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

[Ed Fast, Conservative, Abbotsford, BC]

moved that Bill C-314, an act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

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

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

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

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

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

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

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

He went on to say:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Madam Speaker, I appreciate what the member is saying. It is a heavy decision that ultimately does need to be made. There is no question about that.

I look at how important it is that we continue to be in touch with the health care professionals, that we continue to be in touch with other jurisdictions and stakeholders, and that we make sure that we continue to move forward.

This is very much an emotional issue that people have very strong convictions on. I do not think there is an easy answer to this. From my perspective, I think that we have to continue the dialogue and have more faith in the system.

Can he provide his thoughts with respect to that?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I want to thank the member for acknowledging that there is further discussion required on this. That is one of the things I have lamented. Medical assistance in dying has been pushed so far, so quickly, that there has not been the appropriate national discussion, or even the appropriate debate within this House, as to whether we should extend this life-or-death policy to the mentally ill.

The stakeholders I quoted represent a very thin slice of the many stakeholders who have written to me. They have said, “Ed, we have not had this discussion. The mental health profession and the stakeholders within the mental health community have not had the debate required to go to this length and extend assisted suicide to the mentally ill.”

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, as I often say in the House, everyone wants to do the right thing. Everyone has the best of intentions and wants to look out for people's best interests. However, being compassionate does not square with undermining human dignity or a person's capacity for self-determination in a decision as personal as deciding one's death.

In his bill, my colleague is telling us that mental illnesses are not considered to be grievous and irremediable medical conditions. However, according to the DSM‑5 definition, a mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning.

Can we really say that is not serious?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I thank the member for his question. I do not quite understand it. He did say that everyone means well. “Everyone means well” is not the appropriate standard to apply here. We are talking about life and death for the most vulnerable in our society.

We owe it to the mentally ill and those who have mental disorders to act justly and fairly toward them to give them every opportunity to recover. That has been one of the failures of Canada's MAID regime. We have not provided the social supports and mental health supports to help the Canadians who would consider MAID because they are not getting those supports.

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

Madam Speaker, I would like to thank my colleague from Abbotsford for the introduction of his bill.

I was a member of the Special Joint Committee on Medical Assistance in Dying. For me, the struggle I had during all of those hearings was weighing up the respect for an individual's ability to make decisions respecting their autonomy and their capacity, versus the need for us to protect the vulnerable in our society with the understanding that the vulnerable in our society also have the ability to be autonomous and have the capacity to make decisions. That was the real struggle.

How does my colleague view those two concepts? I would like to hear his views on the ability of an individual to make a decision that is best for themselves. We may not always agree with it, but how do we ultimately respect that?

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, that is a great question.

Autonomy is critically important. The problem when we are dealing with the mentally ill is that autonomy is often much diminished. That is just one of the problems. What we hear back from stakeholders within the mental health profession is that issues of autonomy, capacity and suicidality have not been addressed appropriately through a national debate. We have not had that discussion, so there is no national consensus on this. Before we ever move forward with something as critical as a life-and-death policy decision like this, we should have that debate and have a national consensus.

[Gary Anandasangaree, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the member for Abbotsford for bringing forward Bill C-314, an act to amend the Criminal Code regarding medical assistance in dying.

I acknowledge that we are gathered on the traditional unceded lands of the Algonquin people.

The bill before us proposes to indefinitely exclude persons whose sole underlying medical condition is a mental disorder from being eligible to receive medical assistance in dying, or MAID. I will be opposing the bill for reasons I will detail in my remarks. I want to start by providing a brief overview of MAID in Canada.

MAID was legalized in 2016 for persons whose natural death is reasonably foreseeable, through former Bill C-14. Four years later, in 2021, former Bill C-7 expanded eligibility for receiving MAID to persons whose natural death is not reasonably foreseeable. Former Bill C-7 also temporarily excluded, until March 2023, eligibility for receiving MAID on the basis of a mental illness alone.

Parliament decided that a temporary exclusion from eligibility for MAID where the sole underlying medical condition is a mental illness was necessary in recognition of the fact that such requests were complex and required additional study. This is why former Bill C-7 also required an independent expert review regarding recommended protocols, guidance and safeguards to apply to such requests. The expert panel on MAID and mental illness was created to undertake this review, and its final report was tabled in Parliament on May 13, 2022.

