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

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, absolutely we need to support individuals. We know that in the recent health care proposal from the federal government to the premiers of the provinces, there was no mention of mental health care support. That is very unfortunate. The Liberals had a wonderful opportunity to expand on and incorporate it into the funding they were providing to the territories and provinces and they chose not to do that.

In addition, with respect to providing supports for folks suffering from a mental health crisis, we know that the cost of living has become a huge burden for individuals and has intensified their feelings of hopelessness and exasperation. Under the Liberal government, we have seen the cost of living increase significantly, and we are going to see it increase more with its proposals for additional taxes.

[Chad Collins, Liberal, Hamilton East—Stoney Creek, ON]

Madam Speaker, I listened with great interest to the last answer, and I have a question on it. We have heard in many speeches today by the opposition that it is all about supporting people, yet every time our government has provided supports, whether it was the one-time income support or assistance for housing, the members opposite have voted against those initiatives. I am not certain how they can have it both ways by suggesting that we need to be there for people in their time of need.

Why do opposition members continue to vote against the initiatives put forward by the government that are helping the very people they are referencing in their speeches today?

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I thank the member for Hamilton East—Stoney Creek for that really good question.

On the surface, it might appear as though we are not supporting the people he made reference to, who need the help I spoke about in my speech. However, that is not the case. What we want to do is give people their freedom back, like the freedom to make choices, which the Liberal-NDP coalition has taken away from them. We want to give people back the freedom to pay for gas and buy the food they require for their children, rather than relying on food banks and skipping meals. We want to give people their lives and their freedom back, which would be a huge asset to their mental health. That is why we as Conservatives have been opposing the reckless spending of the Liberal government.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Madam Speaker, in the opening part of his speech, my colleague said that he would be voting in favour of extending the deadline by another year. Is he optimistic that in that one year the government will be able to develop regulations, safeguards and guidelines to assist the medical profession in the responsible application of medical assistance in dying?

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I partially answered that question in my speech. I am voting in favour of Bill C-39, which will provide for an extension of one year. I think the government needs to sit back, take a pause and listen to what the experts and Canadians are saying. Is this legislation they really want? Is it something we should move forward with?

I hope the government takes the time to reflect on this. Based on the comments the Minister of Justice has made in this House and in the media, I am not optimistic that he is going to do that. I think for him this is a one-year delay of his plan of implementation to provide MAID to people who are suffering with mental illness. I hope he takes the time, together with his party, to re-evaluate moving ahead with this legislation. In fact, I hope they stop it, because it is wrong.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Madam Speaker, there is something very broken in Canada today. I could talk about inflation being at 40-year highs. I could talk about interest rate hikes in the last 12 months that are doubling the average mortgage payments and making residential rental rates out of reach for many workers in Canadian cities that need workers. I could talk about the housing affordability crisis and I could talk about crime. We have talked about these things.

We are now learning in recent polls that two-thirds of Canadians feel that Canada is in fact broken. One of the pillars of our society they feel is broken is our health care system. Canadians used to be proud of our universal, world-class, leading-edge health care system. Now people wait for hours for emergency care and months for specialist appointments.

This does not line up with the view that we as Canadians have of ourselves as a prosperous nation. There is indeed something broken, and nowhere is this more evident than in our mental health care arena.

We are in the midst of a serious opioid crisis right across this country, and certainly in British Columbia, my home province. Decriminalization, safe supply and anti-stigma campaigns have had, at best, very little positive effect. At worst, they have contributed to the skyrocketing number of opioid deaths in the last eight years. Clearly, what the government has been doing has not been working.

It is in this environment that we are now, as parliamentarians, talking about whether MAID, medical assistance in dying, should be made available to those whose only underlying health condition is a mental illness. Indeed, there is something broken.

There was a time when those suffering a mental illness got the help they needed. I want to note an editorial that ran in last weekend's Vancouver Sun by editorial writer Douglas Todd. He writes often but not often about himself or his family. This is a very personal story.

When Mr. Todd was a young man, his father Harold, a World War II vet, was diagnosed with schizophrenia. He spent many stable years in metro Vancouver's Riverview Hospital, where he received three meals a day, where he was kept safe and where nurses administered and monitored his medications. He was stable. Riverview was not perfect but it kept Harold off the streets.

