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

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

Mr. Speaker, today we are talking about Bill C-62, a bill necessitated by the Liberal government's total mismanagement of the medical assistance in dying, or MAID, regime.

The first example of the mismanagement is the government's failure to appeal a lower court decision that mandated Parliament to expand MAID beyond what it was initially intended to be. This lower trial court ordered that Parliament delete the reasonable foreseeability of natural death requirement for applicants of MAID. The Supreme Court of Canada should have been asked to weigh in on this very important topic, particularly since the law that was being challenged had, just a few years ago, been written by this Parliament in response to a Supreme Court of Canada decision, the Carter decision, which started this whole conversation.

The second example of Liberal incompetence was that they accepted the reckless addition by the Senate of mental illness as a sole underlying condition for MAID qualification. It is clear from expert testimony that there is no consensus in the medical or the psychiatric fields of what “irremediable” means when it comes to mental illness. However, it was certainly clear a year ago when a similar bill, Bill C-39, was before the House for debate to extend the deadline for one year. Here we are at the end of that one-year period seeking another extension, and it is even truer today that there is no consensus, which is why we are here today debating what is now going to be a three-year extension.

Bill C-62would extend, by three years, the deadline for expanding MAID to include people whose only underlying health condition is a mental illness. Now, just like we supported the one-year extension a year ago, we will support this three-year extension, because it is better than the alternative, which would be a disaster for Canada.

I would note that this three-year extension brings us beyond the next election, which must happen within a year and a half. We are feeling pretty confident on this side of the House, as are many Canadians across the country, that the next government will be a Conservative government led by our current leader, the member for Carleton, and he is on record as saying that this three-year extension will become a forever extension. In the meantime, until that happy day arrives, Canadians are going to have to continue living with the uncertainty around the Liberal government's mismanagement of the file.

The uncertainty and confusion around our current MAID regime is exemplified in this example, which is a story coming out of St. Catharines about 15 months ago. A reporter interviewed a middle-aged man who was in the process of applying for MAID. The reporter quoted this man as saying “I don't want to die but I don't want to be homeless more than I don't want to die.”

Here is the backstory. This man had already qualified for MAID by the first assessor, and he was waiting for a second one. Why was he applying for MAID? It was not because he wanted to die, but because in addition to his chronic back pain, which I acknowledge was probably intolerable for him, he had just gotten news that he was soon to homeless because the boarding house in which he was living was up for redevelopment due to plans in the neighbourhood. He was pretty certain that in his current health condition, he would not survive long on the streets. Therefore, even though it was not his first choice, he thought it would be better to die in a dignified manner, dignified by a government seal of approval with medical assistance in dying, or MAID. However, when he was asked by the reporter that if his housing was stable would he still consider MAID, his answer was “absolutely not”, which was when he said, “I don't want to die but I don't want to be homeless more than I don't want to die.”

I believe this story is a commentary on the state of our nation today with the MAID regime under this current government, and there are two problems. First of all, why was this man not given the medical treatment he needed and why, in a wealthy nation like Canada, did he not have stable housing? After eight years of this government, it is clear that many people are being left behind, and we have failed this man.

What is more relevant to the discussion today is the question of where this man got the idea that the government might step up to relieve him of his pain and discomfort by helping him to commit suicide. Proponents of expanding MAID to include more people in more circumstances will object to me using this as an example of what is wrong with our MAID regime. They will point out that this man was misinformed about MAID availability and that it was never intended to alleviate problems associated with poverty.

I agree, but I would note, parenthetically, that the first assessor had approved him for MAID. Did the first assessor ask him the same question that the reporter asked him? If he or she had, I am assuming that this man would have given the same answer: “I don’t want to die but I don’t want to be homeless more than I don’t want to die”.

No wonder people are confused. At the centre of this confusion is an incompetent Prime Minister and an equally incompetent attorney general, now former attorney general, who failed to appeal a lower court decision, failed to stop a reckless amendment coming from the Senate and gave confusing signals about the state of the law in Canada.

A year ago, a group of 32 constitutional law professors from law schools across the country wrote a letter to the Prime Minister and the then attorney general pointing out that, despite what they had been saying, the Supreme Court of Canada has never said that MAID should be expanded to include mental illness. In the Carter decision, the nine justices of the Supreme Court of Canada had this to say: “euthanasia for minors or persons with psychiatric disorders or minor medical conditions” were cases that “would not fall within the parameters suggested in these reasons”. That is pretty clear.

It is a shame that our now former attorney general, the top lawyer of the land, muddied the waters on this very difficult topic. A year ago, Mr. Lametti appeared before the justice committee when we were debating the first one-year extension. He asked who was right, the 32 law professors or him. He arrogantly said, “I'm right, quite frankly.” Mr. Lametti was wrong then and he is wrong today. This clouding of what the courts have said has led to confusion for Canadians.

The story about the man from St. Catharines has a happy ending. Some community leaders reading the story about him in the news were heartbroken by his story and started a GoFundMe campaign that raised more than enough money to stabilize his living conditions. This is what he said just a couple of months later: “I still continue to get many offers of help, but as my situation is now stabilized, I have asked that the fundraising pages stop accepting new donations.” In another later interview, he told the reporter, “I'm a different person. The first time we spoke, you know, I'd wake up every morning and I had nothing but darkness, misery, stress and hopelessness. Now I've got all the opposites of those things.”

That was a happy ending. I like happy endings. Another suggestion for a happy ending would be to not delay this just for three years but to delay it forever. We need to stop the expansion of MAID altogether and, instead, build on the hope that this ordinary, common-sense person expressed so clearly.

Conservatives want to turn hurt into hope. We are going to hold the government accountable to deliver on its promise to fund Canada mental health transfers. Let us give hope for a better tomorrow and the support needed to live through today.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, Canadians would be forgiven for thinking they have seen this movie before, because they have. It was only last year that we debated Bill C-39, which provided an extension of the coming into force of this dangerous legislation. Now we are debating Bill C-62, which was introduced two weeks ago thanks to consistent pressure from Conservatives, advocates, experts, organizations and individuals from across the country who want to help individuals live with mental illness, not help them end their lives.

How did we get here? We got here because we have a justice minister, a Prime Minister and a government that have ignored the science, the legal experts, the courts and the pleas of the most vulnerable. They have ignored Canadians. They have plowed ahead with legislation to expand medical assistance in dying to Canadians who deserve help, Canadians who are suffering from mental illness.

I do not need to tell the House about some of the shocking headlines we have seen over the last year. Veterans suffering with PTSD are being told by employees of Veterans Affairs that they could consider MAID. Individuals without housing are considering MAID for economic reasons. Individuals, as we heard at our justice committee when we studied Bill C-7, who did not wish to have MAID were consistently pressured to considered it.

On this side of the aisle, Conservatives have chosen the path of hope rather than harm, and we will continue to do so, but across the way, just this week, we heard a government minister say it is not a matter of if this expansion takes place; it is a matter of when.

I mentioned ignoring the law. When we were at the justice committee studying Bill C-7, we consistently heard the government say that we have to do this because the courts told us we have to. Nothing could be further from the truth. First of all, there was a court decision, which the government did not appeal. That decision in no way directed the full expansion of accessibility to MAID to those suffering from mental illness. In fact, it was not in the original legislation.

What happened with Bill C-7, which we studied at justice committee, in no way, shape or form involved expansion of MAID to those suffering from mental illness. However, when the bill got to the unelected Senate, it was amended to include this provision, which we had not even studied. The minister at the time assured us his bill was charter-compliant. The previous justice minister was at committee.

