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

[Ya'ara Saks, Liberal, York Centre, ON]

Madam Speaker, this is exactly the reason why mental health literacy is so important, because those who suffer with mental illness are not necessarily, by default, suicidal. I would be more than happy to educate the member on the determinants of that.

[Jacques Gourde, Conservative, Lévis—Lotbinière, QC]

Madam Speaker, I am pleased to speak to Bill C-39 this evening. As a legislator and member of Parliament for Lévis—Lotbinière since 2006, I have been told about, and sometimes even witnessed, some very difficult situations involving people or families in distress.

On May 3, 2016, in the House, I allowed myself the privilege of expressing the thoughts sent to me at the time by several of my constituents during the sensitive debate on MAID. It is a topic that leaves no one indifferent.

I want to emphasize that, regardless of their political allegiance or their position on this issue, all parliamentarians are once again demonstrating courage by taking part in this debate, which is difficult for all of us.

The Supreme Court gave members of Parliament the daunting task and responsibility of setting the foundations of a law. This forced us to do some soul-searching about the purpose of our lives and the lives of the citizens we represent. We were aware that the law as a whole would not be perfect, that it would merely be acceptable, given all the changes it made to our way of seeing life and living in the future.

It is always a great privilege for me and a sign of undeniable trust when people share heartfelt confidences with me, especially when they deal with matters of life and death. The expansion of MAID to people with mental health disorders definitely falls into that category. I see parents, grandparents, brothers, sisters and friends worried about the expansion of the MAID legislation. When we stop and think about it, obviously we all want to keep our loved ones with us as long as possible.

Surprisingly, however, many of the discussions I have had with my constituents have revealed another very important issue that can cause mental health problems. I am talking about how the Liberals have trivialized the consequences of cannabis use, even though they knew the extent of the consequences when legalization was studied in committee. Several studies confirmed that use in adolescence would cause mental health challenges for those who already had a genetic predisposition.

We were promised that a lot of money would be invested in programs for people grappling with that addiction, as well as mental health services. Unfortunately, given the challenges that already exist across Canada in terms of access to regular health care, we suspected that specialized mental health care would be inaccessible and insufficient for Canadians. Therein lies the rub. One can easily imagine what will happen when hard drugs are legalized in Canada, again by the Liberal legacy that is destroying the Canada we once knew.

I would like to share that I will soon be a grandfather for a sixth time. I am obviously very happy, but I am also very concerned about our Canada, which has been deteriorating by the day since 2015. Canada is deeply broken, and millions of Canadians are suffering because of the erosion of their sense of security and quality of life.

I would like to use the time that I have to speak to Bill C-39 as an opportunity for honest reflection. As members no doubt know, humans need to give meaning to their lives to fully appreciate all the good things life has to offer. It is human nature to seize the best opportunities we get to enjoy life. However, what do we do when the government takes away those opportunities by implementing policies that go against our well-being and we lose faith and hope in the future?

Is it right for us, in the near future or the next few years, to allow people with mental health challenges to put an end to their lives, when they might have a better quality of life if we were to give them ways to fix what is going wrong and more resources so that they could find balance in their everyday lives?

I think the public is aware that nothing is working anymore and that we are living the opposite of what we are used to in so many aspects of our lives.

In spite of that, we must not see the future as inevitable. There are always solutions, and, as fragile as life may be, we have the privilege of sharing love and friendship. We can strengthen our bonds and help one another.

Our society is constantly changing. It shapes our fundamental, cultural, religious and spiritual values when it comes to life and the end of life. What was personally unacceptable yesterday may change tomorrow. We need to respect one another here, because we all have a say in this Parliament. That being said, the end-of-life choice that is acceptable to the individual is based on their convictions, their beliefs, their physical health and perhaps, ultimately, their mental health.

We have to be careful about that fourth point, mental health, because when it comes to care and scientific advances, we are still making progress. Who knows if we will find drugs that open up new possibilities for people who currently do not see any solutions?

We are faced with the same question we had to answer when the initial law was drafted in 2016: How can we ensure that this will not get out of control? It will be difficult to include safeguards in the law that will cover all of the very different cases of people with mental health issues.

I think it is wise to make the right choices for Canadians' safety and for future generations. Once again, time will tell whether this change in direction was a good one. All parliamentarians in the House and the Senate will make a significant contribution to this debate. We must all bring a rational and moral tenor to this bill as we align it with Canadian values and thinking in a way that respects all of our Canadian communities. We will live with the future changes that will come from this law. We have to ensure that it will be interpreted in accordance with our guidelines, because the consequences will be irreversible.

I am pleased that we are giving ourselves some time to address this delicate subject in order to protect vulnerable people and not to do something irreparable to people who are precious and who have the potential to live a better life with dignity.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Madam Speaker, I thank my colleague for his speech. He is right, there are service gaps. People with mental health issues may be unable to access what services there are. This is a huge problem. The government has not put any resources into it.

