Bill C-14 (Historical)

An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assist­ance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

Motion That Debate Be Not Further Adjourned

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the minister did not answer one aspect of my question.

Why the double standard?

The minister had a full year to implement the recommendation of the Special Joint Committee on Medical Assistance in Dying concerning advance requests. An Ipsos poll of 3,500 people showed 85% support across Canada. If the minister does not know that, he is not staying on top of his file.

As far as postponement is concerned, the minister has implemented the recommendation to the letter. Three years is too long. He knows that. However, he could have added another dimension to Bill C‑62. He had a year to do it. Will he introduce legislation on advance requests, yes or no?

Bill C‑14 is bad legislation.

The minister says that he worked carefully. People have been forced to go on hunger strikes to meet the reasonably foreseeable natural death criterion. Is that what he means by protecting vulnerable people?

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I thank hon. Minister of Justice for sharing these comments with other members of the cabinet, particularly the Minister of Health.

This is perhaps the most difficult issue any of us will ever deal with as members of Parliament. Strangely enough, I will just add that, had she been alive when I was a member of Parliament, Sue Rodriguez, who went all the way to the Supreme Court of Canada for the right to die with dignity, would have been my constituent. She lived in North Saanich.

There is tremendous public support in my area for medical assistance in dying being available to Canadians. However, I have to say, when it came to Bill C-14 and extending it to where mental illness was the only underlying cause, I voted for that bill only because there was a time delay, and we should be ready before it comes into effect.

I support what the Minister of Justice just said. We know the provinces have spoken with one voice. I am very concerned that access to treatments for mental health are still not available and might push people toward seeking MAID because they cannot get access to something like psilocybin that could deal with their underlying causes.

I very much object to using time allocation. I do not think I have ever voted for time allocation in this place, but now I must because the court deadline is approaching; March 17 is soon. We need to make sure that we do not leave Canadians in this awful gap where we do not have anything in place, as a Parliament, to deal with the current crisis.

I offer those comments just to say that I will be voting differently from the way I typically have, but I still vigorously object to time allocation being used routinely.

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

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, let us try to calm down a bit.

In this debate, the government is basing itself on the Special Joint Committee on Medical Assistance in Dying for its amendment to Bill C‑62.

The Bloc Québécois would have liked to lend its support. The problem is that we believe that we should not indefinitely delay the possibility of medical assistance in dying for people with an irremediable mental disorder, when no psychiatrist worth their salt has been able to treat them or relieve their suffering. After 10, 20 or 30 years of suffering, the decision whether or not to request MAID should not lie with this person, who is supposed to determine whether the patient is eligible.

We asked for an amendment to the bill. Why take three years when, last year, we were told that it would take a year to make sure that MAID for people with mental disorders could be set up in a safe and appropriate manner? The main issue we have is that, in 2015, there was an election, but there was also the Carter decision. The government and this Parliament passed terrible legislation, similar to the one Quebec adopted a year earlier.

Quebec passed a law that only covers end-of-life cases, people who are terminally ill. I want to reiterate that, in the terminal phase of life, the process of dying has begun and is irreversible. People can be well taken care of in palliative care. Good palliative care, as described by Cicely Saunders at the time, is full, comprehensive, holistic support for people as they are dying. It involves adequately managing the person's pain and suffering, both physical and emotional, and supporting their family. All of this should be done in an environment that resembles a normal environment as much as possible. However, it is possible that, all of a sudden, in the midst of this process, the patient, who is slowly dying, will request MAID because, one day, they are feeling at peace and ready to let go. That is not a failure, in my opinion. It can be seen as successful palliative care. When my colleagues are about to depart this life, I hope that they will be calm and at peace. That is what I would wish for everyone.

So Quebec had taken those steps. Then in Parliament came the Carter decision, which stated that Ms. Carter was not at the end of her life, but she was suffering a great deal. It was therefore decided that depriving her of medical assistance in dying impinged on her right to life. Why? She was being forced to end her life prematurely, when the fact is that letting her decide what happened next would empower her. It was up to her to define when her suffering became intolerable.

It was a bad law. Bill C‑7 had to be introduced. When we began studying Bill C‑7, there was another factor that had to be considered; that was in 2021.

The Carter decision states that there cannot be an absolute prohibition on MAID simply because people belong to a particular group, one that is vulnerable. It must be assessed on a case-by-case basis.

The reality is that people can and do struggle with irremediable mental disorders. Irremediability is established through a rigorous process. During that process, practitioners must be certain that the person has never refused treatment that we know would have absolutely improved their situation.

There are indeed people whose mental disorders cause intolerable suffering, and psychiatry does not help them. If anyone here wants to claim otherwise, I would say that they lack intellectual integrity. Psychiatrists cannot cure everyone; it is impossible. That said, psychiatry is rife with medical paternalism.

That being said, what we wanted was for the government, whose Bill C‑62 is based on the work of the Special Joint Committee on Medical Assistance in Dying, to plan ahead for when it might have to introduce Bill C‑62 and include another key recommendation of the special joint committee in the bill. That recommendation was presented a year ago and was the subject of a consensus. One Conservative member even joined the majority. There is a consensus in favour of advance requests.

Why was that not included in the bill? It should have been anticipated. The government knew that the date would have to be pushed back. It had a year to introduce a measure in the House that would have also covered people suffering from dementia and Alzheimer's. Why did the government not do that? We asked the government why it was not doing so when it had the chance. Quebec drafted its own legislation. It is structured, rigorous and unanimously supported in Quebec.

An Ipsos poll shows that 85% of the Canadian population supports advance requests. In British Columbia, 84% supports advance requests. In Alberta, it is 84%; in Saskatchewan and Manitoba, it is 81%; in Ontario, it is 84%, in Quebec, it is 87%; in Atlantic Canada, it is 81%. I could go on. There are other figures. They vary. The results are based on a sample of 3,500 people. That is not nothing. When will the government take action? Why has it not heard this request? Why has it not spoken with Quebec, who has worked on this issue? Why did it not hear the unanimous will of the National Assembly, just last week? Why is it afraid of its own shadow? Why do the Liberals lack courage so?

The last time they lacked courage, we ended up with Bill C‑14. What is the problem with Bill C‑14? The real problem with Bill C‑14 is not a legal problem. The problem is for a patient who is suffering, who, to satisfy the reasonably foreseeable natural death criterion, has to go on a hunger strike. We have seen that. The problem is for people who, like Ms. Gladu and Mr. Truchon, have to fight for their constitutional rights in court. When I say there is a lack of courage, that is what I mean.

