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

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, I believe that we should be viewing mental health in parity with physical health. Yes, there are a lot of different things that contribute to one's mental health, such as affordability, access to food and homelessness. We should be making sure that we are doing everything to raise people up and offer the supports that they need. First and foremost, the government needs to follow up and actually follow through with its mental health act promise that it made during the previous election.

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

Madam Speaker, I want to thank our hon. colleague from Cariboo—Prince George from the bottom of my heart for the work he has done in this place for people who are suffering from mental illness and who are feeling suicidal ideation, and on the need for the ability to get that 988 number. I know how heartfelt his engagement is on this.

I will also be voting to see Bill C-39 through, but I probably differ from my colleague on the question of at what point do we say there has to be, with proper protocols and rules, access for people to medical assistance in dying. Is the member open to considering at some point, if there were a medical consensus on this, that we should proceed to extend to mental health issues as well?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, that is a tough one for me. I would have to actually work with the experts who are out there. Right now, as it sits, I could never support medical assistance in death for those who are struggling with mental illness because I believe recovery is always possible.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, it is always a pleasure to rise in the House. Of course, speaking on issues as weighty as medical assistance in dying, these are perhaps some of the most difficult things we will speak of in the House. I note that this is going to be an issue I am sure we will face in the chamber over the next several months, and perhaps again, as the bill comes to pass.

Today we are talking about mental disorder as the sole underlying medical condition for Canadians to access medical assistance in dying. The bill is presenting legislation for a one-year delay. Why is the government asking for a one-year delay? Certainly, this is about the concerns Canadians have across this great country with respect to the presentation of the government.

Perhaps, it will be similar to Bill C-21, when the issues Canadians had were brought forward by the Conservatives, and the Liberals had to change position on that bill. We know that there are mental health advocates who have significant concerns about the bill, such as the Association of Chairs of Psychiatry, which brought forth issues related to mental disorder as the sole underlying medical condition.

One of the things that is germane is to help people understand what it is we were studying at the joint committee on medical assistance in dying. We were talking about mature minors. We were talking about advance requests. We were talking about Canadians with disabilities. We were talking about the state of palliative care in Canada, and we were talking about Canadians who suffer with a mental disorder. When we looked at these particular topics, there were many contentious issues, and it became heated and personal at times, which was perhaps as it should be.

For comparison, I think we need to understand that, when we look at Canada and its perhaps 38 million people, we know that in the last year, 10,000 people died from medical assistance in dying. In California, which has a very similar population and perhaps similar rules, there were only 400 deaths due to medical assistance in dying.

People might ask why we would not compare with the Netherlands. It has been at this for a while, and maybe it is a better representation. They have a population of 17 million people and about 5,000 people died to medical assistance in dying.

They already have statutes that include depression, dementia and all the other things I have mentioned previously, so if we wanted to compare that directly to Canada, including depression and perhaps advance requests, they would have about 10,000 deaths at the current time. We know that in Canada, without mental disorder and without advance requests, there are already 10,000 people who have died between 2020 and 2021 due to MAID. That is a year over year increase of 32%.

That, to me, is concerning, and I think that anybody in this chamber would also know that on the world stage, sadly, in my mind anyway, Canada has been a world leader in medical assistance in dying, and many countries around the world have brought forward concerns of the slippery slope that Canada is now going down.

One of the things the government has promised to Canadians, which they have not delivered upon, is the Canada mental health transfer, and I am sure that my hon. colleague just before me spoke about this, so I am sad to have missed it. That was a $4.5 billion transfer that was promised by the government in its platform in the last election. I read a new article about this, and it says, “in August 2021, Prime Minister Justin Trudeau said this brand new transfer was needed”—

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Madam Speaker, on a point of order, in his speech, the member called the Prime Minister by his first name.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I think the hon. member may have just caught himself as well. Although the hon. member may be reading a quote, he can just mention “Prime Minister” instead of mentioning the name.

The hon. member for Cumberland—Colchester.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, I thank you for that astute advice. I really appreciate it.

This article said, “because mental health should be a priority.” That is the article I am quoting, which has the Prime Minister's name. It is important that Canadians understand that.