Former Bill C-7 also required the establishment of a joint parliamentary committee to conduct a comprehensive review of the Criminal Code MAID provisions and other related issues, including MAID and mental illness. The Special Joint Committee on MAID, or AMAD, took this review and tabled its final report in Parliament on February 15, 2023.

Our government extended the temporary exclusion to March 2024 through the enactment and coming into force of former Bill C-39. This was due to concerns about provincial and territorial readiness. It is important that we get this right.

I want to take a moment to point out that the intention has always been for the mental health exclusion to be temporary. This is a complex, sensitive and polarizing issue. Some very legitimate concerns have been raised.

However, I believe that the health care system will be ready for the safe provision of MAID where the sole underlying medical condition is a mental illness by March 2024. Significant progress has been made by our government, in collaboration with the provinces and territories and other stakeholders and experts, to prepare for this deadline.

We are not ignoring the concerns that have been raised. In fact, many of these concerns led to the one-year extension of the exclusion. We are moving in a prudent, measured way with the ultimate goal of ensuring that our MAID framework supports the autonomy of those who are eligible to receive MAID and protects those who may be vulnerable.

I will now turn to Bill C-314 and outline some of the technical issues.

As I stated previously, the bill proposes to indefinitely exclude eligibility for MAID based on a mental disorder alone. It would do this by replacing “mental illness” with “mental disorder” in subsection 241.2(2.1) of the Criminal Code.

There are two main issues with this approach. First, such a change may result in the unintended exclusion of persons with some medical conditions that are not currently excluded from eligibility for MAID. This is because “mental disorder” is a clinically defined term that practitioners have explained would likely capture all mental disorders included in the American Psychiatric Association's “Diagnostic and Statistical Manual of Mental Disorders”, or DSM-5, whereas “mental illness”, as it relates to MAID, is meant to capture mental disorders that are primarily treated within the domain of psychiatry.

“Mental illness” likely captures a smaller set of conditions than what would be captured by “mental disorder”. As such, making the switch in terminology without an accompanying definition may have the unintended consequence of excluding certain medical conditions that are not currently excluded from eligibility for MAID and that do not raise the same concerns as “mental illness” does in relation to MAID.

The second issue is that the term “mental disorder” is already defined in section 2 of the Criminal Code as “a disease of the mind”, and there is extensive case law interpreting what this means in the context of the “not criminally responsible” regime. Therefore, a switch in terminology in the Criminal Code MAID provisions without an accompanying definition may unintentionally complicate legislative interpretation and may also result in the existing case law interpretation of “mental disorder” and the “not criminally responsible” regime context being applied to the MAID context.

Although many experts and practitioners have noted a preference for the term “mental disorder” since it is a clinically defined term, this preference has already been expressed in the context of developing protocols, standards or guidance for MAID. It is important to remember that MAID is not just a health care issue. It is also a criminal law issue, and as I have just explained, things can get complicated in the legislative context given existing definitions and legal interpretations.

Finally, I simply want to point out that Bill C‑314 also restructures the exclusion set out in the Criminal Code but does not seem to change its application.

Currently, in order to be eligible for MAID, a person must have “a grievous and irremediable medical condition”, which is present when a person has a serious and incurable disease or disability, is in an advanced state of irreversible decline and is experiencing enduring and intolerable suffering, as per subsection 241.2(2).

Right now, a mental disorder is not considered an illness, disease or disability under the first part of the definition of a grievous and irremediable medical condition.

As such, a mental illness cannot satisfy the definition and therefore cannot be grounds for a request for MAID.

Under the proposed new exclusion, a mental disorder would not be considered a grievous and irremediable medical condition at all. In other words, it would exclude mental disorders from the whole of the definition, even though some of those aspects may well exist in the case of a mental disorder, namely intolerable suffering and an advanced state of decline. Although this new exclusion would operate slightly differently than the existing exclusion, it seems as though its effects would be the same.

I want to reiterate that Parliament considered this two years ago during its consideration of former Bill C-7 and decided that a MAID mental illness exclusion should be temporary. The point was reinforced by Parliament's enactment of former Bill C-39 this past March.