My only viewpoint is the viewpoint of patients who are suffering. The only thing I am standing for here is the suffering patients' right to self-determination. Patients had to fight an uphill battle against medical paternalism when it comes to MAID.

As I mentioned last week, there was a time when the palliative care that is so dear to the heart of my Conservative friends and that I personally consider to be very important was called passive euthanasia. Doctors obstinately used aggressive life-support measures because their duty was to save their patients. As we know, every doctor thought that they could save every patient back then. It was actually doctors suffering from cancer who started to assert their right to refuse treatment. Today, cessation and refusal of treatment are part of what are considered to be good medical practices.

Why are we not studying the bill today? The government is imposing a gag order. We will not be overly critical of this decision. I understand that this has to be done before March 17. We are not getting too worked up about this, but still, we have not consented and will not consent to this. Why not? It is because we wanted a bill that was based on the recommendations from the Special Joint Committee on Medical Assistance in Dying. I want answers from the government in that regard.

Why the delay in expanding medical assistance in dying to people with mental health issues? We did what the committee asked. Bill C‑62 even provides for the Special Joint Committee on Medical Assistance in Dying to reconvene in order to determine whether the groundwork has been laid. That is what we are doing. We basically took the recommendation and inserted it into the bill. Then, there is the issue of advance requests. There is a consensus on that across the country, but the government lacks the courage of its convictions.

The Liberals are afraid of demagoguery because there has been a lot of it on this issue. They are lumping everything together. However, at some point, they need to be consistent in their approach. The Liberals are well aware that the state's role is not to decide for the patient what is best for them when it comes to a decision as personal as one's own death. The state or the patient's neighbour is not the one who is going to die. The state's role is to determine the proper conditions and ensure that they are put in place so that patients can make a free and informed choice. If people are worried about abuse or the slippery slope when it comes to advance requests, then they should look at Quebec's law, which is a model to follow.

The government could have easily inserted elements of the Quebec law into its regulations. It is all well and good to say that the law is a little vague, but the amendment we are making to the medical assistance in dying legislation, expanding section 241 of the Criminal Code, is followed by a procedure, regulations on enforcing regulations. That is where the various safeguards are put in place.

There are standards of practice when it comes to mental disorders. A year ago, a committee began looking at standards of practice, and they will be sent to the regulatory bodies in each province, namely the colleges of physicians. Once we have clear guidelines and standards of practice and the criteria I was talking about earlier are met, someone in a suicidal crisis will not have access to medical assistance in dying.

It bears repeating, because I am hearing a lot of confusion over this. A suicidal person is not eligible for medical assistance in dying, even if they suffer from a mental disorder and are in suicidal crisis, and even if they have recently been admitted to care and diagnosed. I have often asked psychiatrists if they thought that giving access to medical assistance in dying to people with mental disorders could also provide an opportunity for prevention. Some people commit suicide and no one sees it coming. No one knows those individuals today, no physician took them on.

For example, knowing that MAID is an option, a person might come forward because they are suffering and want to exercise that option. Well, that person would not qualify. However, they would then be taken care of and get the treatment they need, since suicidal ideation is reversible. There is no question about that. However, it is not about those patients. When we asked the chair of the expert panel, psychiatrist Mona Gupta, how many patients in her practice would have been eligible, she told us of two or three patients over her entire practice. Still, these are people who are suffering.

When people talk about the fact that the resources are not there—the resources in terms of someone to assess capacity, for an independent psychiatrist to look at a case—I would point out that right now, the decision-making capacity of a person struggling with a mental disorder, but who has cancer, for example, is verified. Psychiatrists are currently assessing the decision-making capacity of people with a mental disorder and a comorbidity. Depending on their condition, practitioners are able to determine the decision-making capacity of these people who have a mental disorder.

The Supreme Court was clear: Not allowing these people to access MAID creates stigma. Not only does it stigmatize them, it discriminates against them. Why infantilize and weaponize people who have a mental disorder and who, in their entire existence, have not found treatment that can alleviate their suffering?

I rather like having discussions and debating with my Conservative colleagues. They have a sense of conviction, but there are some Conservatives who use scare tactics and conflate everything. It is not enough to repeat some 20 times that someone came to say that irremediability is hard to address. Everyone agrees. Even the expert panel starts with that. They did not hide that fact. In fact, they say that because irremediability is hard to establish there must be safeguards and precautionary principles put in place.

I therefore move the following amendment:

That the motion be amended in subparagraph (b)(ii):

(a) by adding after the words “be deemed referred to a committee of the whole,” the words “that an instruction be deemed to have been given to the committee granting it the power to expand the scope of the bill so as to take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care,”;

(b) by replacing the words “deemed reported without amendment” with the following: “deemed reported with the following amendments:

That the bill be amended by adding the following new section 241.21 to the Criminal Code:

New section 241.21

Medical assistance in dying eligibility criteria for advance requests

“241.21 The government of a province may establish a medical assistance in dying framework for advance requests from persons who have an illness that could deprive them of the capacity to consent to care, in accordance with the laws of that province.””; and

(c) by replacing the words “deemed concurred in at report stage” with the following: “deemed concurred in at report stage, as amended”.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, when it comes to MAID, this government is not exactly a shining example of proactivity. After the Carter decision, it took a long time for the government to table a half-decent bill. Bill C‑14 was pretty worthless. It was a poor imitation of the Quebec legislation and was far from addressing the crux of the Carter decision.

That being said, the issue of proactivity is still relevant. Regarding MAID for people with mental health conditions, a three-year delay was unnecessary; one year would have been enough. The government has been aware of that for a year, since it is basing its decision to kick it down the road on the consensus recommendations of the Special Joint Committee on Medical Assistance in Dying.

Why has the government not done anything on advance requests for the past year? Why is it dragging its feet? Why is it not basing its decision to go ahead with this on the joint committee's key recommendation?

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

Mr. Speaker, it is a pleasure to rise to speak to a very important issue. This is a deeply personal and complex issue, one that has had a great deal of debate in the House for number of years now.

We are not directly speaking to that. Rather, we are speaking to the motion that would enable the government to get the MAID issue resolved for the next few years. The motion would ensure that the legislation actually passes. I will give a little background on that.

There is a time limit for us to ultimately get Bill C-62 passed in order to fulfill our commitment to the court. Obviously, we want to keep the law validated, appropriately. The motion we have brought forward today would allow for the House, while providing some time for the Senate, to pass and give royal assent to the bill before the House breaks in March for a couple of weeks. In essence, it allows for a little more debate this week, when it will ultimately pass.

It would then afford the Senate, in the week following the break, the ability to deal with the legislation and hopefully pass it without amendment. This is very important, as that would then enable the legislation to receive royal assent before the deadline.