“But despite the sense of urgency in [the Prime Minister's] remarks last year,” and I have changed that word to satisfy the chamber, because we all know who the Liberal Prime Minister is, “no money has yet materialized for this new Canada mental health transfer”.

I am going to say that again, just to make sure that everybody has heard it. No money has yet materialized, “including an initial $875 million that was supposed to have been spent or budgeted by now, according to the Liberal party’s 2021 election platform.”

“The Liberal platform document included a line-by-line costing of all its election promises, and it outlined a promise to spend $250 million in 2021-22 on the new mental health transfer, and then $625 million in the current 2022-23 fiscal year, with additional amounts over the next three years adding up to $4.5 billion total.”

“None of the promised spending over the last two fiscal years has yet been allocated or spent.”

To me, that is important. Again, I will quote from the Liberal Prime Minister, “because mental health should be a priority.”

Where is the priority of mental health, and why is it not materializing?

We know that my hon. colleague, who spoke just before me, talked incessantly about a three-digit suicide prevention hotline, which was harder than giving birth to a baby elephant to make it happen. It is absolutely shocking to think about how the government wants to talk about being helpful to Canadians and how it has their proverbial backs, etc. I just do not see that. That is absolutely atrocious.

This article goes on to talk about the national director of public policy for the Canadian Mental Health Association, and they pointed out that the “April budget contained no money earmarked for this new transfer.”

“Let’s be clear, for it not to be in Budget 2022, at least with a timeline of ramp up to the $4.5 (billion), you know, it was really concerning to us.” That was stated by the Canadian Mental Health Association.

After eight years, why does the government continue to fail Canadians? That would be a great question to know the answer to.

We also heard in the health committee last week that counsellors and psychotherapists are required to charge GST on their services. We know that, sadly, many Canadians do not have private coverage for those services, but to add insult to injury, to pour salt in a wound, what we are now requiring is for Canadians to pay GST on those services. How does that make any sense?

It goes on to say that, “psychiatrists across the country [are] 'incredibly concerned' about patients needing better access to care, including addiction services”. These are addiction services that the government would tout are a whole other kettle of fish and are quite shocking.

There is still controversy around providing medical assistance in dying for people with mental disorders among providers. Obviously, one of the other things that I think is very important is the fact that the government has not transferred any, zero, nada, zilch, of the $4.5 billion. Think of my riding of Cumberland—Colchester and the difficulties that rural Canadians are suffering.

Because of their geography, rural Canadians are struggling not only to get access to mental health, but also to put gas in their cars to get them to the actual appointments. The punishing carbon tax that the government wants to put on everything in this country is really affecting their ability to have the money to pay the extra GST required for counselling and psychotherapy.

We all know that if people are struggling to put food on the table, and if Canadians have to choose between eating and looking after their mental health, they are likely going to choose eating. This is a sad commentary on life in Canada where it appears that everything is broken. The sad commentary will continue in this country because of the punishing taxes the government wants to continue levying on Canadians, which is making life unaffordable.

We know the crisis in mental health is going to continue. It would appear that approximately one in three Canadians is struggling with their mental health. We know that the government has put out its own projections to say, if we read the report on departmental results, it would expect that 22% of Canadians would not be able to access mental health care, and the actual result is 25% of Canadians cannot access mental health care. This is unacceptable. Zero percent of Canadians should have this issue, and we have a government that thinks 25% is acceptable.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, we have been hearing a lot of very disturbing news items about people who are living in poverty. A lot of them are people with disabilities. A lot of those people have mental health issues, and they are considering MAID because they cannot afford to live in dignity.

I am wondering if the member would join the NDP in saying that those people should have the resources to live in dignity, whether they are living with disabilities or not. They would need the resources to buy food. They would need affordable housing.

Would the hon. member comment on that side of the problem?

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, first and foremost, I will not join the NDP. That certainly is something I would not entertain.

What we do know is that Canadians are suffering significantly in this country. How we go about solving that problem is certainly an issue that would be a matter of debate for many years here in the chamber.

