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.

Criminal Code

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, as always, I want to thank the constituents of Niagara West for electing me to represent them in Parliament and be their voice in this place on the key issues of our country. What is more important than the bill we are discussing today, Bill C-39, respecting medical assistance in dying? We all know how sensitive and complex a topic this is. We as parliamentarians, with this bill, are dealing with the issue of literal life and death, which is a deeply personal decision, and that is as complex as it gets.

On both sides of the House, the focus and priority of all of us is to ensure that safeguards are always in place for the most vulnerable people in our society, particularly for those with mental health challenges. I believe that we are all trying to get this legislation right. Lives are at stake, and again, we need to get this right. We also have to keep in mind that we have to be respectful and accepting of the different perspectives on this issue.

Many folks from my community in Niagara West are people of faith, and they are struggling with this concept of doctor-assisted suicide. This issue is of particular importance to the thousands of my constituents who took the time to write letters, send emails and make phone calls to my office to express their views. This is an issue that is exceptionally difficult to accept for many Canadians across the country, including those in my riding of Niagara West.

The planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify on mental health grounds, to me and to many of my constituents, is even more troubling. These folks want to ensure that we, as the representatives in this place, safeguard human life in the aftermath of the Carter v. Canada Supreme Court decision.

There is also strong concern that people with mental health issues may be persuaded into ending their lives while they are in a state of personal suffering. That is wrong, and I am sure that we all want to prevent that kind of thing from ever happening to anyone. I am also concerned that there may be horrible stereotypes reinforced, such as that that a life with a mental health challenge is not a life worth living, or that living with it is a fate worse than death. This cannot happen.

I know it has already been discussed, but I would like to provide some information and context for my constituents who are not yet aware of how we got to this point and why we are currently discussing medical assistance in dying in Parliament.

On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. In other words, the Supreme Court made medical assistance in dying a legal right for Canadians under our Charter of Rights and Freedoms. The Supreme Court declared that paragraph 241(1)(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter rights of life, liberty and security of the person for individuals who wanted to access an assisted death. The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the Charter of Rights of individuals and patients. As a result, the government introduced Bill C-14 on April 14, 2016, and it received royal assent on June 17, 2016. Medical assistance in dying has been legal ever since.

An important fact to remember, once again, is that the legalization of assisted death began with the Supreme Court decision in Carter v. Canada. The last time I spoke to this issue, I reiterated my concern, and the concern expressed by thousands of my constituents, that there simply are not sufficient safeguards for those who are most vulnerable in relation to accessing medical assistance in dying. I feel the same today.

I believe my esteemed colleague from Calgary Nose Hill is absolutely correct. This week, she spoke to the same bill and said that she finds it reprehensible and an abdication of responsibility of every parliamentarian of every political stripe to allow medically assisted dying to be extended to Canadians with mental health challenges, given the abject, miserable state of mental health supports in Canada. She spoke about the difficulties in accessing mental health supports across the country, and I believe she is correct. Mental health services are not readily available. They are also very expensive. The availability of quality mental health services must be there across the country before we even start to consider this debate on legislation that allows folks experiencing mental health issues to seek medical assistance in dying.

Let us not forget something very important here: One of the symptoms of a mental health issue is the unfortunate thought of wishing to die. How can we not get our mental health care system in order first before we contemplate allowing folks to commit medically assisted suicide because of a potentially treatable mental health challenge? I cannot fathom a life being lost because of a treatable mental health issue that went untreated because of a lack of quality and available supports.

I am sure my hon. colleagues have also heard the story of an Ontario man who requested MAID, not because he wanted to die, but because he thought it was a preferable alternative to being homeless. Housing is another major issue the government has not adequately addressed. We should not be a country where folks who are homeless should live in such despair that they feel they have no option than to request medical assistance in dying.

In another story, a disabled Ontario woman applied for MAID after seven years of applying for affordable housing in Toronto with no luck. I think we are all in agreement that these types of cases should never happen.

I am also very concerned about the mental health of all Canadians, given the difficult times we are in. Inflation is at a generational high. The cost of groceries is up 11%. Half of Canadians are cutting back on groceries, and 20% of Canadians are skipping meals. The carbon tax is being tripled, adding unnecessary costs to families’ gas, grocery and home heating bills.

The average rent in Canada’s 10 largest cities is more than $2,200 a month, up more than $1,000 a month over the last eight years. Average monthly mortgage costs have more than doubled, now costing Canadians over $3,000 a month. We are seeing a record number of Canadians visiting food banks.

All of this takes a tremendous toll on the mental health of families, seniors and especially those suffering with mental illness and other vulnerable groups. Life was not exactly easy for many people before the pandemic, and it has certainly gotten worse with the inflationary crisis we are in. The important thing to remember here is that investments into mental health services must be made a top priority, because as we all agree, mental health is health.

Let us turn back to Bill C-39. I believe there should be strong safeguards to ensure those most vulnerable never fall through the cracks and end up on a list of people to be medically put to death before they have exhausted all avenues to live a meaningful life.

Let us be clear about something, medical assistance in dying is a tremendously difficult issue to debate. It is a highly emotional topic, and there are many factors and personal convictions that come into play. We agree on many things, but we also disagree strongly on others.

On this issue, specifically, we must respect and listen to one another’s views as we chart the course of our future and the future realities of those who are most vulnerable. We can either signal to them that we care by expanding mental health supports and investing in quality services, or we can unfortunately go down a dark path of allowing those who are struggling with treatable mental health challenges the opportunity to end their lives.

I support investing in our people by providing quality and easily accessible mental health treatments. However, this is not what the government’s Bill C-39 does. It seeks to delay, for one year, the implementation of provisions that would expand the availability of assisted dying to those whose sole underlying condition is mental illness. That is wrong.

Unfortunately, the Liberal government has brought forward this delay to their MAID expansion because they failed to heed the concerns of our Conservative members, mental health advocates and Canadians when they passed legislation in 2021. I personally do not believe that we should ever give up on those experiencing mental illness. According to the most recent polls, a majority of Canadians would agree with me.

A majority of Canadians oppose the government’s plan to offer assisted dying to patients with incurable mental illness. The Angus Reid poll shows 51% of respondents said they oppose the expansion of medical assistance in dying to Canadians whose sole condition is mental illness. In other words, 51% of Canadians believe that we should be focused on offering help and treatment rather that assisted death.

Having said all this, at this point we will be supporting this delay to prevent the immediate expansion of assisted death to those suffering with mental illness. In the near future, we will bring forward alternative proposals. My hope is that we all uphold the original objective of the initial legislation, which was “to affirm the inherent and equal value of every person’s life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled.” That we must protect “vulnerable persons...from being induced, in moments of weakness, to end their lives.”

This issue is very important to me and to many of my constituents, and I look forward to working with all my colleagues, from all parties, to get this right.

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

Madam Speaker, when we were looking at Bill C-14 two Parliaments ago, there was a statutory requirement for a review. The government went ahead and introduced Bill C-7 before we ever did that review. It accepted the Senate amendment to its bill before it established the special joint committee, of which I was a member, both in the previous Parliament and in this one. We struggled with many of the issues the member highlighted in his speech. Two of the themes we were grappling with as a committee were respect for individual autonomy versus protection of the vulnerable.

I share the member's concerns with this. How, in his mind, do we try to rectify those two concepts, so that we are respecting a person's autonomy to make decisions that are in their own interest but also making sure that we as a society are protecting the most vulnerable?

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

Mr. Speaker, I want to say a huge thanks to my colleague and dear friend from Louis-Saint-Laurent for his speech. I totally agree with him.