I know some members may be a little uncomfortable with respect to this programming motion before us today, the limitations that it puts on members and the importance of the subject matter itself. As some members may recall, last week I stood in my place and asked for unanimous consent to sit late in the evening. That way, members would have had more opportunity to have debate on this issue. Unfortunately, we did not get unanimous consent. As a direct result, we have to work within the time frame of when the House allows us to sit. As a result, in order to meet the deadline, we have brought in a programming motion.

I made reference to the very beginning, about when we started to talk about the issue of medical assistance in dying. It came up in 2015. A Supreme Court of Canada decision, Carter v. Canada, made it very clear that we, as a government, and Canadians, through the Charter of Rights, needed MAID legislation. That was decided midway through 2015, but no action was taken, knowing full well that we had to bring in a law to address what the Supreme Court had put in place.

We all know that an election took place. Shortly after that election, it was made very clear that as a government we needed to bring in the legislation. An approach was made to the Supreme Court to take into consideration what had taken place over the last number of months following its decision, including an election.

The Supreme Court ultimately provided grace to the House of Commons so that we could, in fact, get the necessary legislation brought forward to the chamber and ultimately passed. We did have to ask for yet another extension back then. I do not think that surprised anyone.

From the day we can recall, in 2015, there was a great deal of discussion that had taken place. In fact, I suspect, if one were to take a look at the different pieces of legislation, today, we call it Bill C-62, and the original legislation was Bill C-14. We have had legislation in between those bills, which the government had to bring into the House.

On occasion, when the government brings in legislation for debate, there is fairly extensive debate not only in the chamber but also in committees. I can remember, quite vividly, a lot of the debate, the issue for which the special committee was put together to deal with the issue and to provide some thoughts, recommendations and ideas to the chamber and the members who were directly involved.

There is no lack of interest or input from the many different stakeholders, of all different natures, in every region of the country. Everyone had an opinion on the issue. In the end, the amount of dialogue that went into the legislation and the creation of MAID, was probably greater than 90% of all other forms of legislation that come to the House.

We saw that in the passion of the debates presented at the time by members of Parliament on all sides of the House. It was not just Liberals, New Democrats, Conservatives or the Bloc, or even the leader of the Green Party at the time, where one could see the emotional toll of the debate. That is why I talk about it being of a very deep, personal nature. There are complex choices and decisions that have to be made on this.

When I reflect on that debate, there were tears inside the chamber. There were all sorts of emotions as members tried, in the best way they could, to explain why they were taking their positions on it. Different members voted for different reasons and so forth.

In the end, Bill C-14 ultimately passed, after many hours of debate inside and outside. When I say outside, I go even further than outside of standing committees. There were emails, correspondence and discussions that I had on this issue, and it was fairly intense. People wanted to know how I felt about it. I am sure all members of Parliament were questioned about what they had to say on the legislation.

I do have differing opinions from members across the way and maybe even, quite possibly, within my own caucus. I genuinely believe that the need for MAID is there. There is no question about that.

However, where I fall on the side that it seems to be acceptable, at least for a good percentage of people I represent, is to have trust and confidence in our system of health care professionals, social workers and support people whom family members go to when the time comes to make difficult decisions, such as another family member, a local pastor or anyone else. Having that confidence has allowed me to feel comfortable as we have gone through this legislation, virtually from day one.

There was a need for changes. To bring in substantive legislation for the first time that so profoundly impacts the lives of Canadians and to expect that the legislation would be perfect and would not require change is somewhat naive. That is in fact what took place. There was a need to make some changes to the legislation. That is why, ultimately, we had the second go-round of the legislation.

There was a fairly wide discussion on that second attempt and, through amendments, something that is now very challenging was brought in, which deals with mental health as a sole condition for MAID. I know that has stirred the emotions of a lot of members and, ultimately, when the legislation passed to allow it, there was a lot more resistance to it than there was to Bill C-14. It did not surprise me, because of the delicacy of the issue.

Again, I fell back to what I believe a vast majority of my constituents are comfortable with, which are the health care professionals and others, because I am not a medical doctor. I do not understand the issue to the same depth as do the different professionals. As a direct result, I feel more comfortable taking the same position as the government took on the issue.

However, we also need to recognize the reality that other jurisdictions are very concerned about the implementation and about the degree to which we are ready to implement the legislation that was passed. That is really the crux of it. Therefore, we have Bill C-62 today, which would allow for that ongoing exemption to continue. That would enable the system, which is large and complex, to ensure that everything is ready. Then, if the legislation takes effect, people would not be let down, and we would still be able to meet the constitutional requirements. Let us remember that the amendment to the original legislation, in part, came from an appeal court in the province of Quebec, which obligated members of the House to bring forward other legislation.

I know my friend opposite, from the Conservative Party, says that we had a choice and that we could have appealed that decision to the Supreme Court of Canada. As a number of them said, we could have attempted to kick the can down the road. Ultimately, it was a decision made and supported by a majority of members of Parliament in the House. Even though the Liberal government had a majority, when it came to Bill C-14, members know full well there were members from all sides who supported it.

Today we have a minority situation, and the only way we can pass legislation through to have the support of other political entities inside the chamber. I would like to think that what we learned through this process has enabled us to look at other things we have been able to do directly.

During many hours of the debates, people talked about palliative care, hospice care and about the lack of that type of care being provided to the people of Canada. It has been a genuine concern for many years, probably a good 20-plus years, where we needed to see more invested in hospice and in palliative care.

Far too often we see individuals who are panelled in our hospitals because there is no place for them to go outside of the hospital. If we look at what took place during the pandemic, we saw that care facilities had to close the doors to people from outside to protect those on the inside. Those on the inside were often dying prematurely, and we know that as fact. Organizations like the Canadian Forces or the Red Cross were involved.

If we take a look at the bigger holistic picture, are we collectively, and contrary to what some might say, it is not just Ottawa, doing enough to be able to deal with these social issues that Canadians have a high standard for? They want politicians of all political stripes and of all levels of government to invest more resources. I am talking about not only money, but also time and debate.

There are probably better ways in which we could spend some of the money that is spent in areas such as health care, social services and so forth. One could take a look at the process for someone who might, first, end up in a hospital situation, and while in the hospital, they find out that things are not good and that their life is going to come to an end in a relatively short time.

One of the things that happen is that hospitals can provide only so much in terms of treatment. There is no consistency within a province, let alone the nation, as to which individuals are being kept in the hospital. Because there are not enough supports in a home atmosphere and there is no other place for an individual to go, far too often they become panelled in a hospital facility in one form or another. I believe the debates we have seen on MAID amplify that.

