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

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, the member spoke about the charter and how every single piece of legislation is supposed to be complying with it. He mentioned that, at the justice committee, they did not have information about whether this particular piece of legislation was charter compliant. I want to give him the extra time to go over the matter just so the House can be well briefed on the current situation with Bill C-39.

[Frank Caputo, Conservative, Kamloops—Thompson—Cariboo, BC]

Madam Speaker, the member for Kingston and the Islands commended me for my honesty. I appreciate that. I like to think I am always honest in this place.

In 1993, if memory serves, we had the Rodriguez case. I am probably simplifying this, but that was a question on the right to die. It was a five-four split, but the Supreme Court of Canada said that there was no charter basis for that decision. It has been a while since I reviewed that in depth, but that is my recollection.

We fast-forward 22 years to the Carter decision in 2015, which came to the opposite conclusion. That case, I believe, was a per curiam decision for the court, which means that all nine justices found that the prohibition did offend the charter. The question that often comes to the House after that occurs is how Parliament should respond. I was not here then. I got here in 2021. Being here has been 18 of the best months of my life.

I can say that, from 2015 to 2023, we have seen a dramatic shift in what seemed to be envisioned both in the legal community and in the Canadian community at large, that change from medical assistance in dying for people who had irremediability, a terminal condition or a condition that was not going to get better, with death being foreseeable. My understanding when I was growing up, and it was an issue when I was in high school and university, was that this was really at the crux of the issue. Should somebody who is terminally ill have a right to euthanasia? That is how we framed it.

I am going to go to the minister's charter statement, dated October 21, 2020. I am going to note that I am not sure whether or not a charter statement has been provided for Bill C-39. I was with the minister at committee yesterday and no charter statement had been provided, so here we are debating a bill on a very serious issue, and we do not have a charter statement.

I am looking at everybody on the government benches. There are a couple of people here on the opposition benches as well. I hope we can all agree that not having a charter statement, which is supposed to accompany legislation like this, is a problem. What is adding to that problem is that, when the minister was asked about that by one of my colleagues yesterday, there was no definitive answer. He was asked where the charter statement is and when it is coming.

We are being asked to decide on this issue inside of what I would call a legal vacuum, where we do not even know what department officials think about this proposed legislation. I would hope, and I would think, that all of my colleagues believe that to be a problem.

The charter statement on Bill C-7 was tabled on October 21, 2020. This was before the legislation was amended by the Senate. On page 7 of 18, the charter statement says, “While expanding eligibility for MAID to include people whose natural death is not reasonably foreseeable, the Bill would exclude individuals whose sole medical condition is a mental illness.” On the next page it continues, “In particular, the exclusion would apply only to mental illness”.

Further on, it says:

The exclusion is not based on the assumption that individuals who suffer from mental illness lack decision-making capacity and would not disqualify such individuals from eligibility...if they otherwise meet the requirements, for example, if they have another medical condition that is considered to be a serious and incurable illness, disease or disability. Nor is the exclusion based on a failure to appreciate the severity of the suffering that mental illness can produce.

This is the key part:

Rather, it is based on 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.... Second, mental illness is generally less predictable than physical illness in terms of the course the illness will take over time.

These are static points, and by that I mean these things will not change with time. It is not like in 2020 there were inherent risks and complexity of judging MAID for people who suffer from mental illness, but now it has changed. We asked the minister about this, as I recall, yesterday. In any event, the minister has not articulated, and the government has not articulated, what changed. Either the charter statement was wrong, or something changed.

Neither has been put forward before the House. How is that possible? Was the charter statement wrong, or have the inherent risks and complexity changed? Has the predictability of mental illness over the course of time changed, or was the charter statement wrong? These are questions that, in my view, the minister has to answer.

One of the more difficult things we discussed yesterday at committee with the minister happened when one of my hon. colleagues asked him about a letter that was written by 32 academics. These are not insignificant people. I know some of these 32 law professors. The minister was asked flat out by the member for Fundy Royal if the professors were right, or if the minister was right. The minister said he was right.

I am going to list a few of these 32 professors, because the hon. minister has said that they are wrong. There is Archibald Kaiser, professor of law in the department of psychiatry at Dalhousie; Tess Sheldon, from the faculty of law at the University of Windsor; Elizabeth Sheehy; Brandon Trask; Brian Bird, a friend of mine who clerked at the Supreme Court of Canada and did his thesis on conscience rights for a Ph.D. in law; Janine Benedet, who I have heard speak to issues that relate to sexual assault; and one of my very good friends, Dr. Ruby Dhand. I am going to give her a few props here. She had five degrees by her 34th birthday. Professor Dhand is one of the smartest and most brilliant people I know.

The minister told us yesterday that he is right and these people are wrong. They wrote a letter saying that what the government is saying is the case with MAID, that it is rooted in Canadian law, is just simply not accurate. That is what they said. Who is wrong: them or him?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Through you, Madam Speaker, I implore the Liberal members of Parliament to stand up against their justice minister and the irresponsible decisions he is taking.

Across Canada every year we celebrate Bell Let's Talk. Mental health services have expanded in hospitals, schools and universities because there is an inherent belief by all Canadians that mental health challenges are things we can overcome. Every family in this country is impacted by mental health, and it pains me to see my country considering offering death to those suffering at their lowest points. We do not need to do this.

