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.

Medical Assistance in Dying

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my goal this morning was not to reignite the debate on mental disorders. We debated that with Bill C‑62. My goal today was to reignite the debate because the government refused to implement the the Special Joint Committee on Medical Assistance in Dying's key recommendation, which was to move forward and accept advance requests. Not only did it refuse to implement the recommendation, but it did not even start thinking about it because it thinks it is too complicated. Only now, after a year and a half, does it want to start talking to people. My goal today is to focus on the issue of advance requests and the Liberal government's inexplicable inertia. The government should be ashamed to have left such an important report to gather dust.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I move that the second report of the Special Joint Committee on Medical Assistance in Dying, presented on Wednesday, February 15, 2023, be concurred in.

Today, I am starting off the debate on the report on medical assistance in dying that was presented in February 2023. It is entitled “Medical Assistance in Dying in Canada: Choices for Canadians” and was presented by the Special Joint Committee on Medical Assistance in Dying, which was struck in May 2021. The report was presented a year and a half ago. I am bringing this debate back to the House because, as reported in the news, Quebec began authorizing advance requests for people with degenerative and incapacitating diseases yesterday. The answers the Prime Minister gave us yesterday suggest to me that he does not understand the issues at all and has not given them any thought since May 2021. That is unacceptable to people who are suffering.

Today, I would like to take a moment to remember all those we have lost, as well as those who are currently disappearing into the abyss of dementia. They are slowly but surely and irreversibly becoming prisoners of time, of each moment that fades away as it is lived. The present moment is gradually erasing the people they once were, and they are losing contact with the things that gave their existence meaning, things like joy, sorrow, the ability to have relate to others and share their experiences, consciousness, and the ability to make others happy and plan for the future. This terrible disease is robbing them of all the things that make life what it is, that make up the experience of life, the human experience, until their life is reduced to a mere biological process. They are irreversibly losing their physical, social, mental and moral autonomy, in every sense of the word.

Wherever you are right now, I am thinking about you, Mom.

I am also thinking about Sandra Demontigny, who is suffering from early-onset dementia. She is fighting for patients who have this debilitating, incurable, incapacitating disease to have the right to self-determination. She is fighting for them to have the right to make an advance request for MAID after being diagnosed. People with dementia want to live as long as possible. They do not want to shorten their lives by requesting MAID while they are still mentally competent. They want to be able to receive it once they have become incapacitated, once they have reached their limit. They are seeking assurance that we will have the compassion needed to respect their final wishes. Fortunately, Quebec decided not to wait for the federal government to wake up. It passed a law, which took effect yesterday, that allows people to make an advance request.

I commend Sandra Demontigny for her courage, her determination and her efforts to assert patients' right to self-determination. That is what we are talking about. The principle of lifelong self-determination is enshrined in law. No one can violate a person's integrity. That being the case, why, at the most intimate moment of a person's life, the moment of their death, should the government get to decide what is best for them? I would remind my colleagues that the government's job is not to decide what is best for a patient. The government's job is to create conditions that are conducive to making free and informed choices. People need to be free to make their own choices.

The Liberals champion the freedom to choose when it comes to abortion, when it comes to a woman's right to control her own body, so how they can question a patient's prerogative to exercise their right to self-determination in a decision as personal as that of their own death? The Liberals are dithering and are still hesitant to amend the Criminal Code to make advance requests legal. The Prime Minister said yesterday that it was a deeply personal decision. If he recognizes that, why can he not put some substance behind his statement? I think I have demonstrated that this is indeed a deeply personal decision.

Why shelve the report of the Special Joint Committee on Medical Assistance in Dying? Why set up joint committees made up of senators and elected representatives, ask them to come up with a key recommendation, and then shelve their report? The committee even managed to convince a Quebec Conservative who agreed with these proposals. The government is finally waking up a year and a half later because it was waiting to see what Quebec would do. The government took a wait-and-see approach so it could see how Quebec would proceed. It was a good idea to look at the example of Quebec, which took a unanimous non-partisan approach. Ottawa could learn something from what happened in Quebec's parliament, which spoke with one voice.

The government is now refusing to amend the Criminal Code, even though we have made it easy to do so. The government is not the one that has been doing the work since 2021, or for the past year and a half. The Quebec National Assembly passed the Act Respecting End-of-Life Care on June 7, 2023. It is now November 2024, and this government is telling us that it needs to have conversations. Who does the government want to have those conversations with? We heard from many experts, groups and citizens. We received many briefs. Despite all that, the government feels it must continue to wait, wait until people are suffering.

The committee report states the following, and I quote:

...Sandra Demontigny eloquently and movingly shared with the committee the sense of peace that advance requests might provide in situations like hers...

These people can feel more at ease dealing with the challenges before them when they are safe in the knowledge that, once they have reached their limit of suffering, we will take care of them and respect their final wishes. That is what we call basic humanity.

Here is what Sandra Demontigny had to say, and I quote:

I am working to calm my vanishing brain and my troubled heart. I feel a need to be reassured about my future so that I can do a better job of living out my remaining days and coping with the more frequent trials I will be experiencing.