Harold died 23 years ago, according to the story, right around the time that the provincial government started taking the view that hospitals and boarding houses for the mentally ill were inhumane and paternalistic, and that patients with mental illness should not be out of sight, out of mind, but should be allowed to live in a community. These facilities have been largely wound down and replaced with nothing, which has led to disaster.

The younger Todd noted that last year alone, 2,272 British Columbia residents died of toxic street drugs. He says this: “If my dad had not had stable housing, he would have been vulnerable to such a fate.” That is where mental health is in Canada in 2023.

That brings me now to the question of recovery and the incurability of mental health issues. A number of my colleagues have spoken about that.

A member of my community shared with me a chilling story of how her daughter struggled with her mental health years ago. Through a proverbial turn of events, she happened upon a hospital during a serious bout of suicidality. My constituent is confident that if her daughter had been offered MAID in the hospital that day, she would have agreed to it. Instead, she found hope for a better tomorrow and access to real support. She has now recovered and is living a full life as a wife, mother and member of our community.

This question of possible recovery is one that experts disagree on. What constitutes irremediability for mental illness? When is a mental illness incurable and how do we discern that? Our special joint parliamentary committee on MAID looked into these very troubling questions. One witness shared that he likely would have chosen MAID in his darkest days but now has a rich life with successful medication and therapy.

Dr. Vrakas gave the opinion that for people struggling with mental illness, offering MAID to them is a “clear signal of disengagement from mental illness”.

Dr. Sareen from the Association of Chairs of Psychiatry said in December 2022 to the committee that, “We're in the middle of an opioid epidemic. And we're in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are the highest ever.”

We cannot pretend that patients have a free choice between MAID and treatment when treatment is simply not accessible.

However, no consensus has been reached about such pivotal questions as: can this person be cured? There is a huge risk in assuming that they cannot. The reality is, providing MAID to a person suffering from mental illness is an irreversible reaction to a condition that we do not know is incurable.

Dr. Maher summed this up perfectly in his testimony to the committee when said, “The rallying cry is autonomy at all costs, but the inescapable cost is people dying who would get better. What number of mistaken guesses is acceptable to you?”

Dr. Mishara added that he has personally known countless people who have “convincingly explained that they wanted to die to end their suffering and are now thankful to be alive. If you proceed to allow MAID for persons with a mental illness, how many people who would later have been happy to be alive are you willing to allow to die?”

There are, of course, experts on the other side of the debate who assure us that we can discern between people who apply for MAID and people who suffer from suicidal ideation; experts who believe that, when a person is depressed and can see no brighter future, we should not try to change their mind by offering care, medication and therapy.

However, I am confident that this lack of consensus alone should be enough to definitively say no, that expanding MAID to those whose only underlying condition is mental health is not a responsible public policy choice. Instead, let us fix our health care system. Let us see this government deliver on its forgotten promise to fund mental health. Let us open or reopen our assisted living homes for people suffering from mental illness. Let us take care of our mentally ill people. Let us give hope for a better tomorrow and the support needed to live through today.

The very narrow question that we are addressing today is whether we will vote in favour of a bill that would extend the deadline. The government has a two-year deadline. That time has come and gone. I think March 17 is the deadline, which will soon be upon us. Do we give ourselves another year to develop the guidelines, regulations and safeguards to make sure that MAID for mentally ill patients is administered in as responsible a manner as possible?

To be honest, I am torn on this. I voted against MAID in the first place, but like my colleague, I will be voting in favour of this, because I am optimistic that we can at least come up with regulations that will put safeguards in place to manage this very troubling public policy question.

[Lori Idlout, NDP, Nunavut, NU]

Uqaqtittiji, my question is on a topic that the member did not really speak to, but he is from British Columbia and is aware of the huge indigenous population in British Columbia.

Does the member agree that there need to be provisions or regulations added to make sure that indigenous peoples are protected better, especially in the mental health care system, which does not recognize broadly enough their culture and the need for reconciliation? Mental health services need to be unique and more tailored for indigenous peoples. I wonder if the member can share his thoughts on that.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Madam Speaker, yes indeed I would completely support the government doing whatever is necessary to make sure that indigenous people, and indeed all Canadians, receive the mental health care that they need.

I gave the example of Mr. Todd's father, which I think is just a great example of where Canada used to do this much better, but for some ideological reason, we have abandoned that. It is a disaster.