Perhaps he would agree with me that in the debates on Bill C-14, the government promised to do more for palliative care, if I remember correctly. That was a few years ago. I think those promises have been broken.

I would like to hear what my colleague thinks.

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

Mr. Speaker, I appreciate the comments from the member opposite because, for the most part, I concur with what the member is saying. In the debate that took place in regard to Bill C-14, if the member looks at Hansard he will see that the issue of palliative care and hospice care was huge. Members on both sides of the House understood how important it was that we have that in our communities, as we did not want to see people using MAID as an escape because of not having that care.

Again, when I reflect on what we are talking about now, more and more members are talking about the issue of mental illness. It is good that we all have a consensus. No one is talking about depression as being something that would allow someone to apply for MAID. If they do apply, the doctors and medical professionals are not going to authorize something of that nature. We are talking about the extreme situations. That is my understanding.

It is good to hear those independent voices on this particular issue and, as much as possible, I would concur. I would just ask the member to continue to expand upon why it is important that we take the party politics out of it, because it is very much a personal issue.

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

Mr. Speaker, I want to begin by thanking my colleague, the hon. member for Kitchener Centre, for such a thoughtful speech, one that anticipates much of what I want to say.

We have not done enough in the year since Bill C-7 passed to know with any degree of certainty that we have lived up to our obligations when passing that act to fully study what it would mean to extend medical assistance in dying to those who are dealing with deep suffering that comes from a mental health issue, not from a medical diagnosis of traditional medicines, such as ALS, cancer or the other cases that moved us forward on this trajectory.

I want to briefly canvass what brought us here and the way in which the Parliament of Canada and the Supreme Court of Canada have dealt with medical assistance in dying, and I want to suggest, in closing, that when one looks to the Supreme Court of Canada for guidance, I do not believe we can say that the Supreme Court of Canada's guidance takes us to the availability of MAID in cases of deep mental health distress.

Going way back, as the member of Parliament for Saanich—Gulf Islands, I want to reflect on one of the champions, heroes or, as one might even say, martyrs on the issue of access to medical assistance in dying. I speak of Sue Rodriguez. She lived in North Saanich, in the electoral district that I am honoured to represent. She had ALS. She famously said, “[W]hose body is this? Who owns my life?” She went all the way to the Supreme Court of Canada back in 1993 in an effort to get access to the alleviation of suffering from a disease that would kill her. This was not in doubt. However, the Supreme Court of Canada, in 1993, denied her request.

As others have mentioned in this place over the last couple of days of discussion, a colleague and friend of many of ours and a dear friend of mine, Svend Robinson, stayed with Sue Rodriguez when a doctor assisted her illegally, and she took her own life, with the doctor's assistance, in probably the first public case of medical assistance in dying in Canada.

The courts took a long time to change, and that decision in 1993 was not changed until 2015 in the Carter case. In the Carter case, the Supreme Court of Canada found, taking a different view, that the charter rights in section 7 to life, liberty and security of the person were violated by not allowing a person to make such a decision and to have access to medical assistance in dying. The Carter case changed things by putting squarely to the Parliament of Canada that it had to deal with this.

I will quote from the Carter case. The Supreme Court of Canada said, “competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering”. That was the basis for creating legal access to medical assistance in dying.

When Bill C-14 went through, I tried so hard to put forward amendments saying we have to allow advance directives. It was not right not to allow them for someone who knows they are terminally ill and are facing incredible suffering. It is their choice and they should be able to access medical assistance in dying with an advance directive. However, back when Bill C-14 went through, this was rejected. My amendments were rejected in the House as well. Similar amendments were then passed in the Senate, and we all recall it came back here without those amendments having been accepted.

Bill C-7 repaired that but opened the door to something entirely different. I do think it is entirely different to say that when people are suffering incredibly and intolerably due to a deep, chronic and unsolvable mental health condition, they should also have access to medical assistance in dying.

I will go back and say what the political promises were when we started down this road. I first want to address the medical conditions.

When Bill C-14 was first debated, a lot of members in this place were asking about palliative care: Would people choose medical assistance in dying if they had the option for palliative care? We heard many promises from the government benches that we would see increased funding for palliative care. That has not happened. That is one thing that concerns me greatly.

We have also heard, since we passed Bill C-7, that there would be more supports for mental health. That has not happened either.

What would we do if we were serious about making sure that every Canadian could exercise, fully, their rights, under section 7 of the charter, to life, liberty and security of the person?

At least, one would know that the health care system should be working well. I am pleased to see that the premiers accepted the federal offer today. I hope that the federal government will defend our public health care system with every ounce of its energy and make sure that the deals with the provinces are specific and tied to outcomes and results.

However, our health care system is in trouble. I was just talking to an incredible indigenous woman. I will not say her name; it was a private conversation. She is Cree. She lost a dear friend recently because that Cree dear friend could not get access to medical care in time to diagnose and treat her cancer. She leaves two small children behind.

The health care system in the country is not equal, any more than the litany of deeply racist and distressing conditions in which the system works against justice for indigenous peoples. We all know it. In the context of the health care system, how can we not know it?

In terms of mental health care supports, we know even more deeply that the suicide rates among youth in this country are a huge source of concern. We know that mental health issues have been worsened among our youth, through the pandemic, through isolation, through all kinds of things, through being preyed on by social media.

We know that our schools, universities and post-graduate programs are failing young people because they cannot get the mental health supports that they need when they need them. They need help to avoid addictions and to kick addictions. Our young people need so much help and we are failing them.

Opening up MAID is not a solution to solvable mental health care issues where we are just falling down on the job because we are not providing the mental health supports that we have promised over the years.

What would we do if we wanted to be serious about section 7 rights? We would bring in a guaranteed livable income, to ensure that no Canadian is living in poverty, poverty being the number one social determinant of ill health, in terms of physical health and mental health. We would address poverty and end it through guaranteed livable income.

We would do more, as I mentioned, for the end-of-life issues and access to palliative care. There is such a thing as having a good death. We do not like talking about death in our society. We are all supposed to be young and preferably sexy forever. Let us face it: people get old and it is a lovely experience. It is a good thing to be healthy in old age and enjoy it right up to the moment when whatever one thinks is going to happen to oneself happens: meet one's makers or feed the worms, whatever. A good death is a good thing.

Medical assistance in dying does give people that option of a good death, surrounded by family, feeling loved. I am very supportive of the work that we have done in Bill C-14 and half of what we did in Bill C-7, but where are the mental health supports?

Again, to the point that the hon. member for Timmins—James Bay made, I totally agree. I say yes to housing, to supports and to ending poverty.

However, I do think that we have to explore and open up. In the next year, let us get serious at looking at non-traditional therapies for people dealing with what appears to be irremediable depression. Do psychedelics make a difference? I am not going to prescribe. As the hon. member for Timmins—James Bay said, do not take health advice from politicians.

However, the evidence is coming in on using such products as psilocybin to actually trigger something that results not just in a bit less suffering and mental health conditions. There are certainly papers out there that are peer-reviewed and very interesting, that one can cure depression. I certainly would not want to turn my back on a potential cure and then embrace medical assistance in dying for people who could be cured.

Neither do I want to turn my back on people who are suffering and who are saying that we are making them wait another year and asking why we are doing that. These are not easy issues but these issues, life and death issues, are at the heart of the sacred and they are at the heart of our work in Parliament.

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

Mr. Speaker, I want to thank the hon member for Timmins—James Bay for such a heartfelt and sincere exploration of how it has made all of us feel in this place. I remember feeling entirely conflicted on the vote on Bill C-7, because I could not see how we could deny advance directives for people who had a terminal diagnosis and were told they had to wait for the day of their MAID procedure, and be of sound mind and confirm.

