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.

[Matthew Taylor]

There is no charter statement tabled yet in Parliament with respect to Bill C-39.

If your question was whether there was a charter assessment done of Bill C-7 as amended by the Senate, as you likely know, charter statements are not evergreen documents. They're a reflection of the charter considerations of the bill as it is introduced.

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

Thank you, Mr. Chair.

Minister, when I was on the special joint committee, we heard from a lot of witnesses on far-ranging topics. I remember, when it came to the specific subject matter we're dealing with here, with Bill C-39, that some of our witnesses said that there aren't really any specific criteria for knowing that a mental illness is irremediable, and that there is not a lot of evidence out there that anyone can reliably determine if an individual suffering from a mental illness will not improve. That's how it's different from a physical illness. That's what's given us a lot of pause. We just want to make sure we are, in fact, getting this right. I think that's why you're seeing a lot of this trepidation.

I agree that Bill C-39 needs to be passed. We do need this extension, but, given the testimony that we received in terms of the irremediability of mental disorders and the unknowns that still exist, when we are approaching March 2024, how are you going to ensure that everything is, in fact, in place? Are you going to put in place plans for Parliament to have another say or another review of this before that deadline comes into effect in 2024?

[Luc Thériault, Bloc, Montcalm, QC]

Bill C‑14 was a terrible bill, a bad copy of the Quebec bill and because of it, people like Ms. Gladu and Mr. Truchon were forced for a time to plead their case before the courts. These are people who had lived full lives, even if they were in a wheelchair, and who refused to be infantilized and considered as vulnerable people. They had put up with enough discrimination during the lives. They went all the way to the Supreme Court, whereas other people were obliged to stop eating and drinking in order to meet the criteria of a predictable natural death. That is horrible. A state cannot allow that.

That said, Bill C‑7 did rectify the problem and in order to get that bill passed, a compromise was made to include mental disorders. Senators said that the bill, which didn't include people suffering from mental disorders, contravened the Canadian Charter of Rights and Freedoms.

The prudent approach consisted of asking people who know what they are talking about, that is to say professionals and experts in the field of mental health and mental illness. Actually, the experts asked us to stop talking about “mental illness” and use the term “mental disorders”. Moreover, they presented us with 19 recommendations for providing access. I encourage you to read them.

Two years ago, I was one of those people who were sceptical about the inclusion. I read the report 20 times. I asked questions and I think that indeed, the prudent approach would be to pass Bill C‑39. That way, for example, a person who has been suffering from schizophrenia for 30 years and who, at certain times, has become a shell of a human being due to his or her medication, could have access to MAID upon request. However, we're not saying that this would apply to a young person, a minor even, who had tried to commit suicide. The report indicates that it would take decades before such a person would have access to MAID. The person's condition would have to be irreversible and all therapies would have to have been tried.

At some point, we will have to put things into perspective. I will be watching you, Minister, and I will be watching people who are telling us that we are ready. We are not ready right now. You stated that we will be ready to go forward in March. I don't think that will be the case. I don't know who was saying that it will be possible, but it was certainly not the members of the Canadian Association of MAiD, Assessors and Providers, CAMAP, who are putting together seven training modules.

That requires trainers, not assessors. People have to be ready on the ground so as not to make any mistakes. To avoid mistakes, we will have to implement two key recommendations of the report, recommendations 10 and 16. They will become safeguarding measures that go beyond what is being done currently in terms of MAID.

I do not have any more questions, but I am sick of hearing nonsense.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Actually, we went to visit a group in Sherbrooke that works with people suffering from mental illness. The members of this group were disappointed that this provision of Bill C‑39 will be pushed back. They were ready to go forward with it. The people that the group works with are suffering tremendously, and some of them would have wished to have access to MAID, because they had made a well-considered decision of their own volition.

Obviously, members of the group wanted to help so that the system would be ready. They were disappointed. However, I told them that we would give our all so that everyone will be ready. I have a lot of empathy for this organization and its clients.

[David Lametti, Liberal, Minister of Justice and Attorney General of Canada]

Thank you, Mr. Chair, for the opportunity to speak to the committee on Bill C-39.

I thank all of you for the urgency you have shown in considering this important legislation.

I would also like to thank officials from both Health Canada and the Department of Justice who are here with me this evening. As you all are fully aware, this bill transcends different departments and, therefore, it is critical that I have Health Canada support here this evening in addition to the usual DOJ support.

In March 2021, the previous Bill C‑7, an act to amend the Criminal Code (medical assistance in dying), provided greater eligibility to medical assistance in dying for people whose natural death was not reasonably foreseeable. It also provided for a temporary exclusion to the provision that mental illness could be the sole basis of a request for medical assistance in dying. If no legislative amendments are made, this exclusion will automatically be repealed on March 17, 2023. On that day, medical assistance in dying will become legal in such cases.

Bill C‑39 proposes to temporarily extend the exclusion relating to mental illness for one year up until March 17, 2024.

The main objective of this bill is to facilitate the safe assessment and provision of MAID in all circumstances where a mental illness forms the only basis of a request for MAID. An extension of the exclusion of MAID eligibility in these circumstances would ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the government more time to meaningfully consider the report of the Special Joint Committee on MAID, or AMAD, which is expected to be tabled by Friday, February 17.

I am confident that a temporary one-year extension will allow us to proceed in a measured and prudent way and will ensure that we get this right. As always, our government remains committed to ensuring that our law reflects Canadians' evolving needs, protects those who may be vulnerable and supports autonomy and freedom of choice.

As I have just explained, the previous Bill C‑7 temporarily excluded access to medical assistance in dying in cases where mental illness was the sole factor. This temporary exclusion is based on the fact that these cases are often complex and that it would be better to have more time to reflect on them.

Over the past two years, much work has been accomplished. The Expert Panel on Medical Assistance in Dying and Mental Illness has conducted an independent review of the protocols, directives and safeguarding measures to be recommended in those cases where mental illness is the basis of a request for medical assistance in dying. The expert panel's report was tabled in Parliament on May 13, 2022.