I am holding today a letter signed by 32 leading experts on the law, professors from faculties of law around the country. The letter says, “We disagree as law professors that providing access to MAID for persons whose sole underlying medical condition is mental illness,” which is what we are talking about today, “is constitutionally required, and that Carter...created or confirmed a constitutional right to suicide, as [the Minister of Justice] has repeatedly stated. Our Supreme Court has never confirmed that there is a broad constitutional right to obtain help with suicide via health-care provider ending-of-life.”

Those are powerful words. If I had time, I would read the names of the 32 professors who signed the letter. People would recognize many of them. They would certainly recognize the different universities they represent.

With the letter in hand, I said to the minister of justice, “Minister, you have come here saying that, constitutionally, you have to do this, but these 32 experts are saying you do not. Who is right, you or these experts?". The minister said, “I'm right.”

That is the attitude we have seen consistently with the government as it has plowed ahead in spite of the evidence, in spite of the concerns and in spite of the pleas from disability groups, mental health experts and psychiatrists.

I have a brief from the Society of Canadian Psychiatry, which makes a number of conclusions. I do not have time to read them all, but I want to touch on a couple of the conclusions:

At this time, it is impossible to predict in any legitimate way that mental illness in individual cases is irremediable. A significant number of individuals receiving MAID for sole mental illness would have improved and recovered.

This is a finding of the Society of Canadian Psychiatry. I have already spoken about this a bit, but even they can see this. They go on to say:

The political process leading to the planned expansion of MAID for mental illness has not followed a robust and fulsome process, has not reflected the range of opinions and evidence-based concerns on the issue, and has been selectively guided by expansion activists.

If that does not send a shiver down one's spine, I do not know what would. When we are talking about Canadians at their most vulnerable place, they should be able to count on us. How many of us participate in, for example, Bell Let's Talk Day every year? We say to people, if they are suffering with mental illness, to reach out, that we are here to help and that they should talk to someone they trust and access mental health support. Now, in spite of all this, we have psychiatrists saying the government is moving in the wrong direction.

I turn to their recommendations:

The Board of the Society of Canadian Psychiatry recommends that the planned 2024 MAID for mental illness expansion be paused—

It's not for a year, not for three years and not for five years, but:

—indefinitely, without qualification and presupposition that such implementation can safely be introduced at any arbitrary pre-determined date.

What are we led to believe when a government will not listen to legal experts when it comes to the criminal law and will not listen to psychiatrists when it comes to mental illness? It begs the question of who it is listening to and why.

This is the second time, and Conservatives have warned all along that there would be a dangerous, slippery slope. Canada has leapt ahead of all other nations. Some nations were ahead of the curve on this compared to Canada. Now they look at us and ask what happened that we would even be discussing providing assisted death to someone who comes to Veterans Affairs or to one of the number of hospitals across our country, looking for help, and instead is offered medical assistance in dying.

I want to set the record straight that the Liberal government has not, in any way, been bound by the courts to expand MAID to those whose sole underlying condition is mental illness. This was a path it chose to take. We need to take this time to reflect on that path, to turn back and to give people hope.

We all know individuals who have been touched by mental illness in the health care system. We know the wait times can be extraordinary for people to get help. We also know the government has contributed to those wait times. After eight years, people are suffering.

I would urge members to support this bill and then to look at ways to provide support for those suffering with mental illness, not to offer them assistance in death.

I move:

That the question be now put.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I will start with an assertion whose veracity will become clear. With Bill C-62, the cowardly Liberal government brought forth a mouse.

If we are talking about Bill C‑62 today, it is because Bill C‑7 created the Special Joint Committee on Medical Assistance in Dying when it passed. The committee's mandate was to review the medical assistance in dying legislation, in particular as regards the issue of advance requests. Because we knew that the problem was more difficult in cases of mental illness, the government set up an expert panel to help MPs do their job. The panel was to issue a report to the special joint committee.

The expert panel was indeed set up. The problem is that, instead of putting everything in place following the adoption of Bill C‑7, the government decided to call an election in 2021. That delayed the process.

Immediately after the useless election, we would have expected the special joint committee to sit but, no, we had to wait. They took their sweet time. The committee was finally convened, but it had a huge mandate. Its mandate was so huge that Bill C‑39 on mental illness had to be introduced, delaying the committee's recommendation.

Since February 2023, the committee has been very clear on the issue of advance requests. In fact, that was its most widely held recommendation. During the entire debate on Bill C‑62 in the House, the government said that we needed to be cautious and proceed slowly. That is fine, but when caution involves making patients suffer, I cannot agree. I think we need to be diligent.

The government took its sweet time. Here we are in 2024, and it introduced legislation seeking to postpone the issue of mental illness. Fine, but what is happening with the main recommendation the committee made in February 2023? The government knew very well that Quebec was laying the groundwork on the issue of advance requests. It knew very well that Quebec would bring in its own law. Instead of taking inspiration from that and seeing what measures could be included in the regulation accompanying Canada's MAID legislation, it did nothing.

I have stood in the House many times to ask the Minister of Justice and the Minister of Health why the government did nothing. Why does the bill not include a component on advance requests, which should have been prepared over the past year? After all, the government introduced legislation enacting the special joint committee's February 2023 recommendation on mental illness. On the issue of advance requests, however, it did nothing, despite the majority recommendation.

Yesterday, I got my answer. The Minister of Health demonstrated in front of the whole committee that he was unfamiliar with the Quebec law, yet he rises in the House and says he has enormous respect for Quebec's process. The Liberals do not even know what they are talking about. The minister told me that the issue of advance requests is more difficult than the issue of mental illness because, for example, there might be family quarrels at the patient's bedside.

I realized that the minister had not read section 29.6 of the Quebec law, which stipulates that, as soon as patient is diagnosed, they can appoint a third party. The third party will not determine when the person can access medical assistance in dying, but will advocate for their wishes, which will be included in the advance request, or the person's criteria.

People in my riding have told me that, when they become incontinent and can no longer control their bowels, when they have reached the point where they no longer have any appetite and it becomes a chore for their caregivers to feed them, although they are well compensated for their troubles, when they are no longer able to recognize their friends and family members and when they can no longer maintain relationships, they would like to have access to medical assistance in dying. The third party in whom they have placed their trust will then ask the care team—because patients are indeed cared for by entire teams—to evaluate whether they are meeting the criteria, if they are there yet.

If people make advance requests, it is because they want to avoid shortening their life. They want to live as long as possible. We could be good to them and take care of them until they cross their tolerance threshold.

The minister does not even know what I am talking about right now. Do members think it is normal that people say they respect Quebec, that they have great admiration for Quebec's progress on this issue, but that they do not even know what is in Quebec's law?

It is no surprise that they come out with a bill like Bill C‑62, that does not address this at all. Then they have the gall to say that Quebec has made good progress, but that not all Canadians are ready for that, so they have to wait and watch their patients suffer. Quebec is not the only province that supports advance requests. According to an Ipsos survey, 85% of Canadians from coast to coast support advance requests.

The Conservatives claim that they want to do good, they want to take care of Canada's most vulnerable. I, too, want to take care of the most vulnerable, but who is more vulnerable than a patient who is about to cross their tolerance threshold, who is suffering and who is being told no by the government?

