.

The bill before us proposes to indefinitely exclude persons whose sole underlying medical condition is a mental disorder from being eligible to receive medical assistance in dying, or MAID. I will be opposing the bill for reasons I will detail in my remarks. I want to start by providing a brief overview of MAID in Canada.

MAID was legalized in 2016 for persons whose natural death is reasonably foreseeable, through former Bill C-14. Four years later, in 2021, former Bill C-7 expanded eligibility for receiving MAID to persons whose natural death is not reasonably foreseeable. Former Bill C-7 also temporarily excluded, until March 2023, eligibility for receiving MAID on the basis of a mental illness alone.

Parliament decided that a temporary exclusion from eligibility for MAID where the sole underlying medical condition is a mental illness was necessary in recognition of the fact that such requests were complex and required additional study. This is why former Bill C-7 also required an independent expert review regarding recommended protocols, guidance and safeguards to apply to such requests. The expert panel on MAID and mental illness was created to undertake this review, and its final report was tabled in Parliament on May 13, 2022.

Former Bill C-7 also required the establishment of a joint parliamentary committee to conduct a comprehensive review of the Criminal Code MAID provisions and other related issues, including MAID and mental illness. The Special Joint Committee on MAID, or AMAD, took this review and tabled its final report in Parliament on February 15, 2023.

Our government extended the temporary exclusion to March 2024 through the enactment and coming into force of former Bill C-39. This was due to concerns about provincial and territorial readiness. It is important that we get this right.

I want to take a moment to point out that the intention has always been for the mental health exclusion to be temporary. This is a complex, sensitive and polarizing issue. Some very legitimate concerns have been raised.

However, I believe that the health care system will be ready for the safe provision of MAID where the sole underlying medical condition is a mental illness by March 2024. Significant progress has been made by our government, in collaboration with the provinces and territories and other stakeholders and experts, to prepare for this deadline.

We are not ignoring the concerns that have been raised. In fact, many of these concerns led to the one-year extension of the exclusion. We are moving in a prudent, measured way with the ultimate goal of ensuring that our MAID framework supports the autonomy of those who are eligible to receive MAID and protects those who may be vulnerable.

I will now turn to Bill C-314 and outline some of the technical issues.

As I stated previously, the bill proposes to indefinitely exclude eligibility for MAID based on a mental disorder alone. It would do this by replacing “mental illness” with “mental disorder” in subsection 241.2(2.1) of the Criminal Code.

There are two main issues with this approach. First, such a change may result in the unintended exclusion of persons with some medical conditions that are not currently excluded from eligibility for MAID. This is because “mental disorder” is a clinically defined term that practitioners have explained would likely capture all mental disorders included in the American Psychiatric Association's “Diagnostic and Statistical Manual of Mental Disorders”, or DSM-5, whereas “mental illness”, as it relates to MAID, is meant to capture mental disorders that are primarily treated within the domain of psychiatry.

“Mental illness” likely captures a smaller set of conditions than what would be captured by “mental disorder”. As such, making the switch in terminology without an accompanying definition may have the unintended consequence of excluding certain medical conditions that are not currently excluded from eligibility for MAID and that do not raise the same concerns as “mental illness” does in relation to MAID.

The second issue is that the term “mental disorder” is already defined in section 2 of the Criminal Code as “a disease of the mind”, and there is extensive case law interpreting what this means in the context of the “not criminally responsible” regime. Therefore, a switch in terminology in the Criminal Code MAID provisions without an accompanying definition may unintentionally complicate legislative interpretation and may also result in the existing case law interpretation of “mental disorder” and the “not criminally responsible” regime context being applied to the MAID context.

Although many experts and practitioners have noted a preference for the term “mental disorder” since it is a clinically defined term, this preference has already been expressed in the context of developing protocols, standards or guidance for MAID. It is important to remember that MAID is not just a health care issue. It is also a criminal law issue, and as I have just explained, things can get complicated in the legislative context given existing definitions and legal interpretations.

Finally, I simply want to point out that Bill C‑314 also restructures the exclusion set out in the Criminal Code but does not seem to change its application.

Currently, in order to be eligible for MAID, a person must have “a grievous and irremediable medical condition”, which is present when a person has a serious and incurable disease or disability, is in an advanced state of irreversible decline and is experiencing enduring and intolerable suffering, as per subsection 241.2(2).

Right now, a mental disorder is not considered an illness, disease or disability under the first part of the definition of a grievous and irremediable medical condition.

As such, a mental illness cannot satisfy the definition and therefore cannot be grounds for a request for MAID.

Under the proposed new exclusion, a mental disorder would not be considered a grievous and irremediable medical condition at all. In other words, it would exclude mental disorders from the whole of the definition, even though some of those aspects may well exist in the case of a mental disorder, namely intolerable suffering and an advanced state of decline. Although this new exclusion would operate slightly differently than the existing exclusion, it seems as though its effects would be the same.

I want to reiterate that Parliament considered this two years ago during its consideration of former Bill C-7 and decided that a MAID mental illness exclusion should be temporary. The point was reinforced by Parliament's enactment of former Bill C-39 this past March.

The expert panel on MAID and mental illness has tabled its final report, which notes that the existing MAID eligibility criteria and safeguards, supported by other key resources, provide an adequate framework for the provision of MAID where the sole underlying medical condition is a mental illness. Parliament considered the issues again via the Special Joint Committee on MAID, and the majority of members agreed with the expert panel's findings.

I urge members to join me in opposing the bill and not reverse Parliament's decision by unintentionally complicating legislative interpretation in the criminal law.