Laurel Collins NDP
Introduced as a private member’s bill. (These don’t often become law.)
In committee (Senate), as of Dec. 5, 2024
Subscribe to a feed (what's a feed?) of speeches and votes in the House related to Bill C-332.
This is from the published bill. The Library of Parliament often publishes better independent summaries.
This enactment amends the Criminal Code to create an offence of exercising coercive control of an intimate partner by engaging in a pattern of conduct that consists of any combination, or any repeated instances, of any of the following acts: using, attempting to use or threatening to use violence against certain persons, coercing or attempting to coerce the intimate partner to engage in sexual activity or engaging in other conduct that could reasonably be expected to cause the intimate partner to believe that their safety, or the safety of a person known to them, is threatened.
It also makes consequential amendments to other Acts.
All sorts of information on this bill is available at LEGISinfo, an excellent resource from the Library of Parliament. You can also read the full text of the bill.
Michael Cooper Conservative St. Albert—Edmonton, AB
Madam Speaker, if the member is referring to the Truchon decision, that was not what the Truchon decision provided for.
That was outside the scope of the Truchon decision. Evidenced by that is the fact that when the Liberals responded to Truchon by introducing Bill C-7, mental illness as the sole underlying condition was expressly excluded from the legislation.
This is a political decision brought on by the Liberals.
Luc Thériault Bloc Montcalm, QC
Madam Speaker, my colleague is always very eloquent when it comes to defending the “no” camp and the pro-life camp. Does his position represent the position of the Conservative party? Is that the official position of the Conservative Party?
I just want us to be able to understand what is at stake in this debate today. Essentially, to him, irremediability is something that can never be proven. That means that, under a Conservative government, people who are suffering intolerably, who are dealing with intolerable suffering because they are victims of a mental disorder, could never be relieved of their suffering.
What I am also hearing is that he claims that he can solve the problem of suffering and irremediable mental disorders by injecting a lot of money into the health care system to make access to health care something that can help these people put all their suffering behind them.
Is that what he is telling us?
Michael Cooper Conservative St. Albert—Edmonton, AB
Madam Speaker, the member for Montcalm is a thoughtful member on this issue.
With respect to irremediability, I am absolutely not comfortable with moving ahead with this expansion if it cannot be accurately determined. We have psychiatrists come before committee and say it is like flipping a coin, that clinicians get it wrong 50% of the time. That is not an appropriate risk. That is evidence of a policy that has not been well thought out, and that is dangerous and will negatively impact vulnerable persons on a matter of life and death.
With respect to the position of the Conservative Party, yes, the position is that a common-sense Conservative government would permanently scrap this radical and dangerous expansion.
Rob Moore Conservative Fundy Royal, NB
Madam Speaker, the arrogance and incompetence of the members opposite on this issue is truly alarming and frightening. Are they not aware that 30 legal experts wrote a letter to the former justice minister and cabinet saying, “Parliament is not forced by the courts to legalize MAID”.
What does the hon. member make of this argument, from the minister who spoke earlier, that somehow, in her words, the debate is over?
Michael Cooper Conservative St. Albert—Edmonton, AB
Madam Speaker, it is arrogance, it is recklessness and it is incredible. It is incredible in the sense that they hide behind a Quebec court decision. It is a decision, frankly, they should have appealed but did not. It did not pronounce on the question of MAID and mental illness, and they are now using that as the basis to say we need to move forward with this legislation, even though, when they initially responded, they said they were going to exclude mental illness from the legislation. They are trying to have it both ways.
They got into this mess because David Lametti accepted a radical Senate amendment and it has been a three-year mess ever since.
Anthony Housefather Liberal Mount Royal, QC
Madam Speaker, I rise on a point of order. I made a technical error in my vote on PMB Motion No. 86 on the seventh vote today, and I would very much appreciate the House's unanimous consent to allow me to change my vote to no.
Luc Thériault Bloc Montcalm, QC
Madam Speaker, I never thought I would end up debating medical assistance in dying in the House again, or reliving what we went through when we passed Bill C‑14, a bad law. I never expected that the Liberals would again be in the same position, or show the same lack of courage they did with Bill C‑14, which was prescribed by the Carter-Taylor decision.