My plan is to make the most of my final years while life is still good, with a free mind and without fear.

If those words fail to strike a chord with members here, those members must be heartless and lacking compassion, perhaps because of sweeping ideological principles that they are not putting on the table.

This prompted the committee to say that the Carter decision needed to be respected. Under Carter, the government must not violate sick people's right to life with legislation that would force them to shorten their lives. We saw this in Carter, and it was reiterated in the Beaudoin decision. These people do not want to commit suicide.

That is what Sandra Demontigny told us. She said that she wanted to make the most of the years she has left, knowing that when she reaches her limit of suffering, she will be taken care of and will not have to go through the same appalling decline as her father. Until that moment comes, she wants to live. She does not want to commit suicide.

Is that clear? Who is more vulnerable than a person making this heartfelt plea?

When people say they want to strike a balance between preserving the autonomy of self-determination and protecting the most vulnerable, unless they have fallen down the rabbit hole of believing that everyone in the health care system is evil, it is impossible not to hear this plea.

Why is the government applying a double standard? This report was tabled in February 2023. The government ignored the key recommendation, but, because Bill C‑7 contained a Senate amendment regarding mental disorders and a deadline, the government did accept the committee's recommendation to take another look at the issue after experts had studied it for a year. The government then recommended waiting, because it does not believe that the entire country is ready for this. It accepted the recommendation and applied it, and the result was Bill C‑62. However, in the past year and a half, no bills have been drafted based on the committee's key recommendation on advance requests. If that is not an example of lacking courage and shirking responsibility, I do not know what is.

The minister is unable to understand that an advance request cannot take effect until a diagnosis has been made. It has been six months since the Quebec law was passed. I do not know what world I am living in. This is certainly not a sign of competence. He clearly finds the issue complex because he keeps inventing problems that should not exist.

We are not only criticizing. We went so far as to table a bill. Bill C‑390 offers the government a solution, because we are in suggestion mode, not just in opposition mode. This bill allows the provinces to pass their own legislation once they have debated the issue. Quebec has been juggling this issue, reflecting on MAID and doing something about it since 2009. Now, in 2024, it can start accepting advance requests. There is a law in Quebec. We have adopted a legislative framework. If the federal government thinks advance requests are too complicated, maybe it should look at Bill C‑390, which says it should go at the provinces' and legislative assemblies' pace. This is a debate that should be undertaken by each legislative assembly, by citizens and their representatives. Once they have debated the issue and established a legislative framework, they will then be able to accept advance requests for MAID. That is a very reasonable suggestion.

This is not preferential treatment for Quebec. It is an additional safeguard for the government. The idea is to amend the Criminal Code to simply say that, once a legislative assembly, a province, has adopted a legislative framework and a law, it can move ahead.

The administration of care is a matter for the provinces. End-of-life care is a matter for the provinces. The Criminal Code is a federal statute, and the federal government does not need to describe how things should be done. Furthermore, we are setting an example for all the other provinces. According to every poll conducted over the past three years, 83% to 85% of Canadians support advance requests, so I have to wonder where the political risk is. I feel like this government is afraid of its own shadow. It lacks the courage of its convictions, assuming it even has any convictions left.

I thought that freedom to choose was a cardinal Liberal Party belief that set it apart from the Conservatives, but no. I can criticize the Conservatives, but I will say one thing about them: We know where they stand and why, so we are able to position ourselves accordingly. As for the Liberals, there is no way of knowing what they think. They are dilettantes.

How can they be so unconcerned when it comes to an issue like this, an issue of human suffering? What are the Liberals waiting for? I can answer that question. What were the Conservatives waiting for in 2015, when the Carter decision forced Parliament to take a stand and an extension had to be sought? This Parliament has never been able to deal with the MAID issue except under a court injunction. The court had to order the government to change the law and the Criminal Code. Parliament has never taken the lead or even listened to patients and the public. Since 87% to 90% of Quebeckers support advance requests, it seems to me we should be moving forward.

Why is there a problem today? There is a problem because the Canadian Medical Protective Association has always said that physicians will be protected so long as they follow the most restrictive law. At certain times, Quebec had the most restrictive law, after the passage of Bill C‑7 and Bill C‑14. In Canada, there is no law like Quebec's. Quebec applies the Criminal Code and the regulations that explain how to proceed. Quebec ended up having to ensure that people like Ms. Gladu and Mr. Truchon could not access MAID. Bill C‑7 would have allowed this, so Quebec had to tweak its law.

I am appealing to people's sense of duty and humanity. I hope that my colleagues will set aside government paternalism and get on the same page as the people of Quebec and Canada. I suggest that the government take Bill C‑390 and make it a government bill.

Today, the government is claiming that a national conversation is needed. I thought that forming a special joint committee of senators and members from both chambers in a parliamentary democracy gave those committee members the standing to make recommendations that reflect what the public thinks.