We knew that people were actually choosing MAID procedures earlier than they needed to because of the failure to have advance directives in Bill, C-14. I know, as I did vote for Bill C-7, that I was approving something to come into place automatically by default that I thought was wrong, so I thank the hon. member.

Has the member ever explored the ideas of things like psilocybin? There are mental health illnesses where the psychiatry profession says there is no hope for a person, they are chronically depressed and nothing will ever lift them out of it. Does the hon member for Timmins—James Bay have any thoughts about what other medical procedures could assist in lifting people out of the deepest of despairs?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I am pleased to be able to join this debate.

The underlying legislation of Bill C-39 is very simple. The government is simply asking that it be given more time to introduce safeguards, guidelines and professional practices that would allow assisted deaths to be administered in such a way that mistakes are not made. However, we already know that mistakes are being made under the current regime, so that should not give Canadians any confidence. In fact, Bill C-7, which is the bill that has given rise to this request for an extension, is just another case of the Liberal government getting it so wrong by failing to consult in advance and then, after the fact, trying to fix all the mistakes and fill in all the gaps.

This is another story of failure, and what I would like to do is explain a bit of the context. Members may recall that back in 2015 the Supreme Court of Canada, for the first time, opened up the door to legalized assisted suicide, and the Liberal government then responded with Bill C-14, which restricted MAID, or medical assistance in dying, to those who were at the end of their lives and living in intolerable, grievous pain. We were assured this was not a slippery slope that was intended to include other vulnerable Canadians in Canada's assisted death regime. That is what we were told. Many of us did not take the government at its word. We did push back, but the government passed the legislation anyway.

Sure enough, here we are, some eight years down the road, and our fears were confirmed when the Quebec court, in the Truchon case, ruled that limiting MAID to those whose natural death was reasonably foreseeable was unconstitutional. The government did not appeal that case, a seminal case because it is opening up a life-and-death piece of legislation and expanding it without a reference to the Supreme Court of Canada. I believe that was an abdication of responsibility in itself. Instead, the government chose to accept the ruling and move forward with Bill C-7, which ended up extending MAID to include, among others, the mentally ill.

I want to be clear here. I do note that the original Bill C-7, which was introduced by the justice minister, did not include the mentally ill in Canada's assisted suicide regime. However, when that piece of legislation, Bill C-7, went to the Senate, the other place, the senators inserted a provision expanding and extending assisted suicide to the mentally ill in Canada. When it came back to this House, the government, instead of pushing back, the way one would expect a government to do, simply rolled over and said it would accept it the way it was, and that is now becoming the law of the land.

Bill C-7 also provided that the mentally ill provisions of Bill C-7 would come into force in two years. That is the sunset clause some people talk about. During that period of time, proper safeguards and practice standards were to be put in place to ensure that mistakes were not made. Not surprisingly, as it is a Liberal government, it got to the end of the two years, and virtually nothing has been done. The government actually struck an expert panel to review this, but it did not give that panel the right to review the merits of the underlying assisted suicide regime in Canada.

There is also a joint parliamentary committee between the Senate and the House that is still reviewing these provisions, and I am looking forward to that report. However, again, the mandate of the committee did not include any real, substantive review and investigation into the substance of medically assisted suicide. All it was allowed to do was tinker around the edges to implement a policy that has life-and-death implications for many Canadians.

Here we are. We have no safeguards and there are no guidelines for our practitioners, but we support the bill because we are trying to push this down the road as far we can. I will mention why in a moment.

The woefully inadequate rollout of the government's MAID regime is a manifestation of a Liberal government that appears to be in disarray and whose ideology is moving Canada from a culture of life to a culture of death rather than providing the necessary resources to our most vulnerable. Many in the House have raised that issue and have asked this: Why is it even necessary to apply assisted suicide to the marginalized in Canada, the vulnerable? They ask because right now we are not providing them with the resources and supports they need to live a satisfying and joy-filled life.

What is really of concern is that numerous stakeholders have said they oppose Bill C-7. By the way, there is no broad consensus in Canada that we move forward with assisted suicide for the mentally ill. There is some consensus for MAID to be in place for other cases where there is extreme pain involved, but Canadians do not support extending it to the mentally ill.

What is also of concern is that the government has now signalled that it will go beyond the mentally ill and would like to include mature minor children in this regime. The government is charging ahead with a life-and-death policy that has increased Canada's momentum down the slippery slope that we had warned of.

Is death now seen as a more cost-effective way of managing the most vulnerable in our society? Many have posited that this is the case now. Canadians have a right to question whether their government can be trusted on issues of life and death. If this is being extended to the mentally ill and to mature minors, what about the indigent? What about the homeless? What about the drug addicted? What about veterans? We know that veterans have already been counselled by the government to consider MAID as an option to serve their needs and provide them with support. We know that people who are arriving at the food banks are asking where they can access MAID, because they do not want to live in poverty anymore. That is a reflection on us as parliamentarians. It is a reflection on our country, and we can do better.

There is, however, some good news, and I will end with it.

I recently tabled a private member's bill in the House, Bill C-314, the mental health protection act. It would reverse the Liberal government's reckless acceptance of the unelected Senate's assisted death amendments. It would arrest the dangerous momentum that the expansion of medically assisted death has triggered on the slippery slope. Under my bill, Canadians whose sole underlying medical condition is a mental disorder would not qualify for MAID. At the same time, the preamble to my bill calls upon the government to finally deliver the mental health supports that have repeatedly been promised in federal budget after federal budget but have never been delivered. This is the least we owe to those who struggle with mental illnesses such as depression.

In closing, to ensure that we do not implement the mental health provisions of Bill C-7 before the House has an opportunity to revisit my piece of legislation, we on this side are very supportive of moving forward and passing the bill expeditiously. It will buy another year and push the whole issue of the mentally ill down the road, and we will make sure that we implement private member's legislation that actually protects the most vulnerable.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, our party has a diversity of views on many aspects of the euthanasia regime in this country. At various stages along the way, there have been Conservatives who have expressed different points of views and voted different ways. My past interventions are well on the record, and I think they have actually been borne out by the experience of this.

When we first debated Bill C-14, I said there was a slippery slope here and the so-called restrictions were not going to work and were not going to remain in place. We have slid quite far down that slippery slope, so I can certainly defend the positions I have taken historically.

I think the diversity of views within our party is often a source of strength, but our caucus is united in saying that this expansion of euthanasia to those with mental health challenges is not acceptable and is not justified. It is something we are united in opposing.

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

Mr. Speaker, it is an honour to stand to give my thoughts on Bill C-39. For those who are watching the debate today, this is the bill to amend the Criminal Code to delay, until March 17 of next year, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition is a mental illness.

It has to be stated very clearly, because of the timeline with which we are dealing, that if this bill is not passed, the original sunset clause that was put in place by the old Bill C-7 will come into effect on March 17, which is just over a month away. It is for that reason that I will support the bill and will work with all parties to get the bill passed quickly.

Today's conversation has to happen within the context of the mental health crisis in Canada. We know and have heard, and this is not just from members of Parliament, from many advocates and stakeholders that there is an extreme lack of funding and resources. Clearly, there absolutely must be parity between physical and mental health in funding.

The Minister of Mental Health and Addictions has stated in the House that Canadians should have access to timely evidence-based, culturally appropriate and trauma-informed mental health and substance use services to support their well-being. With that I agree wholeheartedly, but words are not enough. We need to see the requisite resources and funding to follow through those words.