Again, through you, Madam Speaker, I implore Liberal members to challenge the justice minister on his overly broad interpretation of the Truchon decision, a ruling of the Quebec court, and to stop what he wants to do.

A recent article in The Globe and Mail talked about Donna Duncan, a 63-year-old woman from my community. Her daughter successfully delayed, through the court, her mother's access to MAID because her mother suffered from a mental illness. However, just hours after leaving the hospital, Donna received a medically assisted death without her daughters being informed, even though their mother already suffered from a mental health condition that was documented.

Both daughters, Alicia and Christie, testified at the medical assistance in dying committee and they made a number of recommendations.

The first, which seems so sensible, is “mandatory access to health care”.

The second is an increase in the required number of independent witnesses to be formally interviewed as part of the assessment, to at least three.

The third is “...a pre-death assessment review. Doctors should be required to submit all assessments to an independent review board prior to a patient's death.”

The fourth is “continuity of care. Multiple assessments should be completed by the same medical professional.”

The fifth is “mandatory wait periods”.

The sixth is “...mandatory release of records. Hospitals and health authorities should be required to release unredacted copies of their MAID assessment records to those who are entitled to them.”

I would be remiss if I did not mention the fact that, when Bill C-39 was tabled in Parliament, the Association of Chairs of Psychiatry in Canada called for this delay at the beginning of December. I will note as well that University of Toronto law professor Trudo Lemmens and numerous colleagues from across Canada challenged the Minister of Justice on his actions today.

Again, my plea today is to the Liberal caucus, through you, Madam Speaker, to challenge the decision of the justice minister, not to irresponsibly expand MAID in one year's time for those suffering from mental health. Canadians know that mental health can be overcome. Canadians know that this does not have to be the solution. Canadians know that they want to take care of people when they need to be taken care of.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, I want my constituents to know that I am staying in the riding to take care of my newborn, but I am happy to participate, in hybrid fashion, on their behalf on this very important subject.

Bill C-39, an act to amend the Criminal Code regarding medical assistance in dying, seeks to delay the expansion of medically assisted death to individuals whose sole condition is a mental illness. We are here today because of previous legislation in the last Parliament, Bill C-7, that responded to the Truchon decision and the justice minister's interpretation of it by removing critical safeguards to accessing MAID, particularly that death must be reasonably foreseeable. However, Bill C-7 contained an arbitrary deadline of March 17, 2023, to expand MAID to those whose sole condition is a mental illness, and now the government is seeking to delay that arbitrary deadline another year down the road.

As I do not want MAID to be offered to those who are solely suffering from a mental health issue, I will be supporting the bill, but I do so in the context of very big and life-altering concerns regarding the direction the Government of Canada has taken since the debate on MAID commenced in 2016.

The Conservatives believe that we should never give up on those experiencing mental illness and should always be focused on offering help and treatment rather than assisted death. The Conservatives will bring forward alternative proposals to support those with mental illness instead of the government's approach.

Going back to 2016, the preamble of Bill C-14 spoke about the vulnerability of persons. It states:

Whereas vulnerable persons must be protected from being induced, in moments of weakness, to end their lives

It also states:

Whereas suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities

Man, have we seen a lot of change in the last seven years.

Conservative members at the time, despite these assurances in Bill C-14, observed that the approach of the government was going down a slippery slope. The member for Selkirk—Interlake—Eastman highlighted a concern that has sadly now become a reality in Canada. He stated, “many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.”

At the time, because of big public concerns, many Liberal members were careful when it came to speaking about expanding MAID in the future. The former justice minister, Jody Wilson-Raybould, said, “In terms of eligibility, the policy choice made by the government was to focus on persons who are in an advanced state of irreversible decline and whose natural deaths have become reasonably foreseeable.” The current member for Lac-Saint-Louis said, “Bill C-14 would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.”

In the last Parliament, in his charter considerations on Bill C-7, which expanded MAID to include those without a reasonably foreseeable death, the current Minister of Justice cited inherent risks and complexity as a reason not to expand MAID to those with mental illness as a sole condition. However, the Minister of Justice, unfortunately, as we find today, is speaking on both sides of this issue very irresponsibly. On the one hand, he communicated in the Bill C-7 charter consideration that due to the complexity and inherent risks, we should not be expanding MAID to those with mental illness as a sole condition. On the other hand, in the same bill, he included a sunset clause to expand MAID to these Canadians and said that his hands were tied by a Quebec court decision. However, not only has the government refused to challenge it at the Supreme Court, but leading legal experts in our country have stated that his interpretation of the decision is flawed.

After telling Canadians time and again that the legalization of MAID would not lead to a slippery slope by allowing death on demand for any citizen whenever they may want it, the government seems set on expanding MAID to anyone.

I plead with the backbench members of the Liberal Party to stand up against the justice minister today. You have more influence than any Canadians right now to stop what he is trying to do.

Do not forget that in 2016, on Bill C-14, he voted against the—

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am glad to be joining this debate at this late hour. I understand this is an issue that is very close to many people's hearts, and a lot of members wanted to rise. I wanted to make sure I caught your eye on this one.