When it was conducting its parliamentary study, the Special Joint Committee on Medical Assistance in Dying also looked at the provisions of the Criminal Code concerning medical assistance in dying and their application in various contexts, such as that of mental illness. In June 2022, the committee published an interim report containing a summary of the testimony that it had heard or received. Witnesses included psychiatrists and other physicians, as well as people living with a mental illness and representatives of various stakeholder groups. We are looking forward to the special joint committee's final report which will be presented before February 17, which is this Friday.

I commend the expert panel and the special joint committee for their hard and important work. MAID is a very personal and challenging subject, and we are better for their careful study and advice.

In addition to the work of the expert group and the special joint committee over the past two years, the provinces, territories and health care community have been working with Health Canada to ensure system readiness. They have developed resources to support MAID assessors and providers, including clinician education and training. They have developed the necessary policies and practice standards. The work is well under way.

Some provinces likely would have been ready to begin offering MAID for mental illness to eligible and properly assessed patients on schedule in March 2023, but we heard from many that they were not quite ready. An extra year will make sure that everyone is ready and well equipped to make MAID for mental illness available in a way that is prudent and safe.

I'm here to talk to you today about the urgent need to extend the exclusion of MAID for mental illness by one year, but I would be remiss if I did not also take this opportunity to address some misinformation about MAID that I've heard over the past few months. I want to reassure all Canadians and all of you around this table that Canada's MAID regime is safe. The system has extensive checks and balances to make sure that only eligible people who clearly and freely choose MAID can access it.

In 2021, in response to the Superior Court decision in Truchon, former Bill C-7 expanded eligibility to receive MAID to people whose natural death was not reasonably foreseeable. To address the additional complexities of these kinds of cases, we created a separate and even more stringent set of procedural safeguards that must be satisfied before MAID can be provided.

Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.

Another additional safeguard is a requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering, or that they must consult with a practitioner who does have that requisite expertise. The assessing practitioners must also ensure that the person is informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It's not enough to merely discuss treatment alternatives. They must ensure that the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.

MAID for mental illness poses even more complex challenges. That is why we need to take the time necessary to ensure that the health care system is completely ready before we expand eligibility for MAID to those whose sole underlying condition is a mental illness. We recognize that mental illness can cause the same level of suffering that physical illness does.

We are aware that there are people who were waiting to become eligible to receive MAID in March 2023. We recognize that these people are suffering and will be disappointed by an extension of the ineligibility period. We empathize with these individuals.

Nevertheless, I believe this extension is necessary to ensure the safe provision of MAID in all cases where mental illness forms the basis for a request for MAID. We need this extension to ensure that we do not rush the expansion of eligibility and to ensure that we make any changes in a prudent and measured way. Our main priority is to ensure the safe provision of MAID. I'm confident that courts would find this short extension to be constitutional.

Canada has implemented legislation on medical assistance in dying that supports autonomy and freedom of choice while offering protection to the most vulnerable. We believe that the timeframe provided for in Bill C‑39 will be sufficient so that this continues to be the case.

We need to take the time to get this right. The one-year extension will give more time to ensure that the health care system is ready, and more time to meaningfully consider and act on the special joint committee's recommendations.

Merci. I look forward to your questions.

[The Chair, Liberal, Randeep Sarai]

Absolutely, and thank you for asking. I confirmed with the clerk that the sound tests were all positive.

Let's begin our study on the subject matter of C-39, an act to amend the Criminal Code, medical assistance in dying.

Please welcome with me the Honourable David Lametti, Minister of Justice and Attorney General of Canada. Along with him are the following officials: Matthew Taylor, general counsel and director, criminal law policy section; Joanne Klineberg—she's online—acting general counsel; and Myriam Wills, counsel.

From the Department of Health, we have Sharon Harper, director general, health care programs and policy directorate; Venetia Lawless, manager, end-of-life care unit, via video conference; and Jacquie Lemaire, senior policy analyst, also by video conference.

Welcome.

Mr. Lametti, I'll give you 10 minutes, if that will suffice.

[The Chair, Liberal, Randeep Sarai]

They're very happy, yes. At least they can all watch you live. They can know that you're not with anyone else and that you're doing productive work, so it's good. Anyway, I thought I'd make a little light of that.

Welcome to meeting number 50 of the House of Commons Standing Committee on Justice and Human Rights. Pursuant to the House order of February 13, 2023, the committee is beginning its study on the subject matter of Bill C-39, an act to amend the Criminal Code, medical assistance in dying.

Today's meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022. Members are attending in person in the room and remotely using the Zoom application.

I'd like to make a few comments for the benefit of the witnesses and members. Please wait until I recognize you by name before speaking. For those participating via video conference, click on the microphone icon to activate your mike, and please mute yourself when you are not speaking.

For interpretation for those on Zoom, you have the choice at the bottom of your screen of floor, English or French audio. For those in the room, you can use the earpiece to select the desired channel. I remind you that all comments should be directed through the chair. For members in the room, if you wish to speak, please raise your hand, and for those on Zoom, if you wish to speak, please use the “raise hand” function.

I use little cue cards, so when you're down to 30 seconds, whether that's your statement or your questioning, I put this up so I don't have to interrupt you. When you're out of time, I raise the red card and ask you to wrap up. If you don't, then, unfortunately, I will have to interrupt you.

Let's now begin our study of the subject matter of Bill C-39—

Criminal Code

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, as always, it is an honour to rise in this place to talk about this important issue facing Canadians, being signalled last week and coming into debate today, and to understand the gravity of the conversation that is Bill C-39. We have before us a bill that presses pause, a one-year pause, on the implementation of the state being able to, through a medical assistance in dying regime, see individuals take their own life for the sole underlying cause of having a mental illness. It is moments like this where one has no option but to pause and think about the gravity of the issues that we discuss here.

