Bill C-62

An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2

This enactment amends An Act to amend the Criminal Code (medical assistance in dying) to provide that persons are not eligible, until March 17, 2027, to receive medical assistance in dying if their sole underlying medical condition is a mental illness.

Criminal Code

[The Speaker, Greg Fergus]

Pursuant to order made on Tuesday, February 13, 2024, the House will now proceed to the consideration of Bill C-62 at third reading stage.

[Anita Anand, Liberal, President of the Treasury Board]

moved that Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, be read the third time and passed.

[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.

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

Madam Speaker, I have sat through much of this debate, on the committee as well. The provinces and territories did not ask for a three-year pause; they asked for an indeterminate pause because they are not ready. Industry is not ready. The health care professionals cannot come to any conclusions.

As a matter of fact, Dr. Gaind, a professor of psychiatry at U of T, summed it up best at the committee last night. He said, “once again, there is no evidence that shows we can predict irremediability in mental illness, and it is vastly different from other medical conditions and neurodegenerative diseases...but we have to remember what MAID is about. It is about us predicting who will never get better, and we can't do that. And if we can't do that with mental illness, we would be providing death under false pretenses.” He equated it to being much like flipping a coin to choose who could get better and who could not. MAID would simply be killing people who could possibly get better.

What would my hon. colleague say to that?

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, the hon. member and I were both at the committee last night, which heard from quite a few experts on MAID. I think it was fairly clear that there was a difference of opinion as to the readiness of the system. There were some experts who believe that MAID for people with mental illness could be provided as early as March 17, 2024.

However, the member is right. There is a letter from seven provinces and three territories that have asked for an extension to the period. The government feels that a three-year period is the right amount of time for the medical profession and the provinces and territories to be ready to be able to provide MAID to people with mental illness, with appropriate safeguards.

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

Madam Speaker, the issue of what guidelines should be in place to allow someone to die is perhaps one of the most profound things we have to discuss. Parliament agreed to move forward with MAID, and we expected that we were going to get a review. Instead there was a Quebec provincial court decision, the Truchon case. The federal government did not appeal the decision; it just rewrote the law.

Then the Senate, an absolutely unaccountable, dismal group as far as I am concerned, decided to just throw in an arbitrary date to allow people with mental illness to die, and the government accepted it. We are now scrambling, with a month left. The government is saying it is going to put some guardrails in place to punt it down the road.

Why is the government not taking the issue seriously? The member for Abbotsford's bill would have dealt with this. The government has put us in this situation, and it is not credible.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, I will take exception to the member's comment because a tremendous amount of work has been done to create the appropriate safeguards. Not only are there legislative safeguards in place in the Criminal Code, which I alluded to in my remarks, but there are also safeguards being developed within the medical profession.

We need to make sure we listen to our health care providers, those who deliver health care at the provincial and territorial level, and extend the date for the change in eligibility criteria for three years so MAID could be administered with all the appropriate safeguards in place.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, we just witnessed a great NDP-Conservative coalition.

The member is reiterating the Conservatives' argument to the effect that the ruling in Gladu and Truchon was not challenged before the Supreme Court. However, the reason why it was not challenged before the Supreme Court is that people were suffering and Ms. Gladu and Mr. Truchon deserved to have relief. This was based on the Carter decision. However, the NDP voted against Bill C-14, which did not go far enough. I do not know why the member is being so inconsistent today.

I would like to know whether the member is aware that, basically, his party is trying hard not to say that it lacks courage, that it is backing down when it comes to mental illness and that it is throwing the ball back into the court of the Conservatives who, as they announced, are going to do away with all of this.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, the government is taking the most prudent approach in making sure people get the care they need. This is a very sensitive issue that requires that we work closely with medical professionals to ensure that all the appropriate safeguards, training and associated curriculum are in place. If there is doubt, as we see by the request that we create an extension, it is only prudent for the government to do so. That is why we are encouraging all members to support Bill C-62 and extend the pause on eligibility for MAID on the sole basis of mental illness by three years.

[Ken Hardie, Liberal, Fleetwood—Port Kells, BC]

Madam Speaker, as the provinces and territories are not ready to implement medical assistance in dying for people with mental disorders, personally I am also not ready. I could not vote for something like it right now.

I am taken by the case of a woman, E.F., who was granted the right to have her life taken with medical assistance in 2016, after reports that she suffered from severe conversion disorder. Nobody could read the media accounts of this and not understand that there are some people for whom life is clearly not worth living anymore.

Would that provision, in the Court of Appeal decision in Alberta, still provide a way forward for the people who are in a terrible condition right now and who need relief?

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, our number one job is to protect people's rights. Given that the various decisions of the courts have said that it is a person's right to determine their end of life, we need to make sure that right is protected.

Of course we need to ensure that they get all of the care they need in order to be able to recover, but as the courts have said, if their suffering is irremediable, they should have that option available because it is a matter of their rights. That is why we are working so hard, along with our provincial and territorial partners, to ensure that all the right safeguards and all of the right training are in place before MAID is extended to people whose sole underlying condition is mental illness.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, we know we are in this situation because a radical justice minister and a radical government have pushed this agenda.

I want to get the member's thoughts on this quote from 32 law professors. They state:

We disagree as law professors that providing access to MAiD for persons whose sole underlying medical condition is mental illness is constitutionally required...as Minister Lametti has repeatedly stated.

I asked the minister, when he appeared at the justice committee, who was right, these 32 legal experts or him. He said, of course, that he was right.

I want to ask the member this. Does he believe that these 32 legal experts are right or that the former minister of justice was right?

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, this is a very sensitive issue. It is highly emotional and complex. I would urge all members that calling names and ascribing labels is not the responsible way forward. Canadians are looking to us to make responsible decisions. That is why it is incumbent upon us to work with everyone, including the legal community. The hon. member across the way knows that if we talk to 10 lawyers we will get 10 different legal opinions on any matter.

Most importantly, we need to work with health care professionals and understand from them what is required with respect to all the appropriate safeguards.

Last but not least are the provinces and territories, which are primarily responsible for delivering health care. We need to listen to them carefully, and they are asking for an extension. That is what Bill C-62 is doing.

[Ed Fast, Conservative, Abbotsford, BC]

Madam Speaker, I seek unanimous consent to split my time with the member for Leeds—Grenville—Thousand Islands and Rideau Lakes.

[The Assistant Deputy Speaker, Carol Hughes]

Does the hon. member have unanimous consent to split his time?