I look forward to seeing what my colleagues have to say during this debate. I invite the government and the Prime Minister to quickly do their homework so they can get up to date on this file, allow advance requests and amend the Criminal Code to harmonize it with what is happening on the ground and eliminate any legal confusion.

Message from the Senate

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

I have the honour to inform the House that a message has been received from the Senate informing the House that the Senate has passed the following bill: Bill C-62, an act to amend an act to amend the Criminal Code, medical assistance in dying, no. 2.

Criminal Code

[Lianne Rood, Conservative, Lambton—Kent—Middlesex, ON]

Mr. Speaker, I rise today to address a question of paramount importance and profound concern to many of my constituents in Lambton—Kent—Middlesex: Will Canada cross the Rubicon and expand access to assisted suicide for otherwise healthy individuals whose mental disorder is the sole underlying medical condition, or do we have enough common sense and moral clarity to stop this radical and dangerous expansion of MAID to mental health cases? The issue at hand stands at the juncture of ethics, medicine and our societal values. This is not merely a policy decision. It is a profound moral question that strikes at the heart of who we are and how we value life and respond to suffering.

The core concern here is the difficulty, if not the impossibility, of determining with certainty that mental disorders are irreversibly incurable. Unlike many physical ailments, the trajectory of mental illness is often unpredictable and can respond to treatment over time. The NDP-Liberal government's push toward expansion, despite substantial opposition from medical professionals and the public, raises serious questions. It reflects a troubling trend of policy-making that seems to prioritize ideological considerations over careful, evidence-based deliberation. How can we, in good conscience, move forward with a policy that many experts in psychiatry and mental health view with significant trepidation?

The opposition from the medical community, particularly from mental health professionals, is not just significant but deeply insightful. The expert panel on MAID and mental illness, the very panel established by the government to study this issue, acknowledged the complexities involved. It noted the difficulty in predicting the long-term prognosis of mental disorders, underscoring the near impossibility of determining with certainty whether a mental disorder is truly incurable.

Leading psychiatrists across Canada have expressed reservations. The Association of Chairs of Psychiatry in Canada, which includes the heads of the psychiatry departments of all 17 medical schools in the country, called for a delay in implementing MAID for patients with mental disorders as the only underlying medical condition. Its concerns centre on the challenges in assessing incurability and differentiating genuine MAID requests from suicidal ideation rooted in treatable mental health conditions.

Surveys conducted within the psychiatric community reflect this opposition. For instance, a significant majority of Manitoba psychiatrists have indicated that Canada is not ready for the implementation of assisted suicide for patients with mental disorder as the sole underlying medical condition. A similar sentiment was echoed in a survey conducted by the Ontario Medical Association, where a two-to-one majority of respondents opposed the availability of MAID for such cases. These results are in line with public opinion, which has consistently shown discomfort with this expansion. In fact, I have heard from hundreds of residents of Lambton—Kent—Middlesex who are opposed to this expansion, and polls such as those conducted by Angus Reid reveal substantial public reservations about MAID for mental illness.

If we ignore experts' warnings and the public sentiment and proceed with this expansion, we risk making irreversible decisions in cases where there might be potential for recovery and improvement with the appropriate treatment. The ethical implications of such a scenario are profound and disturbing. In our examination of this issue, we must not overlook the societal context in which decisions about MAID are being made.

The CEO of Food Banks Mississauga recently issued a stark warning that the inability to afford basic necessities is pushing people towards considering MAID. This is a harrowing indication that, for some, the choice to pursue assisted dying may be influenced more by socio-economic despair rather than by unimaginable physical or mental health conditions. This revelation is deeply troubling. It compels us to question whether we are addressing the root causes of such despair or merely offering a tragic and irreversible solution to what are fundamentally social and economic problems. This is particularly concerning in light of the ongoing mental health crisis that was exacerbated by the COVID-19 pandemic and the government's divisive response.

Additionally, we must also reflect on the alarming reports concerning our veterans. There have been stories of veterans being offered MAID. This raises profound concerns about the support and care that we provide to those who have served our country. These individuals, who have sacrificed so much, deserve better than an expedited path to assisted death. These stories underscore the need for robust mental health support and the dangers of expanding MAID without adequately addressing these needs first.

When the Liberal government has such a cavalier attitude toward assisted suicide, with a one-way slope toward access expansions and safeguard removals, is it any surprise that, according to the latest available numbers, the annual growth rate of MAID between 2021 and 2022 was 31.2%? Between 2016 and the end of 2022, 44,958 people died by MAID. That is more than the number of Canadians who died in military service during World War II.

My point is that Canada's current MAID access may already be the most discretionary in the world. That is before the proposed mental health expansion. We are the only country whose legal system does not see assisted suicide as a last resort. What can we expect to happen to the growth rate if the House enables the “treatment” of mental illness with assisted suicide? We would be past the slippery slope concern if that were to happen. Crossing the Rubicon here would put us closer to free fall.