We know that beyond the Canada mental health transfer many advocates have long been calling for legislation to enshrine in law parity between mental and physical health. I am very glad today that I am giving my speech beside the hon. member for Courtenay—Alberni, who is our mental health and addictions critic and who has himself tabled Motion No. 67, which calls on the government to develop that legislation and to urgently fulfill its promise to establish that Canada mental health transfer.

In my own riding of Cowichan—Malahat—Langford, many of my fellow citizens are going through extreme struggles with the opioid crisis. They are dealing with trauma. They are dealing with underlying mental health challenges that are simply not being addressed. That is an extreme gap and the cause of an extreme amount of shame for a country as wealthy as Canada to be still having these conversations about the resources that need to be brought to bear in communities like mine.

I have been a member in the House since 2015, so this is now my third Parliament. I have been here for the entirety of the legislative journey of medical assistance in dying. I can remember Bill C-14 and the sometimes difficult debates we had in the House. That legislation was in response to the Carter decision in the Supreme Court, which basically said that to deny people this right was contrary to our charter. It therefore gave the government a timeline to address it with the appropriate legislation.

What is not often talked about with Bill C-14 is that there was a legislative requirement in that act when it received royal assent. There was a five-year statutory review of medical assistance in dying. Unfortunately, that never occurred before the government went ahead in the previous Parliament and introduced Bill C-7, which established a second track for people whose death was not reasonably foreseeable.

The context of today's speech and C-39 is the fact that we have a story here of the government in several instances putting the cart before the horse. It not only introduced Bill C-7 before a statutory review occurred, which was a requirement of Bill C-14, but it then went ahead and accepted a Senate amendment to the bill that ran contrary to its own charter statement. It did that pretty massive expansion to the law without establishing a special joint committee that was a requirement of Bill C-7.

I am intimately familiar with what this process has been because I have not only been a member of the House since 2015, I have not only participated in debate on Bill C-14 and on Bill C-7, but I have also been a member of the special joint committee, both in the previous Parliament and in this Parliament.

The message all along has been that this kind of a review should have occurred before we were dealing with a timeline crunch. It became quite obvious during the special joint committee that too many Canadians, too many professionals in our country had apprehension about mental disorders as the sole underlying medical condition for being able to access medical assistance in dying as early as next month. Hence, we have Bill C-39.

I want to go back to the original charter statement that the government released as a part of Bill C-7. That includes a number of important statements as to why the government felt, originally, that mental disorders should be excluded from accessing MAID. It did say in that charter statement that the exclusion was not based on the assumption that individuals who suffered from mental illness lacked decision-making capacity. It also said that the exclusion was also not based on a failure to appreciate the severity of the suffering that mental illness could produce. Rather, it was based on the inherent risks and complexity that the availability of MAID would present to those individuals.

First, that charter statement identified that the evidence suggested that screening for decision-making capacity was particularly difficult. It could be subject to a high degree of error. Second, the statement identified that mental illness was generally less predictable than physical illness with respect to the course that the illness may take over time. Finally, it highlighted the experience that a few of the countries that permitted MAID, namely Belgium, the Netherlands and Luxembourg, for the sole underlying medical condition of mental illness had and some of the concerns relating to the increasing number of these cases and the wide range of mental illnesses in respect to which MAID could be provided.

Again, it really highlighted the fact that precaution was the necessary mode that was required before we embarked on this path. However, the government in its wisdom decided to accept a late stage Senate amendment to the bill after the House, full of its duly elected members, had given a final vote on Bill C-7. As a member at that time, I could not bring myself to accept that Senate amendment. Therefore, I ended up voting against the final version of Bill C-7 because of that.

It also needs to be said, when we are going over the history, that the special joint committee that was a requirement of Bill C-7 got a very late start. It was first brought into being just before the summer recess in 2021. We only had a few meetings before the summer of 2021 and we had the unnecessary election, launched solely at the request of the Prime Minister, in August of that year. This completely wiped out anything that was happening during the 43rd Parliament. That Parliament ceased to exist, and all of the committees that were a part of it did as well.

The new Parliament, the 44th, reconvened later that year, but it was not until around April or May of 2022 that serious discussions started coming together and we could actually get the special joint committee reformed. Again, we have to put that in the context of the impending deadline of March 17, 2023.

An incredible amount of time was wasted, not only from an unnecessary election but also from the delays of getting that committee up and running. We had to twice request an extension of our mandate from both houses of Parliament because the timelines we had been given were completely unrealistic, not only in hearing from as wide a range as possible of witnesses but also in producing a report that would reflect the gravity of the subject matter with which we were entrusted. That has to be highlighted in the debate today on Bill C-39.

I also think it is important because there have been a few narratives around this legislation. It is important to go back to understand what the Criminal Code actually says, and also to put that in the context of the definition of irremediability.

It is important that, in order to be eligible for medical assistance in dying, a person has to meet all of the following criteria: they have to make sure that they are in fact eligible for health services in the province they reside in, they have to be at least 18 years of age and capable of making decisions with respect to their own health, they have to have a grievous and irremediable medical condition, and they have to have made a voluntary request. All these conditions must be satisfied. A person must also give informed consent to receive medical assistance in dying, after having been informed of the means available to relieve their suffering, including palliative care.

Now we get to the definition of a grievous and irremediable medical condition as outlined in the Criminal Code. A person has to meet the following criteria for that definition: it has to be a serious and incurable illness, disease or disability; they have to be in an advanced state of irreversible decline in capability; and that illness, disease or disability, or that state of decline, has to be causing them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.

Those are the definitions in the Criminal Code, so despite the narratives we hear out there, those conditions must be met or the person administering MAID will have committed a crime. They will be in violation of the Criminal Code of Canada and will get the appropriate punishment as a result.

One of the difficulties is the fact that the term “irremediable” is not a medical or scientific term. It is a term that finds its definition within the Criminal Code. If we go to scientific or medical literature, it is a difficult term to define, and that, I think, is why we are seeing a lot of the apprehension around accessing MAID for mental disorders where the sole underlying medical condition is a mental disorder.

Some witnesses who appeared before our committee expressed the opinion that this should not be permitted, because there cannot be any certainty with respect to the incurability of a mental disorder. However, other witnesses told us that certainty is not required and that there are ways to consider irremediability, for example by looking at the years of treatment that people have had and whether any responses of the patient have actually been positive.

We also have to understand that the respect for personal autonomy in all of this is paramount, and it is has to be a treatment that is acceptable to the individual receiving it. They not only have to express informed consent, but it has to be something acceptable to them as a person.

I now want to talk a little about the special joint committee, which I have had the honour of being a member of, as I previously mentioned.

I think it is important to underline that our committee has struggled with the question of how to balance individual autonomy with protections for the vulnerable. We were tasked with looking at five themes through the passage of Bill C-7 and the motion that guided our work from both the House of Commons and the Senate: how we institute protections for persons with disabilities; the state of palliative care in Canada; advance requests; mature minors; and, of course, the subject of today, mental disorders as a sole underlying medical condition and their eligibility with respect to applying for medical assistance in dying.

Our final report is due to be tabled in the House this Friday, February 17. We wrapped up our committee meetings last week and finally approved a draft report. That draft report, as I speak, is going to translation services so that it can be ready for tabling here in the House, and so we will be able to meet the deadline that was given to us.

Before we did that work, we had others who did some important work ahead of us. We had the expert panel that was established. They also wrestled with major concerns, such as incurability, irreversibility, capacity and suicidality, and of course the intersection between structural vulnerability, mental disorder and medical assistance in dying.

That panel report, an important precursor to our work as a special joint committee, did state that assessors in medical assistance in dying should be able to establish incurability and irreversibility with reference to treatment attempts made; the impacts of those treatments; and the severity of the illness, disease or disability. The incurability of a mental disorder cannot be established in the absence of extensive attempts at interventions with therapeutic aims.

