Bill C-314

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

This enactment amends the Criminal Code to provide that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.

Criminal Code

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Madam Speaker, as always, it is a true honour and privilege to stand here in the House of Commons to represent my beautiful community of Peterborough—Kawartha.

Today we are debating Bill C-39, an act to amend the Criminal Code in terms of medical assistance in dying, which I will refer to as MAID for the remainder of this speech, and extend the exclusion of persons living with mental illness from being eligible to receive MAID beyond March 17, 2023.

We are going to need to rewind a bit to paint a picture of how disturbing this legislation, conversation and ideology are. In December of 2021, without any consultation, study or discussion, the Senate added an amendment to Bill C-7 to make people with mental illness eligible for MAID. This is gravely concerning and indicative of the Liberal government's recklessness to add such a serious amendment, which targets the most vulnerable, without due diligence of study and consultation with experts.

Instead of recognizing the undemocratic and dangerous way the amendment was added and scrapping the entire thing, which should have been what happened, the Liberals' proposal is simply to extend the deadline with an arbitrary date.

The MAID special joint committee was created after the amendment was added. How backward is that? The committee heard testimony from many experts, including Dr. John Maher, clinical psychiatrist and medical ethicist, who said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”

Of course, today I will support this bill, but let us call it what it is, which is window dressing for a much bigger ideological problem. We do not need to extend the timeline of this bill; we need to get rid of making those with mental illness eligible for MAID. We need to call out the Liberals for not providing a dime of their promised $4.5 billion to the Canada mental health transfer. We need to ensure people at home watching know we are working diligently to give them timely access to treatment and recovery when they are willing to get it. That is what we need to be doing.

I urge every member in this House to listen to their constituents and recognize how dangerous the message is that we are sending to those struggling. I encourage every member in this House to support Bill C-314, which was introduced last Friday by my colleague from Abbotsford and would solve this problem instead of prolonging and dragging out an amendment that should never have been put there in the first place.

It is difficult, if not impossible, in the case of mental illness to determine whether someone can recover, get better or get healthy. Therefore, one can appreciate how dangerous a bill like this is.

I am going to read into the record a letter that was recently sent to me.

It reads:

“Dear Michelle Ferreri,

“My name is Kayla. I am going to be sending this letter to several MPs, but as you are the MP presiding over the constituency where I reside, I thought I should send this to you first. I am very troubled by something that is going to be happening very soon in this country, and I hope you will listen to what I have to say.

“Overall, I am a very healthy individual. I have a mental health condition, but it is my sole medical condition. However, I was mortified to discover last month, that medical assistance in dying (MAID for short) will be available to people whose sole health condition is a mental health condition as of March 17, 2023.

“Persons who suffer from mental health conditions suffer horribly. I know that. I have suffered with mine for nearly 12 years. Perhaps the most appalling things of all are that ‘The law no longer requires a person's natural death to be reasonably foreseeable as an eligibility criterion for MAID,’ (Government of Canada, 2021) and ‘There is no obligation for a person or their health care practitioners to inform family members if that person has requested or received MAiD.’ (CAMH, 2022).

“I think you are an intelligent person, Michelle. I think you see this for what it is. As of March 17, 2023, I will be eligible to end my own life on the basis that I have an incurable mental illness. Let me give you a bit more background: I have two university degrees, in biology and environmental science. I have a job that I love and have held since a little while after I graduated. I have never failed to pay taxes, nor have I ever taken extended leave or gone on EI due to my mental illness, no matter how hard it gets. I have family and friends that I love dearly, and they love me too. And yet now my own government has deemed my life not worth living. This just isn't unfair. This is monstrous.

“But it gets worse. What about those people who are in the same boat that I am medically, but are much, much worse off. They cannot pay their taxes because they cannot work. They have a substance addiction. They are veterans with PTSD. They are homeless because they cannot seem to fight off their demons. These are some of the most vulnerable people in our society. To say nothing of the nature of the 'mature minors' (whatever on Earth that means) that will be able to access MAiD in the future if this doesn't stop.

“Make no mistake. This thing that we dress up with a nice name 'MAiD' is euthanasia of our most vulnerable people because they cannot 'contribute to society' like others can. The fact that the government would offer to get them out of the way (read: convince them that they should die) in this way, just because the systems that the government put in place are failing them is an unspeakable evil.

“I hope, Michelle, that you will do everything in your power as an MP, as I will do everything in my power as a citizen, to abolish this law. I understand the federal government is seeking to push back the timing of this law, likely because it has received so much criticism. I understand that it likely wasn't you that made any of the decisions for this law to go ahead. But I also understand that you are in more of a position to do something about it than many other people are. I hope you will respond after reading this letter.

“Sincerely,

“Kayla.”

I did talk to Kayla, and it was a heartbreaking conversation. She is living very well, and I would like to give Kayla a round of applause for being so brave as to share that. This letter says everything Canadians need to hear. We need to be sending a message of hope and recovery, not a message that their life does not matter.