The expert panel on MAID and mental illness has tabled its final report, which notes that the existing MAID eligibility criteria and safeguards, supported by other key resources, provide an adequate framework for the provision of MAID where the sole underlying medical condition is a mental illness. Parliament considered the issues again via the Special Joint Committee on MAID, and the majority of members agreed with the expert panel's findings.

I urge members to join me in opposing the bill and not reverse Parliament's decision by unintentionally complicating legislative interpretation in the criminal law.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I heard the member for Abbotsford say right out of the gate that his bill seeks to reaffirm the dignity and worth of each and every human life. Who could be against that?

The dignity of every human life, as I was trying to say to him earlier, depends on autonomy and respect for a person's self-determination. We may have good intentions, but if we claim to know what is good for a so-called vulnerable person because we think we know better than they do about what is good for them, because we mistake sympathy for compassion, if we decide through some sort of state or medical paternalism what is supposedly good for them, without considering the person's suffering at all, if we take away a person's self-determination, then we undermine their dignity. That is what I wanted to say, but my colleague did not understand.

That is the very foundation of our position. It is called ethical and political philosophy, not theology or any sort of religious ideology.

The preamble to the bill sets out its intentions: “Whereas Parliament considers it a priority to ensure that adequate supports are in place for the mental health of Canadians”. Who could be against that?

I see no problem with that, but it has nothing to do with the purpose of the bill. This can be done without saying that the mental disorder considered as a serious and irremediable medical condition is excluded. I will come back to that.

The second paragraph of the preamble states, “Whereas Parliament considers that vulnerable Canadians should receive suicide prevention counselling rather than access medical assistance in dying”. This really shows a lack of rigour.

All the experts spoke about this and we can even read it in the literature. It is a little twisted to associate suicide with medical assistance in dying. I heard the leader of the opposition make that link a few times during oral question period, but conceptually that is false. Medical assistance in dying is initiated when an individual expresses that that is what they want. It is not imposed. Above all, it is for situations where the person's condition is irreversible. As far as I know, no witness at committee told us that a suicidal state is not reversible. Furthermore, witnesses also told us that we should not conflate the two. This is not getting off to a good start.

When a request for medical assistance in dying cites a mental disorder as the reason, the first step is to establish whether the person suffering has been struggling with the mental disorder for 10, 20 or 30 years of their life. In the experts' report, which I hope my colleague has read, it says that a person exhibiting suicidal ideation would not be eligible. It is one thing to want or to request medical assistance in dying, and another to meet the eligibility criteria. This is essential.

A person who is depressed or in crisis will not necessarily receive medical assistance in dying. Moreover, the experts say that an assessor would never consider a request for medical assistance in dying from a person in a state of crisis. The patient would have to first exhaust all available treatments for alleviating their suffering, without refusing a single treatment capable of restoring their health.

As Dr. Black said, “One study estimated suicidal thinking as an 8% lifetime risk for adults in the Netherlands, yet 65 or 0.0004% of adults in the Netherlands have died of MAID in any given year due to psychiatric reasons.”

Now we have members talking about a potential slippery slope, citing Bill C-14 and ignoring the obligation given to us by the courts to proceed with passing Bill C-7. Bill C‑14 was a bad bill that confused the public. Is it respectful of human dignity to force people to go on a hunger strike to reach the standard of likely and reasonably foreseeable natural death? I think there is something a bit inhumane about that.

In order to reach a criterion that was unworkable for some, people had to actually go on a hunger strike. Others, like Ms. Gladu and Mr. Truchon, had to assert their rights in court. Members say they want to protect the vulnerable. They should start by not treating these people like children and not exploiting them for any purpose. They should instead think about their well-being.

Who is more vulnerable than someone who is suffering intolerably and is close to their tolerance threshold? Who are we to decide for them what their tolerance threshold should be? That is essentially what this is all about.

People want to live as long as possible. The court determined that these individuals' right to life was being infringed upon. I am sure the Conservatives have a lot to say about the right to life. The court found that by denying these individuals the right to medical assistance in dying, their ability to live as long as possible is being taken away. This prevents them from living until they reach their tolerance threshold. That is when we could provide care to them and proceed.