“The Lord rewards a good deed but maybe not right away.” That is a Yiddish proverb I have often heard. I have heard it in Polish. I love Yiddish proverbs, as many members know. Growing up in my family, my grandmother used to say them. She said them in Polish. It turns out that nearly all of them are Yiddish in their origin. That was something humorous I would talk to her about.

In this case, some members of the public think we have actually voted through things that we have not voted through. All we are doing here, directly in the summary of this legislation, is delaying making a final decision until March 17, 2024, on the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole, the only, underlying medical condition identified in support of the request for medical assistance in dying is a mental illness.

I am prepared to speak on this piece of legislation as I have done in past Parliaments. I have been here since the 42nd Parliament, so I have been through the debate on Bill C-7, and the debate on Bill C-14.

Bill C-7 was originally the response to the Carter decision rendered by the Supreme Court of Canada. In it, the Supreme Court found that there was a constitutional right to seek an assisted suicide from a medical professional. It is an exemption to a part of the Criminal Code, but do not ask me to quote which section of the Criminal Code. I have, fortunately, not been burdened with a legal education, so I come at this with a layperson's eyes.

It provided an exemption. Sometimes, when I have a back-and-forth with constituents back home, I raise that point. It is an exclusion to that particular section of the Criminal Code. Then, it becomes incumbent on the federal government to put in place some measures to protect the vulnerable in society.

There were a few people who emailed me over the last few months to talk about that vulnerability, people from different sectors of our society, and how they would be affected. This is not a unanimity in my riding, but the vast majority of the people who contacted me are opposed to the extension of medical assistance in dying, or assisted suicide, for people with a mental illness, when it is the sole condition that they have. They have been very clear on this. Some of the emails are quite emotional. Some of them are a dissertation of what has happened to their family, essentially, and they give particular cases.

I want to do them justice by reading some of their thoughts without using their full names, just to protect their anonymity in the emails. I was also here for the debate on Bill C-14. I remember this debate quite vividly, because Bill C-14 came after the Truchon decision. In that decision, the court found that there was a wording we had used, irremediable or unforeseeable deaths. I remember debating in a previous Parliament and saying this would likely be struck down by the court. It was such a broad term that it could mean anything. It went beyond what the Carter decision said. It was struck down by a court. Let that be said to my friends who are lawyers. I am occasionally right on the law and about what the courts would do. They did strike it down in Bill C-14.

Now we are going back again. I understand that, today, the special committee on medical assistance in dying, which was struck by the House, finished its review and tabled the report. I have not yet had the time to completely review that report. To the constituents in my riding who have emailed me over the last few months as this issue has gained more traction, I want to read a part from Allison.

Allison wrote to me, “A family member with complex health conditions said she was asked so many times about it,...” it being medical assistance in dying, “...she wondered if her Dr. would get a commission for the procedure!! Where are the safeguards and regulations? Who protects vulnerable patients from being coerced by subtle suggestions?”

She goes on, “To be human is to experience pain, suffering and vulnerability. In my family, we have had people that have struggled with mental illness and recovered to live productive, healthy lives, thanks to support from family and community.” She is saying, “let us help you live better” should be the message we send people who are suffering from a mental health condition or a mental illness of some sort. I have known people in my life, around me, who have gone through that as well.

Lisa in my riding emailed me in December and said, “As a citizen who is deeply invested in the going ons with MAID and disability services in this country I keep current in what is happening and research.” She started off by saying that she is the mother of a child with a disability. Her son has no siblings and no close family to look out for him and advocate for him. She mentioned that once she and her husband are no longer alive, she is worried what type of country will be left behind for her son.

She uses some pretty harsh language, but it is parliamentary; I checked. She went on to say, “The way in which Canada has expanded MAID is nothing short of predatory, opportunistic and ableist.” Those are the words she uses. She asked some questions, and I do not have easy answers for her, but I will ask them openly here: “Why are they not being offered better mental health and physical health supports? Why is the government expanding MAID without first expanding holistic supports to our disabled people?”

She then says, “As a mother of a vulnerable child who one day will be left alone who may be exceptionally impressionable and dependant on our broken system I am deeply concerned about the expansion of MAID and its possible implications.” She implores us, “Do better Canada!” That was from Lisa in my riding.

Bev in my riding is very concerned about MAID being expanded to adolescents. I know that debate is going on concurrently. It is not directly in Bill C-39, because we are just talking about delaying for a year the approval of mental illnesses and mental health issues as the sole underlying conditions for applying for medical assistance in dying. However, in her email to me, she noted how vehemently opposed she is to MAID being expanded to adolescents or children and to making this expansion permanent in the law. She went on a bit, but some of it is not entirely parliamentary, so I will avoid violating the rules of the House.

Joe in my riding mentions the following: “We have already had someone in the Department of Veterans Affairs advocating Maid for those with PTSD. What terrible advice to give our veterans. Please do not proceed with eliminating those whose only problem is that they are mentally ill.” I have talked to Joe many times. He is what I would call one of my regulars, as he emails me quite often. He is very passionate about public education, I will add.