This evening, we learned that, when people seek access to psilocybin, a therapy that makes a difference for them, the government and Health Canada are not responding to those requests in due time.

Here is my question for my colleague. Why does the government seem unwilling to take mental health issues as seriously as they deserve to be taken?

Why is the government dragging its feet on approval for a therapy like psilocybin? Why is it so slow to follow its own guide on the importance of authorizing this kind of treatment?

[Jacques Gourde, Conservative, Lévis—Lotbinière, QC]

Madam Speaker, that is a very important question. Canada is facing huge challenges right now with respect to mental health. We should double down on this and make mental illness a priority, because it is affecting hundreds of thousands of Canadians.

There are plenty of ways to add more resources to our health care system. The government could speed up the approval process for certain drugs. We can all be more open to new ways of thinking, working and living in society that would alleviate this problem. Let us hope the government will see it and show a little leadership on things like that.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I largely agreed with the hon. member's speech, except for when he started blaming everything on the Prime Minister. Other than that, I thought he made a good and thoughtful speech.

Has the hon. member had any interaction with the health care system in Quebec? Has he made any observations with respect to how it deals with the mental health care that is given in Quebec for the patients who might well be accessing this particular MAID service?

[Jacques Gourde, Conservative, Lévis—Lotbinière, QC]

Madam Speaker, I find my colleague's questions very interesting.

In Quebec, once a patient enters the system and has access to psychiatrists and health care, the results are relatively good. However, the unfortunate part is that there are not nearly enough staff, people and psychiatrists for the number of cases that exist.

Wait times to access this type of service can be six months, even a year or a year and a half, depending on the severity of the case. This unfortunately means that there are some people who, while waiting for treatment, may commit an irreparable act and leave this earth.

[Blake Desjarlais, NDP, Edmonton Griesbach, AB]

Madam Speaker, I just align with one of my colleagues, the hon. member for New Westminster—Burnaby, in relation to doing everything we can for those who may be suffering before it gets to the point of an application for medical assistance in dying.

Earlier today, for example, one of our colleagues gathered folks who were suffering from immense pain and living day by day, not knowing what to do. That pain contributes to their overwhelming feeling of despair, which then leads them to apply for something like medical assistance in dying. In fact, the government could put in place regulations to support these folks before they get to that place. They could ensure psilocybin, a treatment that they are calling for; they have already established a right to have access to this treatment. Would the member speak to the importance of ensuring that we do everything we can to support these folks, including providing medicine that they desperately need?

[Jacques Gourde, Conservative, Lévis—Lotbinière, QC]

Madam Speaker, I thank my colleague for his very interesting question.

Yes, if there is an opportunity to speed up the approval of certain medications here in Canada to help people with mental health issues, let us do it as quickly as possible.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I understand I am the last member to speak on this debate. I doubt, however, that I will be the last word on this. I am not. I see that I am neither the last speaker nor the last word then.

I have been kind of reluctant, frankly, to engage in this debate because I do not consider myself to be an expert. I have not participated in committee hearings, and I have not had the benefit of listening to the expert witnesses. Therefore, the only thing that I bring to this particular debate is 25 years in and around the mental health system in the eastern part of the GTA. This is due to the fact that my son, technically my stepson, has schizophrenia.

The schizophrenia started to manifest itself when he was about 15 years of age; he is now about 40. As a family, we have been able to make some observations about the current state of the mental health care system in our neighbourhood. We are a well-resourced family; we have been able to access the best that there is on offer in and around the city of Toronto.

Our son has spent some weeks at the Whitby Psychiatric Hospital east of Toronto, one of the best that Ontario has to offer. He has also spent some time at the CAMH in downtown Toronto, which is possibly the leading health care facility in this particular area of health care. He has also spent time at our local Scarborough Health Network; this is a good health network, but my observation is that it is just absolutely overwhelmed.

The previous speaker talked about access in the order of 12 to 18 months. This has been our experience as well, even though we have supported him as a family. As I said, we are well resourced, and his mother, in particular, is fierce in her protection of him.

We started to notice his erratic behaviour when he was around 15. For three or four years, we really did not know what it was, in spite of taking him to various health care experts. When he went off to university, he had his first diagnosed psychotic break. If members know anything about schizophrenia, they know that when one is recovering from that psychotic break, one never regains everything. Over the years, he had a number of psychotic breaks, and each time, he did not fully come back.

The observation is that when one is around 40 years of age, that is as good as it is going to get. One neither gets any worse nor certainly any better. He fills the definition of somebody who has an irremediable condition. It is medically diagnosed, and he has had episodes where we had the police there and things of that nature. Fortunately, as I said, his mother is a fierce advocate for him, and we have been able to stabilize his housing. He is well housed and well fed, which has not always been the case. However, at this period of his life, he is stable.