Without this assurance, what do many of these individuals do? They commit suicide prematurely, and this infringes on their right to life. This is indisputable, and it could not be considered reasonable in a free and democratic society, even if it went to the Supreme Court.

Some people always want to go to court. However, right now, people are suffering. While we are procrastinating, people are suffering. We have to put things into perspective.

The committee that considered the issue of mental illness as the sole underlying medical condition made a recommendation. That is why I think that Bill C-314 is premature, at the very least, if not irrelevant at this time.

I will read the committee's recommendation. It states, and I quote: “That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate.”

At the very least, I would have expected a debate to take place following the work of that committee. That is the least that could have been done. I invite my colleague from Abbotsford to read the report of the Special Joint Committee on Medical Assistance in Dying and especially the expert panel's report. The recommendations set out in the expert panel's report include criteria and guidelines that do not exist for other forms of MAID practice. He should feel reassured after reading those recommendations, and I am sure he will never talk about a slippery slope again.

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

Madam Speaker, today we are revisiting a subject that never seems to leave me in this place, which is medical assistance in dying. It has come up repeatedly: in the 42nd Parliament, in the 43rd Parliament and again in the 44th Parliament. I think it underlines the gravity of the nature of this subject matter.

I want to thank the member for Abbotsford for bringing forward this bill and for giving us as parliamentarians an opportunity to discuss this incredibly important subject.

What Bill C-314 is essentially going to do, for the constituents of Cowichan—Malahat—Langford who are watching this debate, is amend the Criminal Code to reverse what was done with Bill C-7 and specify that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.

It is important to mention Bill C-7, because it is an important part of why we are here today. Bill C-7 was originally introduced in the 43rd Parliament. The government is, of course, required by law to issue a charter statement with its main pieces of legislation. In that charter statement, the Minister of Justice went to lengths to make people understand why the government had specifically excluded in the first draft of the bill why a person with a mental disorder as a sole underlying medical condition could not be eligible to receive medical assistance in dying.

The charter statement did say that the exclusion was not “based on a failure to appreciate the severity of the suffering that mental illness can produce”. Rather, as the statement took pains to say, it was “based on the inherent risks and complexity that the availability of MAID would present for individuals who suffer solely from mental illness.” It is important to understand we are not using the term “mental illness” anymore. Every text is now recommending that we use the term “mental disorder”.

There were three primary reasons given in the charter statement at that time. First, the charter statement said, “evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error”.

The charter statement went on to say, secondly, “mental illness is generally less predictable than physical illness in terms of the course the illness will take over time.” I think a lot of people can understand that. Someone may receive a diagnosis for a physical illness like cancer, which is particularly well known. We know a lot about cancer these days, and based on what part of the body it strikes, we can predict with a fairly certain amount of accuracy what a person's ability to survive it is based on how far it has progressed and so on. It is the same with other physical ailments. With mental disorders, on the other hand, there still are, indeed, a lot of unknowns.

Finally, that same charter statement went on to explain that the recent experience in the few countries that do allow it, and it did mention Belgium, Netherlands and Luxembourg, “has raised concerns”.

That was the charter statement at the time with the first draft of Bill C-7. Of course, When Bill C-7 went to the Senate, the Senate amended that part of the bill to allow a person with a mental disorder as a sole underlying medical condition to access MAID. There was some back-and-forth between the government and the Senate to establish a sunset clause so that it would not come into effect until March 17 of this year.

At the time, the New Democrats decided to vote against the Senate amendment because the requirements of the earlier Bill C-14 had not yet been met. We had not yet had a parliamentary committee to delve into these issues, and we felt that, despite the government having gone to all those lengths through its charter statement to explain its position, accepting an eleventh-hour Senate amendment without having done that important work was very much akin to putting the cart before the horse.

There was also Bill C-39, which was introduced earlier this year because we found that more time was needed. Whatever anyone's feelings are in this House with regard to people with mental disorders being able to access MAID, there was agreement that more time was needed. Therefore, Bill C-39 was passed in very short order in both Houses, and that delayed the implementation of it until March 17, 2024. That is the timeline we are on now.