We know that Canadians around the country are looking at the Conservatives and saying they need a change in the government. They know that the Conservatives have ideas that are going to allow Canadians to make their own money, to spend their own money in the way Canadians think is desirable and to be a part of the greatest country in the world. That is how Conservatives would do that.

[Monique Pauzé, Bloc, Repentigny, QC]

Madam Speaker, I listened to three or four speeches, and members seem to be talking a lot about the idea that we need good mental health care, that we need psychologists and psychiatrists, that we need to help people before considering the option of medical assistance in dying for people with mental illness. For all that to happen, we need more money in the health care system. There was a meeting about improving health care last week, but the offer that the federal government put on the table was shameful. The leader of the official opposition said that he would honour that offer. It seems to me that everyone agrees that better mental health care is needed, but that means that the government needs to increase funding for the health care system.

I would like to hear my colleague's thoughts on that. I think his party should be calling for more health care funding.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, I thank my colleague for that great question.

We know, very clearly, there are multiple ways to fix the health care system. Certainly those would be rolled out, as we come closer to election time, in the platform of the Conservative Party. What we also know is that people who want to immigrate to this country to be a part of the health care system are being disrespected in terms of how their credentials may or may not be recognized in this country.

As everybody in the chamber knows, if we were going to create another psychiatrist from inception, at the time of going to university, there is a four-year undergraduate degree, four years of medical school and at least four years of residency. We cannot wait for that.

On this side of the House, when the Conservatives form the government, we would be very respectful of immigrants and the talents they bring to this country, and how they could help the ailing health care system.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Madam Speaker, I have been sitting on the special MAID committee with the member for some time, and I appreciate his contribution.

I take issue when he said that the conversations have been heated and personal. I do not remember it being that way. There were passionate discussions, but it was certainly never personal. I hope he did not find that I ever contributed to that impression.

We can disagree all day long on whether the government has been making mental health funding a priority. He has made a point of talking about the mental health transfer. If the mental health transfer had happened yesterday, is there any scenario in which the member would agree that mental health is appropriate grounds for MAID, or is it just full stop for him?

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, I do not recall my hon. colleague making anything personal in the MAID committee, so I am thankful for that.

There is one thing that is very important. We can talk about scenarios, what-ifs, therefores and plausibility, but let us be clear. What we know is that the Liberal government committed $4.5 billion to fund the Canada mental health transfer, and it sent none of it, zero, zilch, nada.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, it is important to outline what we are talking about here today: Bill C-39. Currently, due to Bill C-7, the Criminal Code explicitly states that, when it comes to MAID, mental illness is not to be considered an illness, disease or disability. However, when Liberals passed Bill C-7 two years ago, it had a sunset clause, and this is an important clarification. That means an important guardrail protecting those with mental illness from being eligible to seek MAID during times of depression or other crisis would expire two years after that bill passed, which means it is set to expire next month.

Now the Liberals, having heard the outcry from across the country, from the medical community and those serving the folks with mental illness, have introduced Bill C-39. This is a last-minute attempt to save face by extending the prohibition on MAID for mental illness for one more year. That is not good enough.

Conservatives have been united in our opposition to expanding the Liberal government’s medical assistance in dying regime to Canadians with the sole underlying condition of mental illness. We do not believe that medical assistance in dying is an acceptable solution to mental illness and psychological suffering. Our health care system should help people find hope when they need to live and not assist in their deaths.

Allowing MAID for people with mental illnesses such as depression blurs the line between suicide assistance and suicide prevention. Experts have been clear that expanding eligibility for medical assistance in dying to Canadians living with mental illness cannot be done safely. It is impossible to determine the irremediability of an individual case of mental illness.

For example, Dr. Sonu Gaind, who is the physician chair of the MAID team at the Humber River Hospital in Toronto, where he is chief of psychiatry, states, “I know that some assessors think they can make those predictions of irremediability in mental illness, and some assessors think they can separate what we consider traditional suicidality from what’s fuelling psychiatric MAID requests. And on both counts they’re wrong. The evidence shows that.”

Andrew Lawton, Canadian columnist and journalist, wrote a harrowing personal article two years ago, stating:

If Bill C-7 were the law of the land a decade ago, I’d probably be dead....