Some claim that there could be abuses, as if the Criminal Code did not provide for punishment of abuses. They seem to believe the medical system to be inherently evil. I heard my Conservative colleague earlier. Listening to the Conservatives, one would think everyone working in the health system wants vulnerable people euthanized. I heard another Conservative member say there is an opioid crisis, there are people in the streets, and we are going to euthanize them. That is absolutely false. It is really far-fetched. That kind of rhetoric is meant to scare people; it amounts to spreading misinformation on a crucial topic.

When we care, we do not infringe on individual autonomy. The role of the state is not to decide matters so personal as how someone wishes to cross their threshold of tolerance. It is not to tell patients what is right for them. It is to provide the conditions so they can make a free and informed choice.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am thankful for the opportunity to speak about Bill C-62 and the extremely important issue of medical assistance in dying, or MAID, and mental illness.

I think all members can agree that this is a highly complex, quite sensitive and emotional issue, that raises divergent and deeply held views from the medical community, experts and the public at large. The questions of whether, how and when to expand eligibility for MAID to persons whose sole underlying medical condition is a mental illness are difficult; they do not have easy answers.

The federal government believes that eligibility for MAID should be expanded to such persons. However, such an expansion should not be rushed and should not occur before the health care system is ready to safely provide MAID in all cases where it is requested on mental illness grounds. This is why we have introduced Bill C-62, which proposes to extend the temporary mental illness exclusion by three years, until March 17, 2027. The bill also includes a provision requiring a parliamentary review prior to that date.

As members will recall, in 2015, the Supreme Court of Canada concluded in the Carter case that the Criminal Code’s absolute prohibition on physician-assisted death was unconstitutional. The Supreme Court held that physician-assisted dying must be permitted in some circumstances, namely, for competent adults who clearly consent to the termination of life and who have a grievous and irremediable medical condition. This decision led to the legalization of MAID in Canada one year later, in 2016, through Parliament’s enactment of former Bill C-14. Our original MAID law limited eligibility for MAID to competent adults with an eligible medical condition whose natural death was reasonably foreseeable. Our MAID framework was added to the Criminal Code and was made up of a stringent set of eligibility criteria, as well as procedural safeguards to prevent error and abuse in the provision of MAID.

A few years later, the “reasonable foreseeability of natural death” eligibility criterion was challenged in Quebec; in 2019, it was declared to be unconstitutional by the Superior Court of Quebec in the Truchon decision. As this was a trial-level decision, it was only applicable in Quebec. Nevertheless, the Attorney General of Canada did not appeal the decision; instead, the federal government made the policy decision to expand eligibility for MAID. This led to Parliament’s enactment of former Bill C-7 in 2021, which expanded eligibility for MAID to persons whose natural death is not reasonably foreseeable. This resulted in the removal of the eligibility criterion that a person’s death be reasonably foreseeable and the creation of two sets of procedural safeguards for the lawful provision of MAID.

The first track of safeguards applies to persons whose natural death is reasonably foreseeable; the second, more robust, track applies to persons whose natural death is not reasonably foreseeable. This second set of safeguards was created in recognition of the fact that requests for MAID by persons who are not at end of life are more complex. This is why a minimum of 90 days must be taken to assess a person for eligibility for MAID when their natural death is not reasonably foreseeable. This is not a reflection period; it is a minimum assessment period. This safeguard aims to respond to the additional challenges and concerns that may arise in the context of MAID assessments for persons whose natural death is not reasonably foreseeable. This includes whether the person’s suffering is caused by factors other than their medical condition, as well as whether there are ways of addressing their suffering other than through MAID.

This second set of safeguards also requires that two practitioners be satisfied that the person meets all the eligibility criteria, and if neither of them has expertise in the medical condition causing the person suffering, one of them must consult with a practitioner who does. Involving a practitioner with the relevant expertise aims to ensure that all treatment options are identified and explored.

Practitioners are also required to inform the person of available counselling services, mental health and disability support services, community services and palliative care; to offer them consultations with the relevant professionals; and to ensure that the person has given serious consideration to such alternative means to alleviate their suffering. Although this does not require a person to undertake treatments that may be unacceptable to them, it requires that they fully explore and weigh the risks and benefits of available treatment options.

Former Bill C-7, as originally introduced, permanently excluded eligibility for MAID on the basis of a mental illness alone. This was not because of the incorrect and harmful assumption that individuals who have a mental illness lack decision-making capacity or because of a failure to appreciate the severity of the suffering a mental illness can cause. Rather, this was done because of concerns about the inherent risks and complexities of permitting MAID for individuals who suffer solely from mental illness.

During its consideration of the bill, the Senate made an amendment that added a sunset provision that would repeal the mental illness exclusion 18 months later. The House of Commons accepted the amendment in principle, but changed the date of repeal to two years; in other words, the provision of MAID based on a mental illness alone was set to become lawful on March 17, 2023.

The decision to temporarily maintain the exclusion of eligibility was based on the recognition that additional study would be required to address the risks and complexities of permitting MAID in these circumstances. This is why the former bill also included a requirement for an independent expert review respecting recommended protocols, guidance and safeguards to apply to such requests for MAID.

Former Bill C-7 also required the creation of a joint parliamentary committee tasked with conducting a comprehensive review of the Criminal Code's MAID provisions and other MAID-related issues, including MAID and mental illness. The committee undertook this important work, and its interim report, which focused on MAID and mental illness, was tabled in June 2022. It urged the federal government to collaborate with regulators, professional associations, institutional committees and the provinces and territories to ensure that the recommendations of the expert panel were implemented in a timely manner.

The committee's second report was tabled in February 2023. The majority view expressed was that eligibility for MAID on the basis of a mental illness alone should be permitted. However, the final report also raised a key concern that more time was needed for standards to be developed and training to be undertaken before the law should permit a mental illness to ground a request for MAID. The federal government recognized the significant progress that had been made by the provinces and territories, stakeholders and the medical community in preparing for the expansion. However, it ultimately concluded more time was needed.

This is why we introduced Bill C-39, and Parliament enacted it. It extended the exclusion by one year, until March 17, 2024. This extension aimed to provide additional time for the dissemination and uptake of key resources by the medical and nursing communities. We thought it essential to prepare for the safe assessment and provision of MAID in all cases where a mental illness grounds a request for MAID. The committee expressed support for the extension in its second report.

I want to take a moment to recognize the work that the federal government has done during this extension to support the fulfillment of some of the expert panel’s recommendations. For instance, we amended the regulations for the monitoring of MAID last year to ensure comprehensive data collection and reporting. Such changes allow for data collection related to race, indigenous identity and disability of persons requesting MAID. These changes came into force in January 2023, and the first set of data will be captured in Health Canada’s 2024 annual report on MAID.

Moreover, Health Canada convened an independent MAID practice standards task group to develop a practice standard for MAID. In March 2023, the model MAID practice standard and supporting documents that provide guidance to support complex MAID assessments were released. Finally, Health Canada supported the Canadian Association of MAiD Assessors and Providers in the development of a Canadian MAID curriculum, which was launched in September 2023.

In Canada, certain aspects of MAID fall under federal jurisdiction and others fall under provincial and territorial jurisdiction. The federal government is responsible for the criminal law aspect, whereas the provinces and territories are responsible for the implementation of MAID within their health care delivery systems. Impressive progress has been made in preparing for the expansion by the March 2024 deadline. However, the provinces and territories have all expressed that they are not yet ready. For this reason, we are proposing to extend the temporary mental illness exclusion for another three years, until March 17, 2027.