Certainly, when it comes to this delay, I support it. I think that a year is not nearly long enough, and like many other colleagues, I believe that a delay simply does not go far enough regarding something that should never be on the table.

When it comes to mental health, we have heard today something that has been mentioned a lot, the idea of hope, the fact that we need hope, and offering death to someone who feels hopeless is not hope. I find it very troubling and a tragic irony that over the course of the time that I have had the honour and responsibility of serving the people of Battle River—Crowfoot we have talked a lot about suicide prevention and mental health. I think back to one of the debates that took place during my nomination campaign. I made a simple statement that I did not realize would have the effect it does today. It was when I and the other nomination contestants in Wainwright, which is home to a military base, were asked a general question about what was required for mental health. It was a productive discussion, but one of the statements I made in response to that was that I believed mental health is health. A young man came up to me afterward, the child of a veteran, and said he was so encouraged by the fact that somebody finally was willing to say that mental health was health.

I cannot emphasize enough how vitally important that context is to the discussions we are having around Bill C-39, and specifically the honour I have of representing a military base. The fact that there are veterans who have called Veterans Affairs asking for help yet were offered death defies what I thought was possible. The reality is that in this country we need to make sure we prioritize hope. When we look at the context of where we got to, this bill is happening a whole lot faster than the three-digit suicide hotline that this Parliament unanimously called for more than a year ago. Where political will exists things can move quickly, but unfortunately when it comes to the idea of help, health care for those struggling with suicidal thoughts, and ensuring that those who have mental health challenges are given the care they need, we have before us a bill that simply delays for one year the offer of death.

I have reflected much on this issue, although being elected in 2019. In much of the debate that took place over medical assistance in dying, we were told that the concerns raised by many members, both those who sit in the Conservative caucus today and others, including but not limited to the former attorney general and I believe representatives from all parties represented in this place, were simply considered a slippery slope, a logical fallacy, yet here we are.

In fact, in the context of this discussion, a story was sent to me, which I would like to read in this place: “Recently, my friend's mother, Carmen, was a victim of a physician attempting to coerce her into MAID. She was quite insistent on it, to the point of causing severe distress. His main point of sale was that it would save the hospital a lot of money, and it was her duty to do the right thing for the hospital and her family to just do it.”

I could not think of a circumstance where somebody would be more vulnerable, dealing with the challenges associated with mental health and some of the challenges associated with underlying health conditions, as was the case with this individual. Instead of being given that opportunity for life, it was presented as a duty to save the state a few dollars and to save her family from having to journey beside her through an illness.

The folks from Battle River—Crowfoot will know very well my faith background. I often think of some of the Bible verses that I was taught as a child and remember here today. I would like to read one here today, which is certainly one that has offered me hope during challenging times. It is Jeremiah 29:11. I think that many in the House will have heard this verse before. It goes, “For I know the plans I have for you, says the Lord. They are plans for good and not for evil, to give you a future and a hope.”

As we enter into the discussion around the idea of whether or not somebody who is facing a challenging circumstance in their life and facing the challenges of mental health distress, to the point where they would be led to or, heaven forbid, coerced into making an irreversible decision such as medically assisted death, let us remember, as others in this place have mentioned, that as members of Parliament, as leaders in this country, and certainly as members of the government across the way, we should always endeavour to be catalysts for hope. We should ensure that, whether it be in partisan discussions, which members in the House will know well I love to participate in, or whether it be in coming to the assistance of those who walk through my office door in Battle River—Crowfoot, we do everything we can to extend the hope that is so desperately needed.

As we have this discussion, as we have this now one-year pause on the implementation of mental health being the sole underlying factor for medically assisted death, let us pause and think very carefully, not only as parliamentarians but as a country, as a society, as those who are called to look out for the most vulnerable among us, whether that be indigenous people, immigrants, women and the list goes on, to ensure that we respond not with the extension of a mechanism that would allow somebody to take their own life, but for those who are facing the most severe mental health challenges, let us ensure that our automatic response would be to offer that olive branch of hope.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I am thankful for the opportunity this evening to speak to Bill C-39.

At the outset, I believe it is important, first of all, that my constituents know that this bill is not a complicated one. It does not propose anything new to Canada’s euthanasia laws, nor does it propose to appeal laws that are currently in place. This is a simple bill that delays the expansion of medical assistance in dying to those living with mental illness by 12 months, one year. On those grounds, Conservatives support its swift passage, but only as a temporary solution.

However, this bill is what happens when a government moves too fast, too aggressively, and fails to take into account the pleas of experts and everyday Canadians living with mental illness and family members living with them. These Canadians include our family members, our friends, our neighbours and our co-workers. They live with mental illness that, to them, should not be a death sentence. They see the provision of MAID for their illness as yet another step along the road to devaluing life in this country. They know it is not going to accomplish anything to end stigma around mental illness, and they know that it puts vulnerable Canadians from all walks of life with illness seen and unseen at risk.

That is why this bill is little comfort to me and to Canadians at large. The extension of assisted death to mental illness must not just be delayed; it must be scrapped completely.

Assisted death has been a highly emotional issue since this place first considered its legalization in 2016. It was the first bill that I debated in this House. Debate has been passionate due to our personal experiences, personal beliefs and convictions on what constitutes dignity in end-of-life decisions. However, today’s debate takes on an even greater heaviness in that respect.

Statistics indicate that one in two Canadians by age 40 has or has had a mental illness. The chances are even greater for young people, and among those who have answered surveys on the topic, respondents report that they would be three times less likely to disclose a mental illness than a physical one, like cancer. The numbers are grim but paint a realistic picture of mental health as it relates to all Canadians. It is universal. No one is immune to life’s difficulties, whether in the short or the long term. That is precisely why stakeholders are asking the government to show true compassion by reconsidering an expansion of MAID to those with wounds that are largely unseen.