I am very sensitive to the fact that indigenous people are disproportionately represented in the Downtown Eastside of Vancouver. People suffering with their mental health need to have the care that is necessary for them to recover. Additionally, I have worked with the Kwantlen First Nation community in my riding to help them develop culturally sensitive seniors housing, seniors care, because I recognize that is absolutely necessary.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Madam Speaker, just over a year ago we had an election campaign, and in the Liberal platform there was nothing about the extension of medical assistance in dying for people with mental illness. What there was in the Liberal platform was a very clear promise to fund a Canada mental health transfer, $4.5 billion over five years, of which it is very clearly laid out, and I think it is on page 75 in the costing document, that by now almost $1 billion was to have been transferred already. We have not seen a cent of that almost $1 billion that was to have been transferred.

I wonder if the hon. member could speak to that disconnect that has a Liberal government that is not fulfilling its own promise to properly fund mental health but instead has moved forward and now is needing to pause, having moved forward on extending medical assistance in dying to people with mental illness.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Madam Speaker, indeed Canadians are disappointed the government has failed to deliver on its promise to fund mental health to the extent that it is necessary, and they are doubly disappointed now the government is now talking about expanding medical assistance in dying for mentally ill people. They need help; they do not need assistance in dying.

[Blake Desjarlais, NDP, Edmonton Griesbach, AB]

Madam Speaker, I asked my Conservative colleague, who spoke just prior to this colleague of mine, the same question I will ask him. It is in relation to trying to deter one of the main contributors to the mental health crisis in Canada, and his colleagues have mentioned this all day, which is poverty.

New Democrats have tabled a solution, which is a guaranteed livable basic income. I understand the Conservatives might disagree with that, but what solutions can the Conservative Party offer, and not criticisms but solutions, to ensure those who are most vulnerable, those living in poverty and those who do not have the means to survive actually have that support so they can live with dignity?

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Madam Speaker, what is not the solution is to allow mentally ill people to live in tent cities or in squalor in some of the single-room occupancy hotels in the Downtown Eastside. This is terrible. The government is funding those homes, but it is inadequate. It is just slightly better than living in a tent. I completely agree that—

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

We need to resume debate.

The hon. member for Fundy Royal has the floor.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I appreciate the opportunity to speak here today to an important bill.

We have to ask ourselves: why are we here this evening debating Bill C-39? What brought us to this place?

What brought us to this place was a government, once again, that had acted completely irresponsibly and with great overreach, ignoring the experts, ignoring Parliament and ignoring the most vulnerable.

We will back up a little bit. Bill C-7, which expanded medical assistance in dying in this country, went through the House of Commons and went through our committee, the justice committee.

Accompanying any piece of government legislation is a charter statement from the Minister of Justice and Attorney General of Canada. A charter statement is the government's certification that the legislation complies with our Canadian Charter of Rights.

I want to read, just briefly, from that charter statement. The minister's charter statement stated, for Bill C-7, that it excluded individuals with mental illness from eligibility to access MAID, because of:

the inherent risks and complexity that the availability of MAID would present for individuals who suffer solely from mental illness. First, evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error, in relation to persons who suffer from a mental illness serious enough to ground a request for MAID.

At the time, the minister said that there was not the public support nor was the infrastructure in place to allow medical assistance in dying for individuals whose sole underlying condition is mental illness.

The bill, Bill C-7, then goes to the Senate, the unelected Senate. The Senate amends the bill to include mental illness with no safeguards, no accounting for the fact that it was an extreme broadening of Canada's MAID legislation and would, in fact, lead Canada to become an outlier.

That bill came back to the House and was passed by the government, with the opposition from our Conservative caucus members. Conservative parliamentarians were strongly opposed, because we knew that MAID should not be expanded to those who are suffering with mental illness.

When we are reaching out to those who are struggling, for example through Bell Let's Talk, and I see members of Parliament posting that on their social media, the terrible message that it sends is that we as a Parliament think that, for those suffering with mental illness, offering them death should be an option.

One may say, well, that is not what this is about. Unfortunately, that is exactly what it is about. It is already happening. Many of us were horrified to hear of bureaucrats from the Canadian government in a department to which we entrust vulnerable veterans, veterans suffering with post-traumatic stress disorder. Can one imagine the family of a veteran who goes to Veterans Affairs for help and, without even mentioning the issue, is offered the opportunity to explore medical assistance in dying, when they are suffering from PTSD?

Imagine how that would make one feel, for someone who is struggling and who is trying to stay motivated to stay alive. The Minister of Veterans Affairs said that this was a one-off, that this was just one problematic situation.