The extension would allow more time for the provinces and territories, and their partners, to prepare their health care systems by implementing regulatory guidance and developing additional resources for their medical and nurse practitioners. It would also provide more time for medical and nurse practitioners to become familiar with the available training and supports. Our ultimate goal is to help ensure that the necessary protections are in place to protect the interests of individuals who may seek MAID on the basis of a mental illness alone.

We believe that this issue should not be rushed. Eligibility for MAID should not be expanded until the health care system is ready to safely provide MAID in these complex circumstances. I urge all members to support the bill so our partners can get this right.

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

Thank you.

I am going to take issue with two of your earlier comments.

I do think, actually, that this issue has been punted down the road. It was punted down the road by two years with the Senate amendment. It was further punted down the road by one year of Bill C-39. Now we're looking at a three-year punt.

I also take issue.... I've been on the special joint committee since its inception. I agree with the recommendation that we put forward, but we did not have anywhere near enough of a time frame to study this issue in depth. We had three meetings of three hours each.

How can you say that this is not punting it down the road? How can you say that the special joint committee had adequate time when in fact we did not?

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

Thank you very much, Mr. Chair.

Dr. Gaind, every problem we've had with this particular issue of mental disorder as the sole underlying medical condition you can trace all the way back to that eleventh-hour Senate amendment to Bill C-7. I was here during the 43rd Parliament. I was here in the 42nd Parliament for the first debate on MAID. I remember when the charter statement was first issued for Bill C-7, which I think reasonably explained the government's original position for excluding mental disorders as qualifying for MAID. They recognized the inherent risks and complexities that would be present for individuals. They noted that the evidence suggests that screening for decision-making capacity is particularly difficult. They noted that mental illness is generally less predictable than physical illness. However, inexplicably they accepted a very consequential Senate amendment.

It seems that we've just been constantly kicking the can down the road. The first delay was for two years. Bill C-39 delayed it by a further year. Here we now are, with Bill C-62, looking at another three years.

I'm just wondering, first of all, what your reaction was at the time when the government did that 180° turn in their decision. Also, I think you sort of answered this, but I'd like you to expand on it a bit more. Can we actually ever be ready for this, or are we just setting ourselves up for failure in 2027?

Government Business No. 34—Proceedings on Bill C-62

[Mike Morrice, Green, Kitchener Centre, ON]

Mr. Speaker, tonight, I rise in strong support of Bill C-62, which would delay expanding medical assistance in dying for those in whom mental illness is the sole underlying condition by three years. My reasons for doing so are the same as they were in my speech to Bill C-39, one year ago to this day, at the time when the government was willing to delay by only one year: First of all, this delay aligns with what I have heard from so many folks in my community; second, we know that this is what experts have been calling for, for some time; and third, as Greens, we believe we should spend more time filling in our social safety net before we expand medical assistance in dying.

Today, Greens also believe that we should be rushing this legislation before the March 17 deadline to ensure that MAID is not expanded for mental illness as the sole underlying condition because this is the next best thing to what Bill C-314 would have done. Bill C-314, which was proposed by the member for Abbotsford, would have avoided this expansion for good.

Substantively, in the process we are in right now, this bill has been moving ahead quite quickly to this point. I expect that, as votes follow over the coming days, we will continue to move based on the motion that was approved earlier in the day. This shows that the House of Commons can move quickly when there is an urgent priority to be addressed, as is the case with the March 17 deadline in the existing legislation. Really, what this is about in terms of moving quickly is not that we do not have the legislative tools but that we need the political will to do it.

When I think about this legislation in front of us, outside what I have shared so far in terms of why I am supporting it, why I have historically and why Greens have historically as well, my question is this: Where is the rush to support legislation that would substantively improve the quality of life of Canadians? Other members have reflected on and shared feedback, which I hope they have heard directly from people with disabilities across the country. Where is the rush on ending legislated poverty for people with disabilities?

The fact is that, to this day, 40% of people living in poverty across the country are people with disabilities. While some will talk all about a piece of legislation that was passed in June of last year, the fact is that a person with a disability is no better off today than they were before that legislation was passed. The benefit is not yet funded, and we have not engaged in and figured out negotiations with provinces and territories. It is shameful. It is an embarrassment that, in a country as rich as ours, we are in a place where people with disabilities continue to live in legislated poverty. The House of Commons could choose to act as urgently to end legislated poverty for people with disabilities as it is moving right now to ensure that the March 17 deadline is met.

The House of Commons could also push to actually address one of the core underlying issues here, which is the lack of supports to address mental health. In fact, at the time of the last electoral campaign, the Liberal Party promised a Canada mental health benefit. It was meant to be called the “Canada mental health transfer”. It was a $4.5-billion commitment, and it was not one of several bullet points in a health accord, the way we have now. One of the challenges is that, while we all want our health care to be delivered in a wholesome way, it is more helpful to have funding agreements that are specific, so we can have accountability on them. However, that is not the case when it comes to mental health. Instead, mental health is one of four bullet points in these provincial and federal agreements. As a result, it is up to the provinces, and it is unclear whether there is any accountability whatsoever on how many of the dollars in those agreements will go directly to mental health.

In this year's budget, we could see the government step up, be more clear and say it is going to make sure it directly funds what was supposed to be the Canada mental health transfer. In so doing, it would substantively improve the quality of life of Canadians, of folks in my community who are waiting on unreasonable wait times and lists to get access to a mental health professional.

If we were really serious about moving quickly on another core crisis in this country, we would move far more quickly on addressing the housing crisis. Again, for me, the little bit of hope I have, seeing what is happening right now, is that we know there are parliamentary tools available to do exactly that. The fact is, in my community, we just had a report come out today that continues to make calls with respect to dealing with people living rough, in encampments. In my community, the number of people living unsheltered has tripled in just the last three years.

We should not be in a place where this is happening, but we know why it is the case. Right now, for every one new unit of affordable housing that gets built, we are losing 15 units to the financialization of housing. Housing has increasingly become a commodity for large institutional investors to trade, rather than a place for a person to live.

This means that we continue to see large institutional investors buying up existing affordable housing, renovicting folks and increasing their rents. We wonder why that crisis is also getting worse. I do not think we would be in the place where we are right now if this Parliament, and the government in particular, were to get more serious about addressing the housing crisis.

After 30 years of underinvestment, where are we now? The fact is that we are at the bottom of the G7 when it comes to the social housing stock in this country; 3.5% of our housing is social housing. This means that, even if we were to double social housing, we would only be around the middle of the pack in the G7.

It means something after 30 years of underinvestment in communities across the country. I am thinking about someone I spoke with this past weekend, a nurse, who told me she cannot afford to live in our community as a result of the reality of the cost of housing. It means that, whether someone is a teacher, a nurse or a tradesperson, this is a generation that is looking at housing fundamentally differently than any one before it has. Why is that? In my community, since 2005, the cost of housing has gone up 275%, but wages have only gone up 42%.

Once again, if we were to truly fill in the social safety net and move as quickly on doing that as the government has moved today on meeting this March 17 deadline, we could substantively ensure that we see the funding necessary to address the affordable housing crisis. We could also address financialization, which is the fact that institutional investors have swept in to make the biggest buck possible, as quickly as possible, on the backs of some of the lowest-income people in my community.

Yes, I will be supporting Bill C-62. I think this is a really important opportunity for us all to mark that this Parliament can move quickly when it needs to on real crises that it sees. We have crises of housing, of legislated poverty for people with disabilities and of mental health, which this Parliament and the government should move a whole lot faster on.