Why are we debating the radical expansion of assisted suicide? Just four months ago, the hon. member for Abbotsford's bill, Bill C-314, was in the House. Conservatives urged the House not to give up on Canadians living with mental illness. Nevertheless, the government voted against the bill, sticking to its original plan, as per Bill C-7, to expand access to MAID to Canadians who are healthy except for their mental disorder.

If it were not for the Special Joint Committee on Medical Assistance in Dying's tabling, on January 29, 2024, its findings and recommendations, the unprecedented MAID expansion would have been implemented within two months. Thankfully the committee, after extensive consultations and a review of expert testimony, concluded that Canada is not ready for the expansion of MAID to include cases where a mental disorder is the sole underlying medical condition. The report highlights the unresolved issues in accurately assessing the irremediability of mental disorders and the challenges in distinguishing between genuine requests for MAID and those stemming from treatable mental health conditions. The report confirms what common-sense Conservatives have been saying for months: Expanding assisted suicide to those suffering from mental illness would result in the deaths of those who could have gotten better.

That is why, just like last year when the government introduced eleventh-hour legislation to put a temporary one-year pause on expanding assisted suicide to those suffering with mental illness, we are once again here at the eleventh hour. There is no question that there is an urgent need to pass Bill C-62 to delay until 2027 the implementation of MAID in cases where a mental disorder is the sole underlying cause and condition.

As highlighted by the report of the special joint committee and the voices of experts and Canadians alike, a mere delay may not suffice. What is required is a comprehensive re-evaluation of our approach to MAID, particularly in the context of mental health. The issues at stake are not just medical or legal but are deeply rooted in our societal values and the respect we need to afford the dignity of human life, especially in its most vulnerable forms.

[Annie Koutrakis, Liberal, Parliamentary Secretary to the Minister of Tourism and Minister responsible for the Economic Development Agency of Canada for the Regions of Quebec]

Mr. Speaker, I would like to inform you that I will be sharing my time with the member for Lambton—Kent—Middlesex.

I am pleased to rise in the House today in support of Bill C‑62. The bill proposes to extend the temporary exclusion of mental illness as a an eligibility criteria for medical assistance in dying for three years, until March 17, 2027.

Today, I will speak to the importance of allowing some time before lifting this exclusion so that the provinces, territories and their health care partners can use it to better prepare for this critical stage in the evolution of medical assistance in dying, or MAID, as we call it in Canada.

The current legal framework for MAID is set out in the federal Criminal Code. However, the provinces and territories are responsible for delivering health care, which includes implementing MAID. Even before the original legislation authorizing MAID was added to the Criminal Code in 2016, we were working closely with the provinces and territories to support MAID's safe implementation. These important relationships are all built around the mutual goal of ensuring quality health care for Canadians.

The expert panel on MAID and mental illness and the Special Joint Committee on Medical Assistance in Dying both emphasized the importance of clear standards of practice and consistent implementation of guidelines across the country, training doctors and nurse practitioners, case review, vigilance in supporting best practices and confidence in the appropriate application of the law.

The provincial and territorial governments and their stakeholders, such as health professional organizations, regulatory bodies and practitioners, are actively planning to make people whose sole underlying medical condition is mental illness eligible for MAID.

As it has been recognized in all areas, significant progress has been made in that regard. However, the provinces and territories are dealing with different challenges within their jurisdictions. They are also at different stages when it comes to implementing these key elements and, consequently, in how prepared they are for the lifting of the exclusion.

For example, an independent task force of clinical, regulatory and legal experts has developed a model practice standard that physician and nursing regulatory bodies can adopt or adapt as part of the development or ongoing review of MAID standards. In addition to the model standard, the task force has also published a companion document entitled “Advice to the Profession”.

Practice standards are developed and adopted by bodies responsible for ensuring that specific groups of health care professionals operate within the highest standards of clinical practice and medical ethics. While some provincial and territorial regulatory bodies have successfully included MAID practice standards in their guidance documents for clinicians, others are still in the process of reviewing and updating their existing standards.

To facilitate the safe implementation of the MAID framework, Health Canada helped develop a nationally accredited bilingual maid curriculum to support a standardized pan-Canadian approach to care. The Canadian Association of MAID Assessors and Providers, known as CAMAP, has created a training program that has been recognized and accredited by the appropriate professional bodies.

The MAID curriculum uses a series of training modules to advise and support clinicians in assessing persons who request MAID, including those with mental illness or complex chronic conditions or who are impacted by any vulnerability.

To assist in the practical application of the legislative framework for medical assistance in dying, the curriculum will help achieve a safe and consistent approach to care across Canada. This will ensure that health care professionals have access to high-quality training on medical assistance in dying.

To date, more than 1,100 clinicians have registered for the program, which is impressive given that the program was only launched in August 2023. However, that is only a portion of the workforce. More time will make it possible for more doctors and nurse practitioners to sign up for and participate in the training so they can absorb the theory and put it into practice as professionals.

Let us talk a bit about the medical assistance in dying review and case study. In Canada, the medical and nursing professions have a self-regulating process. The above-mentioned provincial and territorial regulatory bodies are tasked with protecting the public with respect to all health care, and medical assistance in dying is no exception.