I leave members with one final story. Elyse is a young university student and she chatted with me during the Christmas break. She said she needed to tell me something. She said she was so worried about this legislation to extend MAID to those with mental illness. She said that she had struggled with mental illness and knew with certainty that if someone had offered that to her during her times of illness, she would not be here today. She told me that she would not be getting her university degree; would not be in a happy, healthy relationship; and would not know that her life is worth living.

We have a duty in the House to bring hope and create legislation that provides a better life for Canadians. A better life means access to help when they need it. I urge every MP in the House to listen to the experts and Canadians, and not just extend an arbitrary deadline, but drop this dangerous and reckless legislation. To everyone at home watching, including families who are supporting those with mental illness and those who are living with mental illness, we see them. They are worth fighting for, and their lives are worth it.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

Madam Speaker, I want to compliment the member for Abbotsford for going forward with his private member's bill, Bill C-314. I have a question for him on veterans.

When veterans were phoning in for help on the helpline, MAID was called a benefit. Several veterans phoned our office in Saskatoon asking what the benefit of MAID was. They said when they phoned looking for assistance, they were told to go to the website; it's right on there that MAID is a benefit.

I would like the member for Abbotsford to talk about this, because at no time has it ever been a benefit for a veteran to accept MAID.

[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.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Madam Speaker, I really appreciate my hon. colleague's perspective. I heard a lot about the intention, and sometimes we have intention versus impact, so I am curious what he thinks the impact would be of just extending the deadline, as opposed to actually throwing out the legislation or supporting Bill C-314.

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

Mr. Speaker, I rise to speak on Bill C-39, a legislation that imposes a new arbitrary deadline of March 2024 in place of the Liberal government's arbitrary deadline of March 2023 whereby persons with a sole underlying mental health disorder would be eligible for MAID.

I support Bill C-39 only because it is better than the alternative, namely that in one short month from now, on March 17, MAID would be available to persons with a sole underlying mental health disorder. This would be an absolute disaster and certainly result in vulnerable persons prematurely ending their lives, when otherwise, they could have gone on to recover and lead healthy and happy lives.

Rather than imposing a new arbitrary deadline that is not grounded on science and evidence, what the Liberal government should be doing is abandoning this radical, reckless and dangerous expansion of MAID altogether. This is why I wholeheartedly support Bill C-314, which was introduced last Friday by my friend and colleague, the member for Abbotsford, and would do exactly that.

One would expect that before deciding to expand MAID in cases of mental illness, a responsible government would take the time to study the issue thoroughly and consult widely with experts. After all, we are talking about life and death. We are talking about a significant expansion that would impact a vulnerable group of Canadians.

However, the Liberal government is not responsible, and that is not what happened. This is why the government finds itself in the mess it is in today with this rushed, 11th-hour legislation to delay the expansion.

Instead, the Minister of Justice accepted a radical Senate amendment to Bill C-7, which established an arbitrary sunset clause. That set in motion this expansion of MAID in cases of mental illness, effective in March of 2023. To provide some context, Bill C-7 was a response to the Truchon decision; its purpose was to remove a critical safeguard, namely that death be reasonably foreseeable before someone is eligible for MAID. It was a terrible piece of legislation that the government should have appealed but did not.

As bad as the bill was, when it was studied at the justice committee, of which I was a member at the time, nowhere in the bill was there any mention of expanding MAID in cases of mental illness. The justice committee did not hear evidence on that point. Indeed, when the minister came to committee, he said that there were inherent risks and complexities with expanding MAID in cases of mental illness, and therefore, it would be inappropriate to do so.

The bill went over to the Senate, and all of a sudden, the minister unilaterally accepted the amendment. Then what did the Liberals do? After little more than a day of debate, they shut down debate on a bill that had drastically changed in scope and rammed through the legislation for this expansion of MAID in cases of mental illness.

There was no meaningful study and absolutely no consultation with experts, including psychiatrists; persons struggling with mental illness; or these person's advocates. There was nothing. In short, the justice minister made the decision to go ahead with this significant expansion and then said the issue would be studied later. Hence, there was the establishment of an expert panel that was appointed after the government had already made the decision to go ahead. One would think that if an expert panel were going to be appointed, it would be appointed before deciding. However, that is not what happened with the justice minister and Liberal government.

We saw a special joint committee established after the fact. Talk about getting it backward, putting blind ideology and hubris ahead of science and evidence, and showing a total disregard for the concerns and lives of Canadians struggling with mental illness. Had the Minister of Justice and the Liberal government done their homework at the outset, they would have learned very quickly that this expansion of MAID cannot be implemented safely.

I serve as a co-vice-chair on the Special Joint Committee on Medical Assistance in Dying. As early as the spring, the committee heard from multiple witnesses, including representatives of the mental health community, and most importantly with respect to some of the clinical issues, leading psychiatrists. The body of evidence showing that this cannot proceed safely was overwhelming. One of the key reasons cited for this was that in the case of mental illness, it is difficult, if not impossible, to predict irremediability. In other words, in the case of mental illness, it is difficult or impossible to determine whether someone can recover and become healthy. This is a serious problem.