Quebec passed its legislation on end-of-life care before the Carter decision. In the Carter decision, the court ruled that Quebec had to revise its legislation to include more than end-of-life issues only. The Parliament of Canada, which had never considered this before, was also told that it had to address not only end-of-life issues, but also degenerative diseases like those afflicting Ms. Carter and Ms. Taylor. Ms. Carter had spinal stenosis and Ms. Taylor had amyotrophic lateral sclerosis. In its decision, the court ruled that Parliament had to legislate because both women's right to life was being infringed.
Why was their right to life being infringed? The right to life is not a minor right. This should be of interest to the Conservatives, who are pro-life. I am too, in that sense. The right to life was being infringed because these people had to shorten their lives when they would have liked to live until their suffering became intolerable.
As members of Parliament, as representatives of the state and the people, our duty is not to decide what the patient needs when it comes to an issue as personal as their death. The role of the state is to ensure the conditions needed for them to exercise free will, so that they can make a free and informed decision. That is the role of the state. Otherwise, we get into government paternalism.
I invite my Conservative colleague to do some reading in clinical ethics and not to limit himself to what psychiatrists in Ontario are saying. We know that psychiatrists are divided on the issue. In fact, if there is one discipline in which medical paternalism continues to reign, it is psychiatry. We would never have seen the progress that we have seen in clinical ethics if medical paternalism in general still ruled supreme.
What happened for patients to be given back control over their end of life? We find the answer to that question in the bioethics literature. In the past, some doctors who had cancer said they did not want treatment. Now, we have good medical practices, whereas in the past, aggressive treatment was the standard. The doctors said that they wanted to live the two years they had left without undergoing treatment that would leave them bedridden. They claimed that they wanted to spend quality time with their loved ones. It took doctors with cancer demanding that option for patients to be able to discuss these sorts of things with their own doctor. In the 1960s, there were patients who only found out that they were dying of an incurable disease and were in fact at the end of their life when the priest came to their room to administer the last rites. They were not even told that they were terminally ill. That was medical paternalism.
Over time, the right to die was granted. Patients were granted the right to die and the opportunity to refuse aggressive treatment. That is when we began providing the palliative care that is so important to my Conservative friends. Before that, palliative care was called passive euthanasia, and it was not allowed.
Medical paternalism has been gradually set aside. What has this led to?
It has led to the right to refuse life-saving treatment, to stop treatment. These are all rights we have today.
We have before us a bill that perpetuates suffering indefinitely for people with a severe mental disorder who have been unable to relieve their suffering through treatment. That is no mean feat. They have spent 10, 20, 30 years suffering, trying multiple treatments and being stigmatized by the society in which they live.
We are able to establish the decision-making capacity of people living with a severe mental disorder. For those capable of making decisions, the court told us that it would be discriminatory and stigmatizing if, just because they have a severe mental disorder causing suffering that psychiatry is unable to properly change or relieve, they were told what was best for them and that they should continue to suffer forever, while psychiatry need only provide a palliative care option until the end. That is what we are discussing today.
I will calm down. It is just that I heard some nonsense earlier.
Then what happens? There was Bill C‑7, which was rather cautious. It set a two-year deadline for creating an expert panel. Who read the report of the expert panel in the House? Who read it before voting? This is the second vote we are having on this subject. We have to read the report of the expert panel. Indeed, the irremediable aspect is something that is hard to implement. Admittedly, there is an additional difficulty, but the expert report does set out guidelines. That is what this is about.
Then the Liberals show up today with a clause they added that says we are going to work with an expert panel for two years and create a joint committee. The problem is that the joint committees have always been set up at the last minute, too close to the deadline.
When we submitted our report the last time, we were forced to admit that, before moving forward with the issue of mental disorders, we needed to assess the situation in the field. Even though I think the group that was supposed to work on it had developed important guidelines and standards of practice, it was obvious to me that there was still not quite enough time. Everyone told us so, including the Collège des médecins du Québec—I will have more to say later about its criteria and guidelines for proceeding that I find useful.