The Canadian Mental Health Association points to socio-demographic factors beyond age, education and income levels as driving forces behind a request for MAID. Racism, poverty, homelessness and gender-based violence have harmful effects on mental health and symptoms of mental illness. Over these past couple of years, we can tell too that isolation, persecution for one's beliefs and hopelessness impact our mental health.

The Ontario Hospital Association is clear that these complex issues must be addressed through appropriate legal safeguards, coupled with societal supports, before assisted death expansion is considered. On the other hand, I believe that we must consider the realities of mental health in Canada among certain groups close to my heart and why expansion must never be entertained.

This summer, Canadians were shocked to learn that a Canadian Armed Forces veteran struggling with PTSD and a brain injury was repeatedly advised of MAID as a solution to his suffering by a Veterans Affairs Canada employee. The veteran had never inquired about MAID, but even after asking the VAC employee to stop pressuring him over and over again, the employee persisted. We know that veterans face a greater risk of suicide compared to the average population. It is truly frightening to know that instead of facilitating the most appropriate care available, this public servant chose to repeatedly suggest MAID as a solution to suffering. This frightens me to know, and I wonder how often this kind of advice has led to tragic consequences.

Debbie Lowther of VETS Canada said that it is like planting a seed within someone who is already struggling with their mental health or may even be contemplating suicide. No matter how isolated the Veterans Affairs issue may be purported to be, and I do not believe it is, it is clearly a result of the government’s attempts to muddy the waters on suicide. It did a lot to draw Canadians’ attention to the normalization of assisted death in this country and just how rapidly it is becoming a “fix-all” solution, not just for end-of-life issues but for treatable illnesses among vulnerable people. When accessing an assisted death takes less time than accessing disability benefits for our veterans, we are completely failing them. Sadly, veterans are not alone in this respect.

Some Ontarians, for example, face multi-year wait times for special mental health care. That is years of living with mental health issues when they could be receiving treatment. Why are they not? We need to ask ourselves that question. Disability advocates have been crystal clear with this government for years that Canadians do not have access to all the supports that they need and deserve and are even available.

In a piece in the Hill Times this past week, Spencer van Vloten of BC Disability is correct when he states that, “too much time is spent considering who should die, rather than how to help people live.” He goes on to note all-time highs in wait times, nearly 30 weeks, for those seeking mental health treatment.

To paraphrase one disability rights advocate, “those living with treatable illnesses likely would not put MAID anywhere near the top of their list if they had unimpeded access to support and treatment.”

Indigenous Canadians also face an increased risk of preventable harm as MAID becomes more accessible. Tyler White, CEO of Siksika Health Services noted that, “Indigenous elders work hard to tell young people that suicide should not be an option, and the medical assistance in dying (MAID) bill [Bill C-7 in this case] says the opposite.”

Many indigenous Canadians can speak to negative experiences with the health care system, including procedures that were done against their will. It is my belief that an assisted death regime, with ever-expanding boundaries and ever-diminishing safeguards, will not help to heal mistrust. It will only worsen it for our indigenous people, our veterans and those with disabilities.

It comes down to this simple fact: The same majority of Canadians who desire empowerment in their end-of-life decisions want Parliament to carefully weigh the risks of MAID for those living with mental health issues, such as depression. Sixty-nine percent fear that depressed individuals could see MAID as a means to escape dealing with the underlying causes of their condition. The experts say they can, over time, deal with those conditions.

The slippery slope does exist, and it exists nowhere near to the effect that it is happening in Canada and spinning out of control. We have to apply the brakes here. We are not only listening to those who will personally be affected by these laws, but we also need to take lessons. I know this government says, “We take no lesson”. Well, do not take them from us then, take them from jurisdictions with a long-standing MAID regime for mental illness.

In Belgium and the Netherlands, MAID laws once limited to mentally competent, terminally ill adults now include adults and children with mental deficiencies, severely disabled individuals, and those with treatable psychiatric conditions such as anorexia and depression. Between 2012 and 2017, the Netherlands alone saw a 600% increase in euthanasia which was sought to address psychiatric conditions; conditions that the experts say cannot be determined to be irremediable.

So, this government has made a choice. This minister has claimed that this is only a pause. It cannot claim as a government that it stands as a champion for mental health treatment while simultaneously cheapening the value of that treatment and, indeed, human life itself.

The minister claims that MAID expansion can be done safely, but experts have been clear that expanding eligibility of medical assistance in dying to Canadians living with mental illness cannot be done safely. It is impossible to determine irremediability in individual cases of mental illness. This expansion will only blur the lines further between suicide assistance and suicide prevention.

Canadians cannot trust this Liberal and NDP government to protect the lives of our most vulnerable, including those who are simply asking for a hand in the seasons of need. Every action they have used for MAID since 2015 has achieved the opposite.

So, let us not further stigmatize those with mental illness by placing euthanasia ahead of other solutions. We need to reject a culture of death on demand and instead let us make Canada a champion for suicide prevention at all stages of life.

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

Mr. Speaker, I want to thank the member for Dufferin—Caledon for being extremely open and honest about his own experience of deep pain and darkness. I also want to keep everything with respect to this issue as non-partisan as possible.

We have a year. Bill C-39 is going to pass. I have not heard any souls in this place say they are not going to vote for it. What do we do in the coming year? What would the hon. member recommend?

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

Mr. Speaker, I share my colleague's concerns. That is why I voted against the Senate amendment to Bill C-7 in the previous Parliament. I have been a member of the special joint committee on medical assistance in dying. It is very clear that Bill C-39 is necessary. We do need to have that delay in place.

The concepts we were struggling with at committee were individual autonomy versus protection of the vulnerable. I would like to get my colleague's thoughts on those concepts. What is his understanding of the capacity of a person who may have a mental disorder to make an informed consent decision and their own internal understanding of what they are going through?

This is a genuine question. I am genuinely curious as to what the member thinks about it because this is a really important debate that our country is having.