Over the course of these 25 years, we have made some observations of the system. The first observation is that it is overwhelmed. If the general health care system in Ontario is at its maximum stretching point, the health care system is always stretched beyond that point. I will not say it is broken, but it certainly is stretched.

This is not a condemnation of the people or the personnel who are in the system. They are good-hearted, overworked and exhausted. It is the patients who suffer. I do not have a great deal of faith, based on my observations, that one year from now somehow we will have a better system than we have today. My guess is that it will be closer to generations.

One of my hon. colleagues from the NDP raised the issue of poverty, homelessness and all the other issues that people face. Again, it has been our observation that we as a family have been able to shield him from a lot of things that mental health patients face on a daily basis, such as how they are going to eat, where they are going to sleep, all that sort of stuff.

Therefore, from time to time, it appears that ending one's life is an attractive alternative. I fear that, primarily for those people who are not well resourced and not well shielded from the vagaries of life, who have no job, no relationships and a limited appreciation of their own reality, it would be an attractive alternative to end their life, and that will be made available to them and, I dare say, available a little too readily at times.

These are observations we have made over 25 years. We have made them in the context of a family trying to support someone who would fall within the specific categories that are delineated in the legislation. We frankly have no real faith that this might not be an alternative for our son. That would be tragic for us all because it would not be a death in isolation.

I would also make the observation that we are long on talk in this place and short on resources. We talk about fixing the system. We talk about making resources available. One can pretty well go back through the speeches in Hansard for the last year or two years or five years or 10 years, and each incident of legislation comes with a promise of resources. I wish that were true, but it is not. In our observation, it is only getting more challenging.

In some respects, this legislation is a way out of doing what we need to do to facilitate the health care challenges of our most vulnerable citizens. While I will, with colleagues, support this legislation, I frankly do not think things will change in a year. It may be that they will change in 10 years. I think this is the kind of timeline and horizon that we would be realistically looking at in order to deal with people who would fall within the specific delineated categories as set out in this legislation.

[Lori Idlout, NDP, Nunavut, NU]

Uqaqtittiji, I would like to thank the member for his thoughtful intervention. This is indeed a difficult debate because we are talking about something that is inevitable for all of us. The difference is ending suffering and how some people have the privilege to die with dignity while others have no choice but to feel like ending their lives through suicide.

This is a very difficult question or debate. We want to talk about ensuring practice standards that meet everyone's needs, so mental health issues are addressed and people with mental illnesses also get the help they need. Given his experience with someone with mental illness, could the member talk about how this kind of discussion needs to be opened up in the next year?

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I thank the member for an excellent question that centres on the issue of practice standards.

I have no doubt that, particularly where I live in the east part of Toronto, we have the highest-quality practice standards. However, there can be the highest standards and most qualified people in the nation, but if they are overwhelmed by virtue of people being in the system because of the circumstances in which they live, no amount of practice standards will get them out of that.

My focus would be on relieving the suffering by helping those people so that they do not find themselves contemplating this alternative.

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

Madam Speaker, I am not really posing a question. I just have a comment.

My friend from Scarborough—Guildwood is a dear friend and someone I have looked up to for many years. I want to thank him for sharing his very personal experience with us. I know it is something that he has shared on a number of occasions and in a very public way. I think it is important that we all understand that we have people in our lives who are deeply impacted by mental health issues.

As government moves forward on this, that is always something the minister, as well as the government, will continuously evaluate and undertake. I really do want to thank him for sharing his very wise comments with us today.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I want to thank the hon. member for his intervention. We are at a watershed. This legislation kind of fixes the problem. We could pass it or we, as a society, could be serious about the under-resourcing of those who are most vulnerable. I dare say that we are going to try to legislate our way out of this instead of trying to resource our way out of it.

[Blake Desjarlais, NDP, Edmonton Griesbach, AB]

Madam Speaker, I want to thank my hon. colleague for what I think is an important intervention.

I will agree with him in some part that this is an important moment for Canadians. Hopefully, this bill allows us the time to contemplate what the important steps will be to ensure that we listen to community members. This means not only those who are suffering from mental illness but also those who are combatting poverty and their contributors to it. Then, we can actually have a chance to do this work during this period and do the things that we need this law to do to ensure that vulnerable folks do not fall victim to an easy way out.

Could the member ensure that the government works hard to do the consultation, talk to those folks and make sure that there are pathways before this becomes the decision they do not have to make?

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, I think the hon. member raises an interesting point, and I do not know whether we are agreeing or disagreeing, frankly. I just do not have the faith that a year from now things will change greatly. Where are we? We are still under-resourcing the system, and we are still not providing the care that these folks need. Members can walk down Bank Street on their way home tonight, and there are a lot of people there who are pretty far gone. I just do not think we have the will, as a nation, to do much beyond providing legislation, and we think this is somehow a way out. Maybe it is. I do not know whether I agree or disagree, but I do not have that faith.