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

Mr. Speaker, it seems to me that we have gotten ourselves into trouble with the use of arbitrary timelines. The Senate amendment to Bill C-7 kicked the can down the road two years. Last year's Bill C-39 added a year, and now Bill C-62 would add three years.

I just want the member to put that into the context of the fact that the health ministers of seven out of 10 provinces and all three territories have asked for an indefinite pause. The special joint committee, likewise, was very careful not to put a timeline in its recommendation for a pause.

How does the member reconcile this three-year pause with the fact that those institutions, those provincial governments, would rather put more of a qualitative benchmark than a timeline on it?

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

Mr. Speaker, on the situation we find ourselves in this week, and last year with Bill C-39, we can draw a direct line back to the Senate amendment that was placed on Bill C-7. The government did a complete 180. It came out with a charter statement explaining why it was excluding mental disorders, and it then went and accepted the Senate amendment.

Bill C-39 last year had to punt the ball down the road by a year. Now we have Bill C-62 trying to do that by another three years. It feels like everything we have been doing has been trying to play catch-up to that change in the law. The law was changed before we had done the work.

Does my hon. colleague regret voting for that Senate amendment, given all he knows now and all of the catch-up we have been trying to do on this very important and sensitive issue?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, it is with a sense of profound responsibility and pride that I address the House today regarding the government's proposed bill, Bill C-62, aimed at extending the temporary suspension of eligibility for medical assistance in dying, MAID, for individuals suffering exclusively from mental illness, for an additional three years. This discussion is not just about policy but about the very essence of compassion, dignity and the complexity of human suffering.

The concept of MAID resonates deeply within the Canadian societal fabric, touching upon the core values of autonomy and the right to end intolerable suffering. In Richmond Hill, as in communities across our nation, I have engaged with constituents, health care professionals and advocacy groups. These conversations have revealed a spectrum of beliefs and underscored the critical importance of adopting this issue with sensitivity, respect and an unwavering commitment to the well-being of all Canadians.

Since MAID was introduced, our office organized three community council meetings to deeply engage on this topic. We also partnered with the Canadian Mental Health Association, among many other professional associations, to enhance the dialogue with our constituents. Following the special joint committee's report, we convened our latest community council to gather our constituents' views and insights. Their response was clear and united in support of the delay. This active involvement with our community underlines the importance of careful reflection and thorough examination in addressing this issue.

The proposed extension under Bill C-62 is not merely a procedural delay. It is a crucial break that would let us look more closely into how mental illnesses and the final choice to end a life interact with each other. Mental health issues are complex and different for everyone, making it hard to fit them into our usual ideas about illness that leads to death. We need to look at each situation individually, taking the person's pain seriously while making sure there are strong protections in place to prevent hasty choices.

Our government acknowledges the importance of the data and reporting in relation to MAID, so much so that the original 2016 legislation obligated the Minister of Health to collect and report annually on MAID assessment and delivery. The formal monitoring system is important to inform our understanding of who applies for MAID in Canada, the medical conditions prompting requests, and trends in MAID activity since the 2016 legislation. As such, we have been working in collaboration with the provinces and territories and with health care professionals to establish a robust monitoring system. It is important to emphasize that this is a significant collaborative commitment.

As members know, on March 17, 2021, revised federal legislation was passed, expanding MAID eligibility to persons whose natural death is not reasonably foreseeable, providing they meet the remaining eligibility criteria.

Since the passing of the new legislation, the vast majority of MAID deaths, that is 96.5%, involved individuals whose death was reasonably foreseeable. Of course, two-thirds had a cancer diagnosis. In 2022, just 3.5% of total MAID deaths, which is 463 deaths, were attributed to individuals whose death was not reasonably foreseeable, representing less than 0.2% of all deaths in Canada. Of those 463 deaths, nearly 50% reported that the main underlying medical condition was neurological, such as ALS or Parkinson’s disease, while the remaining cases involved a variety of other complex conditions, including multiple comorbidities, cardiovascular disease, organ failure and respiratory illnesses.

Although the current sample is small, 2022 data also shows that where death was not reasonably foreseeable, 64% of individuals were approved for MAID, compared to 83% of individuals in cases where death was foreseeable. Each MAID request where the person’s natural death is not reasonably foreseeable is complex and unique, and early indications show that approvals for MAID in this stream are much lower than when the person’s death is reasonably foreseeable.

The decision-making process for MAID, especially in the context of mental illness, is fraught with complexity. It necessitates a meticulous evaluation of the individual's condition, an exploration of all viable treatment options and a profound understanding of the person's lived experience. This process is not undertaken lightly. It is grounded in empathy, clinical expertise and a rigorous adherence to ethical standards.

I also previously engaged in discussions on this matter in 2016 and again in February 2023. Today marks my third address to the House on this subject, which holds personal significance for me and, undoubtedly, affects numerous households in Richmond Hill and beyond.

I wish to highlight the government's consistent commitment to thorough and collaborative investigation, in concert with provincial, territorial and societal stakeholders, to ensure that MAID is administered with rigorous safeguards to protect the vulnerable while respecting the rights and dignities of applicants.

In pursuit of these objectives, the government enacted Bill C-39 last year, extending the moratorium on MAID for those with mental disorders as their sole medical condition until March of this year. This extension was pivotal in facilitating the safe provision of MAID, allowing for the broader dissemination and adoption of essential resources among medical and nursing professionals and ensuring the readiness of our health care infrastructure.

Moreover, this period provided the government with a crucial window to review the conclusive report by the Special Joint Committee on Medical Assistance in Dying. The one-year extension has proven invaluable, enabling the special joint committee to conduct a review in October 2023 concerning Canada's preparedness to accommodate MAID requests for mental disorders.

On January 29, 2024, the committee tabled its third report, which outlined recommendations regarding Canada's readiness for the safe execution of MAID under these circumstances. Following the committee's recommendations, the government, via Bill C-62, seeks to extend the pause on MAID for those with only a mental disorder until March 17, 2027. This aims to give our health care system enough time to prepare for MAID under these conditions.

We have held detailed talks with health care experts and the public, which showed a clear need for more time to maintain the integrity of this process. This time would also help in creating and sharing specialized training for health care workers, developing detailed policies and encouraging discussions on this important matter. The goal is to create a system that acknowledges mental illness complexities, protects those at risk, respects individual rights and dignity, as well as the Constitution, and ensures the proper safeguards.

In conclusion, we know that the MAID regime has provided relief from suffering for thousands of Canadians so far, the vast majority of whom are already at the end of life, and that individuals living with intolerable suffering will continue to explore MAID as an option in the future.

We have made a commitment to transparency and accountability across all levels of government to support public confidence in the MAID regime. I am also confident that we are honouring that commitment by providing Canadians with accurate and reliable information on MAID as it continues to evolve in this country.

As I stand before you, Mr. Speaker, acknowledging the profound impact of this issue on myself, the constituents of Richmond Hill and countless other Canadians, I am confident that this bill would facilitate the careful and considered approach required to address this sensitive matter appropriately.

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

Madam Speaker, I would like to inform the you that I will be splitting my time.

Today, we are not debating Bill C-62; we are actually debating Motion No. 34, which is a programming motion to get the bill through the House of Commons. We are having to resort to a tactic that I do not often like to use, but time is forcing us to do this.

If the House of Commons, the Senate and Governor General do not act and we do not have this bill into royal assent by March 17, the law is going to change. Essentially, many experts have expressed an extreme amount of discomfort with that. There is a lot of professional discomfort. We have seen also from our provinces and territories that they are very uncomfortable with the pace of change that is going on.

