Bill C-39

An Act to amend An Act to amend the Criminal Code (medical assistance in dying)

This enactment amends An Act to amend the Criminal Code (medical assistance in dying) to delay, until March 17, 2024, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition identified in support of the request for medical assistance in dying is a mental illness.

Criminal Code

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Rob Moore, Conservative, Fundy Royal, NB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I turn to their recommendations:

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

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

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

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

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

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

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

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

I move:

That the question be now put.

[Luc Thériault, Bloc, Montcalm, QC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you.

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

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

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

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

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

Thank you very much, Mr. Chair.

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

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

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

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

[Mike Morrice, Green, Kitchener Centre, ON]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Majid Jowhari, Liberal, Richmond Hill, ON]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Mike Morrice, Green, Kitchener Centre, ON]

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

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

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

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

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

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

Criminal Code

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

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

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

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

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

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

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

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

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

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

The government identified the following in its charter statement:

First, evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error, in relation to persons who suffer from a mental illness serious enough to ground a request for MAID. Second, mental illness is generally less predictable than physical illness in terms of the course the illness will take over time. Finally, recent experience in the few countries that permit MAID for people whose sole medical condition is a mental illness (Belgium, Netherlands and Luxembourg) has raised concerns.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you.

I'm sorry to interrupt you. My time is a little bit limited and I would like to go to Dr. Rajji.

You, sir, have very clearly told the committee that you don't believe Canada is going to be ready by March 2024. It's quite striking because Parliament had to quickly pass Bill C-39 to give us an additional year. Ultimately, this committee is going to be tasked with presenting a report to both Houses of Parliament with recommendations.

In terms of a recommendation, do you have a time frame in mind? Do you have knowledge of approximately how much time the medical community is going to need to arrive at those conditions you have given both in your opening statement and to other colleagues around this table?

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

Thank you very much, Mr. Chair.

Dr. Green, I guess I will finish this round with you.

If it had not been for Bill C-39, which Parliament passed really quickly, we would, of course, be living in a country right now where mental disorders as a sole underlying medical condition would be eligible for MAID.

Looking at it from British Columbia's perspective, how did that additional year factor into the degree of preparation in our province? According to you, given how involved you are in this, when was the determination made that our province was ready, approximately? I'm just trying to walk backwards in the timeline here.

[Myriam Wills, Counsel, Criminal Law Policy Section, Department of Justice]

I'll start off by stating the obvious. There are very diverging views on this topic. No court has ruled on whether or not the charter requires MAID for mental illness. If we look at the charter statements in former Bill C-7 and former Bill C-39, they set out the charter considerations supporting the charter consistency of both prohibiting MAID for mental illness and permitting MAID for mental illness.

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

Mr. Speaker, it is a pleasure to rise and speak on an issue that has been fairly extensively debated over the last number of years. Members will recall that the reason we are having today's debate goes back to 2015, when a Supreme Court of Canada decision ultimately obligated parliamentarians here in the House to develop and pass a law that took into consideration the ruling made by the Supreme Court, with the necessity for the government to provide a framework.

It was not a very easy challenge when that decision was ultimately made. I do not know how best to put it, but the Government of Canada, at the time run by Stephen Harper, ultimately sat on the issue until there was an election. That election saw a change in government, and it was one of the first orders of business that the Government of Canada, under the current Prime Minister, had to deal with.

Over the years, I have been engaged in many different types of debates on all forms of legislation. When I am talking to young people who are trying to get a sense of what we do here in Parliament, I talk about legislation, and I will often make reference to Bill C-7. For Bill C-7, a very passionate debate took place on the floor of the House of Commons back in Centre Block. I can recall it vividly because of all the different emotions that were being expressed on the floor and all the discussions that took place.

It was not taken lightly. If we take a look over the years at the number of Canadians who have been consulted in one form or another with regard to medical assistance in dying, we are not talking about tens of thousands. We are talking about hundreds of thousands of Canadians from coast to coast to coast, in many different forms. They came together to voice opinions and concerns. In fact, we had a standing committee that did an incredible number of consultations, not only with individuals in our communities but with many different stakeholders.

In the debates that I have seen, I do not think we referenced our health care professionals and the important role they played in the debates. I want to start off by talking about that, because I think it is really important that, as Bill C-314 will ultimately be voted on, we understand and appreciate the number of discussions and the amount of effort that took place for the current legislation we have, which was amended.

As we saw, there were some issues that ultimately came out of Bill C-7, which caused another government bill to come to the floor. Again, a lot of repeat discussions took place and it ultimately passed. I think that is why the member has made the decision to propose his private member's bill. The changes that were made in what I think was Bill C-39, although I am not 100% sure and the member can correct me if I am wrong in his closing comments, are what might have brought forward this particular piece of legislation.

To be clear on what Bill C-314 does, it proposes to permanently exclude the eligibility to receive medical assistance in dying on the basis of a mental disorder alone. Wording is really important. I know that in the original debates with all the different stakeholders, and I made reference in particular to our health care professionals, the quality of the presentations and the understanding of the serious nature of the issue were, I would suggest, second to no other out of the debates I have witnessed, in particular given some of the things we heard coming out of committees.

As I reflect on that debate, I think that, in good part throughout the process, we saw many members of Parliament put their party position to the side and reflect in terms of what each believed as a parliamentarian. Maybe it was a crossover of personal beliefs versus the canvassing that many people no doubt had in terms of their constituents and wanting to reflect the general will of their constituents.

At the end of the day, when we think of medical assistance in dying and the issue of a mental disorder, I do not think that we want to try to simplify the message. As we all know, I am not a medical professional, but I have an immense amount of respect for what our medical professionals have to go through in order to be put into a position, because it is not just any and every doctor or nurse practitioner; there is a whole lot more that is involved. Towards the end of the debate, particularly on the second piece of legislation dealing with this particular issue, we had members who stood up and said, “Well, just put in your order”, almost as if someone were going through a drive-through and then it is done. We all know that is, by far, not the case.

I will fall back on the fine work that our standing committees have done. I am going to fall back on the issues and how they were explained, in good part, by the different stakeholders. I am going to stand by what the health care professionals brought forward to us. I will look at the information that was provided and ultimately reflect on what I believe in this particular situation and what a vast majority of the constituents I represent would want me to say on this particular issue. I will do this with very much a sympathetic heart, understanding the difficult situation that, unfortunately, far too many people have to face.

We can have as much sympathy as we want for those individuals who are looking at the possibility of getting medical assistance in dying, but it is one thing to sympathize and it is another thing to empathize. Based on everything I have looked at and listened to over the last number of years, I have not been convinced that this is, in fact, the direction that we should be going with regard to Bill C-314. I am just not convinced.

I think that what we ultimately need to do is continue to monitor and look at ways in which we can ensure that there is no abuse of the MAID legislation. We need to continue to show compassion in every way we can. We need to continue to listen to what the experts, individuals and stakeholders are telling us and try to build more value to the legislation so there is a higher sense of comfort in the broader community, which I believe there is today. The mechanisms are there, and there are opportunities to continue to be able to review.

Sitting Resumed

[Claude DeBellefeuille, Bloc, Salaberry—Suroît, QC]

Madam Speaker, I am pleased to rise and speak this evening—although I must say the hour is late, almost 9 p.m.—to join the debate on Bill C‑47.

Before I start, I would like to take a few minutes to voice my heartfelt support for residents of the north shore and Abitibi who have been fighting severe forest fires for several days now. This is a disastrous situation.

I know that the member for Manicouagan and the member for Abitibi—Baie-James—Nunavik—Eeyou are on site. They are there for their constituents and represent them well. They have been visiting emergency shelters and showing their solidarity by being actively involved with their constituents and the authorities. The teamwork has been outstanding. Our hearts go out to the people of the north shore and Abitibi.

Tonight, my colleague from Abitibi-Témiscamingue will rise to speak during the emergency debate on forest fires. He will then travel back home to be with his constituents as well, so he can offer them his full support and be there for them in these difficult times.

Of course, I also offer my condolences to the family grieving the loss of loved ones who drowned during a fishing accident in Portneuf‑sur‑Mer. This is yet another tragedy for north shore residents. My heart goes out to the family, the children's parents and those who perished.

Before talking specifically about Bill C-47, I would like to say how impressive the House's work record is. A small headline in the newspapers caught my eye last week. It said that the opposition was toxic and that nothing was getting done in the House. I found that amusing, because I was thinking that we have been working very hard and many government bills have been passed. I think it is worth listing them very quickly to demonstrate that, when it comes right down to it, if parliamentarians work together and respect all the legislative stages, they succeed in getting important bills passed.

I am only going to mention the government's bills. Since the 44th Parliament began, the two Houses have passed bills C‑2, C‑3, C‑4, C‑5, C‑6, C‑8 and C‑10, as well as Bill C‑11, the online streaming bill. My colleague from Drummond's work on this bill earned the government's praise. We worked hard to pass this bill, which is so important to Quebec and to our broadcasting artists and technicians.

We also passed bills C‑12, C‑14, C‑15, C‑16, C‑19, C‑24, C‑25, C‑28, C‑30, C‑31, C‑32, C‑36 and C‑39, which is the important act on medical assistance in dying, and bills C‑43, C‑44 and C‑46.

We are currently awaiting royal assent for Bill C‑9. Bill C‑22 will soon return to the House as well. This is an important bill on the disability benefit.

We are also examining Bill C‑13, currently in the Senate and soon expected to return to the House. Bill C‑18, on which my colleague from Drummond worked exceedingly hard, is also in the Senate. Lastly, I would mention bills C‑21, C‑29 and C‑45.

I do not know whether my colleagues agree with me, but I think that Parliament has been busy and that the government has gotten many of its bills passed by the House of Commons. Before the Liberals say that the opposition is toxic, they should remember that many of those bills were passed by the majority of members in the House.

I wanted to point that out because I was rather insulted to be told that my behaviour, as a member of the opposition, was toxic and was preventing the work of the House from moving forward. In my opinion, that is completely false. We have the government's record when it comes to getting its bills passed. The government is doing quite well in that regard.

We have now come to Bill C-47. We began this huge debate on the budget implementation bill this morning and will continue to debate it until Wednesday. It is a very large, very long bill that sets out a lot of budgetary measures that will be implemented after the bill is passed.

I have no doubt that, by the end of the sitting on June 23, the House will pass Bill C‑47 in time for the summer break.

What could this bill have included that is not in there? For three years, the Bloc Québécois and several other members in the House have been saying that there is nothing for seniors. I was saying earlier to my assistant that, in my riding of Salaberry—Suroît, we speak at every meeting about the decline in seniors' purchasing power. I am constantly being approached by seniors who tell me—

Criminal Code

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

Madam Speaker, today we are revisiting a subject that never seems to leave me in this place, which is medical assistance in dying. It has come up repeatedly: in the 42nd Parliament, in the 43rd Parliament and again in the 44th Parliament. I think it underlines the gravity of the nature of this subject matter.

I want to thank the member for Abbotsford for bringing forward this bill and for giving us as parliamentarians an opportunity to discuss this incredibly important subject.

What Bill C-314 is essentially going to do, for the constituents of Cowichan—Malahat—Langford who are watching this debate, is amend the Criminal Code to reverse what was done with Bill C-7 and specify that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.

It is important to mention Bill C-7, because it is an important part of why we are here today. Bill C-7 was originally introduced in the 43rd Parliament. The government is, of course, required by law to issue a charter statement with its main pieces of legislation. In that charter statement, the Minister of Justice went to lengths to make people understand why the government had specifically excluded in the first draft of the bill why a person with a mental disorder as a sole underlying medical condition could not be eligible to receive medical assistance in dying.

The charter statement did say that the exclusion was not “based on a failure to appreciate the severity of the suffering that mental illness can produce”. Rather, as the statement took pains to say, it was “based on the inherent risks and complexity that the availability of MAID would present for individuals who suffer solely from mental illness.” It is important to understand we are not using the term “mental illness” anymore. Every text is now recommending that we use the term “mental disorder”.

There were three primary reasons given in the charter statement at that time. First, the charter statement said, “evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error”.

The charter statement went on to say, secondly, “mental illness is generally less predictable than physical illness in terms of the course the illness will take over time.” I think a lot of people can understand that. Someone may receive a diagnosis for a physical illness like cancer, which is particularly well known. We know a lot about cancer these days, and based on what part of the body it strikes, we can predict with a fairly certain amount of accuracy what a person's ability to survive it is based on how far it has progressed and so on. It is the same with other physical ailments. With mental disorders, on the other hand, there still are, indeed, a lot of unknowns.

Finally, that same charter statement went on to explain that the recent experience in the few countries that do allow it, and it did mention Belgium, Netherlands and Luxembourg, “has raised concerns”.

That was the charter statement at the time with the first draft of Bill C-7. Of course, When Bill C-7 went to the Senate, the Senate amended that part of the bill to allow a person with a mental disorder as a sole underlying medical condition to access MAID. There was some back-and-forth between the government and the Senate to establish a sunset clause so that it would not come into effect until March 17 of this year.

At the time, the New Democrats decided to vote against the Senate amendment because the requirements of the earlier Bill C-14 had not yet been met. We had not yet had a parliamentary committee to delve into these issues, and we felt that, despite the government having gone to all those lengths through its charter statement to explain its position, accepting an eleventh-hour Senate amendment without having done that important work was very much akin to putting the cart before the horse.

There was also Bill C-39, which was introduced earlier this year because we found that more time was needed. Whatever anyone's feelings are in this House with regard to people with mental disorders being able to access MAID, there was agreement that more time was needed. Therefore, Bill C-39 was passed in very short order in both Houses, and that delayed the implementation of it until March 17, 2024. That is the timeline we are on now.

I am rising to speak to this particular bill because of my experience with this file. Both in the 43rd Parliament and in this Parliament, I was the New Democratic member on the Special Joint Committee on Medical Assistance in Dying.

It was not an easy committee to be on. Let me just say that. For me personally, I constantly wrestled with two concepts: How do we as parliamentarians, with the power we have to change Canada's laws, find a way to honour the personal rights, capacity and autonomy of the individual versus the need of society to step up and protect the most vulnerable? Those were two great themes that were constantly a struggle for me personally when listening to all of the witnesses who came before the special joint committee on the five thematic areas we were charged with by this House and the Senate.

I would encourage people, if they have not done so already, to look at the good work done by the special joint committee, both the interim report, which specifically focused on this area, and the final report, which was tabled earlier this year and completed the committee's mandate. I also want to draw people's attention to the executive summary of the final report of the expert panel on medical assistance in dying and mental illness because there was some incredibly good work done in that as well. We did recognize the authors of that report. The report states:

That MAiD requests may mask profound unmet needs or conversely, that such requests may not be received with the seriousness they deserve, has been raised with respect to several historically marginalized populations (e.g., racialized groups, Indigenous peoples, persons living with disabilities, and sexual orientation and gender minorities). In the course of assessing a request for MAiD—regardless of the requester’s diagnoses—a clinician must carefully consider whether the person’s circumstances are a function of systemic inequality.

That is the warning sign that I think much of the medical community is struggling with.

People with mental disorders qualifying for MAID will be under track two of the MAID regime, because death is not a naturally foreseeable outcome. I would remind people that track two has safeguards in place:

request for MAID must be made in writing....

two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met....

the person must be informed that they can withdraw their request at any time....

the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care....

I want to underline that last point. They have to be informed of the available and appropriate means, but we know that for a lot of marginalized populations, those are not always available.

I want to recognize my colleague from Courtenay—Alberni, who has called on the government to urgently fulfill its promise to establish a Canada mental health transfer. This is a very great need in our country. We can see it from coast to coast to coast. I can see it in my community of Cowichan—Malahat—Langford.

The question of Bill C-314 and the state of mental health care in Canada are two things weighing on me quite a bit. I am certainly going to take a lot of time to think about which way I want to go with this bill, but I appreciate the member for Abbotsford for bringing it forward and giving parliamentarians an opportunity to read the report and consider what this bill seeks to do.

[Gary Anandasangaree, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the member for Abbotsford for bringing forward Bill C-314, an act to amend the Criminal Code regarding medical assistance in dying.

I acknowledge that we are gathered on the traditional unceded lands of the Algonquin people.

The bill before us proposes to indefinitely exclude persons whose sole underlying medical condition is a mental disorder from being eligible to receive medical assistance in dying, or MAID. I will be opposing the bill for reasons I will detail in my remarks. I want to start by providing a brief overview of MAID in Canada.

MAID was legalized in 2016 for persons whose natural death is reasonably foreseeable, through former Bill C-14. Four years later, in 2021, former Bill C-7 expanded eligibility for receiving MAID to persons whose natural death is not reasonably foreseeable. Former Bill C-7 also temporarily excluded, until March 2023, eligibility for receiving MAID on the basis of a mental illness alone.

