Bill C-7 (Historical)

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

This enactment amends the Criminal Code to, among other things,
(a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Alleged Premature Disclosure of Bill C-63

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I am rising this afternoon on a question of privilege concerning the leak of key details of Bill C-63, the so-called online harms bill, which was tabled in the House earlier today.

While a lot will be said in the days, weeks and months ahead about the bill in the House, its parliamentary journey is not off to a good start. Yesterday afternoon, the CBC published on its website an article entitled “Ottawa to create regulator to hold online platforms accountable for harmful content: sources”. The article, written by Naama Weingarten and Travis Dhanraj, outlined several aspects of the bill with the information attributed to two sources “with knowledge of Monday's legislation”.

I will read brief excerpts of the CBC's report revealing details of the bill before it was tabled in Parliament.

“The Online Harms Act, expected to be introduced by the federal government on Monday, will include the creation of a new regulator that would hold online platforms accountable for harmful content they host, CBC News has confirmed.”

“The new regulatory body is expected to oversee a digital safety office with the mandate of reducing online harm and will be separate from the Canadian Radio-television and Telecommunications Commission (CRTC), sources say.”

“Sources say some components of the new bill will be modelled on the European Union's Digital Services Act. According to the European Commission, its act “regulates online intermediaries and platforms such as marketplaces, social networks, content-sharing platforms, app stores, and online travel and accommodation platforms.””

Then, today, CTV News published a second report entitled “Justice Minister to Introduce New Bill to Tackle Harmful Online Content”. In Rachel Aiello's article, she says, “According to a senior government source [Bill C-63] would be expected to put an emphasis on harms to youth including specific child protection obligations for social media and other online platforms, including enhanced preservation requirements. It targets seven types of online harms: hate speech, terrorist content, incitement to violence, the sharing of non-consensual intimate images, child exploitation, cyberbullying, and inciting self-harm, and includes measures to crack down on non-consensual artificial intelligence pornography, deepfakes and require takedown provisions for what's become known as 'revenge porn'. Further, while the sources suggested there will be no new powers for law enforcement, multiple reports have indicated the bill will propose creating a new digital safety ombudsperson to field Canadians' concerns about platform decisions around content moderation.”

As explained in footnote 125 on page 84 of the House of Commons Procedure and Practice, third edition, on March 19, 2001: “Speaker Milliken ruled that the provision of information concerning legislation to the media without any effective measures to secure the rights of the House constituted a prima facie case of contempt.”

The subsequent report of the Standing Committee on Procedure and House Affairs concluded: “This case should serve as a warning that our House will insist on the full recognition of its constitutional function and historic privileges across the full spectrum of government.”

Sadly, Mr. Speaker, the warning has had to be sounded multiple times since. Following rulings by your predecessors finding similar prima facie contempts on October 15, 2001, April 19, 2016 and March 10, 2020, not to mention several other close-call rulings that fell short of the necessary threshold yet saw the Chair sound cautionary notes for future reference, a number of those close-call rulings occurred under the present government that would often answer questions of privilege with claims that no one could be certain who had leaked the bill or even when it had been leaked, citing advanced policy consultations with stakeholders.

Mr. Speaker, your immediate predecessor explained, on March 10, 2020, on page 1,892 of the Debates, the balancing act that must be observed. He said:

The rule on the confidentiality of bills on notice exists to ensure that members, in their role as legislators, are the first to know their content when they are introduced. Although it is completely legitimate to carry out consultations when developing a bill or to announce one’s intention to introduce a bill by referring to its public title available on the Notice Paper and Order Paper, it is forbidden to reveal specific measures contained in a bill at the time it is put on notice.

In the present circumstances, no such defence about stakeholders talking about their consultations can be offered. The two sources the CBC relied upon for its reporting were, according to the CBC itself, granted anonymity “because they were not authorized to speak publicly on the matter before the bill is tabled in Parliament.”

As for the CTV report, its senior government source “was not authorized to speak publicly about details yet to be made public.”

When similar comments were made by the Canadian Press in its report on the leak of the former Bill C-7 respecting medical assistance in dying, Mr. Speaker, your immediate predecessor had this to say when finding a prima facie contempt in his March 10, 2020 ruling:

Everything indicates that the act was deliberate. It is difficult to posit a misunderstanding or ignorance of the rules in this case.

Just as in 2020, the leakers knew what they were doing. They knew it was wrong and they knew why it was wrong. The House must stand up for its rights, especially against a government that appears happy to trample over them in the pursuit of legislating the curtailing of Canadians' rights.

Mr. Speaker, if you agree with me that there is a prima facie contempt, I am prepared to move the appropriate motion.

Criminal Code

[Lianne Rood, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, I rise today to address a question of paramount importance and profound concern to many of my constituents in Lambton—Kent—Middlesex: Will Canada cross the Rubicon and expand access to assisted suicide for otherwise healthy individuals whose mental disorder is the sole underlying medical condition, or do we have enough common sense and moral clarity to stop this radical and dangerous expansion of MAID to mental health cases? The issue at hand stands at the juncture of ethics, medicine and our societal values. This is not merely a policy decision. It is a profound moral question that strikes at the heart of who we are and how we value life and respond to suffering.

The core concern here is the difficulty, if not the impossibility, of determining with certainty that mental disorders are irreversibly incurable. Unlike many physical ailments, the trajectory of mental illness is often unpredictable and can respond to treatment over time. The NDP-Liberal government's push toward expansion, despite substantial opposition from medical professionals and the public, raises serious questions. It reflects a troubling trend of policy-making that seems to prioritize ideological considerations over careful, evidence-based deliberation. How can we, in good conscience, move forward with a policy that many experts in psychiatry and mental health view with significant trepidation?

The opposition from the medical community, particularly from mental health professionals, is not just significant but deeply insightful. The expert panel on MAID and mental illness, the very panel established by the government to study this issue, acknowledged the complexities involved. It noted the difficulty in predicting the long-term prognosis of mental disorders, underscoring the near impossibility of determining with certainty whether a mental disorder is truly incurable.

Leading psychiatrists across Canada have expressed reservations. The Association of Chairs of Psychiatry in Canada, which includes the heads of the psychiatry departments of all 17 medical schools in the country, called for a delay in implementing MAID for patients with mental disorders as the only underlying medical condition. Its concerns centre on the challenges in assessing incurability and differentiating genuine MAID requests from suicidal ideation rooted in treatable mental health conditions.

Surveys conducted within the psychiatric community reflect this opposition. For instance, a significant majority of Manitoba psychiatrists have indicated that Canada is not ready for the implementation of assisted suicide for patients with mental disorder as the sole underlying medical condition. A similar sentiment was echoed in a survey conducted by the Ontario Medical Association, where a two-to-one majority of respondents opposed the availability of MAID for such cases. These results are in line with public opinion, which has consistently shown discomfort with this expansion. In fact, I have heard from hundreds of residents of Lambton—Kent—Middlesex who are opposed to this expansion, and polls such as those conducted by Angus Reid reveal substantial public reservations about MAID for mental illness.