This means that someone who has not had access to adequate care would not be eligible for MAID. Therefore, MAID could never be used as a substitute for good psychiatric care. I think that is an important thing we have to realize. There will be safeguards in place, not only with the Criminal Code, but also, we hope, with the standards of practice.

For patients who are considering this, we want to make sure that there has been a long track record of attempts to deal with their illnesses. At the same time, we have heard very clearly that there are many Canadians and many professionals who feel that additional time is needed to make sure we get this right.

One of the witnesses before our special joint committee was the chair of the Government of Quebec's Select Committee on the Evolution of the Act respecting end-of-life care. She explained that Quebec had decided that MAID for mental disorders as a sole underlying medical condition should not be permitted at this time because of the challenges of determining irremediability, as well as the lack of social consensus. Another level of government, this time the Province of Quebec, is also underlining the concerns that many members of Parliament are expressing here today.

I mentioned the final report that will be tabled in the House, but our committee did release an interim report. That interim report was specifically on this subject matter. I will read from our conclusion. It states:

We must have standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight in place for the case of [medical assistance in dying for mental disorders as the sole underlying medical condition]. This task will require the efforts and collaboration of regulators, professional associations, institutional committees and all levels of governments and these actors need to be engaged and supported in this important work.

Although some work is already underway to implement the recommendations of the Expert panel, there is concern that more remains to be done to ensure that all necessary steps have been taken to be ready by the March 2023 deadline...

Again, in our interim report, our special joint committee was already, at that time, expressing concern with the upcoming deadline, and I think it is a smart move that we are moving ahead with Bill C-39. If we back that up with the testimony we heard at committee, we had a number of different witnesses who clearly expressed that they had troubles with this deadline and that those standards of practice were not yet ready.

It needs to be underlined again that, if Bill C-39 is not passed, the original sunset clause of March 17 will come into effect. My vote for this bill is occurring because of that very fact. This is aside from the broader conversation we need to have about medical assistance in dying in general. It is support for a bill that is going to extend the deadline by one year so we can make sure that we get these standards of practice right, so we have the necessary time to engage with the broader community.

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

Mr. Speaker, let me just say from the outset what a pleasure it was to serve on the special joint committee with the member for Montcalm, both in the last Parliament and in this one. I always appreciated his very thoughtful interventions and I could tell that he always came to committee quite well prepared.

The member and I have been here since 2015. He will remember that in the original bill, Bill C-14, there was a statutory requirement for a five-year review. We know that Bill C-7 was introduced before that review happened and that the government decided to accept a Senate amendment before it had a chance to establish a special joint committee. That process, that timeline, underlines why Bill C-39 is necessary now.

I wonder if my hon. colleague would just reflect on what has led us to this point and why Bill C-39 is necessary, and for this House to pass it quickly, because of the impending deadline and the fact that we do need to have some space to make sure we are getting these standards right. It is extremely important.

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

Mr. Speaker, like the minister, I have been here since 2015, so I have seen the entire legislative journey of medical assistance in dying, and I have also been the NDP's member on the special joint committee, both in the last Parliament and this one.

Back when Bill C-14 was passed, there was a requirement in that act for a statutory review of the legislation. We did have Bill C-7, and the government did accept the Senate amendment, even though it was contrary to its own charter statement on the matter. It was only after that that we established the special joint committee, which was then delayed by the 2021 election and did not get up and going until May of last year.

In the context of that, I think the Liberals have, in some instances, put the cart before the horse before we have had the appropriate review, but I would also like to hear his comments because there is a crisis in funding for mental health in this country. We have had the Canadian Mental Health Association talk about this. I would like to hear from the justice minister that his government can make a commitment to bring mental health care funding up on par with that of physical care. There is a real crisis, not only in my community, but also in communities from coast to coast to coast. I think that is going to be an important component of this conversation.

[David Lametti, Liberal, Minister of Justice and Attorney General of Canada]

moved that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.

An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.

My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.

In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.

In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.

Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.

Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.

The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.

In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.

The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.

I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.

This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.

As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.

That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.

As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.

In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.

This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.

The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.

These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.

I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.

I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.

I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.

I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.

The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.

Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.

[Ed Fast, Conservative, Abbotsford, BC]

moved for leave to introduce Bill C-314, An Act to amend the Criminal Code (medical assistance in dying).

Madam Speaker, I am pleased to table today the mental health protection act. As members know, medically assisted suicide was legalized in Canada in 2016. Under Bill C-14, medical assistance in dying was expressly limited to capable adults who have an irremediable disease that causes enduring and intolerable suffering that cannot be alleviated, and when their natural death is reasonably foreseeable.

At the time, the government and its supportive stakeholders assured Canadians that this would not lead to a slippery slope on which the scope of MAID would be continually be expanded to include other Canadians. Not surprisingly, in the intervening seven years, the government has expanded the scope of MAID by de facto extending its scope to those who are not dying, but who are living with disabilities.

More recently, the government expanded MAID to include mentally ill persons and also signalled its intention to extend this right to mature minor children. Clearly, we are on the slippery slope many of us had warned about, and Canadians have a right to ask who is next. Will it be the drug addicted, the indigent, the homeless, or needy veterans? What about willing seniors who are tired of life? Where does it end?

My bill would reverse this momentum and repeal the government's decision to extend MAID to the mentally ill. The evidence from mental health experts is very clear. There is no consensus in Canada that the mentally ill should be covered by Canada's medically assisted death regime. Issues of irremediability, competency and suicidality are not anywhere close enough to being resolved to justify this major policy shift in favour of death.

Let me be clear: My bill does not, in any way, reverse the rest of Canada's MAID regime. Instead, it arrests Canada's slide down the slippery slope of assisted suicide, which so many of us had predicted would happen. I would respectfully ask that all of my parliamentary colleagues give thoughtful consideration to my bill, and join me in protecting and supporting the most vulnerable in our society.

(Motions deemed adopted, bill read the first time and printed)

Judges Act

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, it is a great pleasure to have the opportunity to speak today on Bill C‑9, right after my friend, the member for Battle River—Crowfoot.

I want to begin by entering this debate midstream and responding to some of the comments that I was hearing in the questions and comments period immediately prior to my speech, before shifting into some of the other comments I want to make specifically about this legislation.

A favourite subject of the member for Winnipeg North is legislative timing and the processes of the House, and I must confess that it is a subject I enjoy engaging in dialogue about as well. However, I think he is always selective in his presentation of the story when it comes to the timing or process of legislation. There are a number of different aspects to that. In particular, he is essentially telling my colleague that we should not be debating this bill because he wants the bill to move forward on a certain timeline.

It is important for everybody listening to know that it is the sole prerogative of the government to schedule the legislation it is moving forward for debate in the time slots we have for presenting it, which is the vast majority of the parliamentary calendar. The government needs to set aside some time for opposition days, where opposition parties put forward motions, and there is the possibility for members to move concurrence of committee reports. However, those are quite constrained given the time that those debates take. Of course, there is also Private Members' Business.

There are therefore some opportunities outside of government for legislation, policy or motions to be put forward for debate in the House, but the vast majority of the time is available to the government to schedule at their sole discretion. It is the government that makes decisions about which bills are priorities and which bills to put forward. If it wants a bill to advance, then I think it has an obligation to schedule it for enough days of debate so that debate can be brought to a conclusion. That principle applies for Bill C-9, as it does for any other bill.

What we often see the government do is fail to prioritize a bill within its own allocation of time. Then it acts mystified about the fact that it is not moving based on some artificial timeline that it has set. We saw this with Bill C-22, where the government scheduled it for one day of debate, did not schedule it for weeks afterwards and then asked why the bill was not moving forward. Of course, debate concluded the next time it was scheduled, but it would have moved forward faster if the government had chosen to prioritize it.