Cindy in my riding said, “At no point does a healthy family or community decide that one of its dearly beloved members is better dead than alive. The veneer of compassion is easily seen through.” She went on to make a point that really struck me:

It is indeed a slippery slope to offer MAID to the mentally ill, depressed, bipolar, and any other non-detectable illness—especially when removing the requirement that death be considered reasonably soon.

By expanding MAID in this way, the floodgates are opened for Canadians to easily choose despair over meaning in their lives.

This is the wrong direction for Canada, and an embarrassment on the international stage.

The last one I will read is from Shirley, which is very simple. She said, “Has the world gone mad?” She talks about expanding MAID to those who have a mental illness, expanding it to young people, and on and on.

Those are the types of emails I have been receiving, on top of phone calls, and those are the worries I wanted to express on the floor of the House.

Some are suffering and going through difficult times, and some are diagnosed with really serious chronic conditions that are essentially terminal, conditions like Alzheimer's and Lou Gehrig's disease. The original foundational decision that Carter was gripped with was what to do about ALS, an awful condition. It is degenerative, chronic and pretty much incurable. There are many therapies out there to delay the condition. There was a member in the 42nd Parliament, an honorary chair occupant for a day, Mauril Bélanger, who passed away from it. Since then, I have met others whose family members have passed away. What I think the judges and the court were trying get at is that these are the people we should be looking after.

I want to lay this before the House. When a doctor gives up on someone, they are much more likely to give up on themselves. I have seen this time and time again. I have also experienced it myself when my disabled daughter was so sick that the four doctors in the room termed the condition “not conducive to life”. There is nothing like being told this by physicians who are supposed to look after a child, and seeing, essentially, the gentle and subtle push that my constituents talked about, which is repeated over and over. There is also the consumption of resources. That will lead to more people using the system when they have other options. Resisting the urge to just give up is difficult to do at the best of times, and people need community and family support all around them.

The House resumed consideration of the motion that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

National Framework on Cancers Linked to Firefighting Act

[Blake Richards, Conservative, Banff—Airdrie, AB]

Madam Speaker, I rise on a point of order.

During the debate on Bill C-39, I had finished giving a speech and was in the middle of the question and answer period. The normal practice is that someone asks a question, and usually, before moving on to the next item of business, there would be an opportunity for the person being asked a question to at least reply to the question. I was not afforded that opportunity. I wanted to raise that because it seemed odd to me. I wonder if it breaks with the usual practice we have.

Madam Speaker, I will ask for your ruling on this, but I think I should have been afforded the opportunity to at least respond briefly to the question I was asked.

Criminal Code

[Leslyn Lewis, Conservative, Haldimand—Norfolk, ON]

Madam Speaker, it is with a heavy heart that I rise today to speak to this extremely important bill, Bill C-39, an act to amend an act to amend the Criminal Code on medical assistance in dying. Bill C-39 would delay by one year the inclusion of mental illness as a sole underlying condition for eligibility to access medical assistance in dying.

I am truly disturbed by where we find ourselves as a country today. We were once a beacon of light to the world, offering hope, opportunity, community and compassion to all. However, we are quickly becoming a place where the darkness of death threatens the light of our nation. We are offering death as a solution to despair and taking the easier, cheaper way out instead of the narrow, harder path. The narrow, compassionate path requires courage and hard work to create support for those who are struggling and desperate for hope.

When the government first introduced the medical assistance in dying regime in 2016, many sounded the alarm. They said it was a slippery slope that would open the door to abuse, and the vulnerable in society would pay the price with their lives. The government assured Canadians that this would never happen; there would be safeguards put in place with strict criteria, and the most vulnerable would always be protected. However, here we are today deliberating on extending assisted dying to those whose sole illness is one of mental health.

This is sadly ironic because during the last election campaign, the Liberals promised $4.5 billion in mental health funding, which we have yet to see. Our society has invested billions in embarking on awareness campaigns to bring dignity to those suffering from mental health issues. We have entire days dedicated to mental health. We have worked tirelessly in society to destigmatize mental health issues. We voted unanimously in this House for a mental health hotline, yet here we are contemplating how the government can legalize taking the life of a person who is lost in the depths of a mental illness.

I believe deep down inside that we are all disturbed by the idea that MAID can be extended to the mentally ill. I believe that members of this House and the government know in their hearts that it is wrong for a government to abandon the most vulnerable among us in their time of need. They know it is wrong to promise mental health supports and then offer assisted dying instead.

What is so sad is that they try to justify it by saying that it is only for those individuals whose mental health is incurable. However, drug addiction, alcohol addiction, the loss of a loved one, broken families, broken relationships, the loss of a job and the inability to support oneself are all real situations that many Canadians are now facing. They could all propel an individual to the darkest depths of their soul. When people find themselves in the depths of despair, lacking the support of friends and family, this precise moment is when it is important for governments to be the beacon of hope and provide support.

The Minister of Justice assures us that individuals who suffer from mental health issues and are suicidal will not be considered for MAID. That statement is a tautological paradox. A person who is in the depths of mental illness and wants to end their life is, by definition, suicidal. When a person cannot cope mentally, their government has abandoned them and they have no prospect of obtaining help, and they decide to take their life, they are not of sound mind.

They do not have the mental capacity to give meaningful consent to ending their life. They are in desperate need of help.