These are the types of discussions and debates that we should be having, not only here in Ottawa but also in our communities and at the different legislatures. Quite frankly, there are some fairly significant stakeholders out there who also have to play a role, like non-profit organizations. That is what I recall about some of the discussions we have been having over the years in regard to MAID legislation. Unfortunately, as I pointed out, the original thoughts in regard to MAID and the need for us to bring in legislation and the types of debates that we saw then are in contrast to today, as it is becoming more of a politicized issue. Politics seems to be more important than the issue itself in some ways.

That is why at the very beginning I referred to the fact that it is not a good thing that we had to bring in a programming motion, but it is important that we do it today, because we were not successful at getting the consensus required to be able to sit longer to allow for a consensus to emerge as to how the legislation could pass through the system. However, we still have an opportunity. The motion talks about going to the Standing Committee on Health as the subject matter.

When this motion passes, it will enable the Standing Committee on Health, as its first priority in terms of the resources of the House, to meet. A minister will in fact be there for a good hour. There will be an opportunity to have a few other witnesses. It will ultimately have to go through the committee. If we can get this motion passed, after this legislation goes through committee it will come back here to the House of Commons for third reading later this week, before being dealt with in the Senate in the last week of February to March 1. That time frame will enable it to ultimately get the necessary royal assent in order for it to be enacted into law.

Based on what the legislation would actually do, I would think that the Conservatives, in particular, would support it. The essence of the legislation is to put in a three-year extension. It provides for particular provinces and jurisdictions to be able to get things in a better state of readiness, so that, at the end of that period of time, we are able to provide the types of services that are necessary. This means, in good part, that there will be ample time for us to continue to have that dialogue and debate, and if there is a need to do and bring forward other things, whether it is through private members' business or government business, that there are opportunities. However, I suspect, by passing Bill C-62, that a sound majority of the House will be content with the modernization, if I can put it that way, of the legislation.

In one part, it reminds me of the issue of the suicide crisis helpline, and I say that for two reasons.

One reason is that some members often will make reference to how the legislation as a whole is enabling individuals to virtually have suicide upon request, which is just not the case. We know that is not the case, and the members who say it know that is not the case but unfortunately we still see some members give that false impression. I find that to be somewhat unfortunate, because it is definitely misleading and does a disservice in terms of the legislation and the thorough process that we have gone through. I cannot imagine the number of hours, and we are talking three digits and more of hours of different types of discussions in many different forums. To try to simplify it by calling it “suicide on demand” does a great disservice to the legislation and to the law that we currently have in place.

The reason I bring up the suicide helpline is that someone indicated to me that there are people who, at times in their lives, give it thought. When they heard about the MAID legislation, they made inquiries, and because of those inquiries they were able to get the type of assistance that made things better for them. In other words, MAID legislation, on occasion, I would ultimately argue, has actually even saved lives.

Criminal Code

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I appreciate the comments of my colleague, who always speaks very calmly and moderately. It is a pleasure to serve with him.

The NDP voted against Bill C‑14, which did not address the Carter decision's requirements at all. Bill C‑7 met the Carter decision's requirements with additional changes that required hard work, to clarify the issue.

Is the NDP saying no to the idea of one day moving forward on mental disorders, or would it rather put the subject off indefinitely?

We could start working on this tomorrow morning, and I am convinced that within a year, we could come up with something very promising.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is an excellent question. In the supplementary report that I tabled, I note that, if we had had more time, we could have engaged with these people. By engaging with these people, we could have understood exactly what their concerns were.

A certain number of associations did tell us that everything was ready for us to do this. The member knows that. For example, the Association of Medical Assistance in Dying Assessors and Providers came and told us after Bill C‑14 and Bill C‑7 were introduced that not all doctors were trained to be MAID providers. There was only a small number and they would be able to meet the demand. When it comes to mental disorders, we are talking about an even smaller number still. The people from this association felt that they were able to do this safely. There was also the Canadian Psychiatric Association, the Canadian Bar Association, the Association des médecins psychiatres du Québec, the Federation of Medical Regulatory Authorities of Canada, the Nova Scotia department of health, and so on.

It comes down to the way people followed the debate and the way they debated within the governments because they sometimes have other concerns. I would have liked to hear them. The government did not call on us as soon as Parliament returned so that we could do a review and ask all of the questions we had. We could have even gone out into the community to see what was missing, but we were unable to.

Here is what I think: We could do it right now, in the next year. We need to work together, get out there and explain it, see what is going on, and share the guidelines. Then, if we need another year, we can take it. Waiting until 2027 to do this is definitely not a progressive way of going about it.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I never thought I would end up debating medical assistance in dying in the House again, or reliving what we went through when we passed Bill C‑14, a bad law. I never expected that the Liberals would again be in the same position, or show the same lack of courage they did with Bill C‑14, which was prescribed by the Carter-Taylor decision.

Quebec passed its legislation on end-of-life care before the Carter decision. In the Carter decision, the court ruled that Quebec had to revise its legislation to include more than end-of-life issues only. The Parliament of Canada, which had never considered this before, was also told that it had to address not only end-of-life issues, but also degenerative diseases like those afflicting Ms. Carter and Ms. Taylor. Ms. Carter had spinal stenosis and Ms. Taylor had amyotrophic lateral sclerosis. In its decision, the court ruled that Parliament had to legislate because both women's right to life was being infringed.

Why was their right to life being infringed? The right to life is not a minor right. This should be of interest to the Conservatives, who are pro-life. I am too, in that sense. The right to life was being infringed because these people had to shorten their lives when they would have liked to live until their suffering became intolerable.

As members of Parliament, as representatives of the state and the people, our duty is not to decide what the patient needs when it comes to an issue as personal as their death. The role of the state is to ensure the conditions needed for them to exercise free will, so that they can make a free and informed decision. That is the role of the state. Otherwise, we get into government paternalism.

I invite my Conservative colleague to do some reading in clinical ethics and not to limit himself to what psychiatrists in Ontario are saying. We know that psychiatrists are divided on the issue. In fact, if there is one discipline in which medical paternalism continues to reign, it is psychiatry. We would never have seen the progress that we have seen in clinical ethics if medical paternalism in general still ruled supreme.

What happened for patients to be given back control over their end of life? We find the answer to that question in the bioethics literature. In the past, some doctors who had cancer said they did not want treatment. Now, we have good medical practices, whereas in the past, aggressive treatment was the standard. The doctors said that they wanted to live the two years they had left without undergoing treatment that would leave them bedridden. They claimed that they wanted to spend quality time with their loved ones. It took doctors with cancer demanding that option for patients to be able to discuss these sorts of things with their own doctor. In the 1960s, there were patients who only found out that they were dying of an incurable disease and were in fact at the end of their life when the priest came to their room to administer the last rites. They were not even told that they were terminally ill. That was medical paternalism.