I detect the same string of argumentation again here from my friend from Winnipeg North. He is keen to see Bill C-9 move forward, apparently, but not keen enough to have successfully lobbied his House leader to schedule this bill and put it forward on a larger number of days. Friday is a very short day relative to the time we get.

I wanted to spend a few minutes on that particular point because I know it comes up again and again, and to pre-empt, in a sense, what I suspect will be a question from my friend from Winnipeg North, although I will say that I did appreciate him tabling a petition relating to Bill S-223 on organ harvesting. I hope that is a bill the foreign affairs committee will prioritize for deliberation and move forward, because as members know, it has been a long time.

Having responded to that, I want to add my voice to the comments by my friend from Battle River—Crowfoot pertaining to the larger issues of trust in our institutions and independence. We are talking today, in the context of Bill C-9, about certain circumstances, events and comments that have impacted trust and faith in the judiciary, and I think we need to affirm the importance of institutions.

We want to see that our institutions are trusted, but we also want our institutions to be worthy of that trust. Sometimes what we hear from some members is a call to trust institutions without being willing to note when there have been significant problems in the conduct of individuals in those institutions. I think the issue raised by the opposition House leader today with respect to interference by the government in a criminal case is another important issue in the ongoing conversation about trust in our institutions and the actions of government. Acts of interference by the government certainly do have an impact on how our institutions are perceived and the degree to which they are trusted. These matters of interference and the independence of institutions are important in their own right, but they are also important in terms of how they contribute to the level of trust that Canadians can reasonably have, in light of the facts, in the institutions that are so critical for holding our public life together.

Bill C-9, the piece of legislation we are debating today, is, on the face of it, a relatively technical piece of legislation, although as members know, every technical piece of legislation has interesting philosophical issues and questions underneath it. The legislation is about making changes to the mechanisms or processes that are in place around judicial discipline, or the discipline of judges. I will just read the summary. It states:

This enactment amends the Judges Act to replace the process through which the conduct of federally appointed judges is reviewed by the Canadian Judicial Council. It establishes a new process for reviewing allegations of misconduct that are not serious enough to warrant a judge's removal from office and makes changes to the process by which recommendations regarding removal from office can be made to the Minister of Justice. As with the provisions it replaces, this new process also applies to persons, other than judges, who are appointed under an Act of Parliament to hold office during good behaviour.

It creates mechanisms by which individuals who have been appointed to hold office, pending “good behaviour”, could be considered not to have fulfilled the standards required around good behaviour and could therefore be removed from office and/or face other mechanisms of discipline. I think the details and mechanics of these mechanisms are extremely important, and are things that will be important not only for the House to consider but for committee to go into further.

After reading through the legislation, one thing I found quite interesting was the presence of a review panel of lay people who, by design, cannot have any legal background. It is always interesting to me when there is this balance where, on the one hand, there are aspects of our judicial system where we demand a certain level of expertise, and then on the other hand, there are certain places where, I think for good, understandable reasons, we demand a lack of expertise formally and in practice as a means of saying that we want some people involved in the decision-making who are non-experts.

I recall a quotation from former British prime minister Clement Attlee, who talked about how he wanted his ministers not to be experts on the subjects they were ministers of. I know that is a bit of a parenthetical question, but it is one that has been debated over the years regarding various kinds of appointments.

In any event, this legislation includes a specific, designated role in the termination process for lay people. I want to note as well the justifications by which a judge could be removed from office. Proposed section 80 says, “For the purposes of this Division, the removal from office of a judge is justified only” for these reasons:

(a) infirmity;

(b) misconduct;

(c) failure in the due execution of judicial office;

(d) the judge is in a position that a reasonable, fair-minded and informed observer would consider to be incompatible with the due execution of judicial office.

These are, in some ways, notionally objective criteria, but naturally there is going to be some level of subjectivity in how they will be applied.

There is a history to the consideration of this issue, and there is a history to the discussion of judicial misconduct that touches on some very important and sensitive issues. In my time as a member of Parliament, there has been a fair bit of discussion specifically around the issue of comments by judges dealing with cases of sexual assault. There was a judge who made some very offensive and outrageous comments in the context of a sexual assault trial that he was presiding over. That provoked a lot of conversation about the reality that someone is not rendered all-knowing and all-virtuous simply by the fact that they have received a judicial appointment, and that maybe there is a legitimate place for saying that someone, by their comments or lack of understanding certain things, is no longer fit to be a judge.

How do we preserve the principle of judicial independence, the principle that judges should be making decisions based on the facts of a case and the law rather than making decisions as democratic legislators do, based on other factors, including public opinion? How do we preserve that principle of judicial independence and also say that there are certain societal norms and values that we would like to see reflected in the conduct and statements of judges? There is a point at which a person can go beyond the pale and simply no longer be suited to that position as a function of some of their comments.

There have been a number of ways of getting at this issue. One was from former Conservative leader Rona Ambrose, who put forward a private member's bill, in 2016 or the first half of the 42nd Parliament, that sought to promote judicial education around sexual assault. That is one way of dealing with comments like this: We can say that maybe it is simply about a lack of knowledge and education.

That bill did not pass in Parliament, but a similar bill was put forward and was passed in the 43rd Parliament. As I said at the time, I think we need to recognize the importance of education around these issues, but also recognize that education is not always the full solution. I think there is a lot of data to suggest that when we mandate certain kinds of training courses, for some people it is a meaningful opportunity for them to learn about the matter at hand, but for other people it is just a matter of checking the boxes that are required. Whether it is a meaningful engagement exercise or a box-checking exercise depends somewhat on the way the material is presented, but a lot of it will depend simply on the disposition of the individual and how willing the individual is to substantively engage with the matter at play.

My conclusion is that the proposal from Rona Ambrose about judicial education was very important and worthwhile, but it does not solve the whole problem of either judicial misconduct or potential issues where a judge is making comments in the context of a trial that are very offensive to the victim and to society at large.

That is some of the history of the issue, but there are also other potential issues. This is not just about comments judges make in trials; it could also be about concerns over personal corruption and other things that could be at play in the context of judicial discipline. This is a piece of legislation that, coming out of that long-running public discussion, seeks to make refinements to the processes around judicial discipline.

One thing I would like to note about this discussion is that it presumes the personal fallibility of judges. Maybe it should be fairly obvious, but with the way some of our Canadian debates have proceeded, maybe it is not so obvious that judges are human beings. They have the potential to develop great expertise, great virtue and commitment to their work.

Judges also, like any other human beings, have the potential for grave errors in reasoning, as well as moral errors of various kinds, including misconduct or corruption. They are human beings, are fallible and can make mistakes in various kinds of situations or ways. The heavy criticism of former justice Robin Camp, some of the subsequent discourse and arguments for judicial education the government has supported, and the very existence of this legislation, affirm the reality of judicial fallibility. However, at other times when we are having debates about criminal justice issues and how we respond to particular kinds of charter litigation, the discourse in the House seems to presume something else, which is the infallibility of judges.

It was very striking to me, when I was first elected as a member of Parliament, that we were, on the one hand, dealing with this whole question of former justice Robin Camp and the issues around judicial fallibility, but on the other hand we had members making comments about at the time Bill C-14, which followed the Carter decision of the Supreme Court, where it was repeated that this was a unanimous court decision. Therefore, our goal as a legislature should simply be to interpret the wisdom we were given from this wise council's vision.

