Bill C-62

An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2

This enactment amends An Act to amend the Criminal Code (medical assistance in dying) to provide that persons are not eligible, until March 17, 2027, to receive medical assistance in dying if their sole underlying medical condition is a mental illness.

Government Business No. 34—Proceedings on Bill C-62

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Mr. Speaker, I think it is absolutely disgusting that the parliamentary secretary to the government House leader would stick his head in the sand and deny well-documented cases of abuse and non-compliance with respect to so-called safeguards that are supposedly in place and are to be enforced. It is just disgusting, when speaking of some of the most vulnerable persons in Canadian society.

With respect to the member and her speech, she talked about Conservative obstruction. I would remind her that every member of Parliament, from all recognized parties, on the committee, which I served in, said to put a pause on this expansion, so did chairs of psychiatry, and so did the Province of Quebec in the national assembly, when the committee determined that mental illness as a sole underlying condition was not appropriate in the context of MAID.

I will tell members that when I hear evidence that clinicians could get it wrong 50% of the time, in other words like the flip of a coin, I will obstruct that expansion.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, I talked about the Conservatives' obstruction. Unfortunately, I could also talk about the Liberals' inaction, which is why we are still here today, why this file was delayed. What is more, they are asking us to wait another three years. Enough is enough.

As for my colleague's remark, the Conservatives are bringing up cases that might have more to do with the justice system. Before being elected, I worked on the issue of elder abuse. These are isolated cases and they have more to do with the justice system.

In the case at hand, we are talking about professional bodies. I talked about it in my speech. We are also talking about a joint committee made up of senators and MPs who worked hard and proved that the safeguards are there and that, no, it is not true that a person can ask for medical assistance in dying as easily as ordering food in a restaurant.

It is not true. There are safeguards and, in Quebec, this is clearly understood. What we need to do is to let ourselves be guided by the scientific evidence and by what professional bodies are saying, not by isolated cases and regressive religious attitudes.

[The Deputy Speaker, Conservative, Chris d'Entremont]

The hon. member for Beauport—Limoilou on a point of order.

[Julie Vignola, Bloc, Beauport—Limoilou, QC]

Mr. Speaker, may I remind my esteemed colleagues that when they ask a question, they should want to hear the answer? At the moment, members seem to be talking to each other across the aisle and not listening to the person who was asked the question.

Respect needs to be shown not only at school, but in everyday life.

[The Deputy Speaker, Conservative, Chris d'Entremont]

I thank the hon. member for pointing out that members need to listen to each other in the House. Those who have been recognized are the ones who should take part in the discussion.

Resuming debate, the hon. member for Vaughan—Woodbridge has the floor.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, it is always an honour and a privilege to rise in the House on behalf of the wonderful residents of my riding of Vaughan—Woodbridge and all of the residents in the city of Vaughan.

I will be sharing my time with my friend and colleague from the wonderful riding of Kitchener Centre.

Before I begin my formal remarks, this is a debate on Bill C-62, medical assistance in dying, which is obviously highly personal to all members in the House. Remarks are being delivered today with much passion, substance and thought. I will add a few words on that front. I have provided my personal beliefs on medical assistance in dying, which I am obviously in favour of. I know many individuals in many families who made tough decisions that were not with regard to mental illness. That gives me great consternation and much thought.

I am glad that a pause will be put in place because mental illness is a complex subject. I am not an expert and will not profess to be an expert, but we all know someone who has struggled with mental illness. We all know family members or friends for whom mental illness continues to be an issue. Unfortunately, many folks have taken their lives, and we need to make sure there is a system in place that is robust, where people can get the help and assistance they need to live their full lives, which God has blessed them with.

I am convinced that our current MAID system is working well. I would like to take the next ten minutes to explain why Canadians should have confidence in our MAID legislation and its application over the past seven years. I also want to describe some of the activities that will help sustain that confidence when eligibility is expanded in March 2027, as proposed in Bill C-62.