[Tracy Gray, Conservative, Kelowna—Lake Country, BC]

Mr. Speaker, it is an honour to rise this evening and speak to Bill C-39. This legislation aims to extend medical assistance in dying to those with the single underlying cause of mental illness for one year. If we do not approve of this legislation, it comes into effect on March 17.

I must begin by expressing my disappointment with the timing of the legislation before us today, with mere days before the House of Commons runs out of time to debate and vote on this, in order for it to go to the Senate to also be debated and voted on prior to March 17. This is the date that medical assistance in dying comes into effect for those with the single underlying cause of mental illness.

As it stands, this eleventh-hour legislation will only create a new arbitrary deadline of March 2024, replacing the present deadline of March 2023. There is no basis in science or evidence for this 12-month delay, only the shuffling of government timetables, although I am grateful that it will not take effect next month if all parliamentarians vote for this bill and it goes through the Senate.

This timetable was originally set, at the government's decision, when it accepted an amendment from the Senate to the original medical assistance in dying legislation, Bill C-7.

Despite the Minister of Justice initially expressing his concern at committee that medical assistance in dying could be done safely for those suffering from mental illness, he accepted that expansion upon amendment from the Senate and then shuttered debate on this issue when Bill C-7 returned to the chamber. He now returns to Parliament, trying to undo a problem that he started.

I will be voting in favour of this legislation, not because I think that the government has gotten this right but because if I do not support it, and if most members in the House do not support this legislation, medical assistance in dying would automatically become available to those suffering solely from mental health issues on March 17.

Abandoning people with mental illness to turn to medical assistance in dying instead is heartbreaking. When the Ontario Medical Association surveyed Ontario psychiatrists in 2021, 91% opposed the expansion of MAID for mental illness. Only 2% supported it.

The Special Joint Committee on Medical Assistance in Dying heard from a range of experts on the topic, clinicians, psychiatrists, and mental health advocates. They all expressed the same concern. Clinically determining that a patient will never be able to recover from a mental health challenge is impossible. It cannot meet end-of-life MAID criteria by any objective standard. Dr. John Maher, a clinical psychologist and medical ethicist, told the committee, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”

Canadians are rightfully horrified by news reports detailing the increasing prevalence of Canadians seeking MAID for circumstances for which it was never intended. Multiple Canadian military veterans who fought for our country, seeking help from Veterans Affairs, claimed to have been pressured by Veterans Affairs staff to consider medically assisted dying. It was reported that the matter was turned over to the RCMP for investigation and that the Veterans Affairs department was doing an internal review. A food bank manager from Mississauga reported clients asking about assisted suicide not for physical illness reasons.

Despite these stories, the government was undeterred in proceeding with its original March 2023 deadline. Thankfully, Canadians stepped in, phoned, emailed and wrote to every MP in the House. They called for us to think again on this matter and there was pressure put on the government. People were concerned about protecting the most vulnerable, and rightfully so. The legislation before us today is a sign of their efforts.

I was very touched by some of the correspondence from my own residents in Kelowna—Lake Country. I often try to be the voice of my residents in Ottawa.

Judith, in Kelowna, wrote to me with her concerns after hearing about the delay in the planned expansion of MAID for those with mental illness as the single underlying cause. She acknowledged that many people have brought forth many concerns to the government, and she was surprised that the Liberals were now just delaying the expansion.

Not every community has the same mental health services, especially rural areas. I was speaking in person to a young man last week who was movably shaken by the thought of medical assistance in dying being considered to be made available to individuals whose sole underlying condition is mental illness. His deceased mother had struggled with mental illness, and he was extremely angry to hear that the Liberal government had not cancelled outright the option for people to seek MAID under these parameters. Instead, this legislation delays it.

The public outcry and concern about this is really what forced the government to take this first step of MAID delay for people with the single underlying cause of mental illness. There are mental health stories from people I know or have met that I could share in the House, but I am not going to because I would not be able to get through them.

I do not want to give up on people, and the government is giving up on those experiencing mental illness. We must focus on giving people help and hope. We must focus on treatment for mental illness rather than assisted death. Conservatives do not want to give up on people.

As I said earlier, this legislation only creates a new arbitrary deadline. Parliament would be better served in our responsibility to Canadians, particularly vulnerable Canadians who feel lost in their lives, to abandon this reckless expansion of MAID to those with mental illness as the sole underlying condition. We cannot, and should not, give up on persons experiencing mental illness, and we must make it clear and ensure support is there for help and treatment.

Medical assistance in dying cannot be the most accessible solution for individuals with mental illness. Instead of bringing forth changes to expand MAID to persons with mental illness, the Liberals should instead be focusing on proposals to bolster mental health support for Canadians, many of whom are facing challenges in a postpandemic world and the impacts of the last eight years of the Liberal government, which has divided families and neighbours, and of its inflationary policies, which are squeezing peoples livelihoods.

The Liberals have failed to keep their pledge from the snap election in the summer of 2021 for a permanent multi-billion dollar mental health transfer to the provinces and territories, which was to ensure that they have the funding and support needed to expand mental health care. We are in a mental health crisis, yet the Liberal promise appears to have gone to the back of the line.

We have to remember that it was the Conservative member for Cariboo—Prince George who spearheaded a three-digit suicide prevention hotline in Canada, 988. All parliamentarians unanimously supported this motion in the House of Commons. This was over 900 days ago, and it still does not exist.

Now, that is not surprising considering the Liberals gave the task to their catch-all department, the Canadian Radio-television and Telecommunications Commission, the CRTC, to implement. What did the Liberals do instead?

They did not bring in legislation to cancel the implementation of MAID for those with the sole underlying condition of mental illness, they just delayed it. Building the mental health support systems Canadians need to live healthy, fulfilling lives will be a top priority for Conservatives in this Parliament and a future Conservative government.