In addition to the existing health care practitioners' regulatory governing bodies, several provinces have established formal oversight mechanisms specific to MAID. In Ontario, for example, the chief coroner reviews every case of medical assistance in dying, as does Quebec's commission on end-of-life care. Both organizations have strict policies on when and what information must be provided by clinicians, and the Quebec commission publishes annual reports.

While provinces with formal MAID oversight processes account for over 90% of all MAID cases in Canada, other provinces do not have a formal MAID quality assurance and oversight process to complement the existing complaint-based oversight processes put in place by professional regulatory bodies. Work is planned to explore case review models to ensure oversight and best practices through a federal-provincial-territorial working group to support consistency across jurisdictions.

All the provinces and territories were united in their call to extend the exclusion in order to have more time to prepare their clinicians and their health care systems that also manage the requests having to do with mental illness, which also deserves having the necessary support measures implemented. The provincial and territorial governments need to ensure not only that the practitioners are trained in providing medical assistance in dying safely, but also that the necessary supports are accessible to clinicians and their patients throughout the entire assessment process.

The Special Joint Committee on Medical Assistance in Dying and the expert panel both underscored the importance of interdisciplinary engagement and knowledge of the available resources and treatments. Specialists and practitioners also expressed the need to bring in support mechanisms for providers conducting the assessments and the people who request medical assistance in dying, regardless of their eligibility.

Although some administrations have strong coordination services to manage requests and provide auxiliary services, others are taking a decentralized approach, which can result in less coordination between services and disciplines. The availability of the support services necessary for practitioners and patients also varies by region. For example, we heard about difficulties accessing health care services in general in rural and remote areas of the country. The additional delay will make it possible to better support the patients and clinicians involved in medical assistance in dying.

This government is committed to supporting and protecting Canadians with mental illness who may be vulnerable, while respecting their autonomy and personal choices.

We think that the three-year extension proposed in Bill C‑62 will give the time needed to work on these important aspects so that this can be implemented in a safe and secure way.

[Gerald Soroka, Conservative, Yellowhead, AB]

Mr. Speaker, I will be splitting my time with the member for Pitt Meadows—Maple Ridge.

Bill C-62, no. 2, suggests that we pause the expansion of medical assistance in dying, known as MAID, to people suffering from mental illness. The Liberals have shown time and again that they consistently pass legislation without the careful consideration needed for such significant changes to our society. This discussion is not just legislative; it is about how we value human life and the impact of the government's choices on all Canadians. In thinking about extending MAID to include mental illness, there is a need for a deep understanding of the complexities and uncertainties in diagnosing and predicting mental health outcomes.

Evidence to the Special Joint Committee on Medical Assistance in Dying showed a worrying truth: Clinicians often struggle to predict whether mental health conditions are irremediable, and they have a 50% chance of being wrong. This alarming fact points to a big problem with the proposed expansion; this is the chance of making permanent choices based on uncertain medical opinions. Mental health involves biological, psychological and social elements. Recovery is not always straightforward, and what seems irremediable at one point may improve with treatment.

Basing MAID on the idea that a mental illness cannot be cured shows a misunderstanding of the changing nature of mental health recovery. As the member for St. Albert—Edmonton put it, it is like flipping a coin on matters of life and death, a practice that is ethically troubling and goes against the idea of patient-focused care. Moreover, we cannot discuss MAID and mental illness without considering the wider issues of access to quality mental health care in Canada.

When people such as Canadian Paralympian and veteran Christine Gauthier are offered MAID from the government when simply requesting help with a wheelchair lift, it shows a worrying trend of suggesting MAID as a fix for systemic failures to providing proper care and support for those with disabilities and chronic conditions. This is not just one case. It reflects a larger problem, wherein essential services and supports are lacking; this drives people to consider MAID not because they want to but because they feel neglected by the Liberal government.

The risks of broadening MAID to include mental illness alone are complex, going beyond clinical doubts to wider social and ethical issues. It makes us question our dedication to mental health care, the value we place on lives touched by mental illness, and the kind of society we want to have. Do we face challenges with empathy, support and a commitment to better care, or do we settle for solutions that ignore the struggles Canadians face?

The Liberal government's approach to expanding MAID shows a wider trend of hasty law-making that leads to policies being introduced, then pulled back or changed after facing reality and public criticism. From errors in firearms legislation to heated debates on the carbon tax, the government often acts first and thinks later. This not only damages our law-making process but also lowers public trust in our ability to govern wisely and carefully.

The rush to include mental illness in MAID, without proper evidence or full discussions with mental health experts, ethicists and affected groups, shows a lack of regard for the careful and expert-led discussions that such a major policy change requires. The need to pause and rethink this expansion, via the bill, is an admission that the government's actions have been rash and poorly thought out.

This legislative step back, marked by two delays in implementation, is not just a minor issue; it is a clear sign of the dangers of choosing political speed over solid, evidence-based policy-making. It raises serious doubts about the government's commitment to responsible governance, which includes the need to fully explore, understand and foresee the effects of laws before they are passed. In this critical discussion on MAID, we must also consider the perspective of those directly affected by such policies. The voices of individuals and families living with mental illness must be central to our legislative process.