I am rising to speak to this particular bill because of my experience with this file. Both in the 43rd Parliament and in this Parliament, I was the New Democratic member on the Special Joint Committee on Medical Assistance in Dying.

It was not an easy committee to be on. Let me just say that. For me personally, I constantly wrestled with two concepts: How do we as parliamentarians, with the power we have to change Canada's laws, find a way to honour the personal rights, capacity and autonomy of the individual versus the need of society to step up and protect the most vulnerable? Those were two great themes that were constantly a struggle for me personally when listening to all of the witnesses who came before the special joint committee on the five thematic areas we were charged with by this House and the Senate.

I would encourage people, if they have not done so already, to look at the good work done by the special joint committee, both the interim report, which specifically focused on this area, and the final report, which was tabled earlier this year and completed the committee's mandate. I also want to draw people's attention to the executive summary of the final report of the expert panel on medical assistance in dying and mental illness because there was some incredibly good work done in that as well. We did recognize the authors of that report. The report states:

That MAiD requests may mask profound unmet needs or conversely, that such requests may not be received with the seriousness they deserve, has been raised with respect to several historically marginalized populations (e.g., racialized groups, Indigenous peoples, persons living with disabilities, and sexual orientation and gender minorities). In the course of assessing a request for MAiD—regardless of the requester’s diagnoses—a clinician must carefully consider whether the person’s circumstances are a function of systemic inequality.

That is the warning sign that I think much of the medical community is struggling with.

People with mental disorders qualifying for MAID will be under track two of the MAID regime, because death is not a naturally foreseeable outcome. I would remind people that track two has safeguards in place:

request for MAID must be made in writing....

two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met....

the person must be informed that they can withdraw their request at any time....

the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care....

I want to underline that last point. They have to be informed of the available and appropriate means, but we know that for a lot of marginalized populations, those are not always available.

I want to recognize my colleague from Courtenay—Alberni, who has called on the government to urgently fulfill its promise to establish a Canada mental health transfer. This is a very great need in our country. We can see it from coast to coast to coast. I can see it in my community of Cowichan—Malahat—Langford.

The question of Bill C-314 and the state of mental health care in Canada are two things weighing on me quite a bit. I am certainly going to take a lot of time to think about which way I want to go with this bill, but I appreciate the member for Abbotsford for bringing it forward and giving parliamentarians an opportunity to read the report and consider what this bill seeks to do.

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

Madam Speaker, as always, it is an honour and a great privilege to speak on behalf of my community of Peterborough—Kawartha.

Tonight, I am speaking on my colleague from Abbotsford's private member's bill, Bill C-314. I have explained this before, but I will do so again. A private member's bill is something a member puts forward for the House to decide on. This is an important private member's bill, as they all are, really, because they come from a place of passion, but this is Bill C-314, an act to amend the Criminal Code, medical assistance in dying, which many of us know as MAID.

The summary states, “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.”

The preamble states:

Whereas Parliament considers it a priority to ensure that adequate supports are in place for the mental health of Canadians;

Whereas Parliament considers that vulnerable Canadians should receive suicide prevention counselling rather than access medical assistance in dying;

Whereas Parliament considers that Canada’s medical assistance in dying regime risks normalizing assisted dying as a solution

The fact that we need a private member's bill to say this feels outrageous. I have listened to other members in the House tonight, and I want to be very mindful of my tone. This is an interesting and emotional debate, but I really urge the members opposite who have said they are not going to support the bill to consider getting it to committee. There is so much more we need to study.

My question is how this is not already in legislation. I will tell members why. In December of 2021, the Senate added an amendment to Bill C-7, without any consultation, study or discussion, to add people with mental illness as eligible for MAID. This private member's bill is currently the only way we can protect those suffering from mental illness. It is the only way for us as parliamentarians to say to those watching that we believe their lives matter and that it is our job to ensure we fight for them. Today might be awful, but none of us know what tomorrow will bring, as no one knows what is out there for them.

The MAID committee was created after the amendment was added. How backward is that? It heard testimony from many experts, and I want everyone to listen to the following quote because it is the essence of this discussion.

Dr. John Maher, clinical psychiatrist and medical ethicist, stated, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.” Anyone who has dealt with somebody who has a mental illness or disorder knows that we have not even scratched the surface of what we know. We do not know.