If we ignore experts' warnings and the public sentiment and proceed with this expansion, we risk making irreversible decisions in cases where there might be potential for recovery and improvement with the appropriate treatment. The ethical implications of such a scenario are profound and disturbing. In our examination of this issue, we must not overlook the societal context in which decisions about MAID are being made.

The CEO of Food Banks Mississauga recently issued a stark warning that the inability to afford basic necessities is pushing people towards considering MAID. This is a harrowing indication that, for some, the choice to pursue assisted dying may be influenced more by socio-economic despair rather than by unimaginable physical or mental health conditions. This revelation is deeply troubling. It compels us to question whether we are addressing the root causes of such despair or merely offering a tragic and irreversible solution to what are fundamentally social and economic problems. This is particularly concerning in light of the ongoing mental health crisis that was exacerbated by the COVID-19 pandemic and the government's divisive response.

Additionally, we must also reflect on the alarming reports concerning our veterans. There have been stories of veterans being offered MAID. This raises profound concerns about the support and care that we provide to those who have served our country. These individuals, who have sacrificed so much, deserve better than an expedited path to assisted death. These stories underscore the need for robust mental health support and the dangers of expanding MAID without adequately addressing these needs first.

When the Liberal government has such a cavalier attitude toward assisted suicide, with a one-way slope toward access expansions and safeguard removals, is it any surprise that, according to the latest available numbers, the annual growth rate of MAID between 2021 and 2022 was 31.2%? Between 2016 and the end of 2022, 44,958 people died by MAID. That is more than the number of Canadians who died in military service during World War II.

My point is that Canada's current MAID access may already be the most discretionary in the world. That is before the proposed mental health expansion. We are the only country whose legal system does not see assisted suicide as a last resort. What can we expect to happen to the growth rate if the House enables the “treatment” of mental illness with assisted suicide? We would be past the slippery slope concern if that were to happen. Crossing the Rubicon here would put us closer to free fall.

Why are we debating the radical expansion of assisted suicide? Just four months ago, the hon. member for Abbotsford's bill, Bill C-314, was in the House. Conservatives urged the House not to give up on Canadians living with mental illness. Nevertheless, the government voted against the bill, sticking to its original plan, as per Bill C-7, to expand access to MAID to Canadians who are healthy except for their mental disorder.

If it were not for the Special Joint Committee on Medical Assistance in Dying's tabling, on January 29, 2024, its findings and recommendations, the unprecedented MAID expansion would have been implemented within two months. Thankfully the committee, after extensive consultations and a review of expert testimony, concluded that Canada is not ready for the expansion of MAID to include cases where a mental disorder is the sole underlying medical condition. The report highlights the unresolved issues in accurately assessing the irremediability of mental disorders and the challenges in distinguishing between genuine requests for MAID and those stemming from treatable mental health conditions. The report confirms what common-sense Conservatives have been saying for months: Expanding assisted suicide to those suffering from mental illness would result in the deaths of those who could have gotten better.

That is why, just like last year when the government introduced eleventh-hour legislation to put a temporary one-year pause on expanding assisted suicide to those suffering with mental illness, we are once again here at the eleventh hour. There is no question that there is an urgent need to pass Bill C-62 to delay until 2027 the implementation of MAID in cases where a mental disorder is the sole underlying cause and condition.

As highlighted by the report of the special joint committee and the voices of experts and Canadians alike, a mere delay may not suffice. What is required is a comprehensive re-evaluation of our approach to MAID, particularly in the context of mental health. The issues at stake are not just medical or legal but are deeply rooted in our societal values and the respect we need to afford the dignity of human life, especially in its most vulnerable forms.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, we have heard that a lot in this debate. We all want to be on the side of the angels. We all want to improve socio-economic conditions. The expert report does take structural vulnerabilities into account, and no assessor is authorized to grant a request for medical assistance in dying if there is any possibility that the request came about because of a structural vulnerability.

I paid close attention to my colleague's speech. Judging from the examples he gave, I gather he was in favour of Bill C‑14 for cases involving reasonably foreseeable death, but that he is against Bill C‑7 for people suffering from an incurable degenerative disease who are forced to cut their life short by suicide because their suffering has become intolerable. If Bill C‑7 is implemented, those people will be able to live until they reach the threshold of what they feel is tolerable.

Did I understand correctly that my colleague is against Bill C‑7 as it relates to degenerative diseases? I am curious, and I would like him to answer this question. He talked about it in his speech.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I have two comments.

First, my colleague says that we could have contested Justice Baudoin's ruling. However, Justice Beaudoin was referring to the Carter decision, which demonstrated in a way that people with a degenerative disease, like Ms. Gladu and Mr. Truchon, should have ended their lives. The right to life is certainly not about allowing people to commit suicide before reaching the tolerance threshold. That is the issue.

How can the Conservatives denounce suicide on one hand and say that we must be careful when it comes to suicide and all that, which I agree with, and on the other hand not understand that the only alternative for these people is to end their life? The Baudoin decision was relevant in that regard, because Bill C‑7 allowed these people to not end their life.

Second, as for the example that the member gave, I would like to say to him that the conclusion he came to himself is found in the expert panel on MAID and mental illness' sixth recommendation. I will read an excerpt:

...the Panel recommends that ‘community services’ in Track 2 Safeguard 241.2(3.1)(g) should be interpreted as including housing and income supports as means available to relieve suffering and should be offered to MAiD requesters...

If his party ever comes to power, will his government increase health transfers? We did not hear a peep from that side when the stingy Liberal government did not put anything on the table that could help us take care of the people he is talking about today.

[Lisa Hepfner, Liberal, Parliamentary Secretary to the Minister for Women and Gender Equality and Youth]

Mr. Speaker, I will be sharing my time today with the member for Lac-Saint-Louis.

I am very pleased to have the opportunity to speak in this House today in support of Bill C-62, particularly after listening to some of the debate this morning and hearing some of the language used in this House today.

For example, the member for Abbotsford, throughout his speech today continually used the words “the mentally disorded” I believe in reference to people who are suffering from mental illness. A little later in the day, we then heard from the member for Leeds—Grenville—Thousand Islands and Rideau Lakes, who continually referred to people as “addicts” throughout his speech.

In this House, we are leaders. Our words are important and we should not be furthering the stigmatization of people who suffer mental illness. I would caution my colleagues across the way to be careful in their language and to please not further marginalize people who are already suffering.