Parliament decided that a temporary exclusion from eligibility for MAID where the sole underlying medical condition is a mental illness was necessary in recognition of the fact that such requests were complex and required additional study. This is why former Bill C-7 also required an independent expert review regarding recommended protocols, guidance and safeguards to apply to such requests. The expert panel on MAID and mental illness was created to undertake this review, and its final report was tabled in Parliament on May 13, 2022.

Former Bill C-7 also required the establishment of a joint parliamentary committee to conduct a comprehensive review of the Criminal Code MAID provisions and other related issues, including MAID and mental illness. The Special Joint Committee on MAID, or AMAD, took this review and tabled its final report in Parliament on February 15, 2023.

Our government extended the temporary exclusion to March 2024 through the enactment and coming into force of former Bill C-39. This was due to concerns about provincial and territorial readiness. It is important that we get this right.

I want to take a moment to point out that the intention has always been for the mental health exclusion to be temporary. This is a complex, sensitive and polarizing issue. Some very legitimate concerns have been raised.

However, I believe that the health care system will be ready for the safe provision of MAID where the sole underlying medical condition is a mental illness by March 2024. Significant progress has been made by our government, in collaboration with the provinces and territories and other stakeholders and experts, to prepare for this deadline.

We are not ignoring the concerns that have been raised. In fact, many of these concerns led to the one-year extension of the exclusion. We are moving in a prudent, measured way with the ultimate goal of ensuring that our MAID framework supports the autonomy of those who are eligible to receive MAID and protects those who may be vulnerable.

I will now turn to Bill C-314 and outline some of the technical issues.

As I stated previously, the bill proposes to indefinitely exclude eligibility for MAID based on a mental disorder alone. It would do this by replacing “mental illness” with “mental disorder” in subsection 241.2(2.1) of the Criminal Code.

There are two main issues with this approach. First, such a change may result in the unintended exclusion of persons with some medical conditions that are not currently excluded from eligibility for MAID. This is because “mental disorder” is a clinically defined term that practitioners have explained would likely capture all mental disorders included in the American Psychiatric Association's “Diagnostic and Statistical Manual of Mental Disorders”, or DSM-5, whereas “mental illness”, as it relates to MAID, is meant to capture mental disorders that are primarily treated within the domain of psychiatry.

“Mental illness” likely captures a smaller set of conditions than what would be captured by “mental disorder”. As such, making the switch in terminology without an accompanying definition may have the unintended consequence of excluding certain medical conditions that are not currently excluded from eligibility for MAID and that do not raise the same concerns as “mental illness” does in relation to MAID.

The second issue is that the term “mental disorder” is already defined in section 2 of the Criminal Code as “a disease of the mind”, and there is extensive case law interpreting what this means in the context of the “not criminally responsible” regime. Therefore, a switch in terminology in the Criminal Code MAID provisions without an accompanying definition may unintentionally complicate legislative interpretation and may also result in the existing case law interpretation of “mental disorder” and the “not criminally responsible” regime context being applied to the MAID context.

Although many experts and practitioners have noted a preference for the term “mental disorder” since it is a clinically defined term, this preference has already been expressed in the context of developing protocols, standards or guidance for MAID. It is important to remember that MAID is not just a health care issue. It is also a criminal law issue, and as I have just explained, things can get complicated in the legislative context given existing definitions and legal interpretations.

Finally, I simply want to point out that Bill C‑314 also restructures the exclusion set out in the Criminal Code but does not seem to change its application.

Currently, in order to be eligible for MAID, a person must have “a grievous and irremediable medical condition”, which is present when a person has a serious and incurable disease or disability, is in an advanced state of irreversible decline and is experiencing enduring and intolerable suffering, as per subsection 241.2(2).

Right now, a mental disorder is not considered an illness, disease or disability under the first part of the definition of a grievous and irremediable medical condition.

As such, a mental illness cannot satisfy the definition and therefore cannot be grounds for a request for MAID.

Under the proposed new exclusion, a mental disorder would not be considered a grievous and irremediable medical condition at all. In other words, it would exclude mental disorders from the whole of the definition, even though some of those aspects may well exist in the case of a mental disorder, namely intolerable suffering and an advanced state of decline. Although this new exclusion would operate slightly differently than the existing exclusion, it seems as though its effects would be the same.

I want to reiterate that Parliament considered this two years ago during its consideration of former Bill C-7 and decided that a MAID mental illness exclusion should be temporary. The point was reinforced by Parliament's enactment of former Bill C-39 this past March.

The expert panel on MAID and mental illness has tabled its final report, which notes that the existing MAID eligibility criteria and safeguards, supported by other key resources, provide an adequate framework for the provision of MAID where the sole underlying medical condition is a mental illness. Parliament considered the issues again via the Special Joint Committee on MAID, and the majority of members agreed with the expert panel's findings.

I urge members to join me in opposing the bill and not reverse Parliament's decision by unintentionally complicating legislative interpretation in the criminal law.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I have the honour to inform the House that a communication has been received as follows:

Rideau Hall

Mr. Speaker,

I have the honour to inform you that the Right Honourable Mary May Simon, Governor General of Canada, signified royal assent by written declaration to the bill listed in the Schedule to this letter on the 9th day of March, 2023, at 5:10 p.m.

Yours sincerely,

Ian McCowan

Secretary to the Governor General and Herald Chancellor

The bill assented to, Thursday, March 9, 2023, is Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying).

Message from the Senate

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

I have the honour to inform the House that a message has been received from the Senate informing this House that the Senate has passed the following bill, to which the concurrence of the House is desired: Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying).

Online Streaming Act

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Madam Speaker, normally, there would not be much debate in the House when we talk about making updates to the Broadcasting Act, which came into effect in 1991. At face value, most Canadians would say that a lot has changed since then. A little thing called the Internet came along, and most would agree.

I have talked about this topic in the House before and I am pretty proud of myself. I am pretty sure that I was the first MP in Canadian history to put Boyz II Men in the parliamentary record, when talking about the legislation before us, because times have changed a little bit. Back in 1991, Boyz II Men, Bryan Adams, MC Hammer and Monty Python were on the charts. I wanted to put that in the record again, and I am glad I have done that.

The goals of the Broadcasting Act have been reasonable: respecting official languages and providing an avenue for Canadian content in the traditional media at the time of TV and radio. Here is the thing I have said in the House, sadly, on many issues over and over again: Only the NDP and the Liberals, working together, can take something so mundane and so innocuous and make a disaster out of it when it comes to policy.

Here is how I know that. Outside of the Ottawa bubble, there are not too many Canadians who know what Bill C-4 or Bill S-252 or Bill C-39 is when it comes to government legislation. We know that the government is in trouble and we know it is on the wrong side of public opinion when a bill title becomes famous. In the last couple of weeks or couple of months, Bill C-21 has become synonymous with an attack on rural Canadians, indigenous communities and hunters, when the government tried to ban commonly used hunting rifles. Here we are now, with the famous term “C-11”, known by millions of Canadians across the country today as the most blatant attempt by the Liberals and the NDP, and bureaucrats in Ottawa, to have control over what Canadians see and what they search on the Internet.

If that was not convincing enough, Bill C-11 being a household name to millions of Canadians, we know we are in trouble when Conservatives and Margaret Atwood are on the same page, pushing back against the government. She is a wonderful Canadian, one of the most regarded and successful Canadian artists and content creators this country has ever seen. Canadians do not have to take my word for it or believe this side of the bench if they do not want to. Canadians will take Margaret Atwood's word on Canadian culture and content any day of the week over that of the Liberals and the NDP.

I want to give members the dictionary version of what she said. She said some pretty harsh things, calling out the government on Bill C-11. When we break it down and use the dictionary to further define what she is calling out the government for, it is creating a centralized and dictator-like system of control that requires complete subservience to the state.

This is bad legislation. They know it. It has been ping-ponged back and forth between the House of Commons and the Senate. It is back in the House of Commons, and it is going to go back to the Senate. Every time there is a committee hearing, every time there are more witnesses testifying, there are more questions than answers about what the government is doing here with this bill. From consumer groups to legal experts to content creators, many, many groups from every walk of life and every angle on this topic are calling out the government's direction and how bad and how flawed the bill is.

I am proud to stand as a Conservative to say that when we form government, we will repeal Bill C-11. We will kill Bill C-11, as simple as that.

Let us get into the weeds and talk about some of these pieces bit by bit. One of the things we hear the Liberals and the NDP say is that we need to support Canadian content more.

When I think about that, I pull up a list and say, sure, let us support Canadian content, things like Deadpool. It was filmed in Vancouver, starring Canadian actor Ryan Reynolds, with a screenplay by Canadian Paul Wernick, based on a Canadian comic book character.

We have Canadian Bacon. Who could forget that? There is John Candy, a legendary Canadian actor, in a story involving Canada.

I talked about Margaret Atwood. We have The Handmaid's Tale, based on her book. When we look at the production, the series was filmed in Mississauga, Toronto, Brantford, Hamilton, Burlington, Oakville, Cambridge.

I think of Canadian content like All or Nothing, a series on the Toronto Maple Leafs. It is a five-part series that followed the Leafs for months during the 2020-21 season. It is narrated by a Canadian, Will Arnett. It used Canadian crews.

Is this all Canadian content? No, every one of those examples I just cited does not meet the definition and criteria for Canadian content in the definitions that we have.

Bill C-11 is currently 56 pages long, and any Canadian can go online and look at it. They can hit Ctrl+F and search. Nowhere in there does it talk about modernizing and cleaning up that definition. I will argue that this is not about Canadian content, but about something else.

Every time, we put an amendment forward to clarify. If the government wants to debunk a myth and say that what we are saying is not the case, it can clarify it and put in amendments to say what it is not, to exclude certain things. The government refused to do so. It says, “Don't worry. We are not going to determine that. It's going to be the CRTC.”

This brings me to my next point, about another fundamentally flawed part of the legislation. The CRTC is an Ottawa-based acronym. Federal acronyms go left, right and centre around here. It is an agency in Ottawa, and on the Quebec side as well, in the national capital region, full of bureaucrats who, behind closed doors, would not only set the rules for what is Canadian content, but also, through the bill, be directed to start controlling the search results we have on the Internet.

Members heard that right: “behind closed doors”. We have asked repeatedly to put some sunshine, sunlight and transparency on those protocols. There are no criteria in the bill. There is no public formula. There are no clarifications or guardrails on what those protocols are, so for Canadians, when it comes to what they search and what they want to see, whether it is searching on Google, Crave, YouTube or any other platform, as a Canadian here and now, the government will control what goes up in search results and what goes down, and we would not be able to find out the algorithms and calculations it uses, because of CRTC bureaucrats doing it behind closed doors. They never have to share their reasoning, or what I call “showing their homework”. That speaks volumes.

The Prime Minister and the NDP will say not to worry because the CRTC is an arm's-length agency of the federal government. “It is independent,” they say. Let us just debunk that right now. The CRTC reports to the Liberal Minister of Canadian Heritage. Its chair and the commissioners who are working there and leading that organization are appointed directly by the Prime Minister and the Liberal cabinet.

Nobody believes it is arm's-length, and nobody believes the legislation is about Canadian artists and everyday Canadians, because if it were the right thing to do and the popular thing to do, and if there were no problems about it, the government would have made that whole process a lot more public, rather than punting it over behind closed doors.

The bill is not about sunlight. It is not about Canadian artists and content creators. I say the bill is a Trojan horse, because there are some very big cheerleaders for it. The bureaucracy at the CRTC would be exploding in size. The size of the Internet is massive. The amount of content uploaded every single day is huge. It is going to take an administrative swarm of new bureaucrats to go through, and the people who are going to hit the jackpot, the people who are doing cartwheels in downtown Ottawa, are the lobbyists who would be hired by all these groups, associations and artists to try to lobby to get them, when the CRTC goes behind closed doors, to take what is going on.

As I share my time with the member for Leeds—Grenville—Thousand Islands and Rideau Lakes, we will continue the commentary on this and how it works. If someone is a budding content creator in north Winnipeg, a Franco-Ontarian or an indigenous artist in northern Canada, in Nunavut, they can currently upload, and may the best content win. The cream of the crop rises. Canadians will determine what they like and what they want to watch, and that should be the most popular search result. That is the most organic way possible. Trust me, the best way is to let Canadians do their own work and let the organic way go. Good videos go to the top. We have thousands of artists who have made a living by creating content and continue to do so. We do not need to fix what is not broken.

I will wrap up by saying that Bill C-11 is bad. It is online censorship. Ottawa telling 37 million Canadians what they should watch and see is wrong. The Liberals and the NDP have had years to get this right, and now they are just being stubborn.

We oppose this bill now, and as a Conservative government, we would kill Bill C-11.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Chair. This is the first time the minister's been back since that last statement. The minister can handle himself. He's an experienced parliamentarian. That's my only question on that matter.

Minister, is the charter analysis completed on Bill C-39?

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Mr. Chair.

Thank you, Minister and Mr. Taylor, for being here with us for this important study.

Minister, before I begin on bail, quickly, when you were here three weeks ago, my colleague Mr. Brock asked you about the very important matter of a charter statement on Bill C-39, which deals with your government offering medical assistance in dying to individuals who are suffering from mental illness.

Do you have that charter statement completed yet? At the time you said we would have it very soon.

Criminal Code

[The Assistant Deputy Speaker, NDP, Carol Hughes]

We will resume debate.

There being no further members rising for debate, pursuant to order made on Monday, February 13, the motion is deemed adopted and Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), is deemed read a second time and referred to a committee of the whole, deemed considered in committee of the whole, deemed reported without amendment, deemed concurred in at report stage and deemed read a third time and passed.

(Bill read the second time, considered in committee, reported, concurred in, read the third time and passed)

It being 8:41 p.m., the House stands adjourned until tomorrow at 10 a.m., pursuant to Standing Order 24(1).

(The House adjourned at 8:41 p.m.)

[Jacques Gourde, Conservative, Lévis—Lotbinière, QC]

Madam Speaker, I am pleased to speak to Bill C-39 this evening. As a legislator and member of Parliament for Lévis—Lotbinière since 2006, I have been told about, and sometimes even witnessed, some very difficult situations involving people or families in distress.

On May 3, 2016, in the House, I allowed myself the privilege of expressing the thoughts sent to me at the time by several of my constituents during the sensitive debate on MAID. It is a topic that leaves no one indifferent.

I want to emphasize that, regardless of their political allegiance or their position on this issue, all parliamentarians are once again demonstrating courage by taking part in this debate, which is difficult for all of us.

The Supreme Court gave members of Parliament the daunting task and responsibility of setting the foundations of a law. This forced us to do some soul-searching about the purpose of our lives and the lives of the citizens we represent. We were aware that the law as a whole would not be perfect, that it would merely be acceptable, given all the changes it made to our way of seeing life and living in the future.

It is always a great privilege for me and a sign of undeniable trust when people share heartfelt confidences with me, especially when they deal with matters of life and death. The expansion of MAID to people with mental health disorders definitely falls into that category. I see parents, grandparents, brothers, sisters and friends worried about the expansion of the MAID legislation. When we stop and think about it, obviously we all want to keep our loved ones with us as long as possible.

Surprisingly, however, many of the discussions I have had with my constituents have revealed another very important issue that can cause mental health problems. I am talking about how the Liberals have trivialized the consequences of cannabis use, even though they knew the extent of the consequences when legalization was studied in committee. Several studies confirmed that use in adolescence would cause mental health challenges for those who already had a genetic predisposition.

We were promised that a lot of money would be invested in programs for people grappling with that addiction, as well as mental health services. Unfortunately, given the challenges that already exist across Canada in terms of access to regular health care, we suspected that specialized mental health care would be inaccessible and insufficient for Canadians. Therein lies the rub. One can easily imagine what will happen when hard drugs are legalized in Canada, again by the Liberal legacy that is destroying the Canada we once knew.

I would like to share that I will soon be a grandfather for a sixth time. I am obviously very happy, but I am also very concerned about our Canada, which has been deteriorating by the day since 2015. Canada is deeply broken, and millions of Canadians are suffering because of the erosion of their sense of security and quality of life.

I would like to use the time that I have to speak to Bill C-39 as an opportunity for honest reflection. As members no doubt know, humans need to give meaning to their lives to fully appreciate all the good things life has to offer. It is human nature to seize the best opportunities we get to enjoy life. However, what do we do when the government takes away those opportunities by implementing policies that go against our well-being and we lose faith and hope in the future?

Is it right for us, in the near future or the next few years, to allow people with mental health challenges to put an end to their lives, when they might have a better quality of life if we were to give them ways to fix what is going wrong and more resources so that they could find balance in their everyday lives?

I think the public is aware that nothing is working anymore and that we are living the opposite of what we are used to in so many aspects of our lives.

In spite of that, we must not see the future as inevitable. There are always solutions, and, as fragile as life may be, we have the privilege of sharing love and friendship. We can strengthen our bonds and help one another.

