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.