Over time, the right to die was granted. Patients were granted the right to die and the opportunity to refuse aggressive treatment. That is when we began providing the palliative care that is so important to my Conservative friends. Before that, palliative care was called passive euthanasia, and it was not allowed.

Medical paternalism has been gradually set aside. What has this led to?

It has led to the right to refuse life-saving treatment, to stop treatment. These are all rights we have today.

We have before us a bill that perpetuates suffering indefinitely for people with a severe mental disorder who have been unable to relieve their suffering through treatment. That is no mean feat. They have spent 10, 20, 30 years suffering, trying multiple treatments and being stigmatized by the society in which they live.

We are able to establish the decision-making capacity of people living with a severe mental disorder. For those capable of making decisions, the court told us that it would be discriminatory and stigmatizing if, just because they have a severe mental disorder causing suffering that psychiatry is unable to properly change or relieve, they were told what was best for them and that they should continue to suffer forever, while psychiatry need only provide a palliative care option until the end. That is what we are discussing today.

I will calm down. It is just that I heard some nonsense earlier.

Then what happens? There was Bill C‑7, which was rather cautious. It set a two-year deadline for creating an expert panel. Who read the report of the expert panel in the House? Who read it before voting? This is the second vote we are having on this subject. We have to read the report of the expert panel. Indeed, the irremediable aspect is something that is hard to implement. Admittedly, there is an additional difficulty, but the expert report does set out guidelines. That is what this is about.

Then the Liberals show up today with a clause they added that says we are going to work with an expert panel for two years and create a joint committee. The problem is that the joint committees have always been set up at the last minute, too close to the deadline.

When we submitted our report the last time, we were forced to admit that, before moving forward with the issue of mental disorders, we needed to assess the situation in the field. Even though I think the group that was supposed to work on it had developed important guidelines and standards of practice, it was obvious to me that there was still not quite enough time. Everyone told us so, including the Collège des médecins du Québec—I will have more to say later about its criteria and guidelines for proceeding that I find useful.

How is it that, a year ago, the government gave itself a one-year deadline and thought that would be enough time? A lot of work has been done in that year, yet the government is saying we should put it off until 2027.

We heard what the Conservatives just said. We can forget about MAID if they form government; they will put it off indefinitely. That means that people will continue to suffer indefinitely, and that suffering will be intolerable because psychiatry is unable to provide relief other than by rendering them virtually incapacitated. Somehow, people find that morally acceptable. I honestly do not know where the morality lies in that. Some people have very flexible morals. In any case, it has nothing to do with suffering.

When people claim that someone living with depression could have access to medical assistance in dying, it is simply not true. Just because someone applies for MAID does not mean they will be able to access it. The assessors will do their job. Stefanie Green was saying that a person in a suicidal crisis is not eligible for medical assistance in dying. Someone who raises their hand and says that they want MAID simply because we allow mental disorders to be eligible grounds for MAID would not have access to it because they have not received proper care.

However, there would be an opportunity for prevention, because we could provide treatment at that time. It is wrong to say that 90% of people who have suicidal ideation and commit suicide received proper care. No, they did not receive proper care. Very often, when people commit suicide, no one saw it coming at all.

What are we going to do? What are the Conservatives going to to with people who are desperate and suffering and who currently still have hope that we are going to consider their suffering and find a solution so that things are done properly and by the law? What do they think those individuals are going to do in their despair? Is suicide morally acceptable? Suicide attests to the failure of our system and our society. I will never, ever accept suicide. That is why, when we talk about medical assistance in dying, we are not in the same page at all.

A person who is feeling suicidal is not eligible. Someone who has just been taken into care and diagnosed is not eligible. Applications take structural vulnerabilities into account. Just because someone is poor and does not have access to care does not mean that they will be eligible for medical assistance in dying. They would not be eligible, because they would have to have tried every possible treatment. Someone who unjustifiably refuses treatment that could improve their condition will not be eligible. If accessible and effective treatments are available and the person refuses them, they are ineligible. If the assessors cannot agree that the criteria have been met, the person is not eligible either.

The Collège des médecins du Québec told us that it remains at the discussion stage, that it has established its guidelines and it still needs time in order to eventually get there. Personally, I think one year would have been enough, otherwise we might give up. We could end up being hypocritical and leave it to chance. We might as well flip a coin.

The Liberals need to work hard if they want to win the election. If not, they are going to be leaving the fate of those who are suffering in the hands of people who just told us today that this will not happen on their watch, that they support suffering for life everlasting, and that they know what is moral and right for these people.

The Quebec college of physicians said, and I quote, “the decision to grant MAID to someone with a mental disorder should not be viewed solely as an episode of care. Rather, the decision should be made following a fair and comprehensive assessment of the patient's situation.” We are talking about taking the time to establish the chronicity of the condition.

The college of physicians also set out a second condition. It said, and I quote, “the patient must not exhibit suicidal ideation, as with major depressive disorders”. It might be a good idea for the members of the Special Joint Committee on Medical Assistance in Dying to hear that, although they are on the same committee as I am and that was said in committee.

That is a far cry from the grandstanding Leader of the Opposition who stands up in the House and asks the Prime Minister, in prime time, whether medical assistance in dying is the only thing he has to offer those who are depressed and having a hard time making ends meet. That is a bit much.

The third criterion laid out by the college of physicians states that the patient must “experience intense and prolonged psychological suffering, as confirmed by severe symptoms and overall functional impairment, over a long period of time, leaving them with no hope that the weight of their situation will ease. This prevents them from being fulfilled and causes them to see their existence as devoid of meaning.”

The experts tell us that they cannot apply irremediability and suffering metrics to mental health, and that prevents them from creating a category as a grounds for MAID. It has to be done on a case-by-case basis. All questions of clinical ethics, in terms of clinical assessment, are examined on a case-by-case basis. Some seem to think that going on a case-by-case basis is hell and that it is not a rigorous process. It is very rigorous.

The fourth condition states, “the patient must have been receiving care and appropriate follow-up over an extensive period of time.” Access to care must have been available. Otherwise, no access to medical assistance in dying will be provided for mental disorders. It seems to me that we heard the same thing in committee. We heard the same criteria.

At some point, we have to have the courage of our convictions. I believe that we have to offer relief to people experiencing intolerable suffering, who have reached their limit. I also believe that we must not make decisions about their life or quality of life for them. They alone can decide what is tolerable or intolerable.