I have a great deal of respect for the role the Supreme Court plays in our democracy, but I also think it is legitimate to disagree with decisions that the courts have made. Part of the process of democratic deliberation is recognizing that, if judges can be personally fallible regarding their own conduct, fallible in the sense of making inappropriate comments in a sexual assault case, then they can also be fallible in there determinations about the appropriate sentence and balance of rights that emerge from a series of arguments about how to interpret given facts in light of the charter.

The fact there is diversity in courts of dissent underlines the potential fallibility of judges, and I think we should, in our Canadian democratic discourse, seek to affirm the importance of judicial independence, and the respect that is owed to that institution, while also recognizing that judges make all kinds of mistakes and that Parliament has a role to deliberate about substantive questions of justice and human dignity and to engage in a constructive and healthy back and forth when it comes to decisions, legislation and how we respond to that.

I could cite other cases that brings this issue to the fore, but I see that I am up against my time to some extent. Therefore, I am grateful for the opportunity to address the issues around Bill C-9, to share a bit of the history, and to underline that, for me, one of the lessons coming out of this is to let us acknowledge that judges are human beings. They have an important job to do, but it is legitimate to disagree with and debate the determinations that are made, and to use constitutional tools that affirm the rights and the role of the legislature when it comes to establishing and advancing common values that are determined through democratic deliberation.

Canada Disability Benefit Act

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I appreciate the opportunity to speak to Bill C-22 and, more broadly, to the situation confronting Canadians living with disabilities.

Bill C-22 proposes a new federal financial benefit for Canadians living with disabilities, however, it does not actually define many aspects of the structure of this benefit. I will be voting in favour of the legislation, because I agree with the principle of providing the support, but I am concerned about some of the lacking substance with respect to how this benefit would actually work.

Increasingly, we see from the government a desire to limit the actual work of Parliament in defining the nature and scope of programs. Instead, the government wants a blank cheque from Parliament, legislation that authorizes ministers to shape and define a program independently, according to their discretion.

In general, this is not a good way for governments to operate in a democracy and, in particular, I do not think the Liberal government has shown itself trustworthy when it comes to working out the details of critical programs.

When it comes to the structure of this benefit, the government's message is “just trust us.” From a government that cannot figure out how to deliver passports in a timely manner, cannot address the affordability crisis in Canada and cannot secure our borders, the message of “just trust us” seems rather hollow.

I have two specific concerns about the prospective structure of this program that I do want to highlight.

First, I share the concern of many about how this program would interact with other existing programs, including those provided at the provincial level. If a new federal benefit leads to a loss of eligibility for other existing benefits, then it would leave people worse off overall. It is not inevitable that this would be the case, but this is a matter that will require careful and respectful dialogue with other levels of government and hard work at every stage, hard work that the government has not always been prepared to do.

At this point, the government is passing broad framework legislation without ensuring that it will actually leave Canadians with disabilities better off in every case. The government does not have to wait for this legislation to pass to begin those discussions and I would encourage it to actually engage those discussions now about protecting existing benefits, because aspects of those dialogues may inform suggested amendments.

The second concern I have is that it is critically important that the structure of this benefit program protects access for Canadians with disabilities who are working or are trying to get into work. Even with existing benefit programs at other levels, certain Canadians with disabilities may find themselves in a position where entering the workforce actually leaves them worse off. It is critically important that work always leaves people better off financially.

Supporting Canadians, including Canadians living with disabilities, in being able to access meaningful work has long been a key priority for Conservatives.

Why is this important? Overwhelmingly, Canadians of all backgrounds and circumstances want to be able to work and are happier and more fulfilled if they are able to work. In this context, by work, I do not just mean commodified work, but work of any sort, where individuals exert themselves in order to contribute positively to the world around them.

The science of happiness and fulfillment measurement shows us that work generally makes people happier by providing them with meaning and with a workplace-based community, and with a greater level of power and agency. Quite apart from the notably important income-earning properties of work, work also provides meaning and happiness, totally independent of whether it generates income.

Think tank Cardus has done excellent work on this question of work and disability. It has found that most Canadians living with disabilities want to work or want to work more, but it has also found that the vast majority of public policy, focus and money has been toward income support as opposed to supports that help people get into work.

The critical point about work support and income support is that they are not mutually exclusive. In fact, often, they are necessarily complementary. Some people require income support in order to afford the resources and transportation required to find and get a job in the first place. If income supports are withdrawn immediately once people work or start work, they may not be able to afford vital necessities, as well as the things they need to sustain them in their new job.

Having both fulfilling work and steady income are vital for human happiness and fulfillment. Having income without work or work without income are both, in a sense, problematic.

Of course, having income is not just about fulfillment and happiness; it is about basic survival. Canadians with disabilities need income to take care of their own needs and the needs of those they love.

For most of us, work comes with earning income. However, when benefit programs are poorly structured, people may actually be forced to choose between work and income, because benefits are cut off or income is lost as a result of working. In such cases, given how essential income is for survival, people will understandably choose income over work if they are forced to choose between these things. It is cruel and pointless to force people to make this choice, to choose between the happiness associated with work and receiving the financial support that they need.

Income supports for Canadians with disabilities can and should go hand in hand with workplace support, only peeling those income supports back gradually when it is clear that income support is not required because of the level that an individual is able to work.

We saw an example of this terrible choice between work and income during the pandemic with the poorly constructed CERB program. Unemployed Canadians who were accessing CERB, and who were then offered part-time work, were in many cases actually worse off financially if they took that work because part-time work would push them over the threshold for CERB eligibility, even if they were not earning close to what they would have been entitled to receive under CERB. Thus people were forced to remain out of work in order to access the resources they needed to support their families.

Not only does it make zero financial or economic sense to create a financial disincentive to work, but it also puts people in the painful position of needing to choose between the happiness and dignity that come from work on the one hand and from financial security on the other hand. That is why we feel it is very important that this new federal program be structured in such a way that Canadians with disabilities, many of whom can and do work, or want to work, are not rendered worse off by entering the work force.

There is nothing in the text of the bill that would suggest it could not be structured in a way to ensure that work always pays, but the past record of the government gives us significant cause for concern. In the 42nd Parliament, the member for Carleton, now the leader of the Conservative Party, proposed Bill C-395, a bill specifically designed to address this problem of work sometimes bringing about a loss in benefits for Canadians living with disabilities.

Bill C-395 would have amended the Federal-Provincial Fiscal Arrangements Act to ensure that, in negotiations around transfers and the construction of benefits for Canadians living with disabilities, people with disabilities would not lose more through taxation and the reduction of benefits than they gain as a result of working. It would have protected Canadians with disabilities from these kinds of perverse situations where they would have to choose between the happiness that comes from work or the financial security that comes from government benefits.

If Bill C-395 were the law of the land, we could then pass this bill, even as written, with the confidence that the benefits constructed would leave people better off, but when it came to a vote on Bill C-395, Liberals actually opposed it. Liberals opposed the common-sense proposal from our leader to ensure that Canadians who work are better off as a result of the money they earn.

Sadly, Liberals do not seem to appreciate the value, dignity and happiness that comes from hard work. I am not sure if it can be found in the scope of this legislation as written, but I would welcome amendments that would capture the spirit of our leader's past work to protect Canadians with disabilities from being punished for working.

Parenthetically, I want to say something directly to employers about hiring Canadians with disabilities. Research done by Cardus shows that many employers have an exaggerated perception of the cost associated with accommodation. Cardus' work shows that including and accommodating employees with disabilities is often much cheaper than employers initially expect and that funding may be available from different levels of government for businesses, including small businesses, seeking to accommodate customers and employees living with disabilities.

