Bill C-39

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

This enactment amends An Act to amend the Criminal Code (medical assistance in dying) to delay, until March 17, 2024, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition identified in support of the request for medical assistance in dying is a mental illness.

Criminal Code

[Tracy Gray, Conservative, Kelowna—Lake Country, BC]

Mr. Speaker, I thank my colleague for his question. I see his other colleague, whom I sit with on the HUMA committee and work with very closely.

I am really glad the member brought up people with disabilities. We worked really hard on Bill C-22, and it is a classic example of a real failure from the government. It championed that it was going to be bringing in this disability benefit act, and we spearheaded it through Parliament, but people with disabilities still do not know how much they are getting, when they are getting it or when it will be implemented. Everything will be done by regulation instead of legislation.

There is so much uncertainty, and that is how the government governs. It has grand announcements and big fanfare, but its actions have no substance to them. A perfect example is what we saw with that legislation.

[The Deputy Speaker, Conservative, Chris d'Entremont]

I have allowed two questions and two answers throughout the question and comment portion, and I want to make sure that we try to keep ourselves brief so that other members can participate in the debate.

Resuming debate, the hon. member for Louis-Saint-Laurent.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, I rise with great pride and emotion to take part once again in the debate on medical assistance in dying.

I have had the privilege of being a member of Parliament for nearly eight years now. I was also a member of the Quebec National Assembly from 2008 to 2015. I, along with my colleague from Bourassa, am one of the few here who have participated in the debate on medical assistance in dying as a member both at the provincial level and the federal level. I can say in all modesty that this gives me a very unique perspective. I will expand on this in a moment.

If there is one issue that calls for political partisanship to be put aside, it is medical assistance in dying. I have a fundamental belief that has not altered one bit in the time I have been involved in these debates: There is no right or wrong position, there is only the position that each person, as a human being, is comfortable with.

When we hear an opposing viewpoint, we should listen and respect it, not attack it in a partisan way. I will always remember something that happened in June 2014 in the National Assembly. A Liberal MNA at the time, Saul Polo, was sharing his views in the debate on medical assistance in dying. He was vehemently opposed to it, to an extent that is hard to imagine. I remember it very well, because I was sitting along a line in the National Assembly that was perpendicular to where he was. His face was flushed with passion and his fist was clenched, and he was saying that we should not touch this subject. When he finished his remarks, I stood up and applauded him, not because I agreed with him, but because I was celebrating the fact that in that legislature we could have completely divergent, but respected and respectful views.

That is the approach we should be taking when dealing with an issue as personal, sensitive and human as medical assistance in dying. We can trade jabs back and forth all day long, and let us just say that I do pretty well when it comes to attacking my opponent. There may be 1,000 good reasons to attack one's opponent, but please, we must not use MAID to attack one another. We must respect opposite views.

We have come together today because the government has decided to set aside its goal to allow access to medical assistance in dying for people with mental illness. It is the right thing to do. While I personally support a well-regulated MAID regime combined with extensive palliative care, the issue of medical assistance in dying for people with mental illness is extremely sensitive, so these kinds of measures must not be rushed through.

The government had intended to expand access to MAID as soon as possible, that is, in just a few days, to include people struggling with mental illness. It has since decided to take a pause. I cannot call it a step back, because the government still plans to go ahead with this, but in a year from now. This is not the right way to go, and I will explain why.

Any number of personal reasons may be in play when people decide where they stand. I imagine we all know one person who has experienced serious mental health issues and hit rock bottom, never to recover—or so those around them believed. We all also know people who have bounced back from terrible trials that dragged them into a downward spiral, an abyss of profound sadness. With time, they managed to adapt to their reality, gradually build themselves back up and regain the sense of self-worth we all need.

That is why, as I see it right now, medical assistance in dying cannot be for people tumbling in the darkness. I have found the Quebec experience to be helpful in pondering this issue. To be clear, I am not saying that Quebec is better than anyone else. That is not it at all, but the fact is, there has been more legislative work and more studies on medical assistance in dying in Quebec than anywhere else. In Quebec, we have been talking about it for 15 years. I know what I am talking about because I participated in the debates in the National Assembly and in the House of Commons.