When people talk to me about a slippery slope, they seem to be working on the assumption that all health care workers are evil. However, people who work in health care need to be kind. As far as I know, gaining admission to medical school is not easy. I imagine that the selection criteria are quite strict and challenging. The same goes for nursing.

The fifth condition states, “requests [from social workers] must undergo a multidisciplinary assessment, including by the physician or specialized nurse practitioner in the field of mental health who has treated the individual”. This is in the case of a follow-up assessment, not in the midst an episode. A person cannot get medical assistance in dying simply by saying that their life no longer has any meaning. Making a request does not mean one is eligible.

The Collège des médecins du Québec concluded by saying, “Under these conditions, it would be possible, in the CMQ's view, to provide individuals suffering from a grievous and irreversible mental disorder with access to MAID. It is important to prevent situations where individuals opt for MAID out of desperation, because they do not have access to proper care or do not consider the care available to be acceptable, such as an extended stay in a facility without the prospect of gaining more autonomy.”

That is the exact opposite of the nonsense we heard earlier. We were told that this was like a house of horrors, that we were dealing with experts and doctors who simply wanted to harm people's physical integrity. We have to be careful.

To access MAID, the individual must first make a request, which is then followed by informed consent. When it comes to mental disorders, doctors currently perform a daily assessment of a person's decision-making capacity if they have a mental disorder and a comorbidity, an additional illness that is hastening their death. Everyone agrees that these people are capable of choosing and consenting to medical assistance in dying. MAID practitioners have long been determining the decision-making capacity of people with a mental disorder. Just because someone has a mental disorder does not mean that their right to self-determination and to make decisions should be violated. That is discrimination and stigmatization.

When people tell me they want to protect the vulnerable, I wonder who could be more vulnerable than someone who has suffered for decades with a mental disorder and has tried every treatment. Who could be more vulnerable than someone grappling with a paternalistic psychiatrist—I am choosing my words carefully—who thinks he knows better than his patient what treatment they need, then chains them to a palliative care pathway and throws away the key because he cannot bring himself to admit that he is unable to provide relief to his patient?

At committee, I put the question to some psychiatrists who told us we were on the wrong track. They admitted that, in 25 or 30 years of practice, they had seen some patients fall through the cracks. Indeed, it is for this small group of people who fall through the cracks in psychiatry that this expansion is necessary. We need to show a little humanity here in the House.

[Dr. Mona Gupta, Psychiatrist and Researcher, Centre hospitalier de l'Université de Montréal, As an Individual]

Thank you very much, Madam Chair, and thank you, all, for the invitation to meet with you today.

I'm a psychiatrist and bioethics researcher at the University of Montreal. I've had the opportunity and the privilege to be closely involved in the public conversation about assisted dying for persons with mental disorders as their sole underlying medical condition—MDSUMC for the rest of my remarks—since its beginning.

I served as a member of the CCA working group on MAID for MDSUMC mandated by Bill C-14. I chaired the federal expert panel on MAID and mental illness, mandated by Bill C-7. More recently, I led the work of Health Canada's MAID practice standards task group, and I also led the working group that developed CAMAP's educational module for MAID and mental disorders.

It is from this vantage point that I want to share some observations about readiness.

When the Government of Canada made the decision to include persons with mental disorders as their sole underlying medical condition on equal terms with all other medically ill suffering persons whose natural deaths were not reasonably foreseeable, it committed to do three things: constitute an expert panel on MAID and mental illness, strike a special joint parliamentary committee to further study the matter, and revise its data collection system. As we know, the federal government has fulfilled these commitments.

When the federal government made the decision to extend the exclusion for an additional year, it spoke about the need for extra time to ensure that two major deliverables—the CAMAP MAID curriculum and the model practice standard for MAID—were complete. As we know, these activities are complete. The standard has been in the hands of physicians and nurse regulators since April of this year, and they are adopting or adapting the standard as appropriate within their jurisdiction. The CAMAP MAID curriculum was launched in September 2023 and has been offered already, numerous times, to physicians and nurse practitioners.

Several other initiatives have occurred since December 2022, including a national MAID MDSUMC preparatory workshop with delegates from every province and territory, including MAID assessors, providers and psychiatrists. There has also been a national system readiness workshop to share knowledge about administrative processes.

Most provinces and territories are working with frontline clinicians, regulators and administrative authorities to ensure that clinical processes are appropriately tailored for requesters with mental disorders. I have provided several examples of these activities in my brief.

A few weeks ago, I taught the CAMAP MAID and mental disorders module to a group of about 20 psychiatrists, family physicians and nurse practitioners in Vancouver. Beforehand, the colleague co-leading the session, an experienced family physician and MAID assessor and provider, Dr. Tanja Daws, bounded up to me. Even though MAID MDSUMC is not allowed, she said, I've already had patients with all the same types of issues in the case studies we cover in the module.

What struck me about Dr. Daws' comment is that persons with mental disorders as their sole underlying condition who make requests for MAID will be in the careful hands of experienced clinicians who, over these last seven years, have already handled the full range of complexities in their MAID practice that MDSUMC requests may present. Her comment also confirms what the expert panel concluded, that the complexities so often attributed to mental disorders are not, in fact, unique to mental disorders and are already being handled in our MAID system today.

The work that has been undertaken on MAID MDSUMC since 2017 has been thorough, the processes transparent and collaborative. The Government of Canada has fulfilled every commitment concerning readiness that it made. It has also made unprecedented contributions to health care professional education and regulation, which well exceed the scope of its jurisdictional responsibilities.

As my colleagues Dr. Gamache and Dr. Grant know better than I, the other essential actors in health care and in the MAID system—regulators and professional associations—have been active concerning MAID since 2015. They will continue to fulfill their mandates. In the case of the regulators, this is guiding clinicians towards safe MAID practice in the public interest, and in the case of professional associations, ensuring their members are equipped to participate in MAID if they choose to do so.

By far, more thought, care and capacity building have been done for persons with mental disorders as their sole underlying medical condition than for any others. This is a good thing, and this work will have the added benefit of strengthening Canada's MAID system for all patients.

If you were to ask me what I need if tomorrow I had to assess MAID eligibility for a person with a mental disorder as their sole underlying medical condition, the answer is nothing. The work has been done. We are ready.

[Dr. Alison Freeland]

Thank you for that question. I'm just reflecting on it as an individual.

I work in Ontario, which is a complicated province. There are lots of different health care systems there. I think there is still work to be done at a local level to ensure that the entire system has created a coordinated point of access.