How is it that, a year ago, the government gave itself a one-year deadline and thought that would be enough time? A lot of work has been done in that year, yet the government is saying we should put it off until 2027.
We heard what the Conservatives just said. We can forget about MAID if they form government; they will put it off indefinitely. That means that people will continue to suffer indefinitely, and that suffering will be intolerable because psychiatry is unable to provide relief other than by rendering them virtually incapacitated. Somehow, people find that morally acceptable. I honestly do not know where the morality lies in that. Some people have very flexible morals. In any case, it has nothing to do with suffering.
When people claim that someone living with depression could have access to medical assistance in dying, it is simply not true. Just because someone applies for MAID does not mean they will be able to access it. The assessors will do their job. Stefanie Green was saying that a person in a suicidal crisis is not eligible for medical assistance in dying. Someone who raises their hand and says that they want MAID simply because we allow mental disorders to be eligible grounds for MAID would not have access to it because they have not received proper care.
However, there would be an opportunity for prevention, because we could provide treatment at that time. It is wrong to say that 90% of people who have suicidal ideation and commit suicide received proper care. No, they did not receive proper care. Very often, when people commit suicide, no one saw it coming at all.
What are we going to do? What are the Conservatives going to to with people who are desperate and suffering and who currently still have hope that we are going to consider their suffering and find a solution so that things are done properly and by the law? What do they think those individuals are going to do in their despair? Is suicide morally acceptable? Suicide attests to the failure of our system and our society. I will never, ever accept suicide. That is why, when we talk about medical assistance in dying, we are not in the same page at all.
A person who is feeling suicidal is not eligible. Someone who has just been taken into care and diagnosed is not eligible. Applications take structural vulnerabilities into account. Just because someone is poor and does not have access to care does not mean that they will be eligible for medical assistance in dying. They would not be eligible, because they would have to have tried every possible treatment. Someone who unjustifiably refuses treatment that could improve their condition will not be eligible. If accessible and effective treatments are available and the person refuses them, they are ineligible. If the assessors cannot agree that the criteria have been met, the person is not eligible either.
The Collège des médecins du Québec told us that it remains at the discussion stage, that it has established its guidelines and it still needs time in order to eventually get there. Personally, I think one year would have been enough, otherwise we might give up. We could end up being hypocritical and leave it to chance. We might as well flip a coin.
The Liberals need to work hard if they want to win the election. If not, they are going to be leaving the fate of those who are suffering in the hands of people who just told us today that this will not happen on their watch, that they support suffering for life everlasting, and that they know what is moral and right for these people.
The Quebec college of physicians said, and I quote, “the decision to grant MAID to someone with a mental disorder should not be viewed solely as an episode of care. Rather, the decision should be made following a fair and comprehensive assessment of the patient's situation.” We are talking about taking the time to establish the chronicity of the condition.
The college of physicians also set out a second condition. It said, and I quote, “the patient must not exhibit suicidal ideation, as with major depressive disorders”. It might be a good idea for the members of the Special Joint Committee on Medical Assistance in Dying to hear that, although they are on the same committee as I am and that was said in committee.
That is a far cry from the grandstanding Leader of the Opposition who stands up in the House and asks the Prime Minister, in prime time, whether medical assistance in dying is the only thing he has to offer those who are depressed and having a hard time making ends meet. That is a bit much.
The third criterion laid out by the college of physicians states that the patient must “experience intense and prolonged psychological suffering, as confirmed by severe symptoms and overall functional impairment, over a long period of time, leaving them with no hope that the weight of their situation will ease. This prevents them from being fulfilled and causes them to see their existence as devoid of meaning.”
The experts tell us that they cannot apply irremediability and suffering metrics to mental health, and that prevents them from creating a category as a grounds for MAID. It has to be done on a case-by-case basis. All questions of clinical ethics, in terms of clinical assessment, are examined on a case-by-case basis. Some seem to think that going on a case-by-case basis is hell and that it is not a rigorous process. It is very rigorous.