Here is a statistic that members might find surprising. More people are dying with medical assistance in Quebec than anywhere else in the world. The statistics published in Le Devoir in January show that 5.1% of the deaths in the province were medically assisted.

That is more than in the Netherlands and Belgium, which have rates of 4.8% and 2.3%, respectively.

Should we be proud of that situation? Should we be ashamed of it? No. It is just something that we should be aware of. It is not up to me to judge the fact that 5.3% of people in Quebec are currently choosing to have medical assistance in dying. That is just the reality. The figures do not lie.

The Quebec nation worked hard on this issue at the parliamentary level and, a few years ago, the government opened the door to studying the idea of whether medical assistance in dying should be made available to those suffering from mental illness.

After many weeks of thorough and rigorous work and hearing from as many as 3,000 people and hundreds of experts as part of a consultation process, the committee that examined the issue and the government in office decided not to move forward on medical assistance in dying for those suffering from mental illness. Why?

Here is what it says in the committee's report, and I quote:

We note, at the conclusion of our work, that there is no clear medical consensus on the incurability of mental disorders and the irreversible decline in capability that would be associated with them. There are differing positions among specialists. As legislators, it is difficult for us to comment on this issue.

The Liberal MNA David Birnbaum explained:

There is no clear consensus in the medical community on the incurability and irreversibility of mental disorders. Yet [these criteria] are part of the fundamental guidelines in the current legislation. Persistent doubts about the evaluation of these two criteria lead us to exercise [the greatest] caution.

That prompted the former Parti Québécois MNA for Joliette, Véronique Hivon, to say:

This decision proves that the goal is not to open up access more and more, to expand, but to open up the right amount of access to respect the individual while protecting the vulnerable.

That comes from Quebec, where 5.3% of the population chooses medical assistance in dying. This legislative measure came from Quebec. For 15 years, Quebec has been studying the issue of medical assistance in dying in an objective, neutral, non-partisan manner. I know what I am talking about, and so much the better.

The current government wanted to proceed hastily on this issue. No. I applaud and will vote in favour of this bill we are discussing this evening. It will allow us to take a lateral step to delay the Liberals' ambition. We will see where things stand in a year and whether they want to go further on this.

Everyone needs to understand one thing. By its very nature, medical assistance in dying is irreversible. Louise-Maude Rioux Soucy said it well in an editorial that appeared in Le Devoir on January 4:

MAID is offered as part of the continuum of care...There is an unwritten obligation attached to it: the quality and universality of palliative care must be beyond reproach in order to guarantee, at all times and in all circumstances, that medical assistance in dying is an exception.

I will now talk about a much more personal story. Last year, I was confronted with the reality of death. My mother, aged 97 years and 10 months, died in May, and my father, aged 99 years, four months and two days, died in December. As we can see, they died seven months apart and lived for a century. They were seriously ill at the end of their lives. In the winter of their lives, my mother and father fought to survive and death came for them.

MAID never came up because it was a non-issue. They were not interested. Our family was lucky. They got the most excellent palliative care available, and we are grateful. We were able to talk to them. Their children, grandchildren and even their great-grandchildren were able to talk to them. I wanted to share this because, at the hospital where my mother was, there was a section for people receiving palliative care who were about to die in a matter of days and, just down the hall, there was another section for people about to receive MAID. I had some great conversations with family members and even the individuals who requested MAID. The point is, we can and must respect the wishes of every individual. There is no right or wrong. There is only what we are comfortable with. I am comfortable with MAID as long as palliative care is available.

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

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

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

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

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, yes, for once I can agree deeply with my colleague from Winnipeg North. As I said earlier, there are hundreds of good ways to attack an opponent. Let us please not take medical assistance in dying to address a political issue.