The encouraging thing is that where I am, there is now a provincial group looking at a community of practice around medical assistance in dying, particularly for a mental disorder. In Toronto, where I work, we now have a coordinated working group sponsored by the two local Toronto hospitals, which, again, is turning its mind to how to do this. It is represented by a number of different health professionals and includes psychiatry. In fact, the Toronto working group is co-chaired by two psychiatrists.

I think people are working hard knowing that there is a date in mind to get to a place of readiness and knowing that readiness is never going to be perfect. When we think about readiness in this context compared to when MAID came out way back with Bill C-14, there's been a lot more work done on the national approach around standards and available curriculum, and I think many different organizations are engaging health care teams around how to best understand this.

I am definitely not a MAID expansionist. I just truly believe that it's very stigmatizing—and this is my personal belief—to take a group of patients and say to them, “You can't even be considered for something because you have a mental illness.”

I believe that very few people would be found eligible should this go ahead with respect to mental illness. Ms. Birenbaum has clearly outlined all of the safeguards and processes we'd have to get through to get to that point.

Those would be my personal reflections, not the CPA's reflections.

[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.

[Ed Fast, Conservative, Abbotsford, BC]

moved 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.

Mr. Speaker, I am pleased to speak to my private member's bill, Bill C-314, the mental health protection act.

In its very essence, this bill is about reaffirming the dignity and worth of each and every human life. It is about recognizing that it is the most vulnerable among us, the disabled and the mentally ill, to whom we owe the greatest duty: to defend and protect their lives and to provide them with every possible opportunity to live life to the fullest.

Medically assisted suicide was legalized in Canada in 2015 by the Supreme Court's Carter decision and later under the Liberal government's Bill C-14. Under this legislation, medical assistance in dying, or MAID, as it is commonly called, was strictly limited to those consenting adults who had an incurable disease that caused enduring, intolerable suffering that could not be alleviated, and where natural death was reasonably foreseeable, which they call the foreseeability test.

At the time, the government and its supportive stakeholders assured Canadians that this was not a slippery slope, where the scope of MAID would continually be expanded to include more and more vulnerable Canadians. However, not surprisingly, in the intervening eight years since the Carter decision, the government has begun to expand Canada's MAID regime to include more and more defenceless Canadians, most particularly those living with disabilities.

In late 2019, a Quebec lower court judge in the Truchon case ruled that the foreseeability test I just mentioned was unconstitutional, requiring Parliament to respond with additional legislation. Sadly, the Liberal government chose not to appeal the Truchon case to the Supreme Court of Canada, presumably because the decision lined up with the Prime Minister's intent to dramatically expand assisted suicide to other vulnerable Canadians. This leaves us with the perverse situation in which the Supreme Court of Canada, the highest court in the country, has never been allowed to opine on whether the reasonable foreseeability test is constitutional.

In any event, the Liberal government responded to Truchon by tabling Bill C-7, which initially eliminated the foreseeability test but expressly excluded mentally ill persons from being caught up in its MAID regime. Here is what the justice minister said at the time:

The fact that there would be risk of ending the life of a person whose symptoms would have improved...is, in part, why we are of the view that it is safest not to permit MAID on the sole basis of mental illness.... There is also ongoing uncertainty and disagreement as to the potential impact on suicide prevention if MAID were made available to this group.

He went on to say:

...there is no consensus among experts on whether and how to proceed with MAID on the basis of mental illness alone. On a question of such importance and with so much uncertainty and expert disagreement, it is incumbent upon us to proceed with caution and prudence.

Those were our justice minister’s views until the unelected Senate suddenly introduced an amendment that expanded MAID to those Canadians whose sole underlying condition is mental illness. Sadly, the justice minister and the government accepted the amendment without protest and, overnight, became zealous proponents of assisted death for the mentally ill. What happened to the caution and prudence the minister was preaching? What about the impact on suicide prevention the minister was so concerned about? What happened to his view that it was safest not to permit MAID on the sole basis of mental illness?

I agree with the Minister of Justice on one thing, which is that, as he has said, this is indeed a complex issue and is deeply personal. It is deeply personal because it involves life, a precious human life.

I would remind the minister and his government that the issue is also profoundly simple; that is, the principle that all life, all human life is precious and worthy of defence and protection, especially for those who do not have the ability to speak for themselves and have no one to speak for them.

One of the primary functions of government is to protect its citizens, to protect life. In fact, the right to life is expressly enshrined in section 7 of our Charter of Rights. Sadly, the government's Bill C-7 fails to protect the lives of our most vulnerable. It removes the critical safeguards that the original euthanasia legislation included in response to the Carter decision. Removing those safeguards will have irreversible consequences for those who suffer from mental illnesses like depression.

What is equally disturbing is that the Liberal government has also signalled its intention to extend the so-called “treatment option” to minor children. That would arguably make Canada the most expansive, most liberal, assisted suicide jurisdiction in the world. Clearly we are on the slippery slope many of us warned about. Canadians have a right to conclude that the Liberal government has gone too far and too fast in its zeal to implement and expand the scope of assisted death.

My bill will reverse this momentum and repeal the government's decision to extend MAID to the mentally ill. It will put a full stop to the expansion of assisted suicide to mentally disordered persons. Let me be clear. My bill does not in any way reverse the rest of Canada’s MAID regime. Assisted death will remain available for those suffering from irremediable, incurable and intolerable illnesses and diseases. My bill is simply focused on reversing the government’s actions in expanding assisted suicide to include the mentally ill. It would arrest Canada’s slide into normalizing assisted death as an alternative treatment option, something so many of us had predicted would happen.

The evidence from mental health experts is very clear. Contrary to what our justice minister is now saying, there is absolutely no consensus in Canada that the mentally ill should be covered by Canada’s medically assisted death regime. In fact, here is what experts and other stakeholders in the mental health community are saying. John Maher, psychiatrist with Canadian Mental Health Association, states that:

Inducement to suicide while simultaneously denying mental health care to two-thirds of Canadians who urgently need it is an unconscionable failing.

Directly undermining suicide prevention efforts is an insidious and ablest perversion of our mental health care duty.

Drs. Ramona Coelho and Catherine Ferrier, co-founders of Physicians Together with Vulnerable Canadian, penned a statement that was endorsed by over 1,000 physicians. This is part of what it said, “Given that there is no medical evidence to reliably predict which patients with a mental illness will not get better, MAID for mental illness will end the lives of patients who would have recovered…Medicine …would fail in its mission if it were to deliberately end the lives of patients living with mental illness… Legislators must work towards safeguarding the lives of the most vulnerable including those placed at a greater disadvantage because of mental illness.”