I want to read this letter from a constituent who has been following the slippery slope of the Liberal government's extension of MAID into the record. I have her permission.

She writes:

“Dear Michelle...,

“My name is Kayla...I am going to be sending this letter to several MPs, but as you are [my] MP...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...) will be available to people whose sole health condition is a mental health condition as of March 17, 2023.”

We have since voted in the House and that date has been extended one year to March 17, 2024. However, this is still in place, and this letter is very pertinent. She goes on to say:

“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 healthcare practitioners to inform family members if that person has requested or received MAiD.' (CAMH, 2022)...

“I think you see this for what it is...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 2 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 El due to my mental illness, no matter how hard it gets. I have a 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 isn't just 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 '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 the 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'...in this way, just because the systems that the government put in place are failing them is an unspeakable evil.”

She put in brackets, “convince them that they should die”. These are her words.

She continues, “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”, which it did, as I said. She says this is “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 people are. I hope you will respond after reading this letter.

“Sincerely,

“Kayla.”

I did respond to Kayla and we had a very powerful conversation. She gave me permission to share this letter.

I think one letter like this is enough reasonable doubt that we need to take this private member's bill very seriously. It is everything we need to know to consider and urge everyone in the House. I have heard people say, on the Bloc side, that people should have the right to choose. The reality is that people who are in such a state of mental disorder do not have that capacity. We have to help them.

I want to leave us with this. This woman's name is Elyse. She is a young university student. She said that she is so worried about this legislation to extend MAID to those with mental illness. She has struggled with mental illness, and she knows with certainty that, if someone had offered that to her during her times of illness, she would not be here today. She would not be getting her university degree. She would not be in a happy, healthy relationship, and she would not know that her life was worth living.

If one is watching at home, if one has a loved one suffering, if one is suffering, one's life matters and it is worth living. It is our job to study this to the depths to determine whether we can do this. This private member's bill is the only thing that would protect those with mental illness and mental disorder from accessing MAID. I urge every member in the House to at least pass it to committee.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

The time provided for the consideration of Private Members' Business has now expired and the order is dropped to the bottom of the order of precedence on the Order Paper.

The House resumed from May 17 consideration of the motion that Bill C-314, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

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

Mr. Speaker, it is a pleasure to rise and speak on an issue that has been fairly extensively debated over the last number of years. Members will recall that the reason we are having today's debate goes back to 2015, when a Supreme Court of Canada decision ultimately obligated parliamentarians here in the House to develop and pass a law that took into consideration the ruling made by the Supreme Court, with the necessity for the government to provide a framework.

It was not a very easy challenge when that decision was ultimately made. I do not know how best to put it, but the Government of Canada, at the time run by Stephen Harper, ultimately sat on the issue until there was an election. That election saw a change in government, and it was one of the first orders of business that the Government of Canada, under the current Prime Minister, had to deal with.

Over the years, I have been engaged in many different types of debates on all forms of legislation. When I am talking to young people who are trying to get a sense of what we do here in Parliament, I talk about legislation, and I will often make reference to Bill C-7. For Bill C-7, a very passionate debate took place on the floor of the House of Commons back in Centre Block. I can recall it vividly because of all the different emotions that were being expressed on the floor and all the discussions that took place.

It was not taken lightly. If we take a look over the years at the number of Canadians who have been consulted in one form or another with regard to medical assistance in dying, we are not talking about tens of thousands. We are talking about hundreds of thousands of Canadians from coast to coast to coast, in many different forms. They came together to voice opinions and concerns. In fact, we had a standing committee that did an incredible number of consultations, not only with individuals in our communities but with many different stakeholders.

In the debates that I have seen, I do not think we referenced our health care professionals and the important role they played in the debates. I want to start off by talking about that, because I think it is really important that, as Bill C-314 will ultimately be voted on, we understand and appreciate the number of discussions and the amount of effort that took place for the current legislation we have, which was amended.

As we saw, there were some issues that ultimately came out of Bill C-7, which caused another government bill to come to the floor. Again, a lot of repeat discussions took place and it ultimately passed. I think that is why the member has made the decision to propose his private member's bill. The changes that were made in what I think was Bill C-39, although I am not 100% sure and the member can correct me if I am wrong in his closing comments, are what might have brought forward this particular piece of legislation.