For sure, we have to be very careful. This is why, when we talk about mental illness, it is very tough to trace the line exactly on what is good and what is wrong, what is mental illness and what is incurable. This is why we have to be careful and we have to listen carefully. It is a bit too early, to say the least, to address it. Based on the Quebec experience, with 15 years of parliamentary work, two bills have been passed and it is very progressive, if we can use that adjective, in this area, where 5.3% of people die with medical assistance in dying. We have to be careful and the Quebec experience told us not to touch it right now.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Mr. Speaker, certainly I agree that there needs to be more investment in palliative care and it is a very important aspect of our society. Today, we are talking about mental health and MAID. We know that one of the pillars of recovery from mental illness is a financial pillar: the ability to have a house, to buy food and to get access to medication and supports. Does the member feel that a guaranteed livable basic income is something that could alleviate suffering in the wake of the mental health crisis in this country?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, in my life as a member of Parliament, and before that as a journalist, I have seen people with so much money and they had deep trouble with mental illness. Also, I have seen people with a huge family and a very tough life, because their income was not as good as expected, but they were happy, all together. Therefore, I do not think that we can put a price on mental illness.

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

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

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

I would like to hear what my colleague thinks.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Mr. Speaker, that is a debate for the provinces. It falls under the issue of health care funding, which, as we know, is a provincial responsibility.

I will let the provincial legislatures debate the ongoing funding for medical assistance in dying, especially for palliative care.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I rise to talk about this issue tonight, because for me it is deeply personal. As someone who has suffered with depression and mental health issues at various times in my life, including a severe depressive period for which I was seeking treatment, I think the expansion of medically assisted death to those with mental health conditions is incredibly troubling. The fact that this is where we are, almost a month away from when this would be available to Canadians suffering with mental health issues, is a catastrophic failure of the government to properly deal with this issue. I am so unbelievably disappointed that the Liberals are rushing through legislation now to try to delay the implementation of this because they did not do any of the hard work that was necessary in order to get this right. The problem is that there is so much evidence out there on how they could have gotten it right, yet they chose not to.

I want to talk a bit about an article that was written on December 15, 2022, by Dr. Karandeep Gaind, a professor of psychiatry at the University of Toronto and the chair of his hospital's MAID team. If anyone has not done it, they should read this article, because it outlines and summarizes the incredible challenges with this issue and how the government has failed in examining it.

I am going to start here: “[E]vidence shows it is impossible to predict that a mental illness will not improve in any individual.” He goes on to say, “Yet expansion activists mistakenly believe they can make such predictions.” Research, which he cites, “tells us their chance of being right amounts to chance or less, with precision modelling showing only 47 per cent of [irremediable medical condition] predictions end up being correct”.

This means that 47% of the time when a doctor says a person's mental health will not improve, they are wrong. This evidence was readily available to the government at any time, yet we find ourselves having to push through legislation to delay it at the last minute.

He goes on to say this: “[W]hen expanded to those seeking death for mental illness, evidence shows MAID becomes indistinguishable from suicide.” We should remember that this is a psychiatrist talking. He says, “We cannot differentiate those seeking psychiatric euthanasia from suicidal individuals who resume fulfilling lives after being provided suicide prevention, rather than facilitated death.”

Let that sink in for a minute. This is a psychiatrist who teaches at the University of Toronto and is the chair of his hospital's MAID team. These are the things he is saying. He has been saying them for a very long time, and the Liberals still could not get this right.

He then talks about the federally appointed panel:

The government-appointed federal panel...was responsible for providing safeguards, standards and guidelines for how to implement MAID for mental illness. Instead, the panel recommended that no further legislative safeguards be required before providing death for mental illness, and did not provide any specific standards for the length, type or number of treatments that should be tried before providing MAID. Its report even suggested society had made an “ethical choice” that MAID should be provided even if suicide and MAID were the same.

This psychiatrist is summarizing what the government panel found. To me, it is absolutely and truly shocking.

He goes on to say, “I am not a conscientious objector.” There are many who are. There are members in this place who conscientiously object to medically assisted death. I am not one of them. I think it can be appropriate in certain circumstances, and Dr. Gaind is in that group as well. He says, “However it is clear to me that Canada’s planned expansion of MAID to mental illness is based on ignorance—if not outright disregard—of fundamental suicide prevention principles.”

Let that sink in. Again, I go back to who is saying this. This is not me saying this, not a parliamentarian saying it who does not have experience in mental health. This is a psychiatrist at the University of Toronto and the chair of the hospital's MAID team. He finishes, “It appears to ignore what drives the most marginalized people to consider death as an alternative to life suffering.”

This again is the incredible challenge. We have heard all the reports about people thinking they should now get MAID as a result of mental health issues. I cannot believe that we let it get this far, that we do not have rules in place and that we have to go forward and put this off.