I say it another way: It is near impossible to separate those with suicidal ideations from those with irremediable mental health conditions. Ninety per cent of people who commit suicide today, in fact, have diagnosable mental disorders. That is why it is utterly unconscionable that, one year from now, we could offer death as treatment to those who are suffering from mental health issues.

This option will be abused in the future. MAID has already been abused, with few safeguards currently in place. There have been countless stories of abuse, including stories of elderly, disabled, marginalized and mentally ill Canadians, even veterans, who have fallen through the cracks of care and have become victims of Canada's permissive MAID regime. Here are some of the headlines across our country and across the world that comment on the MAID regime:

“‘Hunger Games style social Darwinism’: Why disability advocates are worried about new assisted suicide laws” is from Niagara This Week.

“Former paralympian tells MPs veterans department offered her assisted death” is from CBC News.

“Homeless, hopeless man to seek medically assisted death” is from Barrie Today.

“Normalizing Death as ‘treatment’ in Canada: Whose Suicides Do We Prevent, and Whose Do We Abet?” is from the World Medical Journal.

“What Euthanasia Has Done to Canada” is from the New York Times.

“‘Disturbing’: Experts troubled by Canada’s euthanasia laws” is from the Associated Press.

“Why is Canada euthanising the poor?” is from The Spectator in the U.K.

The government needs to read those headlines and generally consider the totality of the evidence. It is clear that there is no way to safely expand MAID to mental illness.

The government heard the evidence presented at the Special Joint Committee on Medical Assistance in Dying. Experts said that it is “difficult, if not impossible” to determine whether someone is suffering from a mental illness and whether they will get better.

Our country is in a mental health crisis. Record numbers of Canadians are struggling with mental health issues that have been exacerbated by COVID.

To push forward with expansion at all is an abdication by this government of its responsibility to provide sufficient social, financial, mental health and suicide prevention supports to our most vulnerable. It is to abandon anyone who is suffering from mental illness.

The darkest hour is just before the dawn. To those suffering with mental illness, we must be the hope of the dawn in the dark night of despair.

We have the resources to wrap our arms around every person in Canada suffering from mental health issues and to embrace and enfold them in the promise of a brighter future, investing in life and dignity for all Canadians.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Mr. Speaker, I am rising today to speak to Bill C-39, which would delay, by one year, the Liberal government's goal of extending medically facilitated death to Canadians living with mental illness.

Extending medically facilitated death to vulnerable Canadians living with mental illness is unjust now and it will be unjust one year from now.

The government's MAID policy has been driven by radical groups. Their end goal is state-provided death on demand to anyone for any reason. These groups have almost constant and unfettered access to the Liberal government, and this is clear because this extreme expansion is backed by radicals within the Liberal government and Liberal-appointed radicals within the Senate.

At the MAID committee, one of this sort remarked that MAID should be available for babies. How far has our collective respect for dignity of the human person fallen that such a grisly statement could be made without rebuke? Many have said that we are at the end of a slippery slope, but it is clear that if the Liberals continue to take their marching orders from groups like this, they are nowhere near done.

By law, to be eligible for MAID, a person must have a grievous and irremediable medical condition that is incurable and in an advanced state of irreversible decline. That means that, to qualify, a MAID assessor must be satisfied that the person's condition will not get better. We know it is impossible to predict whether or not a person suffering from a mental illness will get better, so it is not possible to determine irremediability.

Dr. John Maher, a clinical psychiatrist and medical ethicist, said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”

MAID decisions in cases of mental disorders will be based on “hunches and guesswork that could be wildly inaccurate”, according to Dr. Mark Sinyor, a professor of psychiatry at the University of Toronto and a psychiatrist who specializes in the treatment of adults with complex mood and anxiety disorders. He also said that “they could be making an error 2% of the time or 95% of the time.”

The Liberal government is willing to say that Canadians with mental illness will not get better and then will end their lives, which could be wrong 95% of the time. Make no mistake, if the government goes ahead with its expansion of MAID for mental illness, people who would have gotten better will not get the chance, because they will be dead.

Right now, 6,000 people with the most severe forms of mental illness are waiting up to five years to get the specialized treatments they need to reduce symptoms, learn to cope and feel better. Instead of working to better those symptoms, to give people the help they need when they need it the most, the government is striving to offer them death.

When appearing before the Senate, Dr. John Maher said, “Clinical relationships are already being profoundly undermined. My patients are saying: ‘Why try to recover when MAID is coming, and I'm going to be able to choose death?’” He goes on to say, “Some of my patients keep asking for MAID while they're actually getting better but can't recognize that yet.”

We need to offer Canadians hope, and not death, when they are in the depths of despair. Under the Liberal government, a wave of hopelessness has spread to every corner of the country, and we are seeing people seeking and being approved for medically facilitated death because they are poor, because they cannot afford adequate care or housing. It has even gotten to the point that veterans have been offered death instead of treatment and support. We must ensure that the dignity of the human person is respected and considered as a foundational block for our society if it is to be a just society.

We have seen the respect for human life, and especially the lives of vulnerable Canadians, threatened by the current government's MAID regime, and that should be weighed against the standard of a society that is right and just, and that measures whether their actions and policies enhance or threaten the dignity inherent in every single person. This is not a dignity that was invented, imagined or assigned by a government, but it can be affirmed or denied.