When the law authorizing medical assistance in dying was originally passed in 2016, it included a number of mandatory eligibility criteria for anyone requesting MAID. The person must be an adult of at least 18 years of age and capable of making health-related decisions. The request must be voluntary. Their request must be fully informed, and the person must have knowledge of the options available to relieve their suffering. They must have a grievous and irremediable health condition, meaning it cannot be cured, which is defined as follows: They have “a serious and incurable illness, disease or disability; they are in an advanced state of irreversible decline in capability”, and they are experiencing “enduring physical or psychological suffering” that cannot be relieved under conditions that they consider acceptable.

In 2016, the law also required that the person's natural death be reasonably foreseeable. In 2019, the Quebec Superior Court ruled that this criterion violated the Charter of Rights and Freedoms. In March 2021, a revised version of the federal law was passed, extending eligibility for MAID to people whose natural death was not reasonably foreseeable as long as they met other eligibility criteria.

In addition to these eligibility criteria, the law also sets out many procedural safeguards that a clinician must meet before administering medical assistance in dying. Here are a few of them: Two independent practitioners must provide a written confirmation of the person's eligibility. The person who is requesting medical assistance in dying must be informed that they can change their mind at any time and in any way and that their wishes must be respected. Also, the person must reconfirm their desire to receive medical assistance in dying immediately before receiving it.

When a person's natural death is not reasonably foreseeable, a series of enhanced safeguards must be respected. I will talk about some of those critical safeguards.

First, at least one of the two MAID assessors must have expertise in the person's medical condition. If they do not have that expertise, they must consult another practitioner who does. Second, the person must be informed of the means available to alleviate their suffering and be offered meaningful consultations. Third, these means must have been discussed, and both MAID assessors must agree that the person has seriously considered these means. Fourth, at least 90 days must pass between the beginning of the eligibility assessment and the day on which MAID is administered. These are legislated safeguards that all practitioners must abide by.

We know that MAID practitioners across the country exercise considerable professional judgment in providing this service by keeping patients' interests and wishes at the forefront.

Practitioners work hard to ensure that MAID is a last resort. They compile essential information about the person's medical condition, their treatment history and their use of support services. They have the necessary conversations to ensure that their patients are aware of the services available to them that might alleviate their suffering. It is about exploring treatment options, facilitating referrals and following up on the results.

If the person who wants to receive MAID consents to involving family members and loved ones, the practitioners will encourage their involvement and include them in the discussions that are part of the overall assessment process.

Practitioners are also aware that they do not always have the necessary expertise in the patient's condition to conduct a full assessment. In these situations, they have to consult the relevant experts and other health professionals who have the necessary expertise to make an informed decision. Some provinces or regional health care authorities have put in place MAID care coordination services or case consultation mechanisms that rely on a team or network of doctors, nurses and other professionals, such as social workers and spiritual leaders, to support the assessment process.

What does that mean for the future, once we begin allowing MAID requests based on enduring and intolerable suffering resulting solely from mental illness? Are our existing legislative safeguards sufficient? How can we be sure that the same level of care, diligence and consistency in the provision of MAID will be the norm?

In 2021, as mandated by the former Bill C-7, an expert panel reviewed the issue and concluded that the existing legal framework for eligibility criteria and safeguards is sufficient, provided MAID assessors apply the existing framework appropriately, with guidance from MAID standards of practice that have been developed as well as specialized training.

In the time I have left, I would just like to say that we all rise in this most honoured House on many topics. One of these topics, probably one of the most personal ones that we have risen on in the number of years I have been here, is medical assistance in dying. I look forward to questions from the hon. members in the House, who have been sent here by their constituents. This is an important debate for us to have, and it is an important topic to discuss.

[Ed Fast, Conservative, Abbotsford, BC]

Mr. Speaker, I do agree that this is an intensely personal decision for each one of us. I listened carefully to the member's speech.