The government had so much time to get this right and it could not. It did not even come close. This to me is just a symptom of how the government does things without thinking them through, without thinking of the consequences. What is going to happen if we do not get this bill passed by March 17? Then it is open and available. How is this legislation just being introduced now to push it back? The government knew ages ago that it was not going to meet this deadline. It knew ages ago that it did not have safeguards in place, and yet here we are now. I find that breathtaking.

The doctor's final comments in the article, I think, we should all listen to. They read:

Postponing the March 2023 expansion of euthanasia for mental illness is the only responsible course. Canadians and mental health organizations recognized this and called for it, with the Canadian Association for Suicide Prevention and over 200 individual psychiatrists so far signing a petition to this effect, and the academic chairs of the departments of psychiatry across Canada joining this call for delay.

That article was written in December and here we are now dealing with this legislation. It is a catastrophic failure by the government and the minister responsible for this. Let us hope it is not a catastrophic failure for Canadians.

Someone who is dealing with a mental health issue needs help. Let us be clear. I went through a period in my life where I did not want to continue to live. It was a deeply dark, terrible period of time.

The government is moving forward with this legislation with absolutely no safeguards in place to protect people who are in that terrible place. Eminent psychiatrists have been banging the clarion bell on this for ages and the government did nothing until the last minute. Now it is saying we have to put it off.

I can tell colleagues that I have absolutely no faith that the government is going to get it right. As the quotation I cited in the article stated, the panel got it wrong. I do not know if there has been any ministerial direction to make sure it gets it right. What I can say is this. On this side of the House, we are going to stand up for people with mental health issues. We are going to protect them and not let the government just throw them under the bus.

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

Mr. Speaker, just to provide a little bit of clarity on the issue of mental health, I challenge the member or others who want to make this more partisan to tell me of another government that has invested as much money in health care or mental health, and has focused so much attention on mental health, as this national government has. Stephen Harper definitely did not do that.

My question to the member is related to the special joint committee. There is a special joint committee whose membership comes from all sides that is doing a lot of work on the issue. Does the member believe there are no exceptions himself where any form of mental illness could be eligible for MAID?

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, the member said they do not want to make it political, but then talked about a former prime minister, spending and other things. I am not making it political. I am reading the words from a psychiatrist who has more experience than the member, or any member of the government, will ever have on this issue. He is outlining a litany of concerns and how they went down the wrong path on this.

If their investments in health care have been so incredible, why are the premiers screaming that health care is in a terrible state of disarray? That happened under his government. If it is spending more money, it is not doing it well. That is the problem.

It is not political. I am begging the government to get it right on behalf of Canadians who suffer from mental health issues. They need the help.

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

Mr. Speaker, I share my colleague's concerns. That is why I voted against the Senate amendment to Bill C-7 in the previous Parliament. I have been a member of the special joint committee on medical assistance in dying. It is very clear that Bill C-39 is necessary. We do need to have that delay in place.

The concepts we were struggling with at committee were individual autonomy versus protection of the vulnerable. I would like to get my colleague's thoughts on those concepts. What is his understanding of the capacity of a person who may have a mental disorder to make an informed consent decision and their own internal understanding of what they are going through?

This is a genuine question. I am genuinely curious as to what the member thinks about it because this is a really important debate that our country is having.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I think that this issue is so complicated that it is incredibly difficult for members of Parliament to try to set those parameters without extensive study.

I want to go back to the figure that was cited by the professor where he said that 47% of the predictions of people's mental health issue being irremediable are wrong. We look at that stat that 50% of the time they are wrong, and if someone with an irremediable mental health issue goes for MAID, 50% of those predictions are wrong, so the possibility is that 50% of the people getting medically assisted death could have had treatment and got better. That is a statistic that every member in this chamber should be haunted by until we get this right.

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

Mr. Speaker, I want to thank the member for Dufferin—Caledon for being extremely open and honest about his own experience of deep pain and darkness. I also want to keep everything with respect to this issue as non-partisan as possible.

We have a year. Bill C-39 is going to pass. I have not heard any souls in this place say they are not going to vote for it. What do we do in the coming year? What would the hon. member recommend?