Our society is constantly changing. It shapes our fundamental, cultural, religious and spiritual values when it comes to life and the end of life. What was personally unacceptable yesterday may change tomorrow. We need to respect one another here, because we all have a say in this Parliament. That being said, the end-of-life choice that is acceptable to the individual is based on their convictions, their beliefs, their physical health and perhaps, ultimately, their mental health.

We have to be careful about that fourth point, mental health, because when it comes to care and scientific advances, we are still making progress. Who knows if we will find drugs that open up new possibilities for people who currently do not see any solutions?

We are faced with the same question we had to answer when the initial law was drafted in 2016: How can we ensure that this will not get out of control? It will be difficult to include safeguards in the law that will cover all of the very different cases of people with mental health issues.

I think it is wise to make the right choices for Canadians' safety and for future generations. Once again, time will tell whether this change in direction was a good one. All parliamentarians in the House and the Senate will make a significant contribution to this debate. We must all bring a rational and moral tenor to this bill as we align it with Canadian values and thinking in a way that respects all of our Canadian communities. We will live with the future changes that will come from this law. We have to ensure that it will be interpreted in accordance with our guidelines, because the consequences will be irreversible.

I am pleased that we are giving ourselves some time to address this delicate subject in order to protect vulnerable people and not to do something irreparable to people who are precious and who have the potential to live a better life with dignity.

[Ya'ara Saks, Liberal, Parliamentary Secretary to the Minister of Families]

Madam Speaker, we are here for what is really such a deeply personal and complex discussion on Bill C-39. I want to start by saying the discussion tonight is about Bill C-39, and it has been the discussion here for the last few nights. I say this because some time ago, and I believe it was in November, we had a one-night discussion in the House, a take-note debate on mental health, in which I participated. Frankly, there were very few participants in that debate. A number of colleagues were here for that.

However, the discussion tonight is not about mental health. It is about Bill C-39, the legislation before us, to delay the implementation of MAID as it pertains to mental illness by a year. The core of the crux is that there is a mental health literacy discussing this problem in the chamber, and perhaps even across the country.

I want to start by saying what mental health is and what it is not. Mental health is really, at its core, in the day-to-day for all Canadians and all of us in the House, who work really hard and have stress for ourselves and our constituents. We have been going through a really challenging time these last two plus years through COVID.

Mental health is the ability to navigate and recover from a challenging situation and to be able to move forward with a sense of self. It does not mean that when we are stressed, when we have anxiety or when we are facing a tough period where there may be ebbs and flows of depression, we are struggling from mental illness. That is mental health.

We really need to start the conversation there. Truthfully, for any human being, and I have two teenage daughters, day-to-day things are up and down. We are not meant to always be happy all the time. We are not always meant to be in a positive state of being. There are ebbs and flows to life, just as there are for every Canadian across this country. Having two teenage daughters, I am sure many colleagues in the House can relate.

The truth of the matter is that mental health is not the opposite of mental illness. When I talk about people being diagnosed with a mental illness, I mean people who are diagnosed by a physician, which means a psychiatrist, a medical professional who is familiar with the categorizations of diagnosis under the DSM-5.

There are individuals with mental illness who are treated for it who have good mental health. Can members imagine that? One can have good mental health while one struggles through mental illness. That is a reality for many, many individuals who deal with mental illness. About 15% to 20% are medically diagnosed with mental illness.

There is a mental health crisis for many Canadians in this country, with many social determinants, whether it be poverty, housing or inflation, that are impacting the mental health of many Canadians, but they are not struggling with mental illness. I really feel strongly that is where we need to start the discussion.

Bill C-39 is not about mental health. Bill C-39 is about mental illness and those who have struggled with mental illness who have been presented treatment after treatment, have tried everything imaginable to address their suffering, and have not found relief. They have not been able to find that ebb and flow of life many of us experience in mental health. We need to acknowledge that.

I heard a lot of disturbing statements in the House, such as this legislation being euthanasia or medical treatment by death. Shame on them for disparaging the DSM categorizations of medical professionals and using fast and loose language in the House on what is a profoundly serious categorization of suffering for individuals in this country.

Frankly, this is a hard issue. MAID is a hard issue for so many of us. It is so hard for us to know people we love may be suffering from a disorder or a terminal condition there is no relief from.

I want to move now into what Bill C-39 is, because we need to go over that.

Bill C-39 is asking for a year. It is asking for a year to pause on allowing for mental illness as the sole determinant for an individual requesting MAID, so that it can be reviewed and so that it can be put into place well. What do we mean by “well”? We have a health care crisis in this country. We have gone through two years of COVID. Doctors, nurses and health care practitioners are exhausted, and they need to be trained on this. They need to understand the DSM-5. They need to understand what the treatment protocols are for those who suffer with mental illness. We are not there yet. We want to ensure that the best practices are in place, and done with compassion and with a deep sensitivity for the individual suffering.

It is about the individual. Many of us in the House have beliefs, which may be religious beliefs or personal beliefs, about how they feel about MAID in general or how they feel about MAID in relation to this particular categorization of mental illness. At the end of the day, it is about the individual. It is not about us. It is about them. We need to remember who is at the core of this legislation and why it has been put forward, and the compassion and time that have been put in by medical experts. One can present me with one panel or another panel. At the heart of this is human suffering. I would not wish on anyone in the House to know what it is to have a loved one who suffers from mental illness, because I did.

I had a 15-year-old nephew who suffered from mental illness. Every treatment was offered to him, every treatment, and he refused. I lost my nephew to suicide, not because we did not have hope, not because there were no resources, not because we did not try, but because everything that was put on the table, and trust me, I am a fierce mama, did not help him. I have to live with that loss, and the grief of that loss, of his choice. He did not make his choice in a medically assisted format. He chose suicide. We need to understand the difference.

Why do I share this? I share it because this is a personal issue. I also have a dear friend who had ALS. She suffered for years, but we put into place protocols for her so that when she knew it was enough, we would be by her side in her choice. There were friends who did not show up for her choice. There were many of us who debated about her choice, that it was gut-wrenching. Each step of the way, we had check-ins with her, even when she could only communicate through her eyelids. Was she sure that this was what she wanted? Was she ready? It was heartbreaking to leave that room that day, but it was her choice.

At the core of this, as hard as it is for members of this House to understand, it is about the individual. We have an obligation to provide every guardrail to every professional framework that is caring and compassionate, and that is why we need time to build it and set it out.

At the end of the day, these are professionals. This is mental illness. To the degree that individuals are suffering at that level, one should never have to watch individuals suffer to that degree.

Even if they go and ask for it from their psychiatrist, even if they are contemplating this, that is the beginning of the process. It is not an automatic decision. Then, their entire history of treatment needs to be reviewed, every protocol questioned. Every stone needs to be turned and reviewed by another professional. This is not even sober second thought, as we would have in the Senate. This is sober after sober after sober, three times, four times, five times, until every check has been done with the individual who is truly suffering.

I want to get out of the speak of professionals and all of that because at the core of this is the human being who is suffering. We need to know our language and be clear about that.

[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.

[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—

[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.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, it is always an honour to rise in the chamber. We have been discussing very profound issues today, perhaps some of the most profound issues we can ever discuss in Parliament, which are life and death. We are discussing the deaths of loved ones and the deaths of those who have no one to love them, yet this is all happening in the context of Bill C-39, which absolutely fails the test of profundity because it is a last-minute scramble. It is a papering over of an absolute failure to deal with something that should have been dealt with from the beginning, and the government continues to drop the ball, so I am going to speak a bit on how we got here.

It is really important in this debate to be careful with the language we use and to be careful with each other. I have heard it alluded to that this was some kind of Nazi regime, which is ridiculous. I have heard people talk about being loved and other people saying that we are not respecting rights. We are talking about the most intimate acts that a human experiences: birth and death.

It may sound odd to say that death is an intimate act. Death can be very traumatic. Death can be violent. Death can really tear families apart, but it can also bring families together. It is those moments of how we confront death and value death that really show who we are as a society. I am thinking right now of my sister Kathleen, who never made it out of her 50s. This week would have been her birthday. Nobody got a rawer deal in life than my sister. She got the bad end of the cards dealt to her every single time, and Doc Holliday had nothing on her when it came to facing down death.

I remember, as she was dying, that every morning she insisted that she look good, and her back was disintegrating from the cancer. One of us got the nerve to ask her about MAID. Man, she almost bit our heads off because that will to live, the will to be there one more day through the pain, was very, very profound.

I remember we sent her off singing Danny Boy because that is how we say goodbye. That is how we said goodbye to her husband when he died just before her, and to my dad and to my grandfather. Those are intimate moments. However, her death, and a natural death it was, was not somehow superior to those of people who have chosen MAID.

I think of my friend Liz from Vancouver Island. Wow, she was a force. She called me and said, “I can't live with the pain anymore and I'm choosing the date.” I spoke to her the day before she went. I had a sense that this was also a very profound moment.

I think of my friend Craig from CBC. I followed his last two weeks on Facebook because he posted every day. It was a very powerful thing to see someone choose that moment and choose how they were going to tell their story in those final two weeks.

We have to respect the choices that people make. The provision for MAID that was brought in was about ensuring that a fundamental respect was given. However, the flaw goes back to the fact that we are not just individuals. We are not just individuals with rights. We are brothers, fathers, uncles, sisters, aunts. We have come from family, and family is part of it because death without family is traumatic. That is a tearing apart.

We come from communities and a death in our community can be traumatic if we are not part of it. We come from neighbourhoods. I think of my father when he died, and he lived up in a townhouse project in north Scarborough. The neighbours were coming all hours of the day and night. They were Sri Lankan, Italian and South Asian families who could not speak English but who would say, “We brought food for Mr. John”, because he was part of the neighbourhood.

Those moments of death are about our involvement with each other, and what concerns me with the changes that have been suggested to MAID, is that it is about separating those who are vulnerable, those who are isolated and those with mental distress from the larger community, which needs to hold them and care for them. We as legislators cannot just say that it is an individual choice. This is a societal choice we are making, and we are making it now on behalf of very vulnerable people who need our back.

We cannot just say, “They are depressed. They have always been depressed. It is their right. They are individuals.” That is a failure of our obligation to be there as a neighbourhood, as a community, as a family to hold them and to get them through the darkness.

How did we get here? There is a lot of blame, enough to go around. We knew that the issue of medical assistance in dying was fundamentally an issue that Parliament had to confront. This was our job as legislators. It was a hard job, but it was our job. The Stephen Harper government just decided to ignore it. It did nothing on this, even though we all knew it was coming.

Then the Carter decision came down. The Supreme Court stepped in. I think it was a failure for the court to step in and do the job parliamentarians should have done. What it did was put a timeline, because it said it did not have faith in Parliament. I think it was also a mistake that the Supreme Court put such a short timeline, because these were profound decisions we were making.

Then, the original bill passed. I had a lot of questions about that bill. I had real concerns about what the protections were and how it would be implemented. When we talk about someone whose death is foreseeable, who is suffering from pain they cannot deal with it, how do we make sure that the legislation is not opening the door to something much broader? We were told at the time as parliamentarians to vote for the legislation and that we would have a review. I trusted that. I thought it was fair. I had a lot of questions, but I recognized there were legal obligations. We had the Supreme Court's ruling and Parliament would have a chance to look at this. We were never given that opportunity. Parliament was never given the right to see the effects of the legislation we brought in.

Then the Truchon decision came in, where a Quebec court said that, with the charter provisions, limiting it to a foreseeable death was not fair and we had to throw the legislation out. That was a time when I think it would have been reasonable for the federal government to bring that to the Supreme Court and ask for a review. It did not do that. It accepted it. I think of how many decisions went in favour of indigenous communities and the government went all the way to the Supreme Court every single time, but on the Truchon decision it did not. That was another opportunity for it to say that the legislation was being expanded, perhaps for good, perhaps for bad, and that it needed to be reviewed. Still, Parliament did not get the chance to do the review.

Then it went to the Senate, of all places, the unelected, unaccountable Senate. These are people who cannot be fired once they hired. They can do whatever they want. They can show up or not show up. They sent us back a bill that said they wanted Parliament, the elected members, to approve their change, which was that if people are depressed they should be able to die.

The government should have rejected that bill outright. It should have told the senators that, number one, they are not elected, not accountable, and that it was a ridiculous provision. It did not, so the bill sat on the Attorney General's desk, to come into effect this coming St. Patrick's Day. Now we are scrambling. We have to deal with this bill. It is not that we are responding to the bill; we are putting it off for another year.

I will support that, but I think it is a complete failure of our obligation to deal with something that needs to be reflected on and needs a profound answer from parliamentarians. It needs for us to stand up and ask what is right, what is fair and what provisions have to be in place to protect the vulnerable, particularly those who, in a moment of darkness, think they want to end their life.

I looked at the statistics of how MAID has been applied, and that alone would cause any parliamentarian to say that we should look at this. In 2016, 1,200 people died by MAID. It more than doubled in 2017. It more than doubled again in 2018, to over 5,000, and to over 10,950 in 2021. That is 30 people every single day in this country deciding to end their life.

That is double all the deaths from breast cancer in this nation. It is more than double the national suicide rate, and we are not going to reflect and say, wait a minute, is this opening the door to a place where we should not have gone, and where none of us thought we were going, when more than double the deaths of what we see in the suicide epidemic in this country are from people going to the doctor and saying they just do not want to be here anymore?

We could be told that there are protections and measurements in place, and we have been told that. I heard that at all the hearings. Then we get examples. I do not want to wave around one example and say that this is proof of what went wrong and the perfidy of the government, but I look at an Associated Press article on Alan Nichols, who had a history of depression and mental illness, and the police brought him to the hospital because they were afraid that he was going to kill himself. His family said that we had to help him, that he had a history of mental illness. He decided to apply for MAID and he was dead. That is an outrage. His family was asking for help for him, but he was treated as an individual in his own right who could just come into the hospital, brought in by the police, who were trying to keep him alive.

I think of the suicide rates that we have had in the communities I represent. Some of the highest suicide rates in the world are in northern Canada, and we have done jack about that.

In 2019, I brought Motion No. 174 to this House, calling for a national suicide prevention action plan, and every single member of the House voted for that. I heard all the speeches, that we have to protect the vulnerable, that we are going to be there for them, that the government has a role to play. We voted for that, and nothing was done, nothing. People continue to die.

Now we have this panic legislation to say, oh my God, let us just put off for another year the fact that people just have to be depressed and they can walk in and say “I want to die” and we will let them die. One could be depressed for all manner of reasons. In Belgium, which had medically assisted suicide for many years, one can claim it for PTSD. My God, will PTSD be a reason for it? It could be depression, or injury at work. Yes, it is a crappy life to have serious chronic pain. It is going to be a crappy life, especially if people do not have a proper pension or a proper place to live, but they will be able to go, as an individual, and say “I want to die.” Are we going to let that happen on our watch? I do not think so.

Again, this is not about my moral choices over someone else's moral choices. This is about who we are as a society, whom we protect and whom we leave on the sidelines.

In Motion No. 174, to establish a national suicide prevention action plan, there were many factors that we brought in because we met with organizations across the country. We talked about what it would take to have a holistic life-supporting system for people in crisis. We talked about establishing national guidelines for best practices in suicide prevention based on the evidence and effectiveness, in a Canadian context. We said we would work to establish culturally appropriate community-based suicide prevention programs by the representative organizations of the Inuit, first nations and Métis people so that they would run the programs that work for them and they would be culturally appropriate.

We said we would create a national public health monitoring program for the prevention of suicide and the identification of groups at elevated risk. That is really important, because when we know where the elevated risks are, we know where to put resources. We talked about the creation of programs to identify and fill gaps in knowledge related to suicide and its prevention, including timely and accurate statistical data. Once again, if we do not know what the data looks like, we have no way to help. It is not the role of the government to go in and do emergency crisis prevention in every single case. That is not what we do, and we would be terrible at it, but it is that information, the analysis and being able to show where the shortfalls are that would allow funding to flow.

There would be the creation of a national online hub, providing essential information in assessing the programs in the various languages: English, French, indigenous and the other languages spoken in Canada. We would conduct, within 18 months, a comprehensive analysis of high-risk groups of people, the risk factors specific to each group, and the degree to which sexual abuse and other forms of childhood abuse and neglect have an impact on suicidal behaviour.

We would assess the barriers for Canadians in accessing appropriate and adequate health, wellness and recovery services, including substance use, addiction and bereavement services, and the funding arrangements required to provide treatment, education, professional training and other supports required to prevent suicide and assist those bereaved by a loved one's suicide. We would look at the use of culturally appropriate suicide prevention activities and best practices, and study the role social media plays with respect to suicide and suicide prevention.