People deserve mental health resources to help them. People deserve hope. Families deserve hope. This is what we will be focused on.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, right before Parliament resumed following the Christmas break, countless Canadians participated in Bell Let's Talk Day. They took the opportunity to talk about mental health, raise awareness, share stories and remind each other that it is good to offer or ask for help whenever it is needed. There are many members of Parliament from all parties who have joined this effort, and it is only fair to assume that they have done so because they sincerely wish to help people.

Every year, after the day comes and goes, it helps us realize that promoting mental health is actually a huge task and it is easier said than done. Over time, there has been some progress with how we approach mental health, but it can sometimes be discouraging to see that we still have to deal with some of the lingering problems or to know how much work there is left for us to do. It puts everything into perspective and shows that the results and decisions we make about an issue are more important than just talking about it.

In that light, Bill C-39, along with the larger issue surrounding it, is a real test for us. It forces us to consider what exactly we mean when we say that we want to promote mental health. Unfortunately, we are looking at a government bill that signals that we are going to take a wrong turn and fail vulnerable people who are suffering with their mental health. In a way, it is good to see Bill C-39 come forward, but it should also be clear that it is not good enough. At the very least, there will be a year before this new change takes effect, but that is nothing but a brief delay of the inevitable instead of reversing a terrible decision.

What is going to happen a year from now? Is the government going to bring another bill like this one forward to delay it another year? Will all the major problems raised by the provinces, professionals, advocacy groups and concerned citizens miraculously get resolved before the year is over? How is that even realistic? Does the government really expect Canadians to believe that?

The timeline is obviously ridiculous. It does not make sense practically and, more importantly, it will not take care of the issue at stake in the first place. There might be different views on assisted suicide for mental illness as the sole condition, but no one on either side of the debate can seriously say that it has been carefully considered in this country, if such a thing were possible. Instead, the whole process has been rushed and incomplete.

If the Liberals truly cared about making the right decision, the new legislation would be quite different. Even on their own terms, they will not be any more ready for the coming change next year than they would be if it was next month. It was only public pressure that made them slow down, but it is not going to stop them entirely. Clearly, they are planning to go ahead with the plan and hoping to get away with it again next spring.

It is highly irresponsible if we take a step back to consider the larger issue. First, I will look at this bill as it has been presented to us. We normally do not have to think too much about the official title of a bill as it comes through Parliament, but in the case of Bill C-39 it does matter, and it might even be fair to say that its name is somewhat misleading. It says that we are amending the Criminal Code related to the medical assistance in dying system, but that is only a technicality. In reality, this bill is not touching the substance of Bill C-7 as it was passed in the last Parliament. All it would do is delay the implementation of Bill C-7 or the aspect of the expansion for one year. That is definitely not a helpful or encouraging response to what Canadians and experts have been telling us since Bill C-7 became law, both inside and outside Parliament.

When Bill C-7 passed in 2021, 91% of Ontario psychiatrists opposed the expansion of euthanasia, but they were ignored. The government has not bothered to listen to critical advice and feedback. Make no mistake, there are ordinary citizens across the country who are horrified when they learn of what is happening here with expanding accessing to MAID for mental illness. I have heard from a lot of people in my own riding who are concerned. They came up to me at hockey rinks. They came up to me at my various town halls that I hosted over the winter break and told me how unimaginable it was for this is to happen in Canada.

There has been the same reaction around the world when people in other countries found out what has happened here in Canada. We stand out compared to other places that offer assisted suicide, and not in a good way. International media coverage shows how Canada's reputation has suffered as a result. It is long past time for the government to get outside of its bubble and hear what Canadians are thinking and feeling. Despite the Minister of Justice trying to claim that our system has strict safeguards, we need to look around and realize that something is not going right.

Canada reported 7,300 deaths in 2020 and 10,000 deaths in 2021. It is interesting that if we compare with another jurisdiction, it gets even more troubling. The state of California started to allow assisted suicide the same year that we did in 2016. The size of its total population is similar to that of Canada, yet it only reported 495 deaths in 2020 and 486 deaths in 2021. The difference in proportion is striking.

People see these numbers and they cannot believe that this government is considering expanding access even further to people with mental illness as a sole condition. They cannot help but wonder if these people are already slipping through the cracks and are caught up in the numbers we have here in Canada.

If we want to understand the background of how we found ourselves in the situation today with Bill C-39, we need to recall what happened with the previous bill. Back then, this Liberal government brought forward a piece of legislation that was a significant expansion from the way MAID was originally set up a few years before. It allowed assisted suicide for conditions where natural death was not reasonably foreseeable.

At the time, we heard overwhelmingly from many advocates, organizations and members from the disability community who were deeply concerned about the government's new direction. They pointed out the flaws and the risks involved for people with disabilities who could find themselves in a vulnerable position, and experience abuse rather than receiving the support and the resources they needed. They also worried about the stigma and the message it could send to the disabled as well as to wider society. It was clear that it would not be unacceptable for anyone, whether they live with a disability or not, to get the impression that these human lives are inferior or not worth living.

Here we are seemingly caught in a similar position once again. It was shocking when the Liberals accepted the last-minute amendment to include mental health as a condition for assisted suicide. Since then, they have had time and opportunity to reconsider, but they refuse to listen and protect the lives of vulnerable Canadians. If government members do not put a stop to the expansion of MAID for mental health, it will be impossible to take them seriously when they try to talk about a mental health crisis.

I want to take a moment to talk about Michael Landsberg, who spoke very passionately about mental health a number of years ago, and I consider this man to be a pioneer and a trailblazer.

Michael Landsberg was the host of Off the Record on TSN. Mr. Landsberg has a foundation called “#SickNotWeak”. A big part of what he talked about 20 years ago, and what he talks about today once again, is the stigma that people with mental illness quite often face and that people with depression face. When we look at the disability community and what we talked about earlier with the stigma around them, we are seeing that happen again for people with mental illness. I think it is important that we look at the stories of people like Michael Landsberg who has spoken so clearly and passionately around making sure that we do not provide harmful stigma for mental illness. When we look at the statistics that I quoted earlier, there is a real and present danger here if we do not address this properly while we have the opportunity.