I will turn back to Bill C-62. As the Minister of Health and the Minister of Justice have emphasized, the government believes an extension of three years is necessary to provide individual clinicians as well as provinces and territories the time they need to prepare for this change.

I also believe a three-year extension of the period of ineligibility to receive MAID on the basis of a mental illness alone is necessary. Although significant progress has been made, more time is needed to ensure the safe assessment and provision of MAID in these circumstances. I have heard from psychiatrists in my riding of Hamilton Mountain who have said these very things. They need more time to get the system ready.

My remarks today will focus on the progress that has been made in preparing the health care system, and also what more needs to be done.

In 2021, as required by former Bill C-7, an expert panel examined the issue of permitting MAID where the sole underlying condition is a mental illness. It concluded that the existing legal framework of eligibility criteria and safeguards is sufficient, providing that MAID assessors apply the existing framework appropriately with guidance, through the development of MAID practice standards and specialized training.

Our government understood the importance of the panel's findings. To that end, we have been working in collaboration with the provinces and territories and other health care partners to implement consistent standards across the country and support a highly trained workforce to undertake these complex assessments.

For example, we supported the development of a model practice standard for MAID by individuals with clinical, regulatory and legal expertise. A model practice standard for MAID was released in March 2023 and has been adopted, or is in the process of being adopted, by most regulators across the country as a basis for assessment for clinical decision-making. The standard also provides guidance for MAID clinicians as they navigate more complex MAID requests.

We also supported the development of the first national, fully accredited bilingual MAID curriculum, which was launched in August 2023. The curriculum consists of seven training modules addressing various topics related to the assessment and provision of MAID, including how to do a MAID assessment, how to assess capacity and vulnerability, how to manage complex chronic situations and how to assess requests involving a mental illness. Over 1,100 clinicians have registered for the curriculum since August of last year.

This progress is the result of leadership and collaboration among health system partners, including federal, provincial and territorial governments, health professional organizations, regulatory bodies, clinicians and organizations like the Canadian Association of MAID Assessors and Providers. This collaboration and progress will continue to make improvements in approaches to safety and quality in assessments and provisions of MAID.

In terms of the future, I want to briefly speak to the Regulations for the Monitoring of Medical Assistance in Dying, which outline the reporting requirements relating to MAID requests. These regulations came into force in November 2018, but were recently revised to facilitate enhanced data collection and reporting on MAID activity. Most notably, the regulations now allow for the collection of data based on race, indigenous identity and the self-reported presence of a disability, where a person consents to provide this information.

The revised regulations came into force on January 1, 2023, and information on MAID activity in 2023 will be released in Health Canada’s annual MAID report this year, in 2024. This information will provide valuable insight into who is requesting and receiving MAID, including those under track 2, whose natural death is not reasonably foreseeable.

Despite all this work, we have heard that the provinces and territories are at various stages of readiness for the lifting of the exclusion of eligibility and that they need more time to prepare their health care systems.

I know that the suffering caused by a mental illness can be just as severe as that caused by a physical illness, but I strongly believe that this extension is necessary to ensure that MAID can be safely assessed and provided on the basis of a mental illness alone. This extension does not question the capacity of people with mental illness to make health care decisions. It is about giving the health care system more time to adopt or implement some of these key resources to ensure that MAID practitioners are properly equipped to assess these complex requests, and that the provinces and territories have the necessary mechanisms in place to support them.

For example, both the expert panel that I referred to earlier and the special joint committee on MAID have emphasized the importance of case review and oversight of MAID, both to educate practitioners and to support accountability and public trust in the law. While the majority of cases of MAID, 90%, take place in provinces with formal oversight processes, other provinces do not have formal MAID case review and oversight processes in place beyond those already undertaken by professional regulatory bodies.

Work is being planned to explore best practices through a federal-provincial-territorial working group, with a view to encouraging more consistent and robust mechanisms across the country.

The expert panel and the special joint committee also identified engagement with indigenous partners as a priority. The Government of Canada has launched a two-year engagement process on MAID to hear the perspectives of first nations, Inuit and Métis, including urban indigenous people, indigenous people living off-reserve with or without status, indigenous people living with disabilities, and two-spirit, LGBTQQIA+ and gender-diverse indigenous people.

The proposed extension under Bill C-62 would provide the necessary time to have these discussions with indigenous partners. It is an essential process to appropriately inform implementation as well as guidance and training material for clinicians to support enhanced integration of cultural safety in MAID practices.

Health Canada will provide its first official update to Parliament on this work in March 2024, just next month.

In conclusion, the Government of Canada remains committed to ensuring that laws reflect the needs of people in Canada, protect those who may be vulnerable, and support autonomy and freedom of choice. While we have made significant progress in the study of MAID and mental illness, and in the development and dissemination of key resources, we are not yet ready. We need to act prudently and not rush this change without the necessary resources in place.

This decision is not an easy one, but I want to assure the House that we will continue to work collaboratively with our partners to improve the mental health of Canadians.

I thank all members for the opportunity to speak today as we debate this important bill.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am glad to be joining debate on Bill C-62. Off the top, I will mention that I will be voting for it. Like the shadow minister for justice on the Conservative side said, this is about protecting the vulnerable. Though the federal government has dropped the ball in this latest iteration of its legislation, these three years, I hope, will be taken to basically fix the mistakes that were made all the way back to Bill C-14. I want to talk a little about what brought us to this moment, and then refer to some constituents of mine who have emailed me over the last few months on the issue of assisted suicide.

I will also mention that I am sharing my time with the member for Mission—Matsqui—Fraser Canyon. I am sure he will add more to this debate.

To go back to the beginning, not too far to the beginning because I could get into Genesis, the Carter decision is what kicked off multiple debates that I have now been a part of. I have now seen this debate go from Bill C-14 to Bill C-7 to Bill C-62, and the attempts by my hon. colleague from Abbotsford, who, I think, tried to do right by vulnerable Canadians all across Canada to make sure that we would not see an expansion of the MAID provisions to those who are still suffering with mental health conditions.

The great thing about Hansard is that I was able to go all the way back and review what I had said on Bill C-14. I spent quite a bit of time complaining that the reasonably foreseeable clause would be knocked down by a court. It was knocked down by a court in the Truchon decision, because all our deaths are reasonably foreseeable; that is what living is all about. At the time, I had said that all of us who are born are born with one foot in our grave. One is assured one will die; one does not know just what it is, but it is reasonably foreseeable. I am just repeating it now. I know that it is morbid, but it is the truth. A lot of what we are dealing with here are issues of life and death and how one's death will happen. Therefore, at the time, this reasonably foreseeable clause would get knocked down, and it was knocked down in the Truchon decision.