If the government had done those things, then yes, it could come in and tell me it will pass this Senate bill allowing people who are mentally depressed to kill themselves. It could tell me that it has actually done the analysis and presented the information to Parliament, and then we would look at it and know where the gaps are. However, if the government has not done any of that work, it should not tell me that we are going to pass a bill that will let someone who has no support, no backup and no help say that life is tough and it is game over for them. This was the final thing we voted for in this Parliament. I know a lot of people were taking pictures and doing press releases about how great it was that they were standing up on suicide prevention.

There should be an annual report to Parliament on preparations for and implementation of the national action plan for suicide prevention, including data on progress over the previous year and a comprehensive statistical overview of suicide in Canada for the year. If we had done that in 2019, if we had four years of statistics, if we had facts and we knew where the mental health dollars needed to go, if we were not just putting it out willy-nilly but actually had statistics, then we could talk about maybe, in certain circumstances, after all these other areas have been exhausted and after all these other supports have failed, a person who may have no other choice. However, that person, in the midst of darkness today, has none of those other supports because nobody at the federal level bothered to put that in place. We have seen our provincial government fail in so many areas as well.

I was deeply concerned when I heard the Attorney General do a podcast on this legislation. He deliberately connected the change of MAID to the right to kill oneself. He said:

Remember that suicide generally is available to people. This is a group within the population [meaning the people who might need MAID] who, for physical and possibly mental reasons, can't make that choice to do it themselves. Ultimately, this provides a more humane way for them to make a decision they otherwise would have made if they were able in some other way.

That is the Attorney General of Canada saying they physically cannot do it, they might not be smart enough to do it and they might be too depressed, but they have a right to kill themselves. That is what he said on a podcast just recently.

When I am told we are going to delay this for a year, I will vote to delay it for a year, but I want to see a plan to address this. I want to see the statistics that prove how this is being used, whether it is being exploited and whether the vulnerable are being targeted or being led to use this because there are no other supports. Until that happens, the last thing we should do as a Parliament of Canada is open the door further for more people to die.

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

Madam Speaker, given the circumstances that, if we do not pass this bill, the provisions that were included in Bill C-7 will automatically come into force, I assume the member will be voting for Bill C-39.

What steps would he and his party want to see taken before March 2024 to ensure that adequate mental health supports are provided to all Canadians?

[Rob Moore, Conservative, Fundy Royal, NB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Ted Falk, Conservative, Provencher, MB]

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

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

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, I thank all my colleagues who have spoken so eloquently here these past many hours.

It will come as no surprise to my colleagues that I am opposed to medical assistance in dying and also opposed to any expansion thereof, but I will be voting in favour of Bill C-39, because what it would do is delay the imminent move the Liberal government wants to make, which is to extend MAID to those with mental illnesses.

When MAID first came to this House and was presented by the Liberal government, I was on the justice committee, and I, early on, warned this House that MAID was going to be a slippery slope, that “reasonably foreseeable” would not remain the standard by which MAID cases would be adjudicated, and that the legislation would also pose a serious threat to those with disabilities, the elderly, the poor and particularly those with mental health issues.

In August of last year, the Associated Press and the National Post both published reports on what has been happening in Canada's hospitals since the Liberal government introduced one of the most permissive assisted suicide regimes in the world. The results are alarming. In an interview, Tim Stainton, director of UBC's Canadian Institute for Inclusion and Citizenship and one of our leading experts on the subject, called MAID “the biggest existential threat to disabled people since the Nazis' program in Germany in the 1930s.”

A follow-up article in Forbes magazine written by journalist Gus Alexiou, who himself suffers from multiple sclerosis, states, “unfettered accessibility [to MAID] could...prove to be one of the most malignant forces the disability community [including those with mental disability or illness] has had to contend with since the 'mercy killings' of the Third Reich almost nine decades ago.”

This is because their reporting discovered that the people who are being targeted for MAID, and I do not think “targeted” is too wrong a word to use, are the most vulnerable Canadians: those who are disabled, seniors, those living in poverty and those with a mental illness.

Their story begins with Alan from B.C., who suffered from severe depression. He was administered MAID shortly after being taken to the hospital for a psychotic episode. His family begged the doctors not to kill him, as he had been involuntarily admitted and was in the throes of a psychotic episode when he demanded MAID. The family's pleas were ignored, and Alan was dead shortly thereafter. As Dr. Mark Komrad, a psychologist at John Hopkins Hospital, accurately predicted, our law “will provide, not prevent, suicide for some psychiatric patients.” Alan's death was not a reasonably foreseeable death. He was killed because he had a mental health condition.

Then, there was a disturbing incident where a Veterans Affairs agent casually offered MAID to a veteran with PTSD and a traumatic brain injury, something they had no business doing. To its credit, the government dealt with that employee, and I commend it for that, as I commend it for taking this pause on MAID expansion. I was in government, and I know how hard it is to walk back on things. It takes courage to do that, so I am glad the government has seen fit to do so. However, it turns out this one veteran incident was not an isolated incident; it was one of six incidents, that we know of, where it was suggested that veterans should consider assisted death.

Moreover, let us be clear about what we are talking about, because as I listened to the justice minister and read some of what has been put into print, it does not sound like he is convinced that those with mental illness should not receive MAID. It just sounds like he was not ready to go.

CBC, on February 2 of this year, quoted him as saying:

COVID slowed everything down. To be honest, we could have gone forward with the original date, but we want to be sure, we want to be safe, we want everyone to be on the same page.

We want, in particular, those health practitioners, those faculties of medicine, colleges who had some concerns to have the time to internalize what is happening.

Let me read that sentence again: “We want, in particular, those health practitioners, those faculties of medicine, colleges who had some concerns to have time to internalize what is happening.” That does not sound like an about-face to me. It sounds like the minister and the government still have every intention of moving forward with this.

According the National Post, a 2021 report by the UN “warned that Canada's liberalization of euthanasia posed a dire threats to its elderly and [infirm] populations.” That threat certainly includes those suffering with mental illness. The report said, “There is a grave concern that, if assisted dying is made available for all persons with a health condition or impairment [including mental health]...a social assumption might follow...that it is better to be dead than to live with a disability.” Given what we have seen to date, that certainly appears to be the case.

Just a little less than a year ago, last February, I received an email from a constituent. She is not my constituent but a constituent of a Liberal member of Parliament. It was sent to several MPs. I would like to read it into the record. It comes from a woman by the name of Melissa, and this is what she said:

...I was the farthest thing from a being a productive member of society. 15 years ago I was struggling really badly. I had entered into my second year of grade 10, which was due to a mental health diagnosis. I was diagnosed with PTSD, a personality disorder, major depression, and I had anxiety and was on a bunch of antipsychotics. I was in and out of crisis stabilization units, psych wards and a couple years later I got kicked out [of] a safe home for youth. I got kicked out of school and home because I was overdosing on the prescription medication and was self mutilating. I was a lost cause and didn't want [to] live and suicide was the only way out from all this pain......or so I thought.

She continued:

...it would have made me a prime candidate for MAiD, since my condition was nearly impossible to overcome apart from a miracle. I was a burden on my family, the medical system, the education system, and on top of it had chronic stomach issues and back pain which I would frequent the hospitals for. If I had an open door to access MAiD, that would have been something I would have seriously considered and would not be here to tell you about my story.

There are so many young teens that, like myself grow up in broken homes and get stuck in hopelessness and despair, and there are others who have everything they could ever want, yet still suffer from issues affecting their mental and physical health. Not everyone overcomes and it gets carried into their adult life, which makes them eligible for Medical Assistance in Dying.

She went on to say:

When you make the choice to go through with MAiD you no longer have an opportunity to go back and reconsider your decision. I know people suffer, and life can be tough and there are moments that seem unbearable. But there is Hope!!!! I've been there before. I suffered for over 10 years, I started on antidepressants by the age of 12, and by [the] middle of high school I had lost my mind and just wanted to end it.

Yet taking life is a very serious matter. I met Jesus who became my hope, I know that the name of Jesus has been frequently misrepresented but, the Jesus I met truly takes away needless pain and suffering.

Then she addressed her Liberal member of Parliament and asked him to reconsider his support for this particular bill.

Sadly, this is happening in Canada at the same time as we are facing a growing and serious health care crisis that has been exacerbated by years of COVID, restrictions and delays. Millions of Canadians are unable to access primary care, and wait times for doctors, appointments, surgeries, mental health support and emergency room visits are among the longest in the developed world.

Since it was expanded, MAID has seen a dramatic upswing, exacerbated by COVID-19 and the inability of too many Canadians to access timely and proper health care, including a lack of mental health supports. In fact, in an Angus Reid survey that just came out today, 55% of Canadians are worried that the expansion of MAID will become a substitute for social services.

An ER doctor recently told my office that prior to COVID, mental health cases accounted for one in every seven ER visits. Post-COVID and post-restrictions, that number is one in three. According research in the National Post, 2020 saw a 17% increase in MAID deaths over 2019 that disproportionately involved the elderly. I see no reason why we will not see an even more significant jump if MAID legislation is permanently expanded to include mental illness.

I recognize there are many for whom every day is a struggle and for whom mental health and physical health issues are debilitating. I will not begin to pretend that I know what it is like, and I want to be sensitive to that, but I believe that every human life, whatever the contents and challenges of that life may be, holds an innate and sacred dignity. Only God can give life and only God should be able to take life. It is my deeply held conviction that from conception to natural death, life is a precious gift.

It is the role of government to seek the best for all its citizens. We must adopt policies that embrace that gift, policies that uphold life and reinforce the value of every citizen. As Pope Francis put it during his recent Canadian tour, “We need to learn how to listen to the pain...of patients who, in place of affection, are administered death.”

We need to be there for the elderly, the infirm, the disabled. We need to be there for those who are suffering from mental illness, not offering the needle—

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Madam Speaker, as always, it is a true honour and privilege to stand here in the House of Commons to represent my beautiful community of Peterborough—Kawartha.

Today we are debating Bill C-39, an act to amend the Criminal Code in terms of medical assistance in dying, which I will refer to as MAID for the remainder of this speech, and extend the exclusion of persons living with mental illness from being eligible to receive MAID beyond March 17, 2023.

We are going to need to rewind a bit to paint a picture of how disturbing this legislation, conversation and ideology are. In December of 2021, without any consultation, study or discussion, the Senate added an amendment to Bill C-7 to make people with mental illness eligible for MAID. This is gravely concerning and indicative of the Liberal government's recklessness to add such a serious amendment, which targets the most vulnerable, without due diligence of study and consultation with experts.

Instead of recognizing the undemocratic and dangerous way the amendment was added and scrapping the entire thing, which should have been what happened, the Liberals' proposal is simply to extend the deadline with an arbitrary date.

The MAID special joint committee was created after the amendment was added. How backward is that? The committee heard testimony from many experts, including Dr. John Maher, clinical psychiatrist and medical ethicist, who 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.”

Of course, today I will support this bill, but let us call it what it is, which is window dressing for a much bigger ideological problem. We do not need to extend the timeline of this bill; we need to get rid of making those with mental illness eligible for MAID. We need to call out the Liberals for not providing a dime of their promised $4.5 billion to the Canada mental health transfer. We need to ensure people at home watching know we are working diligently to give them timely access to treatment and recovery when they are willing to get it. That is what we need to be doing.

I urge every member in this House to listen to their constituents and recognize how dangerous the message is that we are sending to those struggling. I encourage every member in this House to support Bill C-314, which was introduced last Friday by my colleague from Abbotsford and would solve this problem instead of prolonging and dragging out an amendment that should never have been put there in the first place.

It is difficult, if not impossible, in the case of mental illness to determine whether someone can recover, get better or get healthy. Therefore, one can appreciate how dangerous a bill like this is.

I am going to read into the record a letter that was recently sent to me.

It reads:

“Dear Michelle Ferreri,

“My name is Kayla. I am going to be sending this letter to several MPs, but as you are the MP presiding over the constituency where I reside, I thought I should send this to you first. I am very troubled by something that is going to be happening very soon in this country, and I hope you will listen to what I have to say.

“Overall, I am a very healthy individual. I have a mental health condition, but it is my sole medical condition. However, I was mortified to discover last month, that medical assistance in dying (MAID for short) will be available to people whose sole health condition is a mental health condition as of March 17, 2023.

“Persons who suffer from mental health conditions suffer horribly. I know that. I have suffered with mine for nearly 12 years. Perhaps the most appalling things of all are that ‘The law no longer requires a person's natural death to be reasonably foreseeable as an eligibility criterion for MAID,’ (Government of Canada, 2021) and ‘There is no obligation for a person or their health care practitioners to inform family members if that person has requested or received MAiD.’ (CAMH, 2022).

“I think you are an intelligent person, Michelle. I think you see this for what it is. As of March 17, 2023, I will be eligible to end my own life on the basis that I have an incurable mental illness. Let me give you a bit more background: I have two university degrees, in biology and environmental science. I have a job that I love and have held since a little while after I graduated. I have never failed to pay taxes, nor have I ever taken extended leave or gone on EI due to my mental illness, no matter how hard it gets. I have family and friends that I love dearly, and they love me too. And yet now my own government has deemed my life not worth living. This just isn't unfair. This is monstrous.

“But it gets worse. What about those people who are in the same boat that I am medically, but are much, much worse off. They cannot pay their taxes because they cannot work. They have a substance addiction. They are veterans with PTSD. They are homeless because they cannot seem to fight off their demons. These are some of the most vulnerable people in our society. To say nothing of the nature of the 'mature minors' (whatever on Earth that means) that will be able to access MAiD in the future if this doesn't stop.

“Make no mistake. This thing that we dress up with a nice name 'MAiD' is euthanasia of our most vulnerable people because they cannot 'contribute to society' like others can. The fact that the government would offer to get them out of the way (read: convince them that they should die) in this way, just because the systems that the government put in place are failing them is an unspeakable evil.

“I hope, Michelle, that you will do everything in your power as an MP, as I will do everything in my power as a citizen, to abolish this law. I understand the federal government is seeking to push back the timing of this law, likely because it has received so much criticism. I understand that it likely wasn't you that made any of the decisions for this law to go ahead. But I also understand that you are in more of a position to do something about it than many other people are. I hope you will respond after reading this letter.

“Sincerely,

“Kayla.”

I did talk to Kayla, and it was a heartbreaking conversation. She is living very well, and I would like to give Kayla a round of applause for being so brave as to share that. This letter says everything Canadians need to hear. We need to be sending a message of hope and recovery, not a message that their life does not matter.

I leave members with one final story. Elyse is a young university student and she chatted with me during the Christmas break. She said she needed to tell me something. She said she was so worried about this legislation to extend MAID to those with mental illness. She said that she had struggled with mental illness and knew with certainty that if someone had offered that to her during her times of illness, she would not be here today. She told me that she would not be getting her university degree; would not be in a happy, healthy relationship; and would not know that her life is worth living.

We have a duty in the House to bring hope and create legislation that provides a better life for Canadians. A better life means access to help when they need it. I urge every MP in the House to listen to the experts and Canadians, and not just extend an arbitrary deadline, but drop this dangerous and reckless legislation. To everyone at home watching, including families who are supporting those with mental illness and those who are living with mental illness, we see them. They are worth fighting for, and their lives are worth it.

[Richard Bragdon, Conservative, Tobique—Mactaquac, NB]

Mr. Speaker, it gives me mixed emotions to rise today in the House on this subject. Our hearts are full of stories. I do not think there is a family that has not been touched by those who have battled with mental illness in some form at some period in their lives. The mere thought that MAID could be extended to those battling mental illness is beyond disturbing.

I believe Canadians from coast to coast are in agreement that this is an extension that goes way too far. I rise today in this House as someone who will definitely support Bill C-39 to delay the extension of MAID to those with mental illness. With that pause and delay, I hope the government will take advantage of that time to finally put in place adequate safeguards to protect our most vulnerable.

It has been said that the character of a nation is revealed in how it treats its most vulnerable. Right now, the character of our nation is being tested. How will we respond to this time of testing? Will we rise to the occasion to help our fellow man, our fellow humans and our fellow neighbours and friends, who are battling and struggling? Will we respond to their anguish? Will we respond to their pain? Will we respond to the cries from many across this country right now who are under increased strain mentally?

Many are coping and trying to self-medicate. It has led to addictions in their lives and further mental health struggles. We are seeing a rise in depression, anxiety and other types of mental illnesses. It is moving across the country at a very rapid rate and to younger and younger Canadians. Our hearts are moved by this.

The importance of this delay cannot be overstated. Let us not just delay this for another year and then have to revisit it again and have this debate again. Let us move with urgency toward putting in the necessary safeguards to protect our most vulnerable. Canadians are demanding that we respond.

We have had many examples of the overreach and overextension of this. Veterans have been offered and advised to utilize medical assistance in dying. This is something that should never happen to those who are heroes and have served, and at a time of post-traumatic stress or in a season of anxiety and depression. We know that with adequate supports and proper care, they can traverse to the other side of the deep valley they may be in temporarily.