What Bill C-62 would do is delay the implementation of MAID for persons who are suffering from a mental disorder as a sole underlying condition. The bill would further kick that can down the road until 2027. It also has a legislative requirement that the Special Joint Committee on Medical Assistance in Dying be reconvened in advance of that date. Hopefully, that committee would have the time necessary.

As parliamentarians, we have to step up to the moment. I am particularly saying this for my hon. colleagues in the House of Commons. There is plenty of blame to be assigned to the Liberals, and, trust me, I have given my fair share. We are in this situation because of an ill-advised 11th hour amendment to Bill C-7 in the previous Parliament, a bill that the government's original charter statement had presented as a reasonable argument against the expansion of MAID to people who had mental disorders. Then that bill went to the Senate and it inexplicably accepted a consequential amendment that brought us to where we are today.

Last year, we had to quickly pass Bill C-39, because, again, we were not ready for the deadline then. That kicked the can further down the road by one year. Now we find ourselves in the exact same position. I am suffering déjà vu, like a lot of my hon. colleagues are, where we now have to force this legislation to kick the can down the road another three years. I feel like I am caught between two forces right now: the ineptitude of the governing Liberals for putting us in this position and a Conservative Party that seems to just want to cause chaos in this final week.

This is a moment when the adults in the room need to step up to the plate. There is plenty of blame to be assigned, but we cannot work around the deadline and the fact that we have only two sitting weeks left to us. We are still at the second reading stage of this bill, and that is why this programming motion is necessary. That is why we need to step up to the plate and ensure that Bill C-62 is through the House of Commons by the end of this week. It still has to run the gauntlet in the Senate, and who knows what is going to happen in the red chamber. That is something for the government members to figure out.

One thing that is really good about this motion is that there is a requirement that the Standing Committee on Health be convened on Wednesday. That will allow members of that committee to question either the Minister of Health or the Minister of Justice and also have two hours to speak to witnesses. Honestly, we need to come together as a Parliament and ensure that we get this through.

It is further bolstered by the fact that seven out of 10 provinces and all three territories sent a letter to the federal government asking for an indefinite delay. These are signatures of ministers of health and ministers responsible for mental health and addiction, which are essentially the departments that are responsible for oversight of the whole medical assistance in dying regime. We have to listen to those incredibly important voices. We have to listen to their expertise. We have to honour what they are requesting in this letter.

I ask my hon. colleagues to step up to the plate and be the adults in the room. Let us get Bill C-62 passed through the House of Commons this week.

[Mike Morrice, Green, Kitchener Centre, ON]

Madam Speaker, it is almost one year to the day that the governing party proposed Bill C-39. I am glad we are once again talking about rushing through legislation to avoid extending medical assistance in dying for mental health.

The parliamentary secretary asked a really important question. He asked in his speech if we are doing enough on these social issues. The answer is very clearly no because the government is not rushing through crucial legislation to address the housing crisis. It is not rushing through legislation to address legislated poverty for people with disabilities, and it is pretending its commitment to a $4.5-billion Canada mental health transfer never happened. Why is this the case?

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

Madam Speaker, this is obviously a week when the House of Commons as a whole has to step up to the plate because we really only have two sitting weeks left on the parliamentary schedule until the March 17 deadline.

That being said, I think it is worth it for us to remember why we are here. We have to go back to Bill C-7 and the Liberal government's 11th hour, inexplicable decision to accept a very consequential Senate amendment to it, which got us into this mess in the first place. The Senate changed the law without having done the proper research and consultations. Ever since, it feels like we have been playing a game of catch-up. That is why Bill C-39 was necessary last year, and why we have found ourselves in the same situation with Bill C-62.

Is the parliamentary secretary prepared to accept some responsibility on behalf of his government and issue an apology for setting that arbitrary deadline and getting us into the mess we now find ourselves in?

Criminal Code

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

Madam Speaker, I am pleased to be standing in the House today to join debate on Bill C-62. Forgive me if I am feeling a bit of déjà vu right now, because it was precisely one year ago, in February 2023, that the House was in a similar position with the earlier bill, Bill C-39.

That bill, of course, extended the delay of the implementation of the acceptance of mental disorders as a sole underlying medical condition to access MAID. That bill kicked the can down the road by one year. As a result, we find ourselves in a position where we are now approaching the deadline of March 17, 2024.

To go into a bit of detail on what Bill C-62 contains, it is not a very complex bill. It should be clear that the bill itself is not relitigating the issue that was first brought in by Bill C-7. I will get into Bill C-7 in a moment. This bill is seeking to further delay the implementation of MAID for mental disorders as a sole underlying medical condition until March 17, 2027, essentially three years down the road from now.

I also think an important part of the bill is that it inserts a legislative requirement that the Special Joint Committee on Medical Assistance in Dying be reconvened in advance of that change, so that a committee of parliamentarians made up of members of Parliament and senators can review our country's readiness and make a determination in advance of that date.

I have been a member of the special joint committee from the beginning, all the way back in the 43rd Parliament, and, speaking for myself, I am very glad to see that we do have that legislative requirement in Bill C-62 and that, more importantly, the committee is actually being given the time it should have had to study this very complex and sensitive issue in advance of its implementation. That is something we could have been much better served by in previous iterations of this legislation.

I think it is important that we explore a little of the history of how we got to this moment. As a member of this special joint committee, I personally have felt that we have been playing a game of catch-up to the change in law that was made in advance of any serious inquiry into this matter.

Bill C-7, in the 43rd Parliament, was, of course, the Government of Canada's response to the Truchon decision. It specifically created a separate track in the Criminal Code for people whose death was not naturally foreseeable. Previous to that, one had to have a medical condition in which one's natural death was foreseeable, so essentially it was for people who were suffering terminal stage cancer, who were going through a great deal of suffering and so on.

It is important to note, though, that when the government first brought Bill C-7 in, there were already questions at that time, in advance of the legislation, about what we do with people who are suffering from mental illness, who have suffered, in some cases, as my colleague pointed out, for decades, for whom treatments have not worked. What were we to do with that?

In the original version of the legislation, by law, the government was required to have the bill accompanied by a charter statement, but mental disorders were specifically excluded from the original version of Bill C-7. The government provided what I thought at the time was a fairly well-reasoned charter statement. It was understood that by excluding this, one could potentially engage two prominent sections of the Charter of Rights and Freedoms, namely section 7, which is the security of the person, the fact that everyone essentially has the right to make a decision about what happens to their own body, and section 15, the equality clause, that the law has to treat everyone equally. With reference, those two sections may potentially be engaged by an exclusion.

The government identified the following in its charter statement:

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. Second, mental illness is generally less predictable than physical illness in terms of the course the illness will take over time. Finally, recent experience in the few countries that permit MAID for people whose sole medical condition is a mental illness (Belgium, Netherlands and Luxembourg) has raised concerns.

That is what the government's original position on Bill C-7 was.

The House passed Bill C-7 and it went off to the Senate. There, for reasons that remain shrouded in mystery to me to this day, the government decided to accept a Senate amendment, essentially at the eleventh hour, which had significant repercussions for the bill. Essentially, the Senate was reversing the government's original position on whether mental disorders qualified for MAID.

The government accepted that Senate amendment. Of course, Bill C-7, because it had been amended, had to come back to the House, and the government managed to cobble enough votes together to get it passed.