To be clear on what Bill C-314 does, it proposes to permanently exclude the eligibility to receive medical assistance in dying on the basis of a mental disorder alone. Wording is really important. I know that in the original debates with all the different stakeholders, and I made reference in particular to our health care professionals, the quality of the presentations and the understanding of the serious nature of the issue were, I would suggest, second to no other out of the debates I have witnessed, in particular given some of the things we heard coming out of committees.

As I reflect on that debate, I think that, in good part throughout the process, we saw many members of Parliament put their party position to the side and reflect in terms of what each believed as a parliamentarian. Maybe it was a crossover of personal beliefs versus the canvassing that many people no doubt had in terms of their constituents and wanting to reflect the general will of their constituents.

At the end of the day, when we think of medical assistance in dying and the issue of a mental disorder, I do not think that we want to try to simplify the message. As we all know, I am not a medical professional, but I have an immense amount of respect for what our medical professionals have to go through in order to be put into a position, because it is not just any and every doctor or nurse practitioner; there is a whole lot more that is involved. Towards the end of the debate, particularly on the second piece of legislation dealing with this particular issue, we had members who stood up and said, “Well, just put in your order”, almost as if someone were going through a drive-through and then it is done. We all know that is, by far, not the case.

I will fall back on the fine work that our standing committees have done. I am going to fall back on the issues and how they were explained, in good part, by the different stakeholders. I am going to stand by what the health care professionals brought forward to us. I will look at the information that was provided and ultimately reflect on what I believe in this particular situation and what a vast majority of the constituents I represent would want me to say on this particular issue. I will do this with very much a sympathetic heart, understanding the difficult situation that, unfortunately, far too many people have to face.

We can have as much sympathy as we want for those individuals who are looking at the possibility of getting medical assistance in dying, but it is one thing to sympathize and it is another thing to empathize. Based on everything I have looked at and listened to over the last number of years, I have not been convinced that this is, in fact, the direction that we should be going with regard to Bill C-314. I am just not convinced.

I think that what we ultimately need to do is continue to monitor and look at ways in which we can ensure that there is no abuse of the MAID legislation. We need to continue to show compassion in every way we can. We need to continue to listen to what the experts, individuals and stakeholders are telling us and try to build more value to the legislation so there is a higher sense of comfort in the broader community, which I believe there is today. The mechanisms are there, and there are opportunities to continue to be able to review.

[Monique Pauzé, Bloc, Repentigny, QC]

Mr. Speaker, I am going to address the subject of Bill C‑314; that goes without saying. However, I feel especially compelled to condemn the excessive and inappropriate nature of this initiative from the hon. member for Abbotsford. His bill is being tabled in reaction to an important, sensitive social issue, namely medical assistance in dying.

The fact that my colleague from Abbotsford wants to amend the Criminal Code to include the notion that mental disorders should not be considered grievous and irremediable medical conditions for access to medical assistance in dying is a proposal that does not even need to be made. Mental illness is an extremely complex issue, even a controversial one in medical circles. There are many reasons for that. To begin with, it would be imprudent and dangerous to rush the process of providing access to medical assistance in dying when the sole underlying medical condition is a mental disorder. However, that is not what is happening right now. The Criminal Code will be revised in due course, if necessary. On this point, experts feel that the current provisions of the Criminal Code are adequate to allow for further work on medical assistance in dying.

What I want to speak out against today is what I see as the official opposition's blatant politicization of this issue. Everything looks normal, or almost, when one reads Bill C-314 objectively, but it is the whole message surrounding the introduction of this bill in the House that I want to condemn. I would like to be able to say that some members just do not understand, but I cannot even use that explanation as an excuse for their behaviour.

Although I agree that being unable to afford a home and dealing with inflation and rising grocery prices are not pleasant experiences, associating them with medical assistance in dying for mental disorders is the worst kind of populism. This just shows an appalling ignorance of the many realities experienced by people living with mental illness or just plain ignorance in general. This is a position of contempt toward people who are working on many fronts to lead a somewhat normal life, despite the suffering caused by their mental condition. With Bill C-314, the Conservatives are putting on their agenda generalizations and falsehoods that they think will win them votes, and I do not see anything good about that.