Their experiences and insights can provide invaluable guidance as we navigate the complexities of this issue. By engaging with these communities, we can ensure that our laws reflect the realities of those they impact most and uphold the principles of empathy and inclusion. Furthermore, the debate on MAID expansion underscores the need for comprehensive mental health services.

The government must prioritize the enhancement of mental health care infrastructure, ensuring that all Canadians have access to the support and treatment they require. By strengthening our mental health care system, we can address the root causes of despair and hopelessness that lead individuals to consider MAID, thereby affirming our commitment to life and well-being.

This moment also calls for a re-evaluation of our societal values and the role of government in safeguarding the dignity of every citizen. As policymakers, we have a duty to foster a culture that values every life, provides hope through support and resources, and respects the autonomy of individuals while carefully considering the ethical implications of life-ending interventions. This approach would not only address the immediate concerns surrounding MAID but would also contribute to a more compassionate and just society.

As we think about what this pause means, we must consider the lessons learned and push for a more thoughtful, consultative and evidence-based approach to making laws. The stakes are too high, and the chance for unintended harm too great, to accept anything less. In MAID's case, where ethics, law and personal choice intersect delicately, our responsibility to be extremely careful and considerate cannot be overstated.

The proposal for a pause on MAID's expansion clearly shows that the Liberal government's policy-making has been quick and poorly thought out. While this pause is needed, it points to a bigger issue of governance, where major legislative changes are made without enough foresight, discussion or understanding of the deep ethical implications. This pause reminds us of the dangers of enacting laws that deeply affect Canadians' lives and well-being, especially the most vulnerable. It shows the current Liberal government's failure to engage in a careful, evidence-based legislative process, preferring instead policies that match ideological aims rather than the complex realities of issues such as MAID and mental health.

This should be more than a brief stop; it should be a crucial time to rethink how policies, especially those about life and death, are made and applied. It questions the government's commitment to maintaining the highest standards of care, empathy and respect for all Canadians' dignity. We must demand greater legislative care and ethical responsibility from the government.

The discussion on MAID and mental illness needs a comprehensive approach that puts individuals' well-being and rights ahead of quick political gains.

It is time for a move towards more responsible governance, where policies are made with great care, are based on wide consultation, and reflect our collective values and ethical standards. Sadly, the current Liberal government seems to lack concern for any of these values.

The way forward should be marked by a dedication to thorough research, wide involvement and a deep respect for life's sanctity. Only by such a comprehensive approach can we ensure our legislative actions truly serve all Canadians, embodying the justice, empathy and respect that define our nation.

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

Mr. Speaker, as we debate here and keep hearing the words, which we are now getting used to, “medical assistance in dying”, in the context of Bill C-62, I wonder whether we can create something different, like “societal assistance in living”.

We desperately need things like a guaranteed livable income. We need better access to social supports, mental health provisions, addictions counselling and a panoply of things that would make us feel more confident that no one would opt for medical assistance in dying. If Canada, if we as neighbours and friends to the family of all Canadians, said that we are there for them and that they can count on something, a guarantee, social assistance in living, would the hon. member think that is a good idea?

[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.

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

Mr. Speaker, I note that I will be splitting my time with my friend and colleague from Langley—Aldergrove.

It is the responsibility of parliamentarians, in certain circumstances, to make decisions that have to do with life or death, and that is where we find ourselves today. In the context of most of parliamentary history, not only here in Canada but in other parliaments around the world, it has to do with times of war and conflict, but today it is unique as we discuss the context of determining the status of what has come to be referred to as medical assistance in dying. It is an incredibly delicate issue that has brought forward a huge range of emotions and opinions from across the country and from across the political spectrum. Certainly, it is something that requires thoughtfulness when being addressed.

However, I do want very specifically to address something that has been very concerning to me in this discussion, and I will get to the substance of Bill C-62 in a moment. It has been brought forward and demanded by other political parties in this place that members' faiths and the values on which we build our moral system should not be included in this discussion, that somehow as parliamentarians we should separate those things from the discussion.

I would assert to members today, on behalf of many of my constituents who have reached out to me on this matter, many of whom agree with me and some of whom do not, that the basis of our moral system, whether that be mine as a Christian or other people's of Muslim, Jewish or other faiths or no faith at all, or whether it be the experience that one lives, plays a role in our ability as parliamentarians and as a society to make decisions.

As such, my message to this House and all Canadians watching is that we should never try to remove our faiths and our value systems from the conversation. Rather, they should be a part of it, thoughtfully, of course, and that certainly is the case when we are discussing something as important as medical assistance in dying.

Let us take a step back. What does Bill C-62 mean? It is a delay on the coming into force of an aspect of the medical assistance in dying regime. All parties, at different points in time, although that is certainly not the status of this debate today, have said there is tremendous concern about the widespread expansion of a system that could put Canada's most vulnerable at risk, and certainly that is something that should force all of us to take pause.