I have family and friends who have had these bouts. I have seen the effects of mental illness in very deep and profound ways. In my previous vocation, I rushed to a bridge where someone was on the edge considering taking the step of ending their life. I have been called to a dam in my area in the dead of winter to respond to someone who had reached their end.

This was some time ago, but I am very thankful to report to this House that both those individuals have moved on with their lives. They are living. They are enjoying their lives and have made some very positive changes. I am so thankful that in that moment they chose life. I am also very thankful that at that time, medical assistance in dying was not extended to those who were battling mental illness alone.

This House must put in the adequate safeguards that are needed. Experts are telling us very clearly that this should not be extended to those solely battling mental illness, because there is no way they can adequately determine if the mental illness is irremediable.

With that uncertainty, with those legitimate concerns coming from health professionals and the majority of doctors and physicians across the country, it would behoove this House not only to pass this bill and give the delay but also to take immediate steps to implement adequate safeguards that would protect our most vulnerable.

I pause for just a moment upon probably one of the most famous passages that has ever been quoted in times of stress and duress for many people. It is oftentimes featured in movies and at most funerals that we attend; it is a verse of great comfort:

Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me.

Death casts a very big shadow, and those of us who have lost loved ones know that pain and grief very well. Those who have lost family members and loved ones to suicide know how dark and deep that shadow is.

However, there is hope that when we are traversing the very valley of the shadow of death, we can pass through and come out on the other side. There is hope for those who are battling mental illness, depression and anxiety; though it may feel permanent in the moment, there are many people who have traversed that valley and come out with hope and light again in their hearts and souls.

Primarily, it is because they came to the realization that they were not alone. They had loved ones who were with them, family who cared for them, neighbours who extended a hand and those who would run in when everyone else ran out of their lives. When it looked darkest, someone lit a candle in their night that brought hope.

I am thankful for those who brought light to me in the darkened times of my soul. I hope that everyone in this room will take the pause that this bill would grant the House, be a light in a darkened place for those who are hurting and extend the hope that is in the valley of the shadow of death. We do not have to fear, but we can walk with people through the most difficult of seasons in their lives.

Let us bring hope and life. Let us not encourage death or a culture of death but foster a culture of hope and life for those who most desperately need it.

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I am pleased to be able to join this debate.

The underlying legislation of Bill C-39 is very simple. The government is simply asking that it be given more time to introduce safeguards, guidelines and professional practices that would allow assisted deaths to be administered in such a way that mistakes are not made. However, we already know that mistakes are being made under the current regime, so that should not give Canadians any confidence. In fact, Bill C-7, which is the bill that has given rise to this request for an extension, is just another case of the Liberal government getting it so wrong by failing to consult in advance and then, after the fact, trying to fix all the mistakes and fill in all the gaps.

This is another story of failure, and what I would like to do is explain a bit of the context. Members may recall that back in 2015 the Supreme Court of Canada, for the first time, opened up the door to legalized assisted suicide, and the Liberal government then responded with Bill C-14, which restricted MAID, or medical assistance in dying, to those who were at the end of their lives and living in intolerable, grievous pain. We were assured this was not a slippery slope that was intended to include other vulnerable Canadians in Canada's assisted death regime. That is what we were told. Many of us did not take the government at its word. We did push back, but the government passed the legislation anyway.

Sure enough, here we are, some eight years down the road, and our fears were confirmed when the Quebec court, in the Truchon case, ruled that limiting MAID to those whose natural death was reasonably foreseeable was unconstitutional. The government did not appeal that case, a seminal case because it is opening up a life-and-death piece of legislation and expanding it without a reference to the Supreme Court of Canada. I believe that was an abdication of responsibility in itself. Instead, the government chose to accept the ruling and move forward with Bill C-7, which ended up extending MAID to include, among others, the mentally ill.

I want to be clear here. I do note that the original Bill C-7, which was introduced by the justice minister, did not include the mentally ill in Canada's assisted suicide regime. However, when that piece of legislation, Bill C-7, went to the Senate, the other place, the senators inserted a provision expanding and extending assisted suicide to the mentally ill in Canada. When it came back to this House, the government, instead of pushing back, the way one would expect a government to do, simply rolled over and said it would accept it the way it was, and that is now becoming the law of the land.

Bill C-7 also provided that the mentally ill provisions of Bill C-7 would come into force in two years. That is the sunset clause some people talk about. During that period of time, proper safeguards and practice standards were to be put in place to ensure that mistakes were not made. Not surprisingly, as it is a Liberal government, it got to the end of the two years, and virtually nothing has been done. The government actually struck an expert panel to review this, but it did not give that panel the right to review the merits of the underlying assisted suicide regime in Canada.

There is also a joint parliamentary committee between the Senate and the House that is still reviewing these provisions, and I am looking forward to that report. However, again, the mandate of the committee did not include any real, substantive review and investigation into the substance of medically assisted suicide. All it was allowed to do was tinker around the edges to implement a policy that has life-and-death implications for many Canadians.

Here we are. We have no safeguards and there are no guidelines for our practitioners, but we support the bill because we are trying to push this down the road as far we can. I will mention why in a moment.

The woefully inadequate rollout of the government's MAID regime is a manifestation of a Liberal government that appears to be in disarray and whose ideology is moving Canada from a culture of life to a culture of death rather than providing the necessary resources to our most vulnerable. Many in the House have raised that issue and have asked this: Why is it even necessary to apply assisted suicide to the marginalized in Canada, the vulnerable? They ask because right now we are not providing them with the resources and supports they need to live a satisfying and joy-filled life.

What is really of concern is that numerous stakeholders have said they oppose Bill C-7. By the way, there is no broad consensus in Canada that we move forward with assisted suicide for the mentally ill. There is some consensus for MAID to be in place for other cases where there is extreme pain involved, but Canadians do not support extending it to the mentally ill.

What is also of concern is that the government has now signalled that it will go beyond the mentally ill and would like to include mature minor children in this regime. The government is charging ahead with a life-and-death policy that has increased Canada's momentum down the slippery slope that we had warned of.

Is death now seen as a more cost-effective way of managing the most vulnerable in our society? Many have posited that this is the case now. Canadians have a right to question whether their government can be trusted on issues of life and death. If this is being extended to the mentally ill and to mature minors, what about the indigent? What about the homeless? What about the drug addicted? What about veterans? We know that veterans have already been counselled by the government to consider MAID as an option to serve their needs and provide them with support. We know that people who are arriving at the food banks are asking where they can access MAID, because they do not want to live in poverty anymore. That is a reflection on us as parliamentarians. It is a reflection on our country, and we can do better.

There is, however, some good news, and I will end with it.

I recently tabled a private member's bill in the House, Bill C-314, the mental health protection act. It would reverse the Liberal government's reckless acceptance of the unelected Senate's assisted death amendments. It would arrest the dangerous momentum that the expansion of medically assisted death has triggered on the slippery slope. Under my bill, Canadians whose sole underlying medical condition is a mental disorder would not qualify for MAID. At the same time, the preamble to my bill calls upon the government to finally deliver the mental health supports that have repeatedly been promised in federal budget after federal budget but have never been delivered. This is the least we owe to those who struggle with mental illnesses such as depression.

In closing, to ensure that we do not implement the mental health provisions of Bill C-7 before the House has an opportunity to revisit my piece of legislation, we on this side are very supportive of moving forward and passing the bill expeditiously. It will buy another year and push the whole issue of the mentally ill down the road, and we will make sure that we implement private member's legislation that actually protects the most vulnerable.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Madam Speaker, I guess I am troubled by the trajectory of the MAID discussion and MAID legislation. I am glad Bill C-39 is here to delay this a bit more. The member talked about how he predicted the slippery slope. Where else could this go?

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

Madam Speaker, I have decided to share today for the first time the story of my young cousin Gabriel, who died by suicide on March 25, 2021. I hope his story provides some comfort to others and sharpens our understanding about the impact of the government’s proposal to legalize suicide for those with mental health challenges.

Gabriel was born here in Ontario, but spent most of his life in the United States. He had a loving and supportive family, which included three siblings, but he struggled throughout his life as a result of personal health circumstances that were generally hard to classify. He had Asperger’s syndrome and other things that affected the way he experienced the world. These health challenges made it difficult for him to form relationships with his peers and contributed to a sense of rejection and loneliness, but his family was always there for him, helping him work through the challenges and helping him to see his God-given dignity and purpose.

In conversations, my uncle has reflected on the contrast between Gabriel’s experience and that of his younger sister, Anastasia. Anastasia has Down syndrome. Society perceives her as having a disability. In fact, babies with Down syndrome face an extremely high abortion rate because our society fails to value people with Down syndrome, and also because it is poorly understood. Though perceived as having a visible disability, Anastasia is full of life, joy and happiness, which she effortlessly shares with all she encounters, especially those who are suffering. Gabriel, by contrast, did not look any different. He did not have an easily recognizable disability, but had immense pain that was largely invisible to the world around him.

I last saw Gabriel during a family road trip in 2019. At the time, he was working as an independent construction contractor and doing very well. However, as happened with many young small business owners, his business was hit hard by the circumstances of the COVID-19 pandemic, even though he himself was not at great risk from the virus. In March of 2020, a lot of North America and the world shut down as a result of fears about this novel coronavirus. People died from the virus, but many also lost livelihoods and communities, as well as opportunities to engage in meaningful work, so many died by suicide, in proportions that we will never know precisely.

The current government chose these unusual circumstances as the time to push forward its radical agenda of legalization of medically facilitated suicide for those facing mental health challenges. It brought its new euthanasia law into force on March 17, 2021. This bill made changes to the euthanasia regime in Canada that were universally decried by the disability community.

As it relates to mental health, the bill contained a mechanism by which the prohibition on legalized medically facilitated suicide would automatically expire two years later, on March 17, 2023. Thus, the government legalized suicide for those with mental health challenges, but delayed the coming into force of that legalization until this year. Meanwhile, my cousin died by suicide eight days after the passage of the legislation, on March 25, 2021, just shy of his 26th birthday.

These events were not connected. My cousin was not following Canadian politics at the time and would not have seen our deliberations as being relevant to him where he lived. Nonetheless, as I got the call from my father in the lobby of this very chamber, I thought about the many people like Gabriel who will be affected by our work, the many people like Gabriel who live with unseen pain, have highs and lows, and are deeply loved by family and friends.

Until now, the message we have all sought to deliver to people like Gabriel is that they are loved and valued and that their lives are worth living. It has been famously said, “He who has a why to live for can bear almost any how.” This insight was explored in depth by the great psychiatrist and concentration camp survivor Dr. Viktor Frankl. Frankl observed and reflected on the circumstances of his fellow prisoners and came to realize how important meaning is to human life.

Human beings are highly adaptable to circumstances, even when those circumstances involve extreme pain. Their ability to endure that pain hinges on their sense of meaning and purpose. I say it again, “He who has a why to live for can bear almost any how.” Frankl developed a psychological method called “logotherapy” out of this insight, meaning that, in a therapeutic context, helping people develop an understanding of their purpose and their meaning provides the critical ingredient for happiness, even happiness in spite of pain.

For someone suffering from physical or mental health challenges, there is the immediate treatment or therapy they receive, but there is also the larger social context that shapes their ability to see meaning and value in their life in the midst of suffering. I think colleagues here will identify with the fact that, when someone in our family is suffering from mental health challenges, we seek to help them reduce or eliminate their pain, but we also seek to show them that their life has value and meaning in the midst of that pain.

The problem is that we now live in a society that increasingly misidentifies the meaning of life as being the avoidance of pain. We follow Bentham in thinking that happiness is simply the maximization of pleasure over pain, instead of appreciating the historically much more common insight that happiness consists in the life well lived and the life lived in accordance with meaning and purpose.

Today, many people think that there is no point in living if one suffers, whereas in the past it would have been universally accepted that a person can live a good, meaningful and even happy life that includes a measure of suffering and pain. If we, as a people, come to define meaning and happiness as the avoidance of pain, then we contribute to a loss of hope for people like my cousin. He can live a good life if he is able to believe that his life has value and meaning in spite of his pain. However, if he is made to believe that the good life consists solely in the avoidance of pain, then he must endure both the pain of the moment and the loss of perceived purpose and value. The combination of pain with a loss of purpose is likely always a cross too heavy to bear.

My uncle told me that his message to Gabriel was always “We'll get through this; we'll figure this out.” Gabriel's family sought to push back against the idea that an early death was inevitable for someone like Gabriel, showing him that a good life was possible and that obstacles could be overcome.

However, when legislators endorse medically facilitated suicide for those who are grappling with questions of purpose and meaning in the midst of great pain and suffering, we send them the message that their life is not worth living and we undermine their pursuit of meaning in the midst of that suffering. When doctors or when employees at Veterans Affairs Canada put suicide on the table as a way out, then they sharply send the message to the sufferer that maybe their life is not worth living or that early death is inevitable because of what they're going through.

Today, I would like to send a different message. I would like to say to the Gabriels of the world that they are loved, they are valued and their suffering and pain do not rob them of their essential human dignity or their ability to live out a noble purpose in the world. I want to send that message because it is true, but also because it is therapeutically useful, so that all those who are looking for meaning in their life can know that such meaning can be found even in the midst of pain. Notwithstanding the government's position, I hope that my statement today does send that message.

I know that the government's response to this is to suggest that there is some sharp moral and legal line between suicide on one hand and MAID on the other, with MAID or “medical assistance in dying” being the uniquely Canadian and politically manufactured term for when a medical professional intentionally kills a patient. Is MAID for a person with mental health challenges the same thing as suicide? Of course it is. The only difference is that the actual pulling of the trigger is done by someone else. It is suicide with an accomplice. Is MAID available to the suicidal? Either MAID is for those who want it or it is for those who do not want it. Assuming that MAID is still supposed to be only for those who request it, and since the term “suicidal” literally means “desiring suicide”, then MAID is for, and only for, those who are suicidal, by definition.

The minister responsible for mental health recently told the House, “All of the assessors and providers of MAID are purposely trained to eliminate people who are suicidal.” Perhaps her use of the term “eliminate” was a Freudian slip, but if she means that those who are suicidal are not eligible for MAID, then who in the world is eligible for MAID? Is it the non-suicidal? It becomes evident, when one provides simple definitions for the words being used, that so-called MAID is the same as medically facilitated suicide, and therefore that the policy of the government is to have the medical system offer to facilitate the suicide of those who are experiencing suicidality as a result of mental health challenges. Such an offer fundamentally changes the message that those suffering will receive from society about the meaning and value of their lives.

Specifically, the House is today debating Bill C-39, a bill that would extend the coming into force of this heinous reality for another year. I support Bill C-39, because I will support any measure that further delays the coming into force of this horror. Conservatives believe that this should be delayed indefinitely. In the meantime, we will vote for the legislation in front of us. Who knows? Perhaps the extra year will mean an election and a chance to euthanize this grievous and irremediable proposal once and for all.

Finally, I know that many members of the government share my opposition to the proposal, at least privately. I spoke earlier about the work of Viktor Frankl. In his work on logotherapy, he outlined how moral distress can be detrimental to a person's mental health. He tells the story of one patient who experienced great moral distress because of things he was asked to do at his job. His psychiatrist had for years been working with him on a complicated regimen that involved the re-evaluation of events in his childhood. Frankl himself told his patient to just get a new job, which solved the problem entirely.

To those experiencing moral distress, they should not over-complicate a simple matter. They will lose their sense of self and their own sense of meaning in life if they sacrifice their moral judgment to a fanatical justice minister. Please stand for what is right. For the Gabriels of the world, there is too much at stake.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I thank my colleague for his effort.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Madam Speaker, I rise today to speak to Bill C-39, an act to amend the Criminal Code with regard to medical assistance in dying. It is a bill I will be supporting to protect the most vulnerable Canadians from the Liberal government's reckless expansion of medical assistance in dying to Canadians who are suffering solely from a mental illness.

Unbelievably, if Bill C-39 does not pass, Canadians struggling with a mental disorder or illness will be able to access MAID as early as next month. As the Canadian Association for Suicide Prevention said, “Just as life is getting harder in Canada, it is getting easier to die.”

It is important to be perfectly clear that when considering MAID in the context of someone who is not dying as a result of their condition, such as a mental disorder alone, we are talking about suicide. It is almost as if the Liberals have given up. Instead of protecting the most vulnerable in society, they have opted for the easy way out. They have chosen a dangerous path, a slippery slope. They have opened medical assistance in dying to the most vulnerable in our society, and now they want to stop the clock, buy more time and find another politically expedient reprieve without doing anything to help.