What we are seeing in Canada is a government that is willing to offer death before it is willing to offer adequate care, access to timely treatment or even a life that is affordable to live. People are asking food banks to help them access death. It is an absolute disgrace that life in Canada has come to that.

That is why the preferential option for the vulnerable must be in mind as we make any decision in this place. Does this protect, or attack, the vulnerable? Does this enhance, or threaten, the dignity of the vulnerable? Does this lift up the vulnerable, or marginalize them further? These are the questions that have to be asked. When it comes to the Liberal government's MAID regime, I will say that it attacks and threatens the vulnerable, threatens their human dignity and marginalizes them further. How could it not, when death is the solution offered to the problems of the most vulnerable people among us?

Throughout this entire process, the government has tried to silence the voices of marginalized Canadians, especially those living with disabilities or mental illness, but it will not silence my voice here today. It will not silence the voices of Conservatives who stand here united in our opposition to expanding medically assisted death for mental illness.

Death is not an acceptable solution to mental illness and psychological suffering. Our health care system should help people. It should help them find the hope and resilience they need in order to live, and not facilitate their deaths. We continue to be, as we always have been, called to attend to the lives of the most vulnerable people and their preferential option in life. That is to listen to them, to include them, to support them, to lift them up, to help them and to love them, not to end their lives.

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

Mr. Speaker, when members had the special joint committee, they had a great deal of consultation with many different stakeholders. A lot of evidence was provided. Earlier today, the Chair presented the report. It is worth recognizing that a majority of the political parties inside this House seem to support Bill C-39.

Can the member comment on whether the extensive discussions and dialogue that have occurred have in fact improved our system? Could she add value to anything I have said?

[Élisabeth Brière, Liberal, Parliamentary Secretary to the Minister of Mental Health and Addictions and Associate Minister of Health]

Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code with regard to medical assistance in dying, which was introduced by the Minister of Justice on February 2.

Through this bill, our government is seeking to extend the timeline that will expand eligibility for MAID where the sole underlying medical condition identified in support of the request is a mental disorder.

Our government is committed to ensuring that the MAID framework is prudent, well‑thought‑out and rigorous so that the assessment and provision of medical assistance in dying is safe. At this point, we believe that delaying the repeal of the exclusion is the best way to achieve these objectives.

It is crucial to strike a balance between promoting the autonomy of those seeking a dignified end and protecting the interests of those most vulnerable in our society. Our government believes that this is the right decision given the inherent complexities of MAID requests that are based only on a mental disorder.

My comments will focus on the current MAID framework, including eligibility criteria and existing Criminal Code protections, and on the broad range of opinions from the public, the medical establishment and other experts, in particular the organizations representing persons living with a mental health disorder.

At present, to be eligible for MAID, an individual must meet five criteria.

All applicants must be eligible for health services funded by the Government of Canada, be at least 18 years of age and capable of making informed decisions relating to their health, have a grievous and irremediable medical condition, have requested MAID voluntarily and not as a result of external pressure, and provide informed consent to receive MAID after being informed of available means to relieve their suffering.

As I just mentioned, one of the criteria is a grievous and irremediable medical condition, which means that the person must have a serious and incurable illness, disease or disability; that their medical situation is characterized by an advanced state of irreversible decline in capability; that their illness, disease or disability or advanced state of irreversible decline in their capability causes them to experience enduring intolerable physical or psychological suffering that cannot be relieved under conditions that the person considers acceptable.

In addition to these eligibility criteria, the Criminal Code also provides two sets of procedural safeguards that must be met before MAID can be provided. The first set of safeguards addresses situations where death is reasonably foreseeable, and the second, more stringent set applies to requests for MAID where death is not foreseeable.

The safeguards for MAID requests where death is reasonably foreseeable include that the request must be made in writing and signed before an independent witness, as well as that the person must be informed that they may, at any time and in any manner, withdraw their request.

There are four additional safeguards when death is not reasonably foreseeable. This is because these MAID requests are more complex than when death is reasonably foreseeable. The four additional criteria are as follows.

A second physician or nurse practitioner must confirm in writing that the person meets the eligibility criteria. There must be at least 90 days between the first MAID assessment and the date on which MAID is administered. The person must be informed of alternative available means to alleviate their suffering, such as counselling services, mental health and disability support services, community services and palliative care, and offered consultations with relevant professionals who provide those services. Finally, both physicians or nurse practitioners must agree that the person has given serious consideration to those means.

If this bill is not passed, requests for medical assistance in dying where the sole underlying medical condition is mental health will become available on March 17, 2023.

I will now briefly discuss some of the concerns that we have heard regarding the upcoming expansion. In their May 2022 submission to the Special Joint Committee on MAID, the Centre for Addiction and Mental Health expressed that “Before eligibility is extended, there must be thoughtful and inclusive discussions to develop consensus definitions of irremediableness and suicidality.” We believe that the extra year will allow for the necessary consideration of these important topics.