It has been asserted very clearly by me and many of my colleagues that this has simply gone too far when the regime that we are talking about is truly putting Canada's most vulnerable at risk, but the specifics of the bill today would bring a needed pause. My assertion, as when I voted in favour of the bill from my colleague from Abbotsford, would be that we should remove the provisions of medical assistance in dying that could very well lead to what we hear examples of. This is not simply an allegation. We hear very clear examples of that, and I will get into some local examples in a moment, but we have to ensure that we protect the most vulnerable.

That is why I will be supporting putting a pause on this expansion of MAID, but I believe we need to go much further than that, and I will get into a few of my reasons in a moment.

It was brought to my attention, and as a Christian taking seriously God's word, the Bible, I would reference a Bible verse in my debate here today. It is 1 Peter 4:10. It says, “As each has received a gift, use it to serve one another, as good stewards of God’s...grace”. The reason I bring that forward today is that I think it provides important context for something that is truly foundational in how we look at the world, and that is the idea of the value and dignity of life and one's life.

I heard recently from a constituent, a woman, who shared a heartbreaking story about her son. He was in a mental health hospital after being found inches away from taking his own life. He reached out at the last moment, asked his parents for help and expressed that while the different things he was facing were incredibly complex, he did not want to die. As a result, the family was able to advocate for him, to work diligently to help support this young man and to ensure that he could get the help he required.

We were told in the beginning that there was no such thing as a “slippery slope”, but we have seen it, over the last eight years, since the Liberals first brought it forward, when Jody Wilson-Raybould was the then minister of justice and attorney general. There were warnings at committee and warnings in the various court decisions that led us to this point that we had to be very aware of the slippery slope. We are seeing that here today.

What I find very tragic, as in a story that I referenced from a constituent, and I will not get into the specifics to ensure that their identity is protected, is that we hear this tragic story where intervention was at least possible. This constituent reached out and said that had there been mechanisms in place that would have even suggested that it was possible, they feared what the outcome would have been and that they would have lost their son. We also hear numerous examples of how addiction is stealing life away from individuals. Instead of ensuring that there is hope and opportunity, they are not given the dignity of getting better. The potential of getting better is so very important in this discussion.

I compliment my colleague, the member for Cariboo—Prince George on the 988 number. It was a tragic irony that it took longer for the government to set up the 988 Suicide Crisis Helpline than it did for the government to bring forward what was the first one-year extension in the expansion of the medical assistance in dying regime.

Before us, we have a delay. When it comes to the heart of the matter, we need to stand up for the life and the dignity of all Canadians. I understand how we need to be thoughtful in how we engage in this subject, because it is deeply personal, and everybody can point to different stories. However, we have to protect life, to offer life, to not lose hope and to ensure that death does not become a part of health care.

We have heard tragic examples of veterans being offered medical assistance in dying instead of mental health supports and of Canadians who are hungry, having to battle through difficult economic times, and having to pursue some of these things. I referenced the committee a number of times. To those who might be watching and listening, some of the stories are of those who shared, very honestly, how their lives would have been put at risk had there been mechanisms in place that did not have safeguards and that did not prioritize the need for life and offer that hope.

I started my speech by talking about how, as parliamentarians, we are sometimes tasked with making decisions that are literally life and death, and this is one of them. My submission to this place, and to all members, is that we need to ensure we always prioritize life.

If we fail in that duty, I shudder to think what the long-term implications of that would be for our society. That would be absolutely devastating for lives that could be lost through a regime that does not prioritize dignity and ensure, whether it is for mental health, for disability or for others who are facing vulnerabilities in moments or longer stages of their life, that Canadians are given every opportunity to choose life and that the government does not facilitate death.

The House resumed consideration of the motion 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, and of the motion that the question be now put.

Business of the House

[Steven MacKinnon, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I can assure you that nothing is scarier than driving down Conservative highways, whether it is in Kamouraska or Témiscouata. Conservatives vote against highway infrastructure and refuse to fund them.

Later today, we will be voting on third reading of Bill C-62, medical assistance in dying.

Tomorrow, we will resume debate on the motion respecting the Senate amendment to Bill C-35, the early learning and child care legislation.

Next week is a constituency week during which the House is adjourned. We will, of course, be in our ridings to serve our constituents.

Upon our return, the agenda will include Bill C‑58, an act to amend the Canada Labour Code and the Canada Industrial Relations Board regulations, 2012, which deals with replacement workers. On Wednesday, we will continue debate on Bill C‑61, an act respecting water, source water, drinking water, wastewater and related infrastructure on first nation lands. Finally, Tuesday and Thursday will be allotted days.

I thank the members for their attention and wish them a good week in their ridings.

Criminal Code

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, I am rising for the second time this week to speak to this issue. As I said at the beginning of my speech at second reading, I was so interested in this issue that I offered to sit on the Special Joint Committee on Medical Assistance in Dying when it dealt with the question of mental illness. I felt it was my duty to take part in a debate that is so important for our society. This is a crucial and extremely complex social debate. As a legislator, I wanted to learn more about this hot-button public policy issue that is so important to my constituents. Many of them have written to me about this.