I listened intently to the debate today, and honestly, it almost makes me ashamed to be a politician. Earlier today, the minister said that we need more time. Yes, we do. I have said this since the very first debate we had on MAID in 2016. During my intervention back then, I said as a new member of Parliament that nothing prepares one to adequately debate or intervene on such a weighty issue. We need to ensure we get this right, yet the Liberals rushed it through.

We have all heard very real stories: an Ontario man requesting MAID because it was more preferable than being homeless, the woman who has applied for MAID after seven years of not finding affordable housing and Canadians accessing food banks and asking for help with MAID. More and more Canadians are struggling, and we should be doing everything to support them, not giving up on them. We have also heard the unbelievable stories of Veterans Affairs employees suggesting MAID to veterans who are struggling with post-traumatic stress disorder. These are real stories; they are not sensationalism.

As the Canadian Mental Health Association has said, “Canada is failing to meet its human rights obligations when [Canadians] with a mental illness cannot receive the programs, supports and resources they need to be well and live with dignity.” The government is failing to provide even the most basic programs and supports.

This is a topic that my constituents feel very strongly about. It is a divisive topic, to say the least, and I respect people's decisions, but one thing is clear: A majority of my constituents, and indeed Canadians all across our beautiful country, are against the expansion of MAID for Canadians solely dealing with mental illness or disorders.

Canadians need to know what we are fighting for today. We need to look beyond what we are debating. The simplicity of Bill C-39 is a contradiction to the complexity of the issue. What we are really talking about is the ability for those suffering with mental illness to end their lives. Instead, we should be here today talking about what we can do to help those in need and what we can do to provide the services that will save lives.

Earlier today and throughout the debate, the Liberals have tried to explain away the provisions that included mental illness in MAID. They have attempted to shift the focus from what is actually happening to what is politically expedient, with the exception of our hon. colleague from Thunder Bay—Rainy River, whose speech I truly appreciated. Instead of addressing the issue head-on, they are looking for us as parliamentarians to buy more time to find a soft landing.

I will be voting in favour of Bill C-39, but I cannot support the addition of suicide to MAID ever. Let us be honest that this is exactly what we are talking about. There are times when partisan politics are called for and this not one of those times. We can disagree on tax hikes, we can disagree on gun legislation and we can disagree on who is best prepared to move our country forward. However, we cannot disagree on the importance of life and the importance of fighting for those who are struggling and who believe their only way out of the hardship they are experiencing is death. Is that not what we are here for? Is that not what all of us, all 338 members of Parliament, ran on? Was it not to stand up for those who are struggling, Canadians from coast to coast?

We need to be doing everything we can to make sure we are helping those who are struggling and who are the most vulnerable. We should be focused on offering help and treatment rather than assisted death.

Just two short years ago, all members of the House stood and voted in favour of creating an easy to remember three-digit suicide prevention hotline. It has been a long road forward, but this fall, Canadians who find themselves in trouble will have a chance to get the help they need. When seconds matter, they will not be forced to google a 10-digit number. They will simply pick up their phone to dial or text 988, and they will be able to talk to a person to start the process to get help.

The 988 hotline will not be the end point. It will be the beginning. It will provide one more tool with which those who are suffering can reach out for help.

As many of my colleagues know, I have dedicated my life to fighting for those who suffer silently or struggle with mental illness. I have sat with so many families devastated by suicide whose only hope is that we do everything in the House to ensure other families never experience what their families have. There is so much pain and so much guilt. Through my work, I have met many who have struggled with mental illness or mental injury due to their service.

I think about my friends. Jason is a giant of a man who was a firefighter. He was gripped with PTSD and wanted to die by suicide, but instead, he chose life. Now he helps others on their journey to beat PTSD and OSI. My friend Kent continues to serve our community each and every day. I think about their families every day and how I am so thankful my friends chose life.

I think about my own life and how at one point, I was struggling. It was one intervention, one by chance intervention that made me chose life. When someone is struggling with a mental injury, it is sometimes tough to see the forest through the trees. Sometimes people cannot see the light through the darkness. Sometimes people just need someone to tell them they are fighting for them and to help them get the assistance they need.

I live every day to fight for those who are struggling. We need to be doing everything we possibly can to make lives easier for Canadians, to give hope when it seems there is none. We need the government to be working with stakeholders to find the means to support those with mental illness. We have spent far too long talking about it. We have spent far too much time on studies that sit on shelves somewhere and gather dust. We have spent far too long doing nothing.

I will be supporting this legislation, but I will never support the inclusion of mental illness in MAID. It is a slippery slope. We need to take the next year or longer, find out how we can provide real support and figure out where we can actually make a difference. We need to spend the next year at least working on solutions that will keep Canadians alive.

A few weeks ago, I had a meeting with a man whose young daughter had ended her life by suicide. We spoke over Zoom for almost an hour, and I listened to his story. I heard the grief. I heard the despair, and I heard the regret.

Those who have children know what I am talking about. We live our lives to make our children’s lives better. We want the world for them. We want to give our kids everything we never had. We want this place to be better for them, and we want them to know we care.

What I heard in that man’s voice was utterly devastating. It was heart-wrenching. He said to me, “Todd, I can live with the death of my daughter, but thinking of what she had to go through, how many hoops she had to jump through just to access help, and how she had to navigate her crisis all alone is unbearable.” He said that he can live with the death of his daughter.

I honestly do not know how someone can listen to those words and think that what we are doing here is totally acceptable. I do not mean the year-long reprieve the government wants us to support. I mean the fact that we are even at this point, having this discussion. Until we have provided every support, exhausted every means, done everything we possibly can to help someone through their pain and suffering, my God, how can we even be here talking about this? The impact of that meeting will live on with me forever: the pain in his voice, the hurt, and the image of his daughter reaching out for help that was not available.

Conservatives do not believe that medical assistance in death is an acceptable solution to mental illness and psychological suffering. Our health care system should help people find the hope that they need to live, not assist in their deaths.

[Dominique Vien, Conservative, Bellechasse—Les Etchemins—Lévis, QC]

Madam Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code (medical assistance in dying), introduced by the Liberal Minister of Justice. This is obviously a particularly delicate subject.

The bill corrects a mistake made by the Liberal government. Another mistake, some will say. This government makes hasty, last-minute decisions and, as usual, has to backtrack. It is correcting one of its mistakes, but in doing so it will make another.

Let us look back to fully understand where we are today. When the government was preparing to amend the medical assistance in dying legislation in accordance with the most recent directives of the Superior Court of Quebec in 2021, the Senate made an unexpected amendment that would allow, starting on March 17, 2023, the provision of medical assistance in dying to individuals whose sole underlying medical condition is a mental illness. The Liberals then said, yes, why not. the Liberal government accepted the amendment, which is now part of the legislation.

The amendment was accepted without study, reflection or any serious consultation. The date set, March 17, 2023, is completely arbitrary. What was the Liberal government's reasoning at the time for accepting this amendment? How did it come up with the date of March 17, 2023? It obviously relied on its political guesswork, and God knows just how much the Liberals govern haphazardly, without a compass, and by improvising in an indecent and dangerous manner. This decision is just one of many very bad decisions made by the Liberals since taking office.

There are two problems with this measure. The first is expanding medical assistance in dying to people whose only underlying medical condition is a mental disorder. The second is setting the date of March 17, 2023, an arbitrary date that was selected without argument or justification.

Let us look at what is being done elsewhere, and not just anywhere. Let us look at Quebec, where the subject of MAID and dying with dignity has seized Quebec parliamentarians for many years. I know, because I was there as an MNA and minister and I voted in favour of MAID. In my soul, my heart and my conscience, I believe that that was the right decision.

With a view to now expanding medical assistance in dying, in its great wisdom, the Parliament of Quebec is taking its time, thinking and studying. The Quebec National Assembly set up a multi-party Select Committee on the Evolution of the Act respecting end-of-life care. It closely examined whether the scope of medical assistance in dying could be broadened. It tabled its report, which was unanimously adopted by the National Assembly in December 2021. This is recent.

Imagine. The Select Committee on the Evolution of the Act respecting end-of-life care does not recommend that medical assistance in dying be made available when a mental disorder is the sole underlying medical condition. It was obvious to the MNAs who sat on the committee that Quebeckers are not there and that there is no social acceptance of this issue.

However, the Quebec committee did not stop there. It went even further. In order to eliminate any possible grey areas, the committee recommended that the Government of Quebec amend its act to specify that medical assistance in dying is not available in instances where a mental disorder is the sole underlying medical condition.

On page 58 of the committee's report, it states, and I quote:

The Committee recommends that access to medical aid in dying not be extended to persons whose only medical condition is a mental disorder; that, to this end, section 26 of the Act respecting end-of-life care be amended.

The committee added:

This recommendation is in line with the precautionary principle that Québec has upheld since the beginning of work on medical aid in dying. We believe that the risks associated with extending access to medical aid in dying to persons whose only medical condition is a mental disorder would entail too many variations and could therefore not be closely monitored.

It goes on to say:

In order to implement this recommendation, we believe that section 26 of the Act respecting end-of-life care should be amended to avoid the possibility that a mental disorder as the only medical condition give access to medical aid in dying.

The committee refused to extend access because of problems relating to incurability, social acceptability, diagnosis and lack of consensus among members of the public and within medical professional organizations.

The committee therefore opted to follow the precautionary principle. As I said before, this is the element that was so regrettably lacking from the Liberal government's decision-making process. Once the Quebec committee completed its work and submitted its unanimous report, the Government of Quebec introduced its Bill 38 in May 2022, which was less than a year ago. The Government of Quebec endorsed the committee's recommendation. To be clear, Bill 38 was never passed because there was an election, so it died on the order paper.

The bill would have amended section 26 of the act by adding a prohibition on administering medical aid in dying to a person whose only health condition is a mental disorder. I will quote clause 13 of the Government of Quebec's Bill 38:

A patient who meets the following criteria may make a contemporaneous request:

(1) be of full age and capable of giving consent to care;

(2) be an insured person within the meaning of the Health Insurance Act...

(3) suffer from a serious and incurable illness or a serious and incurable neuromotor disability;

(4) be in an advanced state of irreversible decline in capability;

(5) experience constant and unbearable physical or psychological suffering which cannot be relieved under conditions that the patient considers tolerable.

What I am about to say is important:

For the purposes of subparagraph 3 of the first paragraph, a mental disorder is not considered to be a serious and incurable illness.

Canada does not exist in a vacuum, and it is not disconnected from what is happening in Quebec. The difficulties experienced by Quebec exist across the country as well. We are not prepared for this expansion. If we do not take action now, if we do not pass this bill, in less than one month, people living with a mental illness could have access to medical assistance in dying. We do not want that, Quebeckers do not want that, and Canadians do not want that. Canadians would not understand our lack of action. That is why we need to vote in favour of this bill.

However, we will vote for it reluctantly and with heavy hearts. We do not want the change to take effect on March 17, 2023, but there is another catch in this bill.

Bill C-39, introduced by the Minister of Justice, extends the deadline by one year. The bill extends the March 17, 2023, date to March 17, 2024. Why is it one year? Why not push it back two years? Why not suspend or abolish this section altogether? Why rush the expansion of MAID to people living with mental illness when the country does not want it and when doctors themselves are divided on the issue?

I would like to close by saying that medical assistance in dying is a sensitive issue that speaks to our values and our history, too. What we are asking of the Canadian government is not to simply postpone the date. We are asking the government to give us time, as parliamentarians and as Canadian citizens, to take the time needed. I believe that rushing such matters is always ill-advised.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, I would like to inform the House that I will be sharing my time with the member for Thunder Bay—Rainy River.

I am pleased to rise today to speak to the government's proposed Bill C-39, which seeks to extend the exclusion clause for those requesting MAID and whose sole underlying medical condition is mental illness.

I would like to take a few moments to draw our attention to the MAID monitoring regime and what we know about MAID cases to this point.

Canadians hold personal and very strong views on medical assistance in dying. They deserve accurate and reliable information to inform their decisions and their opinions. This is why we are working to ensure that our public communications are clear and comprehensive through our annual reports.

We know that a lack of accessible information opens the door to misinformation about evolving MAID systems. To be clear, while the proposed legislation would not impact the monitoring regime directly, a year's delay could bring the added benefit of more time to collect and the ability to report on important data regarding those complex cases where death is not reasonably foreseeable.

Putting this into perspective and context, our government acknowledges the importance of the data and reporting in relation to MAID, so much so that the original 2016 legislation obligated the minister of health to collect the necessary information and report annually on MAID activity.

This formal monitoring system is important to informing our understanding in three ways: who applies for MAID in Canada, medical conditions prompting requests and trends in MAID cases since the 2016 legislation.

As such, we have been working in collaboration with provinces and territories, as well as other health care partners, to ensure a robust monitoring system. It is important to understand that this is a significant, collaborative commitment.

Let us begin with a glimpse into what we know right now. As of December 31, 2021, there had been a total of 31,664 MAID deaths in Canada. This is the total number of MAID deaths since the law permitting medical assistance in dying passed in 2016.

MAID deaths represent 3.3% of all deaths in Canada as of 2021. This is very much in line with jurisdictions that have MAID regimes similar to Canada's.

The proportion of all deaths attributed to MAID varies across the country, with the highest rates reported in Quebec and British Columbia, and lower rates in the remaining provinces and territories.

Conditions include multiple comorbidities, cardiovascular disease, organ failure and respiratory illnesses.

Although the current sample is small, 2021 data also shows that, where death was not reasonably foreseeable, 50% of individuals were approved for MAID, compared to 81% of cases where death was foreseeable.

Each MAID request where the person's natural death is not reasonably foreseeable is complex and unique, and early indicators show that approvals for MAID in this stream are much lower than when the person's death is reasonably foreseeable, 50% versus 81%.

The assessment process for a person whose natural death is not reasonably foreseeable is often much more challenging due to the nature and complexity associated with medical conditions of this population. These assessments require detailed clinical analysis of each one of the elements of the eligibility criteria, which define a grievous and irremediable medical condition.

Let us spend a little bit of time talking about the human aspect of this data collection.

We should acknowledge that behind every data element in our annual report is, indeed, a human story. Implicated in each case is a group of people, their families, MAID assessors and providers, health care teams, and most importantly, the person making the request for MAID. The data we collect comes from thoughtful and compassionate conversations involving people who are making the most important decision of their lives and the MAID practitioners. The practitioners are responsible for assessing the requester in accordance with the person's wishes and the law. Through these discussions and the recording of information arising from them, we have a robust monitoring and reporting system for MAID in Canada.

MAID practitioners must ensure that every requester is aware of the services available that might relieve their suffering. This includes exploring treatment options, facilitating referrals and following up on the outcomes. When faced with a MAID request where death is not reasonably foreseeable, assessors spend much more time gathering the necessary information about the person and their condition. The process often involves a review of many years of treatments, surgeries and/or medications, as well as consultation with one or more experts in order to exercise due diligence in making a decision regarding eligibility.

New regulations for the monitoring of medical assistance in dying came into force on January 1 of this year. The MAID monitoring system will report on an expanded set of MAID data points that are collected according to these new regulations. The additional information should provide a greater understanding of persons applying for MAID whose natural deaths are not reasonably foreseeable, as well as their associated circumstances.

In conclusion, we are committed to transparency and accountability across all levels of government to ensure public confidence in the MAID regime. We are honouring this commitment by providing Canadians with accurate and reliable information on MAID as it continues to evolve in this country.

The House resumed consideration of the motion that 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.

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

Mr. Speaker, as I clearly outlined in my speech, the safeguards are very clearly laid out, not only in the Criminal Code, but also in what we believe the standards of practice should be, and that is going to apply to the medical community. That being said, the medical community has indicated it does need more time, hence the need for Bill C-39. I would just remind the hon. member that many stakeholders in the field of mental health have underlined the fact that the Liberal government needs to step up to the plate and increase the funding and the resources to appropriately address this major crisis happening from coast to coast to coast.

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

Mr. Speaker, it is an honour to stand to give my thoughts on Bill C-39. For those who are watching the debate today, this is the bill to amend the Criminal Code to delay, until March 17 of next year, the repeal of the exclusion from eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition is a mental illness.

It has to be stated very clearly, because of the timeline with which we are dealing, that if this bill is not passed, the original sunset clause that was put in place by the old Bill C-7 will come into effect on March 17, which is just over a month away. It is for that reason that I will support the bill and will work with all parties to get the bill passed quickly.

Today's conversation has to happen within the context of the mental health crisis in Canada. We know and have heard, and this is not just from members of Parliament, from many advocates and stakeholders that there is an extreme lack of funding and resources. Clearly, there absolutely must be parity between physical and mental health in funding.

The Minister of Mental Health and Addictions has stated in the House that Canadians should have access to timely evidence-based, culturally appropriate and trauma-informed mental health and substance use services to support their well-being. With that I agree wholeheartedly, but words are not enough. We need to see the requisite resources and funding to follow through those words.