At the beginning, he seemed to suggest that the reason the government was compelled to move forward with expanding MAID for the mentally ill was that the lower courts have forced the government to do this, but the courts have not actually directed the Canadian government to implement MAID for the mentally ill. The Supreme Court of Canada has never opined on the matter. In fact, every time the Liberal government has been given the opportunity to appeal a case to the Supreme Court, it has refused to do so, probably for ideological reasons.

I would ask the member for his opinion. Does he believe that the Supreme Court of Canada has directed the House, this Parliament, to implement medical assistance in dying for the mentally ill, yes or no?

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, I have had much respect and much time for the hon. member in all of our conversations. I am not a lawyer. On having something referenced to the Supreme Court for a decision, I would have to get back to the learned member for Abbotsford on that front.

I would say that it is important for all members in the House to look at the evolving needs of individuals in this country, speak with the pertinent experts and work with the provinces and territories.

I have always believed that we should legislate and not defer to the courts. That is my own personal opinion. I believe in that. I think that is the best way to legislate and govern. We should do so by taking decisions in the House, while making sure they are obviously compliant with the Charter of Rights and Freedoms, which I know all members in the House hold dear.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, my colleague opposite was wondering about the Carter decision. In my opinion, Carter clearly demonstrates that absolute prohibition would indeed be discriminatory and stigmatizing.

That said, I would like to ask him the following question.

My colleague obviously supports his government's bill, which defers application of the law by three years. Does this mean that he is going to lobby within his government so that, the day after tomorrow, once we have voted, the bill has gone through the Senate and the law has come into force, the committee will get back to work and eventually come up with a bill focusing on mental disorders, in particular, as well as on advance requests?

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, I would like to thank my colleague from Quebec for his question and assure him that this is very important to us.

My answer would be yes, of course, as a member of Parliament, I always work in the interests of my constituents, and this is an issue and a law that has been brought forth in the last number of years that people are quite passionate about. I have always grappled with the technical and fine details of the law and the early provisions on a personal level. One term that has been used is “foreseeable death”. Thinking about this must be done with much diligence and judiciousness.

I continue to advocate on our side and within our caucus for a law that is robust, that reflects the individual interests of Canadians and that is obviously compliant with the Charter of Rights and Freedoms.

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

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?

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, in terms of a timeline of three, five or six years, obviously, a decision was made. As the member identified, we need to work with the provinces and territories as we move forward on this policy. We need to make sure that all provinces, territories, health ministers and individuals working in the various fields are ready for this. We need to make sure that we are ready for this and that it goes through in a manner that is prudent and appropriate.

[Mike Morrice, Green, Kitchener Centre, ON]

Mr. Speaker, tonight, I rise in strong support of Bill C-62, which would delay expanding medical assistance in dying for those in whom mental illness is the sole underlying condition by three years. My reasons for doing so are the same as they were in my speech to Bill C-39, one year ago to this day, at the time when the government was willing to delay by only one year: First of all, this delay aligns with what I have heard from so many folks in my community; second, we know that this is what experts have been calling for, for some time; and third, as Greens, we believe we should spend more time filling in our social safety net before we expand medical assistance in dying.

Today, Greens also believe that we should be rushing this legislation before the March 17 deadline to ensure that MAID is not expanded for mental illness as the sole underlying condition because this is the next best thing to what Bill C-314 would have done. Bill C-314, which was proposed by the member for Abbotsford, would have avoided this expansion for good.

Substantively, in the process we are in right now, this bill has been moving ahead quite quickly to this point. I expect that, as votes follow over the coming days, we will continue to move based on the motion that was approved earlier in the day. This shows that the House of Commons can move quickly when there is an urgent priority to be addressed, as is the case with the March 17 deadline in the existing legislation. Really, what this is about in terms of moving quickly is not that we do not have the legislative tools but that we need the political will to do it.

When I think about this legislation in front of us, outside what I have shared so far in terms of why I am supporting it, why I have historically and why Greens have historically as well, my question is this: Where is the rush to support legislation that would substantively improve the quality of life of Canadians? Other members have reflected on and shared feedback, which I hope they have heard directly from people with disabilities across the country. Where is the rush on ending legislated poverty for people with disabilities?