Unfortunately, we found out that it was not a one-off and that it had happened many times, an untold number of times. We do not know how many times it happened. This is before medical assistance in dying is officially expanded to those suffering with mental illness.

Why are we here today? We are here because the Minister of Justice supported this and pushed this forward in spite of, we know, the Liberal caucus members who are very uncomfortable with this, because they know it is wrong.

Just today, we read an article saying that only three in 10 Canadians support the idea of allowing patients to seek MAID based purely on mental illness. Seven in 10 Canadians, the constituents that these Liberal caucus members represent, do not support this going forward.

The Minister of Justice said, in the same article, “To be honest, we could have gone forward with the original date, but we want to be sure. We want to be safe. We want everybody to be on the same page.”

The government is saying that it needs everyone to think like it does and that everyone needs to warm up to the idea. We do not accept that. We are going to continue to fight for the most vulnerable. This is happening right now in Canada. It is very upsetting for many of us.

Then we read, in the same article, of a report that noted that an Ontario man recently made news after he requested MAID, not because he wanted to die, but because he thought it was a preferable alternative to being homeless. A disabled Ontario woman also applied for MAID after seven years of applying for affordable housing in Toronto with no luck.

The abuse of this system is happening in real time. It is happening now. Because of the passage of the amended Bill C-7, we were set for next month to have, without any safeguards, those suffering from mental illness be eligible for MAID. Bill C-39 is the government's attempt to kick this down the road another year.

Where have we seen these U-turns? We saw them with Bill C-75 on bail changes. The government overstepped, and now it is reversing course. On the gun legislation, the government realized there was a big overreach, and now it is time to climb down from that.

Canadians suffering with mental illness deserve better. They deserve a thoughtful approach. I stood in the House not long ago, back in October 2020, and Parliament was observing mental health week. Unfortunately, at that time, parliamentarians did not know that the Liberal government would soon include mental illness in its planned expansion.

The point in that speech was that one of the key foundations of Canadian society, in our collective identity, is that we are a caring and compassionate country. Canadians, many in this chamber, do not see anything caring or compassionate about making people who are living with mental illness eligible for medically assisted death.

What message does it send to Canadians who live with mental illness? They are not people who are at the end of their lives. These are not people who would otherwise die. Why is the Liberal government pushing to include them in its medical assistance in dying regime?

The president of the Canadian Medical Association said, “We have a responsibility, we believe, as physicians and as society, to make sure that all vulnerable Canadians have access to proper care and the support they need.” I listed two scenarios, and we all have these scenarios in our ridings of individuals in need who are not getting the help they need.

If we have not succeeded to make sure that every Canadian living with mental illness has access to timely mental health care or adequate support, how is it that the government and the minister were comfortable in proceeding with broadening medical assistance in dying in such a radical way to take effect next month? All this despite the fact that this radical expansion of MAID was passed in early 2021. Conservatives have not given up the fight to do what is right and to protect vulnerable Canadians. We will not give up that fight.

The government failed to conduct a mandatory review of its own MAID legislation. That was supposed to happen, and it did not happen. The minister was to complete a charter statement. He did that on Bill C-7. The Bill C-7 charter statement very clearly rationalized why individuals suffering with mental illness were not included in Bill C-7. That is how they arrived at the constitutionality of the bill.

With this massive change, we do not see the updated charter statement. We do not hear the minister talking about the charter rights of those who are suffering. This is remarkable because the statement was written over two years ago.

A few days ago, more than 25 legal experts signed a letter addressed to the Prime Minister and members of the cabinet, challenging them to do better on this.

This expansion is wrong. Conservatives will support extending the coming into force by this year, but in that time, we will not give up the fight to protect the most vulnerable.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, the government has said that its approach is to try to eliminate from consideration those who are suicidal. In other words, those who are suicidal cannot have MAID, but those who are not suicidal can have MAID.

On the face of it, this does not make any sense, because by definition a person who is seeking suicide, facilitated through the medical system, is suicidal. The government is trying to make distinctions between concepts where no real distinctions exist.

The reality of the government's policy is that people who are experiencing suicidal thoughts and mental health challenges will be able to go to the medical system, and they will be facilitated in that by the medical system.

Would the member have a comment on the wordplay, the misrepresentation being used by the government to mask what is truly going to be the reality under its program?