Across the country there is a lack of mental health support, especially in rural ridings like mine. It is absolutely shameful to offer death as a solution. While Bill C-39 brings a pause in this expansion, it is inappropriate to use it as a selling tactic with the hope that public opinion will shift to their direction in the meantime.

However, a delay is not enough. We need to exclude mental health as an eligible condition for assisted suicide. This government must stop and review what it has done with the system. If not, it only shows that it is untrustworthy. There has been no sign of meaningful reflection about its previous legislation. Because of this, it has failed to reassure Canadians about further changes. We talked about the safeguards earlier; people are wondering if they even exist.

How can we ignore the veterans who are offered MAID instead of mental health support? How can we proceed when we have seen people in poverty and distress offered it against their will? These types of reports are coming far too often, and we cannot say that we had no warning. The predictions of experts and from many of us here on the official opposition have been proven to be correct so far. If this expansion happens in March 2024, how can anyone possibly pretend that these problems cannot get much worse?

Because the Liberals will not do what is necessary, one of my Conservative colleagues has taken the initiative to introduce a bill that will remove eligibility for mental illness. It would give us another chance to prevent this catastrophe, and I hope my colleagues support it.

[Gerald Soroka, Conservative, Yellowhead, AB]

Mr. Speaker, I am pleased to rise in the House today to speak on Bill C-39 regarding medical assistance in dying, which proposes to delay for another year the implementation of provisions that would expand the availability of medical assistance in dying to those whose sole underlying condition is mental illness. I think we really need to start looking at how we got to this stage.

It went to the Senate and we had no issues with it, to some degree. Most of Parliament was fine with it. However, when it came back, the Senate had added in a provision with respect to one's mental state.

I started thinking about the many people I have spoken with over the years when I was either a mayor or now as a member of Parliament. When people would phone me, they would usually start the conversation easily by talking about whatever issues they were dealing with. Then they would start talking about themselves. I do not know if it is me, my voice or my appearance, but they would open up to me and start telling me about how they were going through these troubles and the difficulties they were facing. It was not necessarily financial. Sometimes that was the trigger, but most times it was their mental state itself. As they would start talking, I would start getting very worried about people like this who have a mental condition and whether there was somebody there to help them. As they kept talking, sometimes they would break down crying or get angry, and that would change throughout the whole conversation.

However, as I was dealing with them, I would hope that they had some kind of assistance from some medical professional. If they did not, then who would be there to help them? I am worried this is the help they are potentially looking for, but I hope that will never be the case. When I was speaking with these individuals, I would usually try to steer the conversation gently and ask if they had a psychologist or psychiatrist working with them. They would say something like they did, but that person does not know anything, and they would start getting angry again. Then I would start to get worried because I did not want to see them in that state of agitation. I wanted to try to help them as best I could. I am not a psychologist or psychiatrist, so I do not have the expertise, but I would try to at least direct them to where there was help.

Probably one of my biggest concerns with respect to this legislation is the fact that we are relying on our medical professionals more than ever. We all know that there is an extreme shortage of doctors and nurses right across this country, so when we start talking about people having the ability to apply for MAID due to their mental state, how is that going to help them if there are no doctors to assist them?

My next concern is whether we are really there to assist them, to cure them or help them out of that state. That to me is where it seems like we as a society have failed on so many fronts.

When I was talking to a grade 10 class during COVID in 2021, the students asked what I thought the number one issue in Canada was going to be when we came out of COVID. I said that was very easy because the number one issue was going to be the mental state of Canadians. It was surprising that the class all responded with, “Really?” I asked them what they thought it was going to be and they said that it was the economy. I said that was not something we really had to worry about and that once people started getting out again and businesses started opening up that, yes, it may be slow at the start, but eventually we would get back to some sense of normal again, but that the mental state of Canadians was something that was going to be with us for years. That was just during COVID.

Unfortunately, before COVID, the mental state of Canadians was suffering. That is something the current government has yet to help with. It promised in the last election that it was going to put more money toward the mental state of Canadians and assist with more doctors, medications and facilities to help those people. However, as we debate here today, it seems that it is easier for the government to offer medical assistance in dying instead of assisting them in achieving the mental state they so deserve.

I have spoken to many people, and they have asked what this MAID legislation is about. Why are so many people concerned about it? I said it is not so much about MAID. It is more about the addition of someone with a mental illness, without a foreseeable death, to actually apply for MAID. People have given me looks, asking what I mean by that. I have said that someone who has a mental illness, depending on what mental illness they have, may or may not qualify for MAID. I would still get people asking why there would not be a doctor, psychologist or somebody there to help them, as opposed to offering them MAID. I replied that that was a very good point and that it is one of the reasons I am speaking out against this legislation.

With moving Bill C-39 forward to extend it for another year, Canadians also need to understand some of the legislation that we are putting forward in the House and how it is not necessarily helping all Canadians. I am not going to bring up someone who has ALS or another disease. That is their right, and that is absolutely fine. To me, they are in charge of their faculties. However, when someone has a mental illness, my biggest concern is whether they are mentally capable of making these decisions.

I know someone will talk to me later and say there will be two psychiatrists evaluating them. Everyone knows that people, when they have a mental condition, have different states of mind where they may seem better at one time, and then they may seem worse or go into a depression, whatever the case may be. Is someone truly getting a fair assessment of the condition someone is dealing with at the time? To me, it is very cold and heartless that people can say, yes, we think someone is acceptable for medically assisted dying, as opposed to really diving into the areas as to how we can help them.

Over the years, there are people who have reached out to me and it is heartbreaking. I do not know if many other MPs have had to deal with something like this, but it is a very sad state. When we start getting into all the funding, or lack of funding, to deal with a mental state. Before COVID, it was estimated that about one-third of all Canadians had had some form of mental condition at one time or another. I cannot imagine what it has grown to after COVID. Are we at 40% or 45%? I do not know the numbers, but we can see how we are escalating the mental stability of Canadians.