Therefore, we, as parliamentarians, were left with a law that had been changed in advance of the hard work being done to properly consult, research and discuss the issue with expert witnesses and with the health systems that have primary responsibility for the oversight of the change in law.

Yes, an expert panel was convened. The special joint committee was convened. Of course, its work was interrupted by the unnecessary calling of an election in the summer of 2021. Some very valuable time was lost there, because, of course, we then had to reconvene in the 44th Parliament, and a considerable amount of time was lost due to that.

However, it is important to realize that everything that has transpired since then has been as a result of that Senate amendment being accepted by the government. Again, I feel, and as a member of the special joint committee I think my feeling has some validity here, that we have been trying to play catch-up ever since that moment.

My time on the special joint committee has been difficult. It is not an easy subject for anyone to sit through, because the opinions of the people with lived experience and those who work in a professional capacity really are on all sides of the spectrum and everywhere in between. It can be quite difficult for a parliamentarian to work their way through that to try and understand the complex legal and medical arguments that exist behind this issue, but it is important.

I would say that, personally, my work on the committee has really been a struggle to find a balance between two concepts that sometimes seem to be in competition with each other. I am a firm believer in the Canadian Charter of Rights and Freedoms. I think it is a very important document in Canadian history, and I believe that we have to respect an individual's right to make decisions over their own body, but that belief system of mine was always struggling with another concept, which is that sometimes society finds itself in a position in which it is necessary for it to step in and protect its most vulnerable members. I think those two themes were echoed, not only for me but for many of the witnesses who appeared before our committee and in the many briefs we received.

I also want to note that our special joint committee has existed twice in this Parliament. We tabled our second report in February last year, in advance of Bill C-39. The committee's mandate at that time was guided by five themes that we had to look at, and mental disorder as the sole underlying medical condition was one of those. Of course, we were reconvened after the passage of Bill C-39, but as my colleague from Montcalm pointed out, our runway was extremely short. It did not do justice to the amount of time that we actually needed and to the extreme complexity of this issue.

Just to give this clarity for people listening, I believe our first meeting as a committee was on October 31, and we had to conduct some committee business, and elect the chairs and vice chairs. We really had only three three-hour meetings with witnesses, so nine hours of testimony. We excluded, by necessity, a lot of people who I would dearly liked to have heard from, namely administrators of our public health system, elected officials of provincial governments and so on.

Because of the short timeline, we did not even have enough time to properly translate all the submissions that were sent to our committee because, of course, before they can be distributed to committee members, they have to be translated into French and English. That is a requirement that honours the fact that we are a bilingual country. We, as committee members, did not even have the opportunity to review important submissions, and those submissions came from people who had lived experience, who were dealing with the situation at home, but they also came from many professionals whose practice is involved in this specific area.

I have taken a position on this. The member for Abbotsford, in the fall, had introduced Bill C-314, and I did vote for that, so my vote on this matter is quite clear. I have been informed by the fact that at our committee, there has been a significant amount of professional discomfort expressed by people who practice medicine in this area, psychiatrists and psychologists. Sure, some of them may be acting in a paternalistic way, but I do not think that can be applied equally to everyone. I think for some of them, we have to review their opinions. We have to take them in the context in which they are given. I think we have to afford them a measure of respect, given the fact that these are their lifelong career choices and, in many cases, we can measure their experiences in decades.

I want to take a little time to read from some of the testimony we received from witnesses. We did hear from Dr. Jitender Sareen from the department of psychiatry at the University of Manitoba, who was there also on behalf of psychiatry departmental chairs at the Northern Ontario School of Medicine, McMaster, McGill, Memorial University, the University of Ottawa and Queen's University. His testimony was that they strongly recommended “an extended pause on expanding MAID to include mental disorders...because we're simply not ready.” He was quite emphatic on the point that we are not going to be ready in another year.

Dr. Trudo Lemmens, who is a professor of health law and policy in the faculty of law at the University of Toronto, was there to clarify some constitutional arguments. He was really trying to underline the fact that we have to keep the section 7 and section 15 rights in balance with section 1 and that this issue has not actually been decided by the courts, contrary to what we heard from some witnesses. Previous speakers on tonight's debate have also pointed out that the Truchon decision did not include any reference to mental disorders. That is an important point we have to make.

Dr. Sonu Gaind, who is the chief of the department of psychiatry at the Sunnybrook Health Sciences Centre, pointed out that:

MAID is for irremediable medical conditions. These are ones we can predict won't improve. Worldwide evidence shows we cannot predict irremediability in cases of mental illness, meaning that the primary safeguard underpinning MAID is already being bypassed, with evidence showing such predictions are wrong over half the time.

Scientific evidence shows we cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests, with overlapping characteristics suggesting there may be no distinction to make.

He also commented on the fact that the curriculum used does not teach assessors to distinguish between suicidality and psychiatric MAID requests, and so on.

We also heard from Dr. Tarek Rajji; he is the chair of the medical advisory committee at the Centre for Addiction and Mental Health. He stated:

CAMH's concern is that the health care system is not ready for March 2024. The clinical guidelines, resources and processes are not in place to assess, determine eligibility for and support or deliver MAID when eligibility is confirmed to people whose sole underlying medical condition is mental illness.

These provide a snapshot of the widespread professional discomfort that exists out there, and I do not think we can discount those voices.

I would agree that there were also a number of professionals on the other side who did feel we were ready, and that is what makes this such an incredibly complex and sensitive subject to try to navigate as a parliamentarian. Again, we as a committee should have been afforded the time and space to really delve into these issues and to greatly expand our witness list to make sure we were in fact ready.

Members will note that our recent committee report had only one recommendation in it. I recognize that the recommendation was a result of the majority of the committee members. There were some dissenting opinions, notably from the senators who were part of the committee. However, the committee did recognize that Canada is not prepared for medical assistance in dying where mental disorder is the sole underlying medical condition, and we did not attach an arbitrary timeline to the recommendation. Our specific call was that MAID should not be made available in Canada until the minister of health and the minister of justice are satisfied, based on recommendations from their respective departments and in consultation with their provincial and territorial counterparts and with indigenous peoples, that it can be safely and adequately provided.

We keep getting ourselves into trouble by setting arbitrary deadlines for ourselves. Setting up an arbitrary timeline is not an adequate replacement for the qualitative work that needs to be done by these departments. I would much prefer that we satisfy the qualitative requirement in the recommendation, where departments, experts and our provincial and territorial colleagues are in fact saying that they are going to be okay with that.

The recommendation and my reference to the provinces and territories is a great segue to the fact that there was also a letter sent to the Minister of Health. It was signed by seven out of 10 provinces and all three territories. The signatures include those of all the ministers of health and ministers responsible for mental health and addictions in those provinces, including Adrian Dix and Jennifer Whiteside from my own province of British Columbia. They quite clearly say:

The current March 17, 2024, deadline does not provide sufficient time to fully and appropriately prepare all provinces and territories across Canada....

We encourage you and [the] federal Justice Minister...to indefinitely pause the implementation of the expanded MAID eligibility criteria to enable further collaboration between provinces, territories and the federal government.

I will wrap up by saying that this is a very sensitive issue. I do think we should pass Bill C-62 and honour the calls we are hearing from the professions intimately involved in this issue and the calls coming from the provinces and territories. We need to step up to the plate and make sure we have a fully ready system in advance of the changing of any laws.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, here we are again, just as we were last February. We are faced with an arbitrary deadline set by the Liberals for their radical plan to expand MAID for mental illness. The Liberal government is completely unprepared and, therefore, needs to bring in eleventh hour legislation to extend the implementation deadline that it set in the first place.