Let us look at some of the evidence that was available to the minister in the spring. Dr. John Maher, a clinical psychiatrist and medical ethicist who appeared before the committee, said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”

Dr. Brian Mishara, a clinical psychiatrist and professor at the Université du Québec à Montréal, told the committee, “I'm a scientist. The latest Cochrane Review of research on the ability to find some indicator of the future course of a mental illness, either treated or untreated, concluded that we have no specific scientific ways of doing this.”

Even the government's expert panel conceded the difficulty in predicting irremediability. At page 9 of the expert panel report, the panel observed, “The evolution of many mental disorders, like some other chronic conditions, is difficult to predict for a given individual. There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.” The government's own expert panel said that it is difficult, if not impossible, to predict irremediability.

If one cannot predict irremediability, persons who could go on to lead healthy and happy lives may have their lives prematurely ended. This is a problem that the government cannot avoid and that has not been resolved. Let me remind this House that, under the law, one must have an irremediable condition in order to be eligible for MAID. However, here we have leading experts and psychiatrists, including the government's expert panel, saying that it is difficult, if not impossible, to predict irremediability.

According to the psychiatrists who appeared before the special joint committee, what that means is that medical assessments in cases of mental illness for MAID are going to be decided on the basis of “hunches and guesswork that could be wildly inaccurate.” Those are the words of Dr. Mark Sinyor, a professor of psychiatry at the University of Toronto, who appeared before the special joint committee. These words were echoed by other psychiatrists who appeared before our committee.

The expert panel did not use such language, but it essentially conceded the point in its report because it was unable to come up with any objective standard by which to measure whether a patient's condition in the case of mental illness is irremediable. Instead, the expert panel ridiculously and recklessly said that it was going to wash its hands clean of this and that it was going to give a big green light and say it can all be done on a case-by-case basis. There would be no objective standard whatsoever; all would be guesswork and subjective assessment.

At the special joint committee on the issue of predicting irremediability in the context of mental illness, Dr. Mark Sinyor said that physicians undertaking a patient assessment “could be making an error 2% of the time or 95% of the time.” A 95% error rate is the risk on a matter of life and death, on a procedure that is irreversible and results in the termination of someone's life. For persons who are struggling with mental illness, this is the government's solution. The minister just stood in this place and said, “Damn the evidence. Damn the facts. We are going full steam ahead”.

I cannot think of a more reckless approach than the one the Liberal government has taken on an issue of profound importance to so many Canadians. It is not just the issue of irremediability, although given that this cannot be resolved, it should be the end of the matter. In addition, psychiatrists and other experts at the special joint committee emphasized that in the case of mental illness, it is very difficult to distinguish between a request motivated by suicidality versus one made rationally. In fact, suicidality is a symptom of mental illness, and indeed, 90% of persons who end their lives by suicide have a diagnosable mental disorder.

To illustrate how radical the government is, I note that when the Ontario Medical Association surveyed Ontario psychiatrists in 2021, 91% said they opposed the expansion of MAID for mental illness under Bill C-7. About 2% expressed support. Some 91% were against, 2% were in support and the reset were undecided. This speaks to how reckless, how radical, how extreme and how out of touch the government is on the question of expanding MAID in the case of mental illness.

In the face of the overwhelming evidence that we heard at committee, we issued an interim dissenting report calling on the Liberals to put a halt to this radical and reckless expansion. The minister ignored our interim dissenting report. He ignored the experts. He ignored the evidence. It appears he is so blinded by ideology that it is impossible for him to see what is in plain sight: This cannot be done safely.

In December, when it was evident that the minister was not listening, the Association of Chairs of Psychiatry in Canada, which includes the heads of psychiatry at all 17 medical schools, said to put a halt to this expansion. However, the minister still was not prepared to act. Indeed, it was not until the day after Parliament rose for Christmas that he had a late afternoon press conference where he made some vague commitment to introducing legislation in which there would be some type of extension. Then, with only 17 sitting days left before the expiration of the sunset clause, the minister finally saw fit to introduce this bill. I think this very clearly illustrates the shambolic approach with which the government has handled this issue.

We now have legislation, but what does this legislation do? As I noted at the outset of my speech, it provides for a new arbitrary deadline, even though issues of irremediability, suicidality and capacity to consent have remained unresolved for the past two years. There is absolutely no evidence that those issues are going to be resolved a year from now.

What we have is nothing more than an arbitrary deadline, and a year from now, we are going to find ourselves in exactly the same place. Let us be clear. When we speak about suicidality, irremediability and capacity to consent, these are not issues to be brushed under the rug. These are serious legal and political issues that are fundamental to determining whether this can go forward.

In closing, whether this expansion takes place a month from now or a year from now, it will be an absolute disaster and will result in persons struggling with mental illness having their lives wrongfully terminated. It is time for the government to get its head out of the sand, stop being blinded by extreme ideology, follow the science, follow the evidence and scrap this ill-conceived expansion.

[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 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)