Further, as our leader has previously shared in the context of speaking to Bill C-395, there are many cases of Canadians with disabilities who make incredible, committed and loyal employees who bring unique competencies for the workplace. Governments have a responsibility to ensure that poorly structured benefit programs do not undermine the ability of Canadians to access work, but employers also need to lead in pushing aside stereotypes and recognizing the contributions that Canadians with disabilities can make to their workplace. Many employers are already doing this, and I congratulate those who are doing this already.

Those were the main points I wanted to make on Bill C-22, but it is also very important to speak to the context of the legislation, which is the significant negative impacts on the lives of Canadians living with disabilities that flow from the government's radical ableist approach to euthanasia, the so-called MAID regime. We simply cannot have a conversation about financial benefits separate from a recognition that the biggest threat to the lives of Canadians living with disabilities is that those without disabilities are much more likely to be offered suicide prevention and recovery support, while our brothers and sisters, cousins and friends who are living with disabilities are being denied those supports and actively pushed towards death, even if they are saying they do not want it.

Among those who support legal euthanasia around the world, Canada is still increasingly seen as a cautionary tale, a warning of what not to do. In this vein, I want to start with a bit of history. Euthanasia in Canada started with Bill C-14, which was passed in the 42nd Parliament. This legislation affixed the name “medical assistance in dying” to what had previously been called euthanasia, the process of doctors killing a consenting patient. That legislation sought to define a regime whereby people could choose hastened death if their death was deemed reasonably foreseeable.

I criticized the legislation at the time for, among other things, not being sufficiently clear about what was actually meant by “reasonably foreseeable”. Indeed, there were significant abuses, even in the immediate aftermath of the passage of the legislation, whereby doctors determined someone's death to be reasonably foreseeable based on a string of hypotheticals when a person had nothing approaching a terminal condition.

For example, back in 2016, I highlighted a case in Vancouver where a physician declared a depressed person eligible for euthanasia without examining the individual because that patient “could easily get bed sores and then die of infection”. A person's death was, prior to examination, declared reasonably foreseeable because the person could theoretically die from an as yet uncontracted bed sore infection if they were bed bound as a result of the depression. These were the kinds of perverse outcomes that were possible even in 2016 as a result of a lack of safeguards and the ambiguity around what was meant by “reasonably foreseeable”.

The current rules allow someone also to consult many different physicians before finding two who will approve. Therefore, if 20 or 200 doctors say no, the criteria are not met, but then two say yes, the criteria are met, then the killing of the patient can proceed. The ambiguity and the opportunity to consult multiple doctors before getting the desired result means that, indeed, the holes were, and still are, large enough to drive a truck through. These were the pre-existing problems that were already, in particular, raising concerns of the disability community. The lack of clarity around what were and were not circumstances where death was reasonably foreseeable opened the door for people who were living with disabilities to be encouraged to pursue MAID, even if they did not want to, and even if they were actually not eligible.

Members do not have to take my word for it because the minister responsible for this legislation, the Minister of Employment, Workforce Development and Disability Inclusion of Canada, during a subsequent discussion of Bill C-7, said, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.” That is from a minister in the government. This was already the context following the passage of Bill C-14 and prior to the passage of Bill C-7.

The road to Bill C-7 was much more contrived than the road to bill C-14. The already nebulous reasonable foreseeability clause was challenged and a lower court in one province proposed to overturn this restriction. The federal government could have appealed that lower court decision and, indeed, had a strong basis for doing so. An appeal would, at the very least, have given parliamentarians more time to consider a broad range of legislative options. Instead, the government made a political choice to embrace the lower court ruling and the artificial timeline it created, pushing medical assistance in dying for Canadians with disabilities. This was not about following a court ruling. This was about something the government could have appealed, but wanted to use the court ruling to advocate for a long-standing objective.

Following this contrived process, the government put forward Bill C-7, which was rightly opposed by all of the leading organizations representing Canadians living with disabilities, as well as by domestic and international human rights authorities.

Krista Carr from Inclusion Canada said, “Inclusion Canada has advocated for safeguards in MAID since we intervened in the Carter case. Our biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide. Bill C-7 is our worst nightmare.” She continued, “By having a disability itself under Bill C-7 as the justification for the termination of life, the very essence of the Charter of Rights and Freedoms would be shattered. Discrimination on the basis of disability would once again be entrenched in Canadian law.”

She said further that the “singling out of one particular...group” of people based on their personal characteristics, which happen to be protected under the Charter of Rights and Freedoms, and to use those as grounds to justify the termination of the lives of the people who have those characteristics is just wrong, and that we would never consider doing this for any other group of people, including those who are indigenous, racialized or LGBTQ.

Dr. Heidi Janz from the Council of Canadians with Disabilities said:

People with disabilities are at a higher risk of suicide due to systemic and internalized ableism, yet they face substantial barriers when trying to access suicide prevention services. Medical professionals overlook typical sources of stress. Problems arising from relationship breakdowns, depression and isolation are wrongly attributed to disability. The removal of “reasonably foreseeable” natural death as a limiting eligibility criterion for the provision of MAID will result in people with disabilities seeking MAID as an ultimate capitulation to a lifetime of ableist oppression.

Finally, Bonnie Brayton from the DisAbled Women's Network of Canada pointed out, “Bill C-7, is sadly lacking in any meaningful public consultation with any people with disabilities despite how much more profoundly it could affect anyone who lives with a disability.” The disability community overwhelmingly opposed Bill C-7 and has repeatedly raised concerns about negative pressure and coercion impacting Canadians living with disabilities.

What about autonomy? The government would argue that Bill C-7 provides people with disabilities the option of medically facilitated death, but they do not have to chose that option. It is just another option that people have. To this, I would note that autonomy is always expressed in a social, legal and economic context. The context is that many Canadians living with disabilities struggle to access the key supports and services they need.

We do not have sufficient workplace supports in place and there are gaps in terms of community and income supports. In that context, the law and the medical system say to a person living with a disability that they have a simple way out and they can choose to die. If someone is at a point of existential agony and they have a disability, then the system will offer them death as a supposed solution.

In effect, if a person like me, without a disability, is experiencing existential distress and suicidal ideation, and if I were to discuss that distress with a doctor, I would be offered suicide prevention. However, if a person with a disability, the same as me in every other respect, is experiencing the same existential distress and suicidal ideations, and they discuss their distress with a doctor, they will be offered suicide facilitation by that same medical system.

That difference in the way the law and the health system treat those living with and without disabilities obviously sends a message to everyone involved in those interactions about whose life the law and the health system deem to be more or less worth living. The Liberal government has built a staircase to suicide prevention and a ramp to suicide facilitation.

As much as members opposite would like to say that this is about autonomy, the social and legal context that the government has created is not neutral and it is, in fact, discriminatory. Disability rights groups overwhelmingly see this reality, which is why they have been diametrically opposed to the approach of the government, and so much for “nothing about us without us”.

Canadians with disabilities feel devalued by a system that offers them easy death and does not offer them critical supports to live. Sadly, the mentality of the medical system is changing as well in response to these legal changes. The House has heard from many witnesses at different times and in different communities where patients were repeatedly pushed toward death and even called selfish for rejecting that option.

I will quote the minister again who said herself, “I regularly hear from families who are appalled by the fact that they take their child, potentially their older child and are offered unprovoked MAID. I think that has to stop.”

In response to the testimony we heard, Conservatives sought to amend Bill C-7 to guarantee that a physician or other health care worker would not raise euthanasia or MAID with a patient, unless the patient raises it first. This amendment would have ensured that, for instance, a person with a disability who goes to the doctor for something unrelated would not be offered facilitated death out of the blue. This would have solved the problem the minister identified, but the government opposed this—