My issues, just generally, are that, in a perfect world, this would not be necessary because people would not suffer. However, because this world is not perfect, people do suffer. People suffer in deep and different ways. Members know that I had a disabled daughter who passed away a few years ago. Had she lived longer, and I know at least one little girl in Calgary who has lived much longer with the same conditions my daughter had, she would be one of those vulnerable Canadians who would be facing the possibility that her physician, her specialist, might push for and might offer MAID.

I say “offer MAID”, but it seems so weird to say “offer MAID”, to offer something that I do not consider to be a medical service and to rush one's death sooner. Although we all die, as I said many Parliaments ago, the act of dying is not one that one does alone; it is done as a family, as a group of friends and with those loved ones around.

It is not something that happens in solitude. There are others who will miss one when one is gone. I know that it is difficult in a moment of suffering and a moment of great pain, or chronic pain, to believe it, to know it. A lot of the emails, the correspondence and the meetings I have had were with people who are worried about the assisted suicide MAID provisions, which the government has ineffectually dealt with through successive pieces of legislation. I think it was a grave error not to appeal the Truchon decision. I really do. I think it was a mistake. I said it to constituents at the time.

I have a Yiddish proverb, because I always do. They are great proverbs, and everybody should live by them and should know more of them. I just wish I could pronounce them in Yiddish: The truth never dies, but it is made to live as a beggar. This legislation is a beggar. This legislation should have been a permanent fix to the issues.

I think that Conservatives have suggested, both in committee and outside of committee, what some of those fixes would be. Although I disagree with an acronym, I will use RFND, reasonably foreseeable natural death. It should be limited to those who are terminally ill, where their death is foreseeable within the next six months, where there is a prognosis from a medical professional saying that one will indeed pass away.

For those most terrible conditions, I am thinking of a lot of cancers. My grandfather passed away from brain cancer in Canada, which brought my family to Canada. His death was very much reasonably foreseeable when it was terminal. There are others who have mental health conditions, which are caused by a physical condition. The mental health condition alone should not be the reason to seek assisted suicide.

Different Conservatives have mentioned, and I very much agree with this, that patients should be the ones requesting it. These are all things the government could have legislated into law. These are things that experts have said, and I want to read some of what the experts said in different committees.

Professor Trudo Lemmens and Mary Shariff persuasively rebutted a bunch of arguments that were made in Truchon. They noted again that reasonably foreseeable natural death applied to “all” persons, “not only to persons with disabilities”. “The judge in Truchon failed to appreciate how such a restriction reflects a constitutional duty to protect the equal value of the lives of all Canadians.”

I have read the Carter decision twice now. As many in the House know, this is something I take pride in saying that I am not a lawyer. I am not burdened with a legal education. I know the member for Fundy Royal is disappointed and that the member for St. Albert—Edmonton will be disappointed too, so I come to this as a layperson. Even the Carter decision did not say he had a right to die. It goes back to this idea, like I have said, that all of our deaths are reasonably foreseeable. It will happen; it is unavoidable in life.

These two experts said that the judge in Truchon made a mistake. This concept, this expertise, was then repeated in observations made by 72 disability rights organizations that penned a letter to the then justice minister. They said that reasonably foreseeable natural deaths are the ones where there is terminal illness that is coming up very quickly, and that this idea is an equalizing effect, guaranteeing a common thread among persons accessing MAID, assisted suicide, namely that they are dying within a very short time window. That is how I think this legislation should work. I am not saying there should be no MAID.

The Carter decision stands as a Supreme Court decision in Canada, so there has to be a provision of it in a method. It should be rare and should be restricted to the very few people for whom it was originally intended. I feel that Bill C-14 to Bill C-7 to the situation we are in today do not address that. That is why we have this legislation that is a beggar. It is not in the original form that it should be. The truth lies in abiding by what Carter decided.

Another one reads, “From a disability rights perspective, there is a grave concern that, if assisted dying is made available...regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.” That is a terrible message to send to persons with disabilities. I am thinking of my daughter, had she lived. That would have been a terrible message to send to her.

All three of my living kids have a chronic kidney condition. My boys will likely need a kidney transplants. What a terrible thing to tell them, that they are a burden on the medical situation and that maybe they should seek faster death. Is that what specialists are going to tell them when they are adults? I will not be in the room, but they will be in the room. Will that be pushed onto them? For those who are on dialysis, it is hard on their bodies to go three to four days a week to get dialysis in a hospital setting. I am not speaking of peritoneal dialysis that can be done in the home.

There have been lots of experts. The member for Fundy Royal explained a lot of what has been said on the issue. The government keeps erring in the wrong direction with more expansive legislation to allow more people to access something that was not the original intention of Carter. We should abide by Carter, as I mentioned before.

I have had constituents write to me. I just want to make sure that I read some of their thoughts into the record. Leanna wrote, “Please Halt the expansion of MAID to include those facing mental illness.” Catherine wrote, “As a parent who has seen my own children experience mental health challenges while in their teen years and early twenties, I am writing to express my deep concern about people with mental illness alone becoming eligible for medical assistance in dying. The move towards this will put countless vulnerable people at risk.”

Joe, in my riding, is a regular writer. I respond to most of his emails. I will send this to Joe just to make sure he knows I read his emails. His second and third points read, “By offering MAID for mental illness governments may put less money into treating mental illness.... Canadians may wish for MAID because of despair. They have not have been offered treatment for their mental illness.”

Cameron talked about a friend of his who is a nurse working in a mental health unit in Calgary. Mental health for him is all about seeing the intrinsic value of every human being, as celebrating the person not for what they contribute but for the beauty of their existence. He feels that once we stop seeing the dignity of one person, we will doubt our own worth and validity.

I know my time is running short, so I will not belabour this. I have heard comments from some members of the House who have tried to impugn a person's faith, religion or philosophical affiliations with whatever beliefs; although, all of us come to the House with our different beliefs. Some of them are sacred. Some of them are secular. It really does not matter where they come from, but all of us try to ascribe value to life, what that life is and what autonomy should be like.

To those members, I note that I did abstain from one vote that was specifically on advance directives because I have a constituent, Jim, who communicated with me over email that he and his spouse saw the experience of his mother, who passed away from Alzheimer's, and how terrible it was. In situations like that, it is incumbent upon the government to find a way to meet the requirements of the original Carter decision so that Jim and his spouse, when that time comes, can have their wishes met.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, my colleague is quite right. With Bill C-7, but for the passage of Bill C-62, the impact would be profound on our health care system, on individuals suffering with mental illness and on the message we send Canadians suffering with mental illness. I can say only that the government has moved forward in this dangerous direction while ignoring at every turn the advice of experts, including, as I quoted extensively, the Society of Canadian Psychiatry, medical experts and legal experts, about the merits of moving forward. It is our job to debate these things, to consider them and to hear from experts. Unfortunately, because the government dropped the ball, it is up to us to pass the legislation before us to protect Canadians suffering with mental illness.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, my hon. colleague is quite right. The government and the minister have been all too eager to lose. When they had a constitutional responsibility to defend their laws, they did not appeal decisions that would protect vulnerable Canadians, and when the then minister appeared at the justice committee on Bill C-7, which expanded medical assistance in dying, he assured us it was quite constitutional. Then, the next day, he was back, assuring us that without the expansion to those suffering from mental illness, it would be unconstitutional, so this was a minister who was all too eager to lead his government, and the government members did not stand up and push back.