The fourth condition states, “the patient must have been receiving care and appropriate follow-up over an extensive period of time.” Access to care must have been available. Otherwise, no access to medical assistance in dying will be provided for mental disorders. It seems to me that we heard the same thing in committee. We heard the same criteria.
At some point, we have to have the courage of our convictions. I believe that we have to offer relief to people experiencing intolerable suffering, who have reached their limit. I also believe that we must not make decisions about their life or quality of life for them. They alone can decide what is tolerable or intolerable.
When people talk to me about a slippery slope, they seem to be working on the assumption that all health care workers are evil. However, people who work in health care need to be kind. As far as I know, gaining admission to medical school is not easy. I imagine that the selection criteria are quite strict and challenging. The same goes for nursing.
The fifth condition states, “requests [from social workers] must undergo a multidisciplinary assessment, including by the physician or specialized nurse practitioner in the field of mental health who has treated the individual”. This is in the case of a follow-up assessment, not in the midst an episode. A person cannot get medical assistance in dying simply by saying that their life no longer has any meaning. Making a request does not mean one is eligible.
The Collège des médecins du Québec concluded by saying, “Under these conditions, it would be possible, in the CMQ's view, to provide individuals suffering from a grievous and irreversible mental disorder with access to MAID. It is important to prevent situations where individuals opt for MAID out of desperation, because they do not have access to proper care or do not consider the care available to be acceptable, such as an extended stay in a facility without the prospect of gaining more autonomy.”
That is the exact opposite of the nonsense we heard earlier. We were told that this was like a house of horrors, that we were dealing with experts and doctors who simply wanted to harm people's physical integrity. We have to be careful.
To access MAID, the individual must first make a request, which is then followed by informed consent. When it comes to mental disorders, doctors currently perform a daily assessment of a person's decision-making capacity if they have a mental disorder and a comorbidity, an additional illness that is hastening their death. Everyone agrees that these people are capable of choosing and consenting to medical assistance in dying. MAID practitioners have long been determining the decision-making capacity of people with a mental disorder. Just because someone has a mental disorder does not mean that their right to self-determination and to make decisions should be violated. That is discrimination and stigmatization.
When people tell me they want to protect the vulnerable, I wonder who could be more vulnerable than someone who has suffered for decades with a mental disorder and has tried every treatment. Who could be more vulnerable than someone grappling with a paternalistic psychiatrist—I am choosing my words carefully—who thinks he knows better than his patient what treatment they need, then chains them to a palliative care pathway and throws away the key because he cannot bring himself to admit that he is unable to provide relief to his patient?
At committee, I put the question to some psychiatrists who told us we were on the wrong track. They admitted that, in 25 or 30 years of practice, they had seen some patients fall through the cracks. Indeed, it is for this small group of people who fall through the cracks in psychiatry that this expansion is necessary. We need to show a little humanity here in the House.
Lloyd Longfield Liberal Guelph, ON
Madam Speaker, I extend my sincere thanks to the member across the way for the details and the compassion with which he made his comments about patient-centred decisions and things around the Charter of Rights and Freedoms that we protect in the House. Right now, I understand the Quebec legislature is debating the Superior Court decision. I was hoping we would have a more fulsome debate tonight, and I was surprised the Bloc did not support having that debate.
I spoke with a nurse practitioner in my area who comes from Ottawa to Guelph to provide service, and she can only do it as a volunteer because she is not paid by the province to work outside of Ottawa. On the ground, we really have problems building capacity. Something that this bill tries to address is building the capacity of our health care system within the provinces to be able to provide MAID effectively in our communities.
Could the member maybe reflect on the need for us to work with provinces and their health care systems to build our capacity and, at the same time, to work with legislatures, both provincially and federally, so that we can get this across the line together, and comment on the amount of time that could take?
Luc Thériault Bloc Montcalm, QC
Madam Speaker, that is an interesting question.
I would like to point out to my colleague that the committee had very little time to assess whether the system was ready. We had two or three meetings to determine that and the deadline was ridiculous. However, many people came and told us that the system was ready.