In 2010, I nearly succeeded in committing suicide. My battle with depression was worsening, and I was losing. Miraculously, I pulled through: I count my lack of success in that attempt as my happiest failure, for which I’m grateful to God’s intervention and a team of dedicated healthcare practitioners.

It’s saddening to think that under different circumstances, these practitioners could have been the ones killing me rather than saving me....

Bill C-7 undermines years of attention and billions of dollars of funding to bolster mental illness treatments and supports, including, ironically, suicide prevention and awareness campaigns and programs.

This bill kills hope and reinforces the flawed belief afflicting those with mental illness, that life is not worth living and that one’s circumstances cannot improve.

Every time I have risen to speak on these bills, that has been my emphasis as well: Life is worth living. Every life has dignity and value. We need to be far better as a nation at communicating that to those who need to hear it the most.

Two years ago my friend Lia shared her story with Canadians. She said, “I was 15 when I first tried to kill myself and I attempted suicide seven times in the years that followed...I’m speaking about my mental health struggles because I’m scared that doctors could soon be able to end the lives of people suffering with mental illness - people like me. To be honest, if medically assisted suicide had been available when I was in university, I would have used it to end my suffering as soon as I could.”

This is Lia's call to parliamentarians: “I don’t need someone to tell me how to die, I need someone to tell me to stay.”

The House should be writing laws that instill the value of life and that there is no question this is what we value. Laws need to encourage people to stay rather than seek to end their lives.

Dr. John Maher is an Ontario psychiatrist and editor-in-chief of the Journal of Ethics in Mental Health. Dr. Maher has highlighted that the wait times for mental health treatment in Ontario programs are up to five years long, and that one of his patients recently told him that he would like assisted suicide because he believed that nobody loved him.

Dr. Maher also rejects assisted suicide as a solution for mental illness by stating the following:

You're assisting someone in the completion of their suicide. The doctor is the sanitized gun...I'm not at all disagreeing that there are people who have an irremediable illness. What I defy you or any other person in the universe to prove to me is that it's this person in front of you.

The suicide prevention community has also pointed out the harsh reality for costs. Shawn Krausert, the executive director of the Canadian Association for Suicide Prevention, testified at committee and said the following:

Ending the life of someone with complex mental health problems is simpler and likely much less expensive than offering outstanding ongoing care. This creates a perverse incentive for the health system to encourage the use of MAID at the expense of providing adequate resources to patients, and that outcome is unacceptable.

Most Canadians do not support expanding MAID to those with mental illness as the only underlying condition. Today, a survey was published in which a mere 30% of Canadians support MAID for those who have a mental illness.

I can assure members that, among my constituents, that number is far lower. The vast majority of my constituents want the federal government to focus on helping people live well and to invest in palliative care and suicide prevention instead of assisted suicide.

Some of the petitions I have tabled here over the years were sent to me by constituents who have recognized that suicide is the leading cause of death for Canadians between the ages of 10 and 19. They are specifically calling on the government to protect Canadians struggling with mental illness by facilitating treatment and recovery, not death.

I agree with my constituents, and the majority of Canadians, that the government should withdraw this bill entirely and table a bill that permanently removes the extension and expansion of assisted suicide for mental illness when it is an underlying condition.

I want to end with some words from my friend Lia. She says:

I want to say right now, to whoever might need to hear this: death doesn’t have to be the answer. It takes work. It takes time. It takes others. And it's complicated. But there is hope...I’m sharing my story because I’m not the only one who has more to live for. There are people in your life who do too. As someone who struggles with mental illness, I don’t need someone to tell me how to die. I need someone to tell me to stay.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I thank my colleague for his effort.

That said, if Bill C-39 were withdrawn, on March 17, mental disorders would not be excluded from medical assistance in dying. It is important to know what we are talking about.

Also, I do not know on what authority my colleague can claim that he would have had access to medical assistance in dying, given that the expert report clearly states that no expert on the planet considers suicidal ideation to be irreversible. Therefore, even if he was thinking about suicide, he would not have had access to medical assistance in dying.

What makes him say that he would have had access to MAID?