Now we are in the situation we are in. We have already extended the coming into force for a year, and now we are debating a bill to extend it by three years. That is a clear indication that the government got it wrong, and we are going to do what needs to be done to protect Canadians.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, Canadians would be forgiven for thinking they have seen this movie before, because they have. It was only last year that we debated Bill C-39, which provided an extension of the coming into force of this dangerous legislation. Now we are debating Bill C-62, which was introduced two weeks ago thanks to consistent pressure from Conservatives, advocates, experts, organizations and individuals from across the country who want to help individuals live with mental illness, not help them end their lives.

How did we get here? We got here because we have a justice minister, a Prime Minister and a government that have ignored the science, the legal experts, the courts and the pleas of the most vulnerable. They have ignored Canadians. They have plowed ahead with legislation to expand medical assistance in dying to Canadians who deserve help, Canadians who are suffering from mental illness.

I do not need to tell the House about some of the shocking headlines we have seen over the last year. Veterans suffering with PTSD are being told by employees of Veterans Affairs that they could consider MAID. Individuals without housing are considering MAID for economic reasons. Individuals, as we heard at our justice committee when we studied Bill C-7, who did not wish to have MAID were consistently pressured to considered it.

On this side of the aisle, Conservatives have chosen the path of hope rather than harm, and we will continue to do so, but across the way, just this week, we heard a government minister say it is not a matter of if this expansion takes place; it is a matter of when.

I mentioned ignoring the law. When we were at the justice committee studying Bill C-7, we consistently heard the government say that we have to do this because the courts told us we have to. Nothing could be further from the truth. First of all, there was a court decision, which the government did not appeal. That decision in no way directed the full expansion of accessibility to MAID to those suffering from mental illness. In fact, it was not in the original legislation.

What happened with Bill C-7, which we studied at justice committee, in no way, shape or form involved expansion of MAID to those suffering from mental illness. However, when the bill got to the unelected Senate, it was amended to include this provision, which we had not even studied. The minister at the time assured us his bill was charter-compliant. The previous justice minister was at committee.

I am holding today a letter signed by 32 leading experts on the law, professors from faculties of law around the country. The letter says, “We disagree as law professors that providing access to MAID for persons whose sole underlying medical condition is mental illness,” which is what we are talking about today, “is constitutionally required, and that Carter...created or confirmed a constitutional right to suicide, as [the Minister of Justice] has repeatedly stated. Our Supreme Court has never confirmed that there is a broad constitutional right to obtain help with suicide via health-care provider ending-of-life.”

Those are powerful words. If I had time, I would read the names of the 32 professors who signed the letter. People would recognize many of them. They would certainly recognize the different universities they represent.

With the letter in hand, I said to the minister of justice, “Minister, you have come here saying that, constitutionally, you have to do this, but these 32 experts are saying you do not. Who is right, you or these experts?". The minister said, “I'm right.”

That is the attitude we have seen consistently with the government as it has plowed ahead in spite of the evidence, in spite of the concerns and in spite of the pleas from disability groups, mental health experts and psychiatrists.

I have a brief from the Society of Canadian Psychiatry, which makes a number of conclusions. I do not have time to read them all, but I want to touch on a couple of the conclusions:

At this time, it is impossible to predict in any legitimate way that mental illness in individual cases is irremediable. A significant number of individuals receiving MAID for sole mental illness would have improved and recovered.

This is a finding of the Society of Canadian Psychiatry. I have already spoken about this a bit, but even they can see this. They go on to say:

The political process leading to the planned expansion of MAID for mental illness has not followed a robust and fulsome process, has not reflected the range of opinions and evidence-based concerns on the issue, and has been selectively guided by expansion activists.

If that does not send a shiver down one's spine, I do not know what would. When we are talking about Canadians at their most vulnerable place, they should be able to count on us. How many of us participate in, for example, Bell Let's Talk Day every year? We say to people, if they are suffering with mental illness, to reach out, that we are here to help and that they should talk to someone they trust and access mental health support. Now, in spite of all this, we have psychiatrists saying the government is moving in the wrong direction.

I turn to their recommendations:

The Board of the Society of Canadian Psychiatry recommends that the planned 2024 MAID for mental illness expansion be paused—

It's not for a year, not for three years and not for five years, but:

—indefinitely, without qualification and presupposition that such implementation can safely be introduced at any arbitrary pre-determined date.

What are we led to believe when a government will not listen to legal experts when it comes to the criminal law and will not listen to psychiatrists when it comes to mental illness? It begs the question of who it is listening to and why.

This is the second time, and Conservatives have warned all along that there would be a dangerous, slippery slope. Canada has leapt ahead of all other nations. Some nations were ahead of the curve on this compared to Canada. Now they look at us and ask what happened that we would even be discussing providing assisted death to someone who comes to Veterans Affairs or to one of the number of hospitals across our country, looking for help, and instead is offered medical assistance in dying.

I want to set the record straight that the Liberal government has not, in any way, been bound by the courts to expand MAID to those whose sole underlying condition is mental illness. This was a path it chose to take. We need to take this time to reflect on that path, to turn back and to give people hope.

We all know individuals who have been touched by mental illness in the health care system. We know the wait times can be extraordinary for people to get help. We also know the government has contributed to those wait times. After eight years, people are suffering.

I would urge members to support this bill and then to look at ways to provide support for those suffering with mental illness, not to offer them assistance in death.

I move:

That the question be now put.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I will start with an assertion whose veracity will become clear. With Bill C-62, the cowardly Liberal government brought forth a mouse.

If we are talking about Bill C‑62 today, it is because Bill C‑7 created the Special Joint Committee on Medical Assistance in Dying when it passed. The committee's mandate was to review the medical assistance in dying legislation, in particular as regards the issue of advance requests. Because we knew that the problem was more difficult in cases of mental illness, the government set up an expert panel to help MPs do their job. The panel was to issue a report to the special joint committee.

The expert panel was indeed set up. The problem is that, instead of putting everything in place following the adoption of Bill C‑7, the government decided to call an election in 2021. That delayed the process.