I cannot think of another time or another issue in which a government has effectively had to bring in emergency legislation twice to extend a deadline for the implementation of its own law. It is truly shambolic. How did we get into this mess, thanks to the Liberals? Very simply, what we have across the way is a radical and reckless government that put blind ideology ahead of evidence-based decision-making. That has been the consistent pattern, in terms of decisions the government has made with respect to this planned expansion. This started with David Lametti, the former justice minister, who accepted a radical Senate amendment back in 2021 to implement MAID for mental illness and then set an arbitrary two-year timeline for implementation.

It should be noted that the charter statement for the bill in which Lametti accepted that radical Senate amendment provided a rationale for excluding MAID in cases of mental illness. The minister said at the time that he and the government were against MAID for mental illness because there were inherent risks and challenges. Indeed, he was right, but then he suddenly flip-flopped and rammed the amendment through with very little debate, one and a half days of debate. There was no parliamentary study, no consultation with experts and affected groups, and no evidence that MAID for mental illness can be implemented safely and appropriately.

The Liberals got it completely backwards. Instead of studying the issue first to determine whether this could be implemented safely, they decided to move full steam ahead and study the issue after the fact. Had they approached this matter responsibly, they would have learned very early on that there are significant clinical, legal and ethical problems with expanding MAID in cases of mental illness.

Among those problems are two fundamental clinical issues. The first is the difficulty of predicting irremediability. In other words, it is difficult to predict whether someone with an underlying mental health condition will get better. That is problematic in two major ways.

One is from the standpoint of the law. Under the Criminal Code, in order to qualify for MAID, a person must have an irremediable condition. More specifically, an irremediable condition is defined as one in which a person has an incurable disease or illness and is in an irreversible state of decline. If it is not possible to accurately determine that someone with a mental illness is in an irreversible state of decline and will not get better, then how can MAID for mental illness be carried out within the law? It cannot.

More significantly, from an ethical standpoint, if it is difficult to predict whether someone will get better, what that means with certainty is that persons who could get better will have their lives prematurely ended. Such persons could go on to lead a healthy and productive life. This was underscored by evidence heard by the special joint committee on MAID, during both its initial study two years ago and its more recent study this past fall. The special joint committee heard evidence that clinicians can get the prediction around irremediability wrong 50% of the time. In other words, it is like flipping a coin with people's lives. Is that a risk that members of the House are prepared to take?

When I posed that question to the minister responsible for mental health, she essentially answered in the affirmative. She doubled down on her support for an expansion of MAID for mental illness in three short years. Flipping a coin, gambling with people's lives, is what MAID for mental illness will result in.

A second fundamental problem is difficulty on the part of clinicians in distinguishing a rational request for MAID from one motivated by suicidal ideation. That is underscored by the fact that, in 90% of suicide deaths, persons suffer from a diagnosable mental disorder, not to mention that suicidal thoughts are often a symptom of mental disorders. This is why psychiatrists who appeared before the special joint committee said that it is not possible to distinguish MAID for mental illness from suicide. At the very least, MAID for mental illness significantly blurs the line between suicide prevention and suicide facilitation. It fundamentally changes the character of MAID and transforms it into something akin to state-facilitated suicide. This demonstrates just how far down the slippery slope we have gone under the Liberals.

To paraphrase the minister, she said that there are robust safeguards in place in that persons with a mental illness would only be able to qualify after years of receiving treatments and not getting better. However, that is simply not accurate; no such safeguards are found in any legislation put forward by the Liberals. In fact, the expert panel that the Liberals appointed, incredibly, recommended that there be no additional safeguards. Therefore, under the MAID expansion, it is simply not accurate that one must go through treatments or that one must be suffering over an extended period of time in order to qualify. In fact, the Liberals expressly rejected such additional safeguards.

In the face of those political challenges, Conservatives called on the Liberals to put an indefinite pause on this expansion. Likewise, in the lead up to the March 2023 deadline for implementation, the arbitrary deadline set by the Liberals, the chairs of psychiatry at all 17 medical schools called on the Liberals to pause this expansion.

What did the Liberals do? Essentially, they kicked the can down the road. They introduced Bill C-39, which merely extended the deadline for implementation from March 2023 to March 2024. In other words, once again, the Liberals put ideology ahead of evidence-based decision-making, making what amounted to a political decision with a new arbitrary deadline.

Nearly a year has passed, and with respect to resolving the fundamental issues and problems regarding safely implementing MAID for mental illness, where are we today? No progress has been made.

Indeed, when the special joint committee heard from psychiatrists, the message was loud and clear that we should not move ahead with this. It is not safe, and it cannot be implemented appropriately. The responsible course for the government to take is to acknowledge that it simply got it wrong and put an indefinite pause on the expansion.

It is no surprise that, in the face of these challenges, there is a professional consensus against the expansion. We saw that last week, when a survey from the Ontario Psychiatric Association was released. It indicated that a full 80% of Ontario's psychiatrists do not believe the health care system in Canada can safely implement MAID for mental illness. Last week, seven of the 10 provincial health ministers, plus the health ministers from all three territories, called on the Liberals to put an indefinite pause on this expansion.

What did the Liberals do in response? Once again, they kicked the can down the road with Bill C-62, which is before us. They defied experts, the provinces and territories, and common sense. This bill is basically the same bill we were debating a year ago. Instead of a one-year pause, it provides a three-year pause, with absolutely no evidence to indicate that fundamental clinical problems can be resolved. These problems include predicting irremediability and distinguishing between a suicidal request versus a rational request.

We have a government that is telling us to forget the evidence. The minister said it is not even up for debate, that the government does not want to talk about evidence as part of this issue. She basically said to forget about irremediability. The bottom line is that we have a Liberal government that is determined to implement this radical policy against a consensus among psychiatrists and other advocates.

Indeed, to get an insight into the mindset across the way, last week, in a press conference, the Minister of Health said that there is a moral imperative to get ready for MAID for mental illness. What is the moral imperative? Is it to give up on people who are struggling with mental illness? Is it to offer death through the provision of MAID to persons who are struggling with mental health issues?

That is what these Liberals characterize as a moral imperative? I say it speaks to the moral bankruptcy of these Liberals after eight years of the Prime Minister.

When the Liberals talk about MAID and mental illness, they are always very vague about what they mean. They know that if Canadians fully understood what MAID for mental for illness meant, most Canadians would be absolutely appalled. The model practice standard, which I believe the minister alluded to, that was prepared by the government's so-called task group of experts provides that a mental disorder would include anything in the DSM-5. Any condition listed in the DSM-5 is what these Liberals are contemplating as constituting a condition that would qualify someone for MAID in the case of mental illness.

What are the conditions listed in the DSM-5? They include personality disorders, depression, schizophrenia and issues when persons suffer from addictions challenges. That is what we are talking about when it comes to MAID and mental illness. It is truly repulsive, it is morally bankrupt to the core and it says everything Canadians need to know about the values of these Liberals.

There is only one piece of good news in all of this, which is that this legislation provides a three-year pause, and what will happen between now and the expiration of those three years is a federal election. Canadians will have a choice. They can choose between a Liberal government that wants to provide death to persons who are struggling with mental illness or they can choose a common-sense Conservative government that will not give up on anyone, will be committed to offering persons struggling with mental health issues hope and health, and will permanently scrap this radical Liberal experiment that gambles with the lives of vulnerable Canadians.