Is the government reaching out to them, trying to make their lives any better? I do not believe so. That is one of the reasons I am so happy that we are able to take another year to look at what we can do to either refine or change this legislation, or actually start dealing with the problem itself. We need to deal with the mental state of Canadians and get the people the help they so rightly deserve.

For people to keep living on with a mental condition, they do not get better until they get help. Without the doctors, nurses or facilities out there, there is no way Canadians are going to see a better society. When we start looking at the mental state of Canadians, there are other areas that we can possibly improve upon, such as our criminal system, because a lot of people are addicted to drugs or whatever else, but we need to start dealing with that as best as possible.

I wanted to focus more on what we can do to assist people with their mental state, as opposed to offering them MAID. We need to start getting into the real cause of the problems and the real situation on why they got to this state. If we can accomplish that, we can build a far superior society than the one we have today. As parliamentarians, our number one goal is to make Canada a much better place to live, as opposed to the alternative being proposed tonight.

[Mike Morrice, Green, Kitchener Centre, ON]

Mr. Speaker, it is an honour to rise this evening to speak on Bill C-39. Before I do, I want to let you know I will be splitting my time with the member for Saanich—Gulf Islands.

This legislation might be the simplest one I have had the chance to speak on in the House since being elected, but it is also one of the more serious and emotional ones. Simply put, it would allow for an extension for mental illness to be a condition for eligibility for medical assistance in dying.

I strongly support this delay for several reasons. The first is about concerns I heard about from so many neighbours of mine in Kitchener. In particular, I remember one conversation a group had in their backyard on a colder afternoon just last month. It was between Hannah, Peter and some friends of theirs, and they wanted to share with me specifically some of their serious concerns with medical assistance in dying being expanded further than it already had been.

I really appreciated them sharing their stories, concerns and recommendations. In my view, that was the best of how our democracy is supposed to function, which is for folks like myself who are sitting in legislatures like this one, who have a say in laws like this, to be hearing from neighbours about their concerns. In that conversation and in emails since, it has been almost been universal that folks in my community want to see at least a delay, if not more.

Second, I am supportive because we heard the concerns of experts across the country, such as doctors and health care professionals. On December 1, I really appreciated hearing from the Association of Chairs of Psychiatry in Canada, which includes the heads of the psychiatry departments of all 17 medical schools across the country, as they appealed for the governing party to delay what was then an expected expansion of MAID for those with mental illness.

The third reason I am supportive is because I believe we should spend more time closing the social safety net before we expand medical assistance in dying. I would put it to all colleagues here and ask why it is we are seeing a movement to expand medical assistance in dying much more quickly than we are seeing an expansion to the social safety net. I will give a few examples.

In my community, as colleagues well know as I have shared it many times, the unsheltered population has tripled in the last three years from just over 300 to over 1,000 people living rough. It is clear what is being done when it comes to the affordability of housing is not nearly enough, that we are going in the wrong direction and that more needs to be done.

As well, there are income supports, whether that is a guaranteed livable income for all or as many in this place, myself included, have pushed very hard for, a guaranteed income for those with disabilities across the country. Although we have made progress, and I am glad to see that Bill C-22 was passed in this House and is now in the Senate, the fact is it is yet to be funded. I would strongly encourage the governing party to fund the Canada disability benefit to get on with closing the social safety net with the urgency it deserves.

Next is mental health specifically. Just last week we saw a big announcement about health care, and yet absent from that announcement was dedicated mental health funding. It is all the more egregious when in the 2021 campaign the governing party ran that campaign on a commitment for a $4.5-billion Canada mental health transfer.

I hope there is no sleight of hand here, that with this new health care announcement we are not going to continue to see dedicated mental health funding. It is imperative that all parliamentarians in this place continue to apply pressure to ensure the Canada mental health transfer is in budget 2023. When I last asked the parliamentary secretary about it on Wednesday night, I did not get a clear answer, and it should concern all of us to not see dedicated mental health funding.

In fact, it was because of this absence of sufficient supports for affordable housing, income supports and mental health care that I joined the CEO of the Canadian Mental Health Association of Waterloo Wellington to encourage the Minister of Justice to follow through on the delay that had been promised in December of last year. I am glad to see him follow through on that.

With my remaining time before I close, I just want to quickly mention the importance of quality journalism in this country and how it relates to this legislation.

I am glad to hear that all parties are supportive of Bill C-39, but I am not surprised to hear that, because of the work of Althia Raj and the Toronto Star. Specifically, back in November, as other members have shared, Ms. Raj spoke with the Minister of Justice. At the time, he said nothing could be done and that it would be a “challenge in the current Parliament” to delay the expansion of medical assistance in dying.

Ms. Raj then did something very reasonable. She reached out to all of the opposition parties, including the Green Party, and asked them if they would support what is now Bill C-39. Opposition parties responded, and days later, on December 11, Ms. Raj published an article sharing that all opposition parties were supportive. Then the question was put back to the Minister of Justice, and days later, on December 15, it was announced that this legislation would come before this House.

While there are many advocates and many campaigns that lead toward legislation such as this one, I think it is important that we call out and appreciate non-partisan journalists across the country doing important work to help bring to light the agreement that is sometimes there to move forward with important changes like the ones we are discussing, and to call out what might be certain rebuttals that may or may not be justified. In this case, they were not, and I appreciate Ms. Raj, as well as the medical professionals I mentioned earlier, like those from the Association of Chairs of Psychiatry in Canada, for their advocacy, which brought us to this point.

In closing, I applaud the governing party for introducing Bill C-39 and following through on the promise that was made back in December, and for listening to the need to slow down. I have no doubt that other parliamentarians across the country heard concerns similar to the ones I heard from Hannah, Peter and so many others. I also encourage the government to move more quickly on the social supports that are needed in my community and across the country.