Immediately after the useless election, we would have expected the special joint committee to sit but, no, we had to wait. They took their sweet time. The committee was finally convened, but it had a huge mandate. Its mandate was so huge that Bill C‑39 on mental illness had to be introduced, delaying the committee's recommendation.

Since February 2023, the committee has been very clear on the issue of advance requests. In fact, that was its most widely held recommendation. During the entire debate on Bill C‑62 in the House, the government said that we needed to be cautious and proceed slowly. That is fine, but when caution involves making patients suffer, I cannot agree. I think we need to be diligent.

The government took its sweet time. Here we are in 2024, and it introduced legislation seeking to postpone the issue of mental illness. Fine, but what is happening with the main recommendation the committee made in February 2023? The government knew very well that Quebec was laying the groundwork on the issue of advance requests. It knew very well that Quebec would bring in its own law. Instead of taking inspiration from that and seeing what measures could be included in the regulation accompanying Canada's MAID legislation, it did nothing.

I have stood in the House many times to ask the Minister of Justice and the Minister of Health why the government did nothing. Why does the bill not include a component on advance requests, which should have been prepared over the past year? After all, the government introduced legislation enacting the special joint committee's February 2023 recommendation on mental illness. On the issue of advance requests, however, it did nothing, despite the majority recommendation.

Yesterday, I got my answer. The Minister of Health demonstrated in front of the whole committee that he was unfamiliar with the Quebec law, yet he rises in the House and says he has enormous respect for Quebec's process. The Liberals do not even know what they are talking about. The minister told me that the issue of advance requests is more difficult than the issue of mental illness because, for example, there might be family quarrels at the patient's bedside.

I realized that the minister had not read section 29.6 of the Quebec law, which stipulates that, as soon as patient is diagnosed, they can appoint a third party. The third party will not determine when the person can access medical assistance in dying, but will advocate for their wishes, which will be included in the advance request, or the person's criteria.

People in my riding have told me that, when they become incontinent and can no longer control their bowels, when they have reached the point where they no longer have any appetite and it becomes a chore for their caregivers to feed them, although they are well compensated for their troubles, when they are no longer able to recognize their friends and family members and when they can no longer maintain relationships, they would like to have access to medical assistance in dying. The third party in whom they have placed their trust will then ask the care team—because patients are indeed cared for by entire teams—to evaluate whether they are meeting the criteria, if they are there yet.

If people make advance requests, it is because they want to avoid shortening their life. They want to live as long as possible. We could be good to them and take care of them until they cross their tolerance threshold.

The minister does not even know what I am talking about right now. Do members think it is normal that people say they respect Quebec, that they have great admiration for Quebec's progress on this issue, but that they do not even know what is in Quebec's law?

It is no surprise that they come out with a bill like Bill C‑62, that does not address this at all. Then they have the gall to say that Quebec has made good progress, but that not all Canadians are ready for that, so they have to wait and watch their patients suffer. Quebec is not the only province that supports advance requests. According to an Ipsos survey, 85% of Canadians from coast to coast support advance requests.

The Conservatives claim that they want to do good, they want to take care of Canada's most vulnerable. I, too, want to take care of the most vulnerable, but who is more vulnerable than a patient who is about to cross their tolerance threshold, who is suffering and who is being told no by the government?

Some claim that there could be abuses, as if the Criminal Code did not provide for punishment of abuses. They seem to believe the medical system to be inherently evil. I heard my Conservative colleague earlier. Listening to the Conservatives, one would think everyone working in the health system wants vulnerable people euthanized. I heard another Conservative member say there is an opioid crisis, there are people in the streets, and we are going to euthanize them. That is absolutely false. It is really far-fetched. That kind of rhetoric is meant to scare people; it amounts to spreading misinformation on a crucial topic.

When we care, we do not infringe on individual autonomy. The role of the state is not to decide matters so personal as how someone wishes to cross their threshold of tolerance. It is not to tell patients what is right for them. It is to provide the conditions so they can make a free and informed choice.

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

Madam Speaker, I would like to say two things. First, there is unanimous consensus in Quebec. All parties in the Quebec National Assembly voted to pass a law, but it has no force or effect because it is being blocked. Quebec is asking that its law be aligned with the Criminal Code so it can come into effect in Quebec alone. That is what we are asking. It is not complicated. The government tells us this is very important, but it chose to do nothing and kick it down the road, even though we need to act quickly.

Second, the decision to delay all debate in the House for three years brings us to after the election. Projections indicate that the Liberals will not form a majority government. In all likelihood we will never discuss this again, we will never come back to this debate. I think that is irresponsible.

We first dealt with Bill C-7 in 2021. That is already three years ago. What has the government done in three years? It came up with the current bill, which says they will ensure the debate will never be over. We think that is irresponsible. I beg the government to at least try to harmonize the Criminal Code with the unanimous will of Quebec. It is a matter of dignity. My society and my nation are ready. However, they are being blocked by their neighbour, who is choosing not to act. I am asking them to act.

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

Madam Speaker, medical assistance in dying is a topic as crucial as it is sensitive. By choosing to delay debate for three years, the Liberal government is aligning itself with the Conservatives, with the blessing of the NDP, to ensure this debate will never happen again. That is highly irresponsible.

The Bloc Québécois was in favour of a one-year delay, but three years pushes it to after the next election. In other words, we will not be discussing this issue for a very long time. Meanwhile, Quebec has passed a law that allows advance requests. Specifically, it covers people suffering from neurodegenerative diseases such as Alzheimer’s and Parkinson’s. However, Quebec’s law is blocked until the Criminal Code is amended by the House. The entire National Assembly of Quebec has asked Ottawa to amend the Criminal Code accordingly. Although the Quebec law allows advance requests, the Criminal Code does not. This leaves doctors open to prosecution.

That is why we presented an amendment addressing this issue. Again, the Liberal government, the Conservatives and the New Democrats chose to oppose it. Again, Quebeckers are reminded that we cannot decide for ourselves, even when there is consensus, and that our neighbour will decide for us. Furthermore, the government did all this by imposing a super gag order, with the NDP's support. It wanted to muzzle the House and put off debate well into the future while rejecting Quebec’s unanimous request. So much for democracy here.

Here we are reviewing a bill that seeks to delay choices involving mental disorders and that says nothing about neurodegenerative diseases and advance requests, unlike Quebec’s law. All this is happening three years after Bill C-7 was passed. Regardless of what other parties choose to do, we continue and will continue to ask that the Criminal Code be aligned with Quebec’s Act Respecting End-of-Life Care by allowing advance requests.

Can I ask for a bit more compassion in the House? Is it so complicated to change the Criminal Code to give effect to the Quebec law with respect to advance requests for people suffering from serious and incurable neurocognitive disorders?