Dr. Sonu Gaind, chief of the Department of Psychiatry at Sunnybrook Hospital, Toronto, stated, “The Ministers have provided false reassurances that we can somehow separate people who are suicidal from those who are seeking psychiatric euthanasia. That is simply not true. In my opinion, that is dangerous misinformation coming from our federal Minister of Justice and our federal Minister of Mental Health and Addictions providing a false sense of safety that does not exist.”

Trudo Lemmens, professor and chair in health law at the University of Toronto, said, “I urge Parliament to take very seriously how offering MAID for mental illness deprives disabled persons, particularly those with mental illness, from equal protection against premature death. Persons experiencing mental illness deserve to be protected against premature death by an unreserved focus on ensuring access to all required health care and social support services. Facilitating their death does exactly the opposite.”

Finally, Sephora Tang, psychiatrist and assistant professor in the Department of Psychiatry at University of Ottawa, said, “One cannot prevent suicide while at the same time facilitating it. Placing expectations upon mental health professionals to do both undermines the effective delivery of recovery-oriented mental health care. Canadians deserve to live in a country that is committed to safeguarding the right to life and security of every person. Current MAID legislation fails to achieve this overarching social good.”

Even Canada's justice minister has publicly acknowledged the fact that issues such as irremediability, competency and suicidality are not anywhere close to being resolved to justify such a major policy shift in favour of death. Furthermore, medically assisted death flies in the face of the government’s own promotion of suicide prevention programs, including the recent creation of a national 988 suicide hotline.

It cannot be both ways. It cannot claim, as the Liberal government has, that it wants to prevent suicide deaths on the one hand, when it actively promotes assisted suicide for the mentally ill on the other. Over the last eight years, many of us have expressed our concern and expectation that the Carter decision and BillC-14 would be expanded by future court decisions, and that these decisions would leave more and more vulnerable populations exposed to the reach of medically assisted suicide.

Our concerns were pooh-poohed. We were accused of fearmongering and of misrepresenting the intentions of this Liberal government. Yet, today, the Truchon decision and the travesty of Bill C-7 bear out our concerns. That is why more and more disability groups have set the alarm bells ringing and are vehemently opposing this legislation. They argue that this legislation amounts to a deadly form of discrimination, making it easier for persons with disabilities to die than to live.

We are hearing more and more reports of the poor and homeless approaching food banks to ask for assisted death, not because they are suffering from a grievous illness but because they do not want to go hungry and homeless. The headline in the British magazine The Spectator asked last year, “Why is Canada euthanising the poor?”

The response from some bioethicists appears to be, “Well, why not?” In fact, a new paper by two bioethicists at the University of Toronto makes the case that euthanizing the poor should be socially acceptable. That is indicative of the path on which our country finds itself. It is terrifying.

We also have verified reports of veterans suffering from PTSD who are being counselled by the Liberal government to consider medical assistance in dying rather than being provided with the treatment and supports they need to recover.

These are the vulnerable that the Liberal government promised to protect. Canadians have the right to ask whether this government is exercising the requisite caution and care to avoid unnecessary overreach and ensure that MAID is not abused or misapplied.

Let me conclude. My private member's bill, Bill C-314 gives all of us parliamentarians an opportunity to take a deep breath and reconsider the perilous road we have embarked upon. As I mentioned, my bill simply reverses the expansion of Canada’s assisted death laws to the mentally ill. At the very least, I would ask my colleagues to allow my bill, at second reading, to go to committee where there could be more discussion.

Have we gone too far and too fast with Canada's assisted suicide program? Will we evolve into a culture of death as the preferred option for those who suffer from mental illness or will we choose life?

I implore my colleagues to choose life. I wish them much wisdom as they make that choice.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, I want my constituents to know that I am staying in the riding to take care of my newborn, but I am happy to participate, in hybrid fashion, on their behalf on this very important subject.

Bill C-39, an act to amend the Criminal Code regarding medical assistance in dying, seeks to delay the expansion of medically assisted death to individuals whose sole condition is a mental illness. We are here today because of previous legislation in the last Parliament, Bill C-7, that responded to the Truchon decision and the justice minister's interpretation of it by removing critical safeguards to accessing MAID, particularly that death must be reasonably foreseeable. However, Bill C-7 contained an arbitrary deadline of March 17, 2023, to expand MAID to those whose sole condition is a mental illness, and now the government is seeking to delay that arbitrary deadline another year down the road.

As I do not want MAID to be offered to those who are solely suffering from a mental health issue, I will be supporting the bill, but I do so in the context of very big and life-altering concerns regarding the direction the Government of Canada has taken since the debate on MAID commenced in 2016.

The Conservatives believe that we should never give up on those experiencing mental illness and should always be focused on offering help and treatment rather than assisted death. The Conservatives will bring forward alternative proposals to support those with mental illness instead of the government's approach.

Going back to 2016, the preamble of Bill C-14 spoke about the vulnerability of persons. It states:

Whereas vulnerable persons must be protected from being induced, in moments of weakness, to end their lives

It also states:

Whereas suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities

Man, have we seen a lot of change in the last seven years.

Conservative members at the time, despite these assurances in Bill C-14, observed that the approach of the government was going down a slippery slope. The member for Selkirk—Interlake—Eastman highlighted a concern that has sadly now become a reality in Canada. He stated, “many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.”

At the time, because of big public concerns, many Liberal members were careful when it came to speaking about expanding MAID in the future. The former justice minister, Jody Wilson-Raybould, said, “In terms of eligibility, the policy choice made by the government was to focus on persons who are in an advanced state of irreversible decline and whose natural deaths have become reasonably foreseeable.” The current member for Lac-Saint-Louis said, “Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.”

In the last Parliament, in his charter considerations on Bill C-7, which expanded MAID to include those without a reasonably foreseeable death, the current Minister of Justice cited inherent risks and complexity as a reason not to expand MAID to those with mental illness as a sole condition. However, the Minister of Justice, unfortunately, as we find today, is speaking on both sides of this issue very irresponsibly. On the one hand, he communicated in the Bill C-7 charter consideration that due to the complexity and inherent risks, we should not be expanding MAID to those with mental illness as a sole condition. On the other hand, in the same bill, he included a sunset clause to expand MAID to these Canadians and said that his hands were tied by a Quebec court decision. However, not only has the government refused to challenge it at the Supreme Court, but leading legal experts in our country have stated that his interpretation of the decision is flawed.

After telling Canadians time and again that the legalization of MAID would not lead to a slippery slope by allowing death on demand for any citizen whenever they may want it, the government seems set on expanding MAID to anyone.

I plead with the backbench members of the Liberal Party to stand up against the justice minister today. You have more influence than any Canadians right now to stop what he is trying to do.

Do not forget that in 2016, on Bill C-14, he voted against the—