The fact is that, to this day, 40% of people living in poverty across the country are people with disabilities. While some will talk all about a piece of legislation that was passed in June of last year, the fact is that a person with a disability is no better off today than they were before that legislation was passed. The benefit is not yet funded, and we have not engaged in and figured out negotiations with provinces and territories. It is shameful. It is an embarrassment that, in a country as rich as ours, we are in a place where people with disabilities continue to live in legislated poverty. The House of Commons could choose to act as urgently to end legislated poverty for people with disabilities as it is moving right now to ensure that the March 17 deadline is met.

The House of Commons could also push to actually address one of the core underlying issues here, which is the lack of supports to address mental health. In fact, at the time of the last electoral campaign, the Liberal Party promised a Canada mental health benefit. It was meant to be called the “Canada mental health transfer”. It was a $4.5-billion commitment, and it was not one of several bullet points in a health accord, the way we have now. One of the challenges is that, while we all want our health care to be delivered in a wholesome way, it is more helpful to have funding agreements that are specific, so we can have accountability on them. However, that is not the case when it comes to mental health. Instead, mental health is one of four bullet points in these provincial and federal agreements. As a result, it is up to the provinces, and it is unclear whether there is any accountability whatsoever on how many of the dollars in those agreements will go directly to mental health.

In this year's budget, we could see the government step up, be more clear and say it is going to make sure it directly funds what was supposed to be the Canada mental health transfer. In so doing, it would substantively improve the quality of life of Canadians, of folks in my community who are waiting on unreasonable wait times and lists to get access to a mental health professional.

If we were really serious about moving quickly on another core crisis in this country, we would move far more quickly on addressing the housing crisis. Again, for me, the little bit of hope I have, seeing what is happening right now, is that we know there are parliamentary tools available to do exactly that. The fact is, in my community, we just had a report come out today that continues to make calls with respect to dealing with people living rough, in encampments. In my community, the number of people living unsheltered has tripled in just the last three years.

We should not be in a place where this is happening, but we know why it is the case. Right now, for every one new unit of affordable housing that gets built, we are losing 15 units to the financialization of housing. Housing has increasingly become a commodity for large institutional investors to trade, rather than a place for a person to live.

This means that we continue to see large institutional investors buying up existing affordable housing, renovicting folks and increasing their rents. We wonder why that crisis is also getting worse. I do not think we would be in the place where we are right now if this Parliament, and the government in particular, were to get more serious about addressing the housing crisis.

After 30 years of underinvestment, where are we now? The fact is that we are at the bottom of the G7 when it comes to the social housing stock in this country; 3.5% of our housing is social housing. This means that, even if we were to double social housing, we would only be around the middle of the pack in the G7.

It means something after 30 years of underinvestment in communities across the country. I am thinking about someone I spoke with this past weekend, a nurse, who told me she cannot afford to live in our community as a result of the reality of the cost of housing. It means that, whether someone is a teacher, a nurse or a tradesperson, this is a generation that is looking at housing fundamentally differently than any one before it has. Why is that? In my community, since 2005, the cost of housing has gone up 275%, but wages have only gone up 42%.

Once again, if we were to truly fill in the social safety net and move as quickly on doing that as the government has moved today on meeting this March 17 deadline, we could substantively ensure that we see the funding necessary to address the affordable housing crisis. We could also address financialization, which is the fact that institutional investors have swept in to make the biggest buck possible, as quickly as possible, on the backs of some of the lowest-income people in my community.

Yes, I will be supporting Bill C-62. I think this is a really important opportunity for us all to mark that this Parliament can move quickly when it needs to on real crises that it sees. We have crises of housing, of legislated poverty for people with disabilities and of mental health, which this Parliament and the government should move a whole lot faster on.

[The Deputy Speaker, Conservative, Chris d'Entremont]

It being 5:30 p.m., the House will now proceed to the consideration of Private Members' Business as listed on today's Order Paper.

The House resumed consideration of the motion, and of the amendment.