In addition, in November, the Canadian Psychiatric Association issued a statement in favour of delaying the repeal of the exclusion from medical assistance in dying in cases where a person's sole underlying medical condition is a mental illness. The CPA is of the opinion that more time is needed to improve education on suicide prevention and access to mental health and addiction services; to develop an expert-approved definition of the irremediability of different mental disorders; and to develop approaches and procedures to help clinicians distinguish between suicide and access to medical assistance in dying.

In December, the Canadian Association for Suicide Prevention also issued some observations in support of the delay. It would like more research to be done into the prognosis of mental disorders in order to draw conclusions on the irremediability of any mental disorder, which is a legal requirement within our MAID framework.

Many of these concerns were raised during the hearings of the Special Joint Committee on MAID, which was established to undertake a review of the Criminal Code MAID provisions and other related topics, including mental illness. The committee’s final report was released this week. One of the reasons for the extension is so that the government can seriously consider the recommendations of this committee.

The government believes that extending the exclusion of mental illnesses is necessary to ensure that MAID is provided appropriately in all circumstances where a mental illness is the sole medical condition for requesting MAID.

I hope that all members will join me in supporting this bill.

[Dean Allison, Conservative, Niagara West, ON]

Mr. Speaker, as always, I want to thank the constituents of Niagara West for electing me to represent them in Parliament and be their voice in this place on the key issues of our country. What is more important than the bill we are discussing today, Bill C-39, respecting medical assistance in dying? We all know how sensitive and complex a topic this is. We as parliamentarians, with this bill, are dealing with the issue of literal life and death, which is a deeply personal decision, and that is as complex as it gets.

On both sides of the House, the focus and priority of all of us is to ensure that safeguards are always in place for the most vulnerable people in our society, particularly for those with mental health challenges. I believe that we are all trying to get this legislation right. Lives are at stake, and again, we need to get this right. We also have to keep in mind that we have to be respectful and accepting of the different perspectives on this issue.

Many folks from my community in Niagara West are people of faith, and they are struggling with this concept of doctor-assisted suicide. This issue is of particular importance to the thousands of my constituents who took the time to write letters, send emails and make phone calls to my office to express their views. This is an issue that is exceptionally difficult to accept for many Canadians across the country, including those in my riding of Niagara West.

The planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify on mental health grounds, to me and to many of my constituents, is even more troubling. These folks want to ensure that we, as the representatives in this place, safeguard human life in the aftermath of the Carter v. Canada Supreme Court decision.

There is also strong concern that people with mental health issues may be persuaded into ending their lives while they are in a state of personal suffering. That is wrong, and I am sure that we all want to prevent that kind of thing from ever happening to anyone. I am also concerned that there may be horrible stereotypes reinforced, such as that that a life with a mental health challenge is not a life worth living, or that living with it is a fate worse than death. This cannot happen.

I know it has already been discussed, but I would like to provide some information and context for my constituents who are not yet aware of how we got to this point and why we are currently discussing medical assistance in dying in Parliament.

On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. In other words, the Supreme Court made medical assistance in dying a legal right for Canadians under our Charter of Rights and Freedoms. The Supreme Court declared that paragraph 241(1)(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter rights of life, liberty and security of the person for individuals who wanted to access an assisted death. The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the Charter of Rights of individuals and patients. As a result, the government introduced Bill C-14 on April 14, 2016, and it received royal assent on June 17, 2016. Medical assistance in dying has been legal ever since.

An important fact to remember, once again, is that the legalization of assisted death began with the Supreme Court decision in Carter v. Canada. The last time I spoke to this issue, I reiterated my concern, and the concern expressed by thousands of my constituents, that there simply are not sufficient safeguards for those who are most vulnerable in relation to accessing medical assistance in dying. I feel the same today.

I believe my esteemed colleague from Calgary Nose Hill is absolutely correct. This week, she spoke to the same bill and said that she finds it reprehensible and an abdication of responsibility of every parliamentarian of every political stripe to allow medically assisted dying to be extended to Canadians with mental health challenges, given the abject, miserable state of mental health supports in Canada. She spoke about the difficulties in accessing mental health supports across the country, and I believe she is correct. Mental health services are not readily available. They are also very expensive. The availability of quality mental health services must be there across the country before we even start to consider this debate on legislation that allows folks experiencing mental health issues to seek medical assistance in dying.

Let us not forget something very important here: One of the symptoms of a mental health issue is the unfortunate thought of wishing to die. How can we not get our mental health care system in order first before we contemplate allowing folks to commit medically assisted suicide because of a potentially treatable mental health challenge? I cannot fathom a life being lost because of a treatable mental health issue that went untreated because of a lack of quality and available supports.

I am sure my hon. colleagues have also heard the story of an Ontario man who requested MAID, not because he wanted to die, but because he thought it was a preferable alternative to being homeless. Housing is another major issue the government has not adequately addressed. We should not be a country where folks who are homeless should live in such despair that they feel they have no option than to request medical assistance in dying.

In another story, a disabled Ontario woman applied for MAID after seven years of applying for affordable housing in Toronto with no luck. I think we are all in agreement that these types of cases should never happen.

I am also very concerned about the mental health of all Canadians, given the difficult times we are in. Inflation is at a generational high. The cost of groceries is up 11%. Half of Canadians are cutting back on groceries, and 20% of Canadians are skipping meals. The carbon tax is being tripled, adding unnecessary costs to families’ gas, grocery and home heating bills.