The Quebec National Assembly took a stand in 2021. Bill C‑7 was passed after that, after a lot of work had been done and brought to a halt in Quebec. The Quebec college of physicians said that it still needed a little more time. However, there is a big difference between needing a little more time to ensure that everything is done safely and properly and putting off indefinitely the need to deal with the suffering of people with serious mental disorders.
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Madam Speaker, it was a pleasure to work the member for Montcalm on the Special Joint Committee on Medical Assistance in Dying. We have both been on that committee from the get-go, and we have both been exposed to a wide range of witness testimony and the briefs.
Following up slightly on the earlier question, our responsibility here in the federal scene, of course, deals primarily with just the Criminal Code. Once we complete our task with the Criminal Code, the oversight and accountability of the system falls largely on the provinces.
It is not insignificant that seven out of 10 provinces and all three territories had their health ministers and ministers responsible for mental health and addictions sign a letter, in which they referenced the fact that back in November, they were already raising concerns, and they have clearly called for an indefinite pause. I understand Quebec was not a signatory to this, but the very fact that seven provinces and three territories are, and those ministers are responsible for the oversight of those medical systems, I do not think that is insignificant.
I am wondering if the member for Montcalm can reflect on that. When we have clear direction from ministers responsible for the system saying that they are not ready, how does he respond to those concerns?
Luc Thériault Bloc Montcalm, QC
Madam Speaker, that is an excellent question. In the supplementary report that I tabled, I note that, if we had had more time, we could have engaged with these people. By engaging with these people, we could have understood exactly what their concerns were.
A certain number of associations did tell us that everything was ready for us to do this. The member knows that. For example, the Association of Medical Assistance in Dying Assessors and Providers came and told us after Bill C‑14 and Bill C‑7 were introduced that not all doctors were trained to be MAID providers. There was only a small number and they would be able to meet the demand. When it comes to mental disorders, we are talking about an even smaller number still. The people from this association felt that they were able to do this safely. There was also the Canadian Psychiatric Association, the Canadian Bar Association, the Association des médecins psychiatres du Québec, the Federation of Medical Regulatory Authorities of Canada, the Nova Scotia department of health, and so on.
It comes down to the way people followed the debate and the way they debated within the governments because they sometimes have other concerns. I would have liked to hear them. The government did not call on us as soon as Parliament returned so that we could do a review and ask all of the questions we had. We could have even gone out into the community to see what was missing, but we were unable to.
Here is what I think: We could do it right now, in the next year. We need to work together, get out there and explain it, see what is going on, and share the guidelines. Then, if we need another year, we can take it. Waiting until 2027 to do this is definitely not a progressive way of going about it.
Marie-Hélène Gaudreau Bloc Laurentides—Labelle, QC
Madam Speaker, from what I understand there are inconsistencies between the processes in the different provinces. Quebec has done its part.
What I am hearing this evening is often what individuals may have experienced. We are talking about human suffering. I know what I am talking about because I have experienced it. Everything my colleague is talking about, everything he got out of all these experts, I experienced it.
Beyond a potential fear of getting to the bottom of things, of figuring out what else is needed to make an informed choice, there is urgency. I would like my colleague to tell me what our dear colleagues here might be lacking to make an informed decision on the fate of human life.
Luc Thériault Bloc Montcalm, QC
Madam Speaker, briefly put, I would say they lack courage. In this place, courage and compassion are lacking, and action is based far too much on ideology.
As I said earlier, only the individual can compare their life in one condition to their life in another condition, and this does not mean comparing two different lives. In that sense, we cannot turn a deaf ear to suffering. We have to listen and we have to act to make sure that these people receive care, of course. That is our goal. However, no matter how difficult it may be to determine whether a condition is irremediable, it would be intellectually dishonest to claim today that psychiatric treatment can relieve the suffering of everyone with severe mental disorders. For those whose suffering cannot be relieved and who request MAID in a considered and coherent manner, with all the safeguards I mentioned earlier in place, we have a duty to listen to what they think and to legislate accordingly.