In an attempt to convince my colleagues of the importance of Quebec's request and the urgency of the issue, I would like to read a very moving letter sent by one of my constituents. She talks about what her mom, Jacinthe Arnault, went through. Here is what the letter says:

At age 56, my mother, Jacinthe Arnaud, a clinical nurse, was diagnosed with early-onset Alzheimer's. Nothing in her family history could have predicted that this huge black cloud would darken the rest of her life. The second thing she told me in 2019 after being diagnosed was:

“Promise me you won't let me die in a long-term care home. Promise me, Cath, that you'll let me go with dignity.” Back then, the MAID legislation did not allow for people with cognitive impairments to access this type of care.

I scrambled to learn about the subject, to talk with MPs, to contribute to the improvement of the legislation at the National Assembly and to get informed about what was being done in other countries. What I found was that we were in a dead end—even if my mother repeated her request week after week, I could not see how I could grant her the end she was hoping for. In 2021, when the “imminent death” requirement was taken out of the legislation, there was a glimmer of hope. Fortunately—or unfortunately—my mother wasn't 100% aware of her condition and wasn't ready to let us go and choose to die, at the risk of losing her chance to die with dignity.

The disease progressed very quickly, much faster than the legislative work to expand MAID. In early 2022, we had to watch over my mother almost constantly as her cognitive abilities, her memory and even her motor skills became more and more impaired. She still had enough clear-mindedness to ask her geriatrician for MAID. We started the procedure. It was very stressful not to know whether my mom would change her mind right until the very end, not because she didn't want MAID anymore, but because the disease would have made her unable to understand her condition and where she was headed.

Do you know that the legislation imposes a 90-day waiting time before MAID can be granted to patients with cognitive impairments? As a nurse myself, and seeing my mother get worse and worse every day, I could not see how she would still have a clear mind after 90 days. After several discussions with the prescribing physician, we were able to move up the date.

Why was my mother's credibility called into question? Why do patients with cognitive impairments have to wait before receiving MAID, but not patients with other incurable diseases? Requesting in advance to die with dignity is a very personal and legitimate choice, according to my mother and me. It is a decision that should, in a perfect world, be made quickly after diagnoses of this nature. Considering that neurodegenerative diseases evolve very differently from one patient to the next, wouldn't it be logical to allow these patients to request a dignified death in advance?

Not knowing if she would be allowed to die put my mother under incredible stress. And let me tell you, as a mother of two young children, I too was under a tremendous amount of stress, not knowing if my mother would pass away or if I would have to institutionalize her within a few months, which would have been a very difficult choice to make, considering the wishes she had so forcefully expressed.

During the last years of her career, my mother worked in the hemodialysis department at the Joliette hospital. She wanted to keep helping others. On May 4, 2022, she died in an operating room at the Joliette hospital, with her by her loved ones at her side. She saved three people. Both of her kidneys and her lungs live on somewhere in Canada. We're extremely proud of that.

I'm so proud of her and of us.

I wish with all my heart that ADVANCE requests for MAID were allowed. All these people who are sick now and who would like to die with dignity are depending on the legislation to be changed quickly.

Best wishes,

Catherine Joly

I thank Ms. Joly for her letter from the bottom of my heart. I agree with her, because I also hope with all my heart that advance requests for MAID will become an option. As she says, it is a matter of dignity. As she points out, everything depends on how quickly the legislation can be changed. Quebec has changed its legislation. The one step left is to harmonize it with the Criminal Code.

I sincerely hope that Ms. Joly's words have helped convince my colleagues about how important it is to make this change and make it quickly. I thank her.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am thankful for the opportunity to speak about Bill C-62 and the extremely important issue of medical assistance in dying, or MAID, and mental illness.

I think all members can agree that this is a highly complex, quite sensitive and emotional issue, that raises divergent and deeply held views from the medical community, experts and the public at large. The questions of whether, how and when to expand eligibility for MAID to persons whose sole underlying medical condition is a mental illness are difficult; they do not have easy answers.

The federal government believes that eligibility for MAID should be expanded to such persons. However, such an expansion should not be rushed and should not occur before the health care system is ready to safely provide MAID in all cases where it is requested on mental illness grounds. This is why we have introduced Bill C-62, which proposes to extend the temporary mental illness exclusion by three years, until March 17, 2027. The bill also includes a provision requiring a parliamentary review prior to that date.

As members will recall, in 2015, the Supreme Court of Canada concluded in the Carter case that the Criminal Code’s absolute prohibition on physician-assisted death was unconstitutional. The Supreme Court held that physician-assisted dying must be permitted in some circumstances, namely, for competent adults who clearly consent to the termination of life and who have a grievous and irremediable medical condition. This decision led to the legalization of MAID in Canada one year later, in 2016, through Parliament’s enactment of former Bill C-14. Our original MAID law limited eligibility for MAID to competent adults with an eligible medical condition whose natural death was reasonably foreseeable. Our MAID framework was added to the Criminal Code and was made up of a stringent set of eligibility criteria, as well as procedural safeguards to prevent error and abuse in the provision of MAID.

A few years later, the “reasonable foreseeability of natural death” eligibility criterion was challenged in Quebec; in 2019, it was declared to be unconstitutional by the Superior Court of Quebec in the Truchon decision. As this was a trial-level decision, it was only applicable in Quebec. Nevertheless, the Attorney General of Canada did not appeal the decision; instead, the federal government made the policy decision to expand eligibility for MAID. This led to Parliament’s enactment of former Bill C-7 in 2021, which expanded eligibility for MAID to persons whose natural death is not reasonably foreseeable. This resulted in the removal of the eligibility criterion that a person’s death be reasonably foreseeable and the creation of two sets of procedural safeguards for the lawful provision of MAID.

The first track of safeguards applies to persons whose natural death is reasonably foreseeable; the second, more robust, track applies to persons whose natural death is not reasonably foreseeable. This second set of safeguards was created in recognition of the fact that requests for MAID by persons who are not at end of life are more complex. This is why a minimum of 90 days must be taken to assess a person for eligibility for MAID when their natural death is not reasonably foreseeable. This is not a reflection period; it is a minimum assessment period. This safeguard aims to respond to the additional challenges and concerns that may arise in the context of MAID assessments for persons whose natural death is not reasonably foreseeable. This includes whether the person’s suffering is caused by factors other than their medical condition, as well as whether there are ways of addressing their suffering other than through MAID.

This second set of safeguards also requires that two practitioners be satisfied that the person meets all the eligibility criteria, and if neither of them has expertise in the medical condition causing the person suffering, one of them must consult with a practitioner who does. Involving a practitioner with the relevant expertise aims to ensure that all treatment options are identified and explored.