This debate is a societal debate. When the official opposition claims that the work that will be done next spring is to allow Canadians who are “losing hope”, the phrase used by the leader of the official opposition, to access medical assistance in dying, I think that is completely irresponsible. There is a difference between a request and the acceptance of the request. That is the first thing the member should take into consideration. Just because a request is made does not mean it will automatically be accepted. I want to come back to the fact that the Conservatives are driven by purely vote-seeking motivations and that these statements are false. At press conferences, they tell Canadians that the intention is to provide medical assistance in dying to people whose only condition is depression or other mental health problems. Come on. Depression is reversible. Suicidal ideation is also reversible. They need to stop for a minute and think. In my opinion, it is completely irresponsible to say such things. However, it gets worse. In March, the leader of the official opposition went so far as to include the following generalizations in his preamble:

Those going to The Mississauga Food Bank [are] seeking help with medical assistance in dying, not because they are sick but because they are hungry...

Here is another quote:

...1.5 million are eating at food banks, and some are asking for help with medical assistance in dying because they cannot afford to eat, heat or house themselves.

Honestly, my colleagues cannot be serious. There are plenty of other passages from Hansard I could quote. In any case, if the Conservatives seriously believe that not being able to afford a house or dealing with the challenge of finding a place to live during post-secondary studies are two factors that lead people to want to end their lives, then I would say that things are an absolute mess.

We expect the official opposition to put an end to its demagoguery and simplistic approach, and instead take a more collegial approach where real discussion can take place and where all opinions can be expressed to allow a full understanding of what is at stake. The Bloc Québécois believes that the strategies and messages coming from the official opposition on such an important and sensitive issue do nothing to advance everyone's understanding of the issue.

The subject we are studying deserves serious consideration. We have a duty to Quebeckers and Canadians, and it is certainly not to tell them a bunch of nonsense, as the opposition leader did last March in the quotes I cited earlier. Medical assistance in dying is not a form of treatment for people with depression or suicidal ideation. It is the last resort, after decades of care, interventions and numerous therapies have all failed, when suffering is never-ending and the disease is incurable. I cannot emphasize that enough.

We believe that suffering is not exclusive to people who have a degenerative disease or who are at the end of their life. There is no need to rush this work, since the outcome has not yet been decided, contrary to what the Conservatives would have everyone believe with their message and their populist election strategy.

In its report, the Expert Panel on MAID and Mental Illness made 19 recommendations and proposed more stringent safeguards. For example, in recommendation 10, the panel proposed that a psychiatrist independent from the treating team and an independent assessor be consulted. Recommendation 16 involves the implementation of prospective oversight. There are other recommendations.

Under no circumstances would the Bloc Québécois condone providing access to medical assistance in dying in this medical context without the following: a thorough analysis of the practices and standards being considered; discussion with civil society groups, patients' rights representatives, professional associations and other stakeholders; a clear interpretation of the criteria regarding incurability, irreversibility and enduring and intolerable suffering; and the establishment of all of the safeguards and legal processes related to the ability to consent.

Members can count on the member for Montcalm, the Bloc Québécois critic on this file, to do a very thorough job.

I invite all members of Parliament, especially the members of the official opposition who might be tempted to repeat their dangerous generalizations and falsehoods, to read all of the recommendations. There are recommendations that have to do with the assessment process. The Criminal Code requires consultation with a specialist, and the key recommendation is for that specialist to be a psychiatrist. There is also the prospective oversight that I was talking about earlier.

The recommendations relating to implementation fall into three categories: consultation, training and data collection. Simply put, in order to access medical assistance in dying when a mental disorder is the sole underlying condition, there must be a significant history of treatment and therapy. Nothing is taken lightly.

In closing, we have to consider our capacity to pay for the health needs of the patients in question. We have to provide care to these people with irreversible illnesses. As a compassionate and empathetic society, we must take care of patients who meet the eligibility criteria for medical assistance in dying and provide them with a gentle and dignified death. Let us allow this work to continue early next spring without polarization or disinformation.