We know that beyond the Canada mental health transfer many advocates have long been calling for legislation to enshrine in law parity between mental and physical health. I am very glad today that I am giving my speech beside the hon. member for Courtenay—Alberni, who is our mental health and addictions critic and who has himself tabled Motion No. 67, which calls on the government to develop that legislation and to urgently fulfill its promise to establish that Canada mental health transfer.

In my own riding of Cowichan—Malahat—Langford, many of my fellow citizens are going through extreme struggles with the opioid crisis. They are dealing with trauma. They are dealing with underlying mental health challenges that are simply not being addressed. That is an extreme gap and the cause of an extreme amount of shame for a country as wealthy as Canada to be still having these conversations about the resources that need to be brought to bear in communities like mine.

I have been a member in the House since 2015, so this is now my third Parliament. I have been here for the entirety of the legislative journey of medical assistance in dying. I can remember Bill C-14 and the sometimes difficult debates we had in the House. That legislation was in response to the Carter decision in the Supreme Court, which basically said that to deny people this right was contrary to our charter. It therefore gave the government a timeline to address it with the appropriate legislation.

What is not often talked about with Bill C-14 is that there was a legislative requirement in that act when it received royal assent. There was a five-year statutory review of medical assistance in dying. Unfortunately, that never occurred before the government went ahead in the previous Parliament and introduced Bill C-7, which established a second track for people whose death was not reasonably foreseeable.

The context of today's speech and C-39 is the fact that we have a story here of the government in several instances putting the cart before the horse. It not only introduced Bill C-7 before a statutory review occurred, which was a requirement of Bill C-14, but it then went ahead and accepted a Senate amendment to the bill that ran contrary to its own charter statement. It did that pretty massive expansion to the law without establishing a special joint committee that was a requirement of Bill C-7.

I am intimately familiar with what this process has been because I have not only been a member of the House since 2015, I have not only participated in debate on Bill C-14 and on Bill C-7, but I have also been a member of the special joint committee, both in the previous Parliament and in this Parliament.

The message all along has been that this kind of a review should have occurred before we were dealing with a timeline crunch. It became quite obvious during the special joint committee that too many Canadians, too many professionals in our country had apprehension about mental disorders as the sole underlying medical condition for being able to access medical assistance in dying as early as next month. Hence, we have Bill C-39.

I want to go back to the original charter statement that the government released as a part of Bill C-7. That includes a number of important statements as to why the government felt, originally, that mental disorders should be excluded from accessing MAID. It did say in that charter statement that the exclusion was not based on the assumption that individuals who suffered from mental illness lacked decision-making capacity. It also said that the exclusion was also not based on a failure to appreciate the severity of the suffering that mental illness could produce. Rather, it was based on the inherent risks and complexity that the availability of MAID would present to those individuals.

First, that charter statement identified that the evidence suggested that screening for decision-making capacity was particularly difficult. It could be subject to a high degree of error. Second, the statement identified that mental illness was generally less predictable than physical illness with respect to the course that the illness may take over time. Finally, it highlighted the experience that a few of the countries that permitted MAID, namely Belgium, the Netherlands and Luxembourg, for the sole underlying medical condition of mental illness had and some of the concerns relating to the increasing number of these cases and the wide range of mental illnesses in respect to which MAID could be provided.

Again, it really highlighted the fact that precaution was the necessary mode that was required before we embarked on this path. However, the government in its wisdom decided to accept a late stage Senate amendment to the bill after the House, full of its duly elected members, had given a final vote on Bill C-7. As a member at that time, I could not bring myself to accept that Senate amendment. Therefore, I ended up voting against the final version of Bill C-7 because of that.

It also needs to be said, when we are going over the history, that the special joint committee that was a requirement of Bill C-7 got a very late start. It was first brought into being just before the summer recess in 2021. We only had a few meetings before the summer of 2021 and we had the unnecessary election, launched solely at the request of the Prime Minister, in August of that year. This completely wiped out anything that was happening during the 43rd Parliament. That Parliament ceased to exist, and all of the committees that were a part of it did as well.

The new Parliament, the 44th, reconvened later that year, but it was not until around April or May of 2022 that serious discussions started coming together and we could actually get the special joint committee reformed. Again, we have to put that in the context of the impending deadline of March 17, 2023.

An incredible amount of time was wasted, not only from an unnecessary election but also from the delays of getting that committee up and running. We had to twice request an extension of our mandate from both houses of Parliament because the timelines we had been given were completely unrealistic, not only in hearing from as wide a range as possible of witnesses but also in producing a report that would reflect the gravity of the subject matter with which we were entrusted. That has to be highlighted in the debate today on Bill C-39.

I also think it is important because there have been a few narratives around this legislation. It is important to go back to understand what the Criminal Code actually says, and also to put that in the context of the definition of irremediability.

It is important that, in order to be eligible for medical assistance in dying, a person has to meet all of the following criteria: they have to make sure that they are in fact eligible for health services in the province they reside in, they have to be at least 18 years of age and capable of making decisions with respect to their own health, they have to have a grievous and irremediable medical condition, and they have to have made a voluntary request. All these conditions must be satisfied. A person must also give informed consent to receive medical assistance in dying, after having been informed of the means available to relieve their suffering, including palliative care.

Now we get to the definition of a grievous and irremediable medical condition as outlined in the Criminal Code. A person has to meet the following criteria for that definition: it has to be a serious and incurable illness, disease or disability; they have to be in an advanced state of irreversible decline in capability; and that illness, disease or disability, or that state of decline, has to be causing them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.

Those are the definitions in the Criminal Code, so despite the narratives we hear out there, those conditions must be met or the person administering MAID will have committed a crime. They will be in violation of the Criminal Code of Canada and will get the appropriate punishment as a result.

One of the difficulties is the fact that the term “irremediable” is not a medical or scientific term. It is a term that finds its definition within the Criminal Code. If we go to scientific or medical literature, it is a difficult term to define, and that, I think, is why we are seeing a lot of the apprehension around accessing MAID for mental disorders where the sole underlying medical condition is a mental disorder.

Some witnesses who appeared before our committee expressed the opinion that this should not be permitted, because there cannot be any certainty with respect to the incurability of a mental disorder. However, other witnesses told us that certainty is not required and that there are ways to consider irremediability, for example by looking at the years of treatment that people have had and whether any responses of the patient have actually been positive.

We also have to understand that the respect for personal autonomy in all of this is paramount, and it is has to be a treatment that is acceptable to the individual receiving it. They not only have to express informed consent, but it has to be something acceptable to them as a person.

I now want to talk a little about the special joint committee, which I have had the honour of being a member of, as I previously mentioned.

I think it is important to underline that our committee has struggled with the question of how to balance individual autonomy with protections for the vulnerable. We were tasked with looking at five themes through the passage of Bill C-7 and the motion that guided our work from both the House of Commons and the Senate: how we institute protections for persons with disabilities; the state of palliative care in Canada; advance requests; mature minors; and, of course, the subject of today, mental disorders as a sole underlying medical condition and their eligibility with respect to applying for medical assistance in dying.

Our final report is due to be tabled in the House this Friday, February 17. We wrapped up our committee meetings last week and finally approved a draft report. That draft report, as I speak, is going to translation services so that it can be ready for tabling here in the House, and so we will be able to meet the deadline that was given to us.

Before we did that work, we had others who did some important work ahead of us. We had the expert panel that was established. They also wrestled with major concerns, such as incurability, irreversibility, capacity and suicidality, and of course the intersection between structural vulnerability, mental disorder and medical assistance in dying.

That panel report, an important precursor to our work as a special joint committee, did state that assessors in medical assistance in dying should be able to establish incurability and irreversibility with reference to treatment attempts made; the impacts of those treatments; and the severity of the illness, disease or disability. The incurability of a mental disorder cannot be established in the absence of extensive attempts at interventions with therapeutic aims.

This means that someone who has not had access to adequate care would not be eligible for MAID. Therefore, MAID could never be used as a substitute for good psychiatric care. I think that is an important thing we have to realize. There will be safeguards in place, not only with the Criminal Code, but also, we hope, with the standards of practice.

For patients who are considering this, we want to make sure that there has been a long track record of attempts to deal with their illnesses. At the same time, we have heard very clearly that there are many Canadians and many professionals who feel that additional time is needed to make sure we get this right.

One of the witnesses before our special joint committee was the chair of the Government of Quebec's Select Committee on the Evolution of the Act respecting end-of-life care. She explained that Quebec had decided that MAID for mental disorders as a sole underlying medical condition should not be permitted at this time because of the challenges of determining irremediability, as well as the lack of social consensus. Another level of government, this time the Province of Quebec, is also underlining the concerns that many members of Parliament are expressing here today.

I mentioned the final report that will be tabled in the House, but our committee did release an interim report. That interim report was specifically on this subject matter. I will read from our conclusion. It states:

We must have standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight in place for the case of [medical assistance in dying for mental disorders as the sole underlying medical condition]. This task will require the efforts and collaboration of regulators, professional associations, institutional committees and all levels of governments and these actors need to be engaged and supported in this important work.

Although some work is already underway to implement the recommendations of the Expert panel, there is concern that more remains to be done to ensure that all necessary steps have been taken to be ready by the March 2023 deadline...

Again, in our interim report, our special joint committee was already, at that time, expressing concern with the upcoming deadline, and I think it is a smart move that we are moving ahead with Bill C-39. If we back that up with the testimony we heard at committee, we had a number of different witnesses who clearly expressed that they had troubles with this deadline and that those standards of practice were not yet ready.

It needs to be underlined again that, if Bill C-39 is not passed, the original sunset clause of March 17 will come into effect. My vote for this bill is occurring because of that very fact. This is aside from the broader conversation we need to have about medical assistance in dying in general. It is support for a bill that is going to extend the deadline by one year so we can make sure that we get these standards of practice right, so we have the necessary time to engage with the broader community.

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.

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

Mr. Speaker, let me just say from the outset what a pleasure it was to serve on the special joint committee with the member for Montcalm, both in the last Parliament and in this one. I always appreciated his very thoughtful interventions and I could tell that he always came to committee quite well prepared.

The member and I have been here since 2015. He will remember that in the original bill, Bill C-14, there was a statutory requirement for a five-year review. We know that Bill C-7 was introduced before that review happened and that the government decided to accept a Senate amendment before it had a chance to establish a special joint committee. That process, that timeline, underlines why Bill C-39 is necessary now.

I wonder if my hon. colleague would just reflect on what has led us to this point and why Bill C-39 is necessary, and for this House to pass it quickly, because of the impending deadline and the fact that we do need to have some space to make sure we are getting these standards right. It is extremely important.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I would like to begin by providing some background on Bill C-39, which is not rocket science, when it comes down to it. Then I would like to talk about the philosophical foundation for dying with dignity, as well as the context and whether or not medical assistance in dying should be extended to patients whose sole underlying medical condition is a mental disorder. I would also like to talk about mental illness generally in our societies and the experts' report before finally concluding my speech.

The context is rather simple. This is not about rehashing the entire debate. We are studying Bill C-39, which simply defers the provision in Bill C-7 that would have ended the two-year exclusion for mental disorders on March 17, 2023.

Following consultations, the government has decided to extend this exclusion clause for one year, which means that on March 17, 2024, mental disorders, or rather individuals whose sole underlying medical condition is a mental disorder, would be eligible for MAID, subject to the conditions, limits, guidelines, standards of practice, safeguards and precautionary principles outlined in the expert report.

Before voting, I invite all parliamentarians in the House to read the report of the expert panel. It contains precautionary principles that do not lend credence to last week's comments by, for example, the leader of the official opposition. It really puts into perspective the ideology underlying the comments by my colleague from St. Albert—Edmonton. Let me dive right into this matter.

Why is there such a delay? The reason is that we believe things should be done properly by the medical world. When a mental disorder is the sole basis for a request for MAID, how prepared are those working in this field across the country to ensure that MAID is adequately and safely delivered in light of the safeguards?

More providers and seasoned assessors will be needed. I should note that the experts did say that assessing whether a person with a mental disorder has the capacity to choose MAID is something they are already doing. Often a person may have cancer and also suffer from a mental disorder. It is not the sole underlying medical condition, and they still need to establish the person's capacity to decide for themselves. Again, in response to the oversimplification by my colleague from St. Albert—Edmonton, first a person needs to want MAID, and then they need to meet the criteria.

As far as mental disorders are concerned, to meet the criteria, this is not going to happen overnight or anytime soon. It is going to take decades before anyone can have access. It is going to take time for the whole range of necessary treatments and possible therapies to be tested without the condition that the person demonstrate that they cannot bear any more and that their pain cannot be relieved. That is a long way from people living in poverty, who are depressed and who might have access to medical assistance in dying. We are far from it.

That being said, what are we talking about? When we talk about medical assistance in dying, I know that everyone in the House wants to do the right thing. Everyone has the best of intentions and wants to look after the best interests of patients and people who are suffering. However, being compassionate does not square with undermining human dignity. Human dignity is grounded in the capacity for self-determination.

Those are the philosophical premises. The law grants any individual with a biomedical condition the right to self-determination. Nothing can be done without the patient's free and informed consent. To that end, the role of the state is not to decide what that patient, who is the one suffering, needs. Rather, the state must ensure the conditions needed for them to exercise free will, so that patients can make a free and informed decision.

Historically, it was difficult to fight medical paternalism. At one time, people who had reached the terminal phase of an incurable disease did not have the right to die. The right to die was acquired, and it was called palliative care. Life was artificially prolonged, and people died from clinical trials or new therapies rather than dying a peaceful death in palliative care. However, palliative care is not a substitute for medical assistance in dying.

I find it strange that my colleague thinks it is unacceptable to grant access to medical assistance in dying to someone whose soul is suffering, and that he even opposes any form of medical assistance in dying, even when people are at the end of their life. He is opposed. At some point, if people are opposed, they need to explain why.

Why does the law recognize people's right to bodily autonomy throughout their lifetime but take it away from them at the most intimate moment of their lives? The government or our neighbour is not the one dying, so on what basis is the government giving itself the authority to decide for us at the most intimate moment of our lives?

These are the ethical and philosophical grounds and principles behind our position. Just because someone has a mental disorder does not mean that they should also be subject to social discrimination and stigma. Even though mental illness is now considered to be an actual illness, mental health is still not on the same footing as physical health. Mental illness results in discrimination and stigma.

Should we be telling people who have to deal with such discrimination and stigma that they will also never be given the right to MAID, even if they have been suffering from a mental illness and have had schizophrenia, for example, for 25 or 30 years? On what grounds are we refusing them that right? That is the basis of the expert panel's report. Do we give that right to someone with a mental disorder who is suffering, who has tried everything, whose problems are far from over and who says that they cannot go on?

There are people out there who have an ache in their soul, and unfortunately, we lose them when they attempt suicide. It is really no better. We absolutely must fight against suicide because it is one decision that cannot be undone.

In the report, the experts set out several precautionary measures. They talk about structural vulnerabilities like poverty. On page 11 of the report, the experts state the following: “In the course of assessing a request for MAiD—regardless of the requester's diagnoses—a clinician must carefully consider whether the person's circumstances are a function of systemic inequality”, and, if so, this should be addressed.

With respect to suicidal ideation, experts offer us another precautionary measure. It is not enough for a person to request MAID to have access to it.

The report states: “In any situation where suicidality is a concern, the clinician must adopt three complementary perspectives: consider a person's capacity to give informed consent or refusal of care, determine whether suicide prevention interventions—including involuntary ones—should be activated, and offer other types of interventions which may be helpful to the person”.

What is this claim about people who are depressed being able to request MAID? Members need to stop talking nonsense. That is not what the expert panel's report says. It says that incurability can be established over the course of several years. The patient must have exhausted all available therapies and treatments. However, that does not include overly aggressive therapy.

What does the member for St. Albert—Edmonton think should happen? When a person with a psychiatric disorder says that they reached their breaking point years ago, should psychiatric science insist that there is a treatment out there and that it is going to find it? That is what I mean by overly aggressive therapy.

Overly aggressive treatment may exist for all types of illness. Who gets to decide when it is too much? The Supreme Court and the Superior Court of Quebec have told us that it is up to the patient to decide. That is important, because the member for St. Albert—Edmonton keeps saying that we are cutting lives short, ending lives prematurely.

In reality, the opposite is true. Everyone wants to live as long as possible. People who are on what we call the second track, whose natural death is not reasonably foreseeable, want to live as long as possible. What they do not want is to be denied help when they reach their breaking point. If we do not give them access to MAID, they will find their own way to avoid ending up in that situation, because it is currently illegal for them, and they will end their lives prematurely. They will commit suicide.

The ruling that some contend should have been appealed to the Supreme Court states that there is an infringement on the right to life. The Conservatives' position infringes on the right to life because it forces people to end their lives prematurely rather than waiting for the moment of death, which sometimes is in one or two years. As proof, there is the case of Ms. Gladu. She did not go ahead with MAID, but she was relieved to know that she had that option. She did not commit suicide; she died naturally.