Practitioners are also required to inform the person of available counselling services, mental health and disability support services, community services and palliative care; to offer them consultations with the relevant professionals; and to ensure that the person has given serious consideration to such alternative means to alleviate their suffering. Although this does not require a person to undertake treatments that may be unacceptable to them, it requires that they fully explore and weigh the risks and benefits of available treatment options.

Former Bill C-7, as originally introduced, permanently excluded eligibility for MAID on the basis of a mental illness alone. This was not because of the incorrect and harmful assumption that individuals who have a mental illness lack decision-making capacity or because of a failure to appreciate the severity of the suffering a mental illness can cause. Rather, this was done because of concerns about the inherent risks and complexities of permitting MAID for individuals who suffer solely from mental illness.

During its consideration of the bill, the Senate made an amendment that added a sunset provision that would repeal the mental illness exclusion 18 months later. The House of Commons accepted the amendment in principle, but changed the date of repeal to two years; in other words, the provision of MAID based on a mental illness alone was set to become lawful on March 17, 2023.

The decision to temporarily maintain the exclusion of eligibility was based on the recognition that additional study would be required to address the risks and complexities of permitting MAID in these circumstances. This is why the former bill also included a requirement for an independent expert review respecting recommended protocols, guidance and safeguards to apply to such requests for MAID.

Former Bill C-7 also required the creation of a joint parliamentary committee tasked with conducting a comprehensive review of the Criminal Code's MAID provisions and other MAID-related issues, including MAID and mental illness. The committee undertook this important work, and its interim report, which focused on MAID and mental illness, was tabled in June 2022. It urged the federal government to collaborate with regulators, professional associations, institutional committees and the provinces and territories to ensure that the recommendations of the expert panel were implemented in a timely manner.

The committee's second report was tabled in February 2023. The majority view expressed was that eligibility for MAID on the basis of a mental illness alone should be permitted. However, the final report also raised a key concern that more time was needed for standards to be developed and training to be undertaken before the law should permit a mental illness to ground a request for MAID. The federal government recognized the significant progress that had been made by the provinces and territories, stakeholders and the medical community in preparing for the expansion. However, it ultimately concluded more time was needed.

This is why we introduced Bill C-39, and Parliament enacted it. It extended the exclusion by one year, until March 17, 2024. This extension aimed to provide additional time for the dissemination and uptake of key resources by the medical and nursing communities. We thought it essential to prepare for the safe assessment and provision of MAID in all cases where a mental illness grounds a request for MAID. The committee expressed support for the extension in its second report.

I want to take a moment to recognize the work that the federal government has done during this extension to support the fulfillment of some of the expert panel’s recommendations. For instance, we amended the regulations for the monitoring of MAID last year to ensure comprehensive data collection and reporting. Such changes allow for data collection related to race, indigenous identity and disability of persons requesting MAID. These changes came into force in January 2023, and the first set of data will be captured in Health Canada’s 2024 annual report on MAID.

Moreover, Health Canada convened an independent MAID practice standards task group to develop a practice standard for MAID. In March 2023, the model MAID practice standard and supporting documents that provide guidance to support complex MAID assessments were released. Finally, Health Canada supported the Canadian Association of MAiD Assessors and Providers in the development of a Canadian MAID curriculum, which was launched in September 2023.

In Canada, certain aspects of MAID fall under federal jurisdiction and others fall under provincial and territorial jurisdiction. The federal government is responsible for the criminal law aspect, whereas the provinces and territories are responsible for the implementation of MAID within their health care delivery systems. Impressive progress has been made in preparing for the expansion by the March 2024 deadline. However, the provinces and territories have all expressed that they are not yet ready. For this reason, we are proposing to extend the temporary mental illness exclusion for another three years, until March 17, 2027.

The extension would allow more time for the provinces and territories, and their partners, to prepare their health care systems by implementing regulatory guidance and developing additional resources for their medical and nurse practitioners. It would also provide more time for medical and nurse practitioners to become familiar with the available training and supports. Our ultimate goal is to help ensure that the necessary protections are in place to protect the interests of individuals who may seek MAID on the basis of a mental illness alone.

We believe that this issue should not be rushed. Eligibility for MAID should not be expanded until the health care system is ready to safely provide MAID in these complex circumstances. I urge all members to support the bill so our partners can get this right.

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

Thank you.

I'd like to turn to Minister Virani, if I could.

You were mentioning, to paraphrase the Supreme Court, that they were going to give a high degree of deference to Parliament when legislating in this area because of how sensitive it was. When Bill C-7 was first introduced, I thought there was a very reasonable charter statement issued that explained the government's initial reasons for excluding this. Then at the eleventh hour, a very consequential Senate amendment was accepted. I think that really is the root of all the problems we're finding ourselves in today.

Do you, as a minister, now have regret about that decision?

I truly believe that this decision was putting the cart before the horse—and I'm speaking as a member of the special joint committee. We have been playing a game of catch-up ever since. The law was changed in advance of the important consultation and in advance of those committee hearings. As a result, we have had to constantly shift the timeline.

Again, why didn't the government exercise that high degree of deference, as you put it, that the Supreme Court gave you the room to exercise in the first place?

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Thanks, Chair. I appreciate the opportunity.

Dr. Gaind, I was on the special committee. You and I have met before.

In fact, I was on the special committee's most recent incarnation and the one before that. I was also on the justice committee that dealt with Bill C-7, so I have some knowledge of this. However, I don't profess to be anywhere close to any of you in terms of my ability to comprehend some of the challenges we're dealing with, which is where I'm going to go with my question.

We're here dealing with a piece of legislation on a fairly specific point. We're not here discussing the morality of medical assistance in dying. We're not here debating whether it is constitutional or is not. We're not here dealing with advance requests. We're dealing with whether or not this bill should proceed in its current form and why.

I'm not a doctor. There isn't a consensus on this. I've been on the committees, as I said. Look, we have three doctors on this committee, and I'm reasonably comfortable in saying that I don't think we have a consensus at this table, and that's excluding you, Dr. Gaind.

Here's my question. We have four witnesses here, two of whom, if I'm correct, have said that we should not delay. Two have said we should.

I want to start with you, Ms. Long. Here's my dilemma. We're tasked as legislators with deciding whether the system is ready or not. I've had the opportunity to hear from numerous witnesses, review numerous briefs and review all kinds of articles and information on all of this, and there's no consensus.

You're here saying there should be no delay because we need to safeguard people's rights—and I'll get to that in a minute too—but put yourself in my shoes. I've heard from all of these people and read all of this information and there's no consensus. It's not even close to being a consensus. I'm not a judge and I'm not on a jury. I don't get to decide who's right and who's wrong. What I have to do is decide whether the system is ready.

If you're in my shoes and you're faced with that situation—you have a whole bunch of people saying the system is not ready and they're highly trained professionals—am I not doing the responsible thing by saying we should delay it and discuss it further?