The average rent in Canada’s 10 largest cities is more than $2,200 a month, up more than $1,000 a month over the last eight years. Average monthly mortgage costs have more than doubled, now costing Canadians over $3,000 a month. We are seeing a record number of Canadians visiting food banks.

All of this takes a tremendous toll on the mental health of families, seniors and especially those suffering with mental illness and other vulnerable groups. Life was not exactly easy for many people before the pandemic, and it has certainly gotten worse with the inflationary crisis we are in. The important thing to remember here is that investments into mental health services must be made a top priority, because as we all agree, mental health is health.

Let us turn back to Bill C-39. I believe there should be strong safeguards to ensure those most vulnerable never fall through the cracks and end up on a list of people to be medically put to death before they have exhausted all avenues to live a meaningful life.

Let us be clear about something, medical assistance in dying is a tremendously difficult issue to debate. It is a highly emotional topic, and there are many factors and personal convictions that come into play. We agree on many things, but we also disagree strongly on others.

On this issue, specifically, we must respect and listen to one another’s views as we chart the course of our future and the future realities of those who are most vulnerable. We can either signal to them that we care by expanding mental health supports and investing in quality services, or we can unfortunately go down a dark path of allowing those who are struggling with treatable mental health challenges the opportunity to end their lives.

I support investing in our people by providing quality and easily accessible mental health treatments. However, this is not what the government’s Bill C-39 does. It seeks to delay, for one year, the implementation of provisions that would expand the availability of assisted dying to those whose sole underlying condition is mental illness. That is wrong.

Unfortunately, the Liberal government has brought forward this delay to their MAID expansion because they failed to heed the concerns of our Conservative members, mental health advocates and Canadians when they passed legislation in 2021. I personally do not believe that we should ever give up on those experiencing mental illness. According to the most recent polls, a majority of Canadians would agree with me.

A majority of Canadians oppose the government’s plan to offer assisted dying to patients with incurable mental illness. The Angus Reid poll shows 51% of respondents said they oppose the expansion of medical assistance in dying to Canadians whose sole condition is mental illness. In other words, 51% of Canadians believe that we should be focused on offering help and treatment rather that assisted death.

Having said all this, at this point we will be supporting this delay to prevent the immediate expansion of assisted death to those suffering with mental illness. In the near future, we will bring forward alternative proposals. My hope is that the we all uphold the original objective of the initial legislation, which was “to affirm the inherent and equal value of every person’s life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled.” That we must protect “vulnerable persons...from being induced, in moments of weakness, to end their lives.”

This issue is very important to me and to many of my constituents, and I look forward to working with all my colleagues, from all parties, to get this right.

The House resumed from February 13 consideration of the motion that Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

We talked about vulnerability. Is there anyone more vulnerable than someone who has an incurable illness causing them so much suffering that they have reached their breaking point? That is why I think the government wisely decided not to take the issue to the Supreme Court. People were going on hunger strikes in an attempt to satisfy the reasonably foreseeable natural death criterion because they could no longer take their suffering and desperately wanted access to MAID. That's horrendous.

My fellow members over here are critical of the judge's decision, but it established that the government's position infringed on the individual's right to life because, instead of providing assistance when the person could no longer tolerate their suffering, the system waited for them to commit suicide. The message that sends people is that suicide is their only option. It amounts to telling them to commit suicide because it's not our problem. On top of it all, those individuals had to take their fight all the way to the Supreme Court despite the intolerable suffering they were experiencing because of their illness. I don't think that is a government's role. A government's role is to make sure the conditions are in place so that people can exercise their freedom of choice.

That said, how many MAID bills, other than Bill C‑39, were private members' bills? None. Bills C‑14 and C‑7 came about in response to court decisions, because citizens were forced to defend their rights in court.

My Conservative colleagues say that, had they been in power, Ms. Gladu and Mr. Truchon would have never had access to MAID, nor would all the others who suffered and were granted access to MAID precisely thanks to Bill C‑7. It's probably worth asking who the most vulnerable members of society are. In my view, the vulnerable ones are those suffering from incurable illnesses who are denied MAID because the right-thinking government knows better than they do what's good for them. For what reason should they be denied that?

Throughout their lives, their right to self-determination is recognized. In biomedical contexts, they are told that no intervention can be provided without their free and informed consent. Then, at the most intimate moment of their lives, meaning death, the Conservatives would have the government make the decision for them because it knows best. It is not the government or their neighbour dying, it is the person themselves. I'm sorry, but I do not agree. I think the passage of Bill C‑7 was a good thing.

However, we need to make sure we are truly ready, because people have mental disorders and are suffering. Implementing this across the country isn't easy. There will be pushback, as there has been in Quebec. Some institutions don't want to provide MAID to people who are terminally ill, even though that criterion is the subject of a countrywide consensus. Patients are prevented from accessing MAID by those institutions. It's scandalous. It's shameful. We have to avoid that.

[Matthew Taylor]

Well, a charter statement is required under the Department of Justice Act for any legislation that's introduced in Parliament. As you know, Bill C-39 was recently introduced. A charter statement will be tabled.