However, if her suffering became intolerable, she knew that she could access MAID because our compassionate and empathetic society would take care of her and ensure that she had a peaceful and dignified death. This meant that she could have the death that she did. Many people say that they choose to end their lives because they are not certain that they will be taken care of.

Is there anything more devastating than a suicide? That is a societal failure. We cannot be complacent about suicide attempts, about people feeling suicidal. In the health care system, mental illness, which is an illness like any other, absolutely must have all the necessary resources.

I just want to say a few words about the governments' ability to pay for the health care needs of the patients I am talking about, given the feds' post-pandemic offer. Governments have to deliver care to these people with irreversible illnesses, but they will not be getting money to do so. Over the next 10 years, they will barely be able to cover indexing on chronically insufficient funding. The federal government's share will go up from 22% to 24%. I hope government members are not too proud of that, especially considering that, during the third wave, people told us the system was in critical condition. The pandemic had destabilized it to the point that it would take 10 years to recover from the pandemic's side effects on patients without COVID. Right in the middle of the third wave, the Prime Minister said it would all be dealt with after the pandemic. We were told an agreement was imminent. I figured that they would come close to the $28 billion everyone expected, that they would give the governments of Quebec and the provinces the predictable funding they needed to rebuild their systems, take care of people over the next 10 years and finally recover from the pandemic.

I have heard the Conservatives say they will honour that small percentage. Of all the G7 countries, Canada still has the best borrowing capacity. If debt is unavoidable, what better justification for it than taking care of our people and restoring and rebuilding our health care systems?

I hear people say that individuals who have had an incurable mental disorder for years should not be given access to MAID on account of structural vulnerabilities. According to the expert report, however, two independent psychiatrists would have to be consulted. Not only would two independent psychiatrists be required, but we also have to consider recommendation 16. So far, I have been talking about recommendation 10, but my colleagues should hold on to their hats, because recommendation 16 states that, unlike for other kinds of MAID, when mental disorders are involved, there would be something called “prospective” oversight. This is different from retrospective oversight, as required by Quebec's commission on end-of-life care, which requires a justification every time MAID takes place. No, this does not happen after, but rather before, in real time.

This prospective oversight needs to be established in each jurisdiction, which is precisely what the delay will be used for. This additional safeguard needs to be established in controversial cases. According to the expert report, when an individual's capacity cannot be properly assessed, MAID is not provided, period. It is not complicated. There will be no slippery slope.

If there is a slippery slope, there is the Criminal Code, the courts, the police. Evil people do not belong in the health care system. They would be fired. If they do harm, they can be taken to court. To my knowledge, the provisions allow action to be taken.

My esteemed colleague seems to assume that everyone in health care is necessarily evil, which is absurd. The slippery slope is based solely on health care workers having evil intentions. However, to work in that field, people have to demonstrate skills proving the opposite. Consequently, all the precautionary measures and principles in this report are sufficient, in my opinion.

What needs to be done now is to ensure that people get training. Not all Quebec psychiatrists have read the report. If they listen to interviews given by the member for St. Albert—Edmonton, they will wonder what is happening with their profession.

We must be able to see things realistically and proportionately, provide training, and ensure that we implement a law that will be both accessible and equitable throughout the country. We must avoid situations where an institution that does not want to provide MAID prevents someone from accessing it, if it is their choice and they meet all the criteria.

This is still a dangerous situation. It is happening in Quebec, and the college of physicians warned last week that, in a simple case of MAID for a terminal patient, some doctors did not want to refer the patient to another doctor who was willing to provide it.

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

Mr. Speaker, I have served on the special joint committee both in the previous Parliament and in this one. It was a lengthy amount of work, and certainly there was some very difficult testimony to go through.

I do not want to cover the same ground that previous members have asked questions on, so maybe I will change tack.

My friend, the member for Courtenay—Alberni, is our mental health and addictions critic, and he has constantly asked the government to bring mental health care funding up to parity with physical health care, understanding that there is in fact a real crisis. When I look at the conditions in ridings like mine, where we see the opioid crisis and the way it has been ravaging communities, there is so much underlying trauma and so many undiagnosed mental health disorders that are not being addressed.

I would like to invite the member to comment on that. In the midst of this very difficult conversation, and I agree that Bill C-39 is a necessity, we have to take this opportunity in time to make sure that our system is appropriately resourced and funded so that we are getting to Canadians who are falling through the cracks.

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

Mr. Speaker, I rise to speak on Bill C-39, a legislation that imposes a new arbitrary deadline of March 2024 in place of the Liberal government's arbitrary deadline of March 2023 whereby persons with a sole underlying mental health disorder would be eligible for MAID.

I support Bill C-39 only because it is better than the alternative, namely that in one short month from now, on March 17, MAID would be available to persons with a sole underlying mental health disorder. This would be an absolute disaster and certainly result in vulnerable persons prematurely ending their lives, when otherwise, they could have gone on to recover and lead healthy and happy lives.

Rather than imposing a new arbitrary deadline that is not grounded on science and evidence, what the Liberal government should be doing is abandoning this radical, reckless and dangerous expansion of MAID altogether. This is why I wholeheartedly support Bill C-314, which was introduced last Friday by my friend and colleague, the member for Abbotsford, and would do exactly that.

One would expect that before deciding to expand MAID in cases of mental illness, a responsible government would take the time to study the issue thoroughly and consult widely with experts. After all, we are talking about life and death. We are talking about a significant expansion that would impact a vulnerable group of Canadians.

However, the Liberal government is not responsible, and that is not what happened. This is why the government finds itself in the mess it is in today with this rushed, 11th-hour legislation to delay the expansion.

Instead, the Minister of Justice accepted a radical Senate amendment to Bill C-7, which established an arbitrary sunset clause. That set in motion this expansion of MAID in cases of mental illness, effective in March of 2023. To provide some context, Bill C-7 was a response to the Truchon decision; its purpose was to remove a critical safeguard, namely that death be reasonably foreseeable before someone is eligible for MAID. It was a terrible piece of legislation that the government should have appealed but did not.

As bad as the bill was, when it was studied at the justice committee, of which I was a member at the time, nowhere in the bill was there any mention of expanding MAID in cases of mental illness. The justice committee did not hear evidence on that point. Indeed, when the minister came to committee, he said that there were inherent risks and complexities with expanding MAID in cases of mental illness, and therefore, it would be inappropriate to do so.

The bill went over to the Senate, and all of a sudden, the minister unilaterally accepted the amendment. Then what did the Liberals do? After little more than a day of debate, they shut down debate on a bill that had drastically changed in scope and rammed through the legislation for this expansion of MAID in cases of mental illness.

There was no meaningful study and absolutely no consultation with experts, including psychiatrists; persons struggling with mental illness; or these person's advocates. There was nothing. In short, the justice minister made the decision to go ahead with this significant expansion and then said the issue would be studied later. Hence, there was the establishment of an expert panel that was appointed after the government had already made the decision to go ahead. One would think that if an expert panel were going to be appointed, it would be appointed before deciding. However, that is not what happened with the justice minister and Liberal government.

We saw a special joint committee established after the fact. Talk about getting it backward, putting blind ideology and hubris ahead of science and evidence, and showing a total disregard for the concerns and lives of Canadians struggling with mental illness. Had the Minister of Justice and the Liberal government done their homework at the outset, they would have learned very quickly that this expansion of MAID cannot be implemented safely.

I serve as a co-vice-chair on the Special Joint Committee on Medical Assistance in Dying. As early as the spring, the committee heard from multiple witnesses, including representatives of the mental health community, and most importantly with respect to some of the clinical issues, leading psychiatrists. The body of evidence showing that this cannot proceed safely was overwhelming. One of the key reasons cited for this was that in the case of mental illness, it is difficult, if not impossible, to predict irremediability. In other words, in the case of mental illness, it is difficult or impossible to determine whether someone can recover and become healthy. This is a serious problem.

Let us look at some of the evidence that was available to the minister in the spring. Dr. John Maher, a clinical psychiatrist and medical ethicist who appeared before the committee, 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.”

Dr. Brian Mishara, a clinical psychiatrist and professor at the Université du Québec à Montréal, told the committee, “I'm a scientist. The latest Cochrane Review of research on the ability to find some indicator of the future course of a mental illness, either treated or untreated, concluded that we have no specific scientific ways of doing this.”

Even the government's expert panel conceded the difficulty in predicting irremediability. At page 9 of the expert panel report, the panel observed, “The evolution of many mental disorders, like some other chronic conditions, is difficult to predict for a given individual. There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.” The government's own expert panel said that it is difficult, if not impossible, to predict irremediability.

If one cannot predict irremediability, persons who could go on to lead healthy and happy lives may have their lives prematurely ended. This is a problem that the government cannot avoid and that has not been resolved. Let me remind this House that, under the law, one must have an irremediable condition in order to be eligible for MAID. However, here we have leading experts and psychiatrists, including the government's expert panel, saying that it is difficult, if not impossible, to predict irremediability.

According to the psychiatrists who appeared before the special joint committee, what that means is that medical assessments in cases of mental illness for MAID are going to be decided on the basis of “hunches and guesswork that could be wildly inaccurate.” Those are the words of Dr. Mark Sinyor, a professor of psychiatry at the University of Toronto, who appeared before the special joint committee. These words were echoed by other psychiatrists who appeared before our committee.

The expert panel did not use such language, but it essentially conceded the point in its report because it was unable to come up with any objective standard by which to measure whether a patient's condition in the case of mental illness is irremediable. Instead, the expert panel ridiculously and recklessly said that it was going to wash its hands clean of this and that it was going to give a big green light and say it can all be done on a case-by-case basis. There would be no objective standard whatsoever; all would be guesswork and subjective assessment.

At the special joint committee on the issue of predicting irremediability in the context of mental illness, Dr. Mark Sinyor said that physicians undertaking a patient assessment “could be making an error 2% of the time or 95% of the time.” A 95% error rate is the risk on a matter of life and death, on a procedure that is irreversible and results in the termination of someone's life. For persons who are struggling with mental illness, this is the government's solution. The minister just stood in this place and said, “Damn the evidence. Damn the facts. We are going full steam ahead”.

I cannot think of a more reckless approach than the one the Liberal government has taken on an issue of profound importance to so many Canadians. It is not just the issue of irremediability, although given that this cannot be resolved, it should be the end of the matter. In addition, psychiatrists and other experts at the special joint committee emphasized that in the case of mental illness, it is very difficult to distinguish between a request motivated by suicidality versus one made rationally. In fact, suicidality is a symptom of mental illness, and indeed, 90% of persons who end their lives by suicide have a diagnosable mental disorder.

To illustrate how radical the government is, I note that when the Ontario Medical Association surveyed Ontario psychiatrists in 2021, 91% said they opposed the expansion of MAID for mental illness under Bill C-7. About 2% expressed support. Some 91% were against, 2% were in support and the reset were undecided. This speaks to how reckless, how radical, how extreme and how out of touch the government is on the question of expanding MAID in the case of mental illness.

In the face of the overwhelming evidence that we heard at committee, we issued an interim dissenting report calling on the Liberals to put a halt to this radical and reckless expansion. The minister ignored our interim dissenting report. He ignored the experts. He ignored the evidence. It appears he is so blinded by ideology that it is impossible for him to see what is in plain sight: This cannot be done safely.

In December, when it was evident that the minister was not listening, the Association of Chairs of Psychiatry in Canada, which includes the heads of psychiatry at all 17 medical schools, said to put a halt to this expansion. However, the minister still was not prepared to act. Indeed, it was not until the day after Parliament rose for Christmas that he had a late afternoon press conference where he made some vague commitment to introducing legislation in which there would be some type of extension. Then, with only 17 sitting days left before the expiration of the sunset clause, the minister finally saw fit to introduce this bill. I think this very clearly illustrates the shambolic approach with which the government has handled this issue.

We now have legislation, but what does this legislation do? As I noted at the outset of my speech, it provides for a new arbitrary deadline, even though issues of irremediability, suicidality and capacity to consent have remained unresolved for the past two years. There is absolutely no evidence that those issues are going to be resolved a year from now.

What we have is nothing more than an arbitrary deadline, and a year from now, we are going to find ourselves in exactly the same place. Let us be clear. When we speak about suicidality, irremediability and capacity to consent, these are not issues to be brushed under the rug. These are serious legal and political issues that are fundamental to determining whether this can go forward.

In closing, whether this expansion takes place a month from now or a year from now, it will be an absolute disaster and will result in persons struggling with mental illness having their lives wrongfully terminated. It is time for the government to get its head out of the sand, stop being blinded by extreme ideology, follow the science, follow the evidence and scrap this ill-conceived expansion.

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

moved 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.

Mr. Speaker, I rise today to speak to Bill C-39, an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.

An extension of the exclusion of MAID eligibility in these circumstances would help 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 federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.

My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.

In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill C-14, an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.

The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.

In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

Former Bill C-7 expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.

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's 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 the 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. The assessing practitioners must also ensure that the person be 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 is not enough just to discuss treatment alternatives. They must ensure 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.

The former Bill C-7 extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.

In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.

The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.

I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.

This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.

As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.

That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.

As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.

In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.

This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.

The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.

These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.

I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.

I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.

I want to turn now to the more technical part of Bill C-39 and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill C-7 expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.

I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.

The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.

Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.

Business of the House

[Mark Gerretsen, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons (Senate)]

Mr. Speaker, there have been discussions among the parties and if you seek it, I believe you will find unanimous consent for the following motion:

That, notwithstanding any standing order, special order or usual practice of the House, Bill C-39, An Act to amend the Criminal Code (medical assistance in dying), be disposed as follows:

(a) the bill be ordered for consideration at the second reading stage later today and Wednesday, February 15, 2023;

(b) later today and Wednesday, the House shall continue to sit beyond the ordinary hour of daily adjournment for the purpose of considering the bill;

(c) after 6:30 p.m. today and Wednesday, February 15, 2023, no quorum calls, dilatory motions or requests for unanimous consent shall be received by the Chair;

(d) today, when no member rises to speak or at 11:59 p.m., whichever is earlier, the debate be deemed adjourned and the House deemed adjourned until the next sitting day, and that the debate pursuant to Standing Order 38 not take place; and

(e) on Wednesday, February 15, 2023, no later than 11:59 p.m., or when no member rises to speak, whichever is earlier, the bill be deemed read a second time and referred to a committee of the whole, deemed considered in committee of the whole, deemed reported without amendment, deemed concurred in at report stage and deemed read a third time and passed; after which the House be deemed adjourned until the next sitting day, and that the debate pursuant to Standing Order 38 not take place; and

that the Standing Committee on Justice and Human Rights be instructed to consider the subject matter of the bill on Tuesday, February 14, 2023 and shall have the first priority for the use of House resources for committee meetings.

[Mark Holland, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, as somebody who has had a battle with mental health issues, I can tell the hon. member that this bill, for our government, for myself and I believe for every member in this House, is something that is exceptionally important and something that we want to get right. We have had very good and deliberative discussions among all parties, and I think we have the opportunity to continue those deliberations to make sure that we get that balance right and that we meet the objective we all have of ensuring that we protect vulnerable people.

Tomorrow we will resume the second reading debate of Bill S-8, an act to amend the Immigration and Refugee Protection Act. On Monday and Wednesday, further to the opposition House leader's question, we will call Bill C-39, which extends the temporary exclusion of eligibility for medical assistance in dying where a person's sole medical condition is a mental illness until March 17, 2024. I would also like to inform the House that Tuesday and Thursday of next week shall be allotted days.

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, Thursday is the day when the government informs the House as to the business for the coming days.

I want to note, in particular, the need to address Bill C-39, which has only been tabled very recently, despite the fact that the government had years knowing about a deadline to protect vulnerable Canadians as it relates to the medical assistance in dying regime. There is a deadline looming of March 17.

Conservatives feel very strongly that mental illness should not be the sole factor when considering medical assistance in dying. Therefore, we very much support passing this bill to establish more of a timeline for the government to get this right, and for parliamentarians to come together and get this part of the regime right.

I am hoping that when the government House leader rises to inform the House as to the calendar for the next few days, he can also tell us what the expectations are and how we can deal with this bill in a timely manner so it can get through the Senate and get royal assent to protect vulnerable Canadians who are struggling with mental illness.

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I rise today for the traditional Thursday question, where the government has the opportunity to inform the House as to the legislation that we will be debating in the days ahead.

I do note that, after the House leaders' meeting, there were some conversations about a very important piece of legislation, Bill C-39. Conservatives feel very—

Criminal Code

[David Lametti, Liberal, Minister of Justice]

moved for leave to introduce Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying).

(Motions deemed adopted, bill read the first time and printed)