I attended much of the debate on the issue this week, and I was very impressed by the tone. It is true that emotions can sometimes get the better of us, but that is to be expected when we are debating such a crucial matter, a matter of life and death. I must say that I was impressed that the debate was conducted in a respectful manner. That is impressive, and we should adopt that same tone when we discuss the many other issues addressed here in the House.

I heard arguments that I do not want to call fallacious, because that is a pejorative term and I do not want to criticize anyone, but let us just say that I heard a few contradictions during certain speeches.

First, someone claimed that we could have simply amended Bill C-62 to include advance requests. I do not think we are ready to make a hasty amendment to open the door to something as complex—if not more—as medical assistance in dying, namely, medical assistance in dying for persons with a mental illness. It took much effort, much debate, much discussion and several committee meetings for us to be able to talk about medical assistance in dying for patients with a mental illness.

Moreover, the idea that we can move an amendment in committee is wrong, because such an amendment would certainly be ruled out of order, since the scope of the bill is not that broad. The bill deals with a specific question, namely, medical assistance in dying for persons with a mental illness.

People claim we are taking too much time to debate this issue, that it has already been three years and that we should end the debate. We are not talking about policies like affordability or the need to build housing as quickly as possible. We are talking about something very serious. We really are going beyond the more practical issues, and I think it will take the time it takes because there is no consensus among the experts. If there is no consensus, we cannot force the issue, suddenly demand consensus and insist we move forward because time is running out. The issue of how long it will take to reach a good conclusion is unfortunately not a problem for me.

As I was saying, this is not simply a technical medical issue, it is a moral and ethical issue for society, certainly.

The matter of caution was also raised. Some claim that the government is too cautious, too timid, on this issue, that it is not acting as quickly as people would like, that it has not addressed the issue fast enough or lacks political will. It does in fact lack political will because there are too many uncertainties. In this case, it is not a bad thing to lack political will in order to forge ahead as soon as possible.

However, on this idea of being too cautious, I would say that this is true even for the Bloc Québécois, because it has accepted the framework we have established. For the moment, we are not implementing this framework. Nevertheless, under the framework, not everyone who requests medical assistance in dying on the grounds of a mental illness will receive it. We are talking about a mere 5% acceptance rate. Even if we went ahead, we would do so with a lot of caution, given the 95% of people who would request medical assistance in dying on those grounds.

We should then not talk as if caution were not an issue. Caution is an issue, even if we agree to move forward. I would like to ask my colleagues who keep disparaging the government for its caution whether it would be too cautious to require that, in these cases, a psychiatrist be involved in assessing the person's request. Right now, it is not necessary for a psychiatrist to be involved in the assessment. In the Netherlands, where medical assistance in dying is legal, a psychiatrist must give an opinion on the request. There is caution built into the process, but it is not unreasonable. I would say that my colleagues in the Bloc Québécois agree that some caution is required.

There is also talk about freedom. Some say that this is a matter of freedom, as if they were talking about absolute freedom. It is not a matter of absolute freedom, because 95% of those requesting medical assistance in dying would not have access to it on the grounds of a mental illness. We need to make things clear and add nuance to this debate to avoid giving the impression we are talking about absolute concepts.

Then they bring up the issue of the Quebec nation. I listened carefully to my friend, the hon. member from Joliette, with whom I enjoyed working on election reform. He is a seasoned parliamentarian who makes excellent speeches in the House. He said that there were many nations in Canada. Indeed, there is the Quebec nation, but there are also indigenous nations. There are indigenous nations within the Quebec nation as well. What I understand is that indigenous nations are not too keen to move this issue forward at this time. They say that they have not been consulted enough. They have concerns about the systemic racism that exists in health care systems across the country. Among other things, they are afraid that not enough thought will be put into processing the requests.

We should not focus too much on the idea of community when it comes to medical assistance in dying. When people get to that point, when they are on their death bed, I do not think they dwell too much on the community. Each person is a soul facing infinity alone. That is why we should not talk too much about nations when we are discussing medical assistance in dying. It is not a matter of being part of a community. I agree that it is a matter of individual rights. That is where it gets complicated, because we do not want people to suffer.

However, we do not want people to do things that have not been assessed with the utmost caution, because it is a matter of life and death.

I will stop here and await my colleagues' questions.

[Lisa Hepfner, Liberal, Parliamentary Secretary to the Minister for Women and Gender Equality and Youth]

Mr. Speaker, I will be sharing my time today with the member for Lac-Saint-Louis.

I am very pleased to have the opportunity to speak in this House today in support of Bill C-62, particularly after listening to some of the debate this morning and hearing some of the language used in this House today.

For example, the member for Abbotsford, throughout his speech today continually used the words “the mentally disorded” I believe in reference to people who are suffering from mental illness. A little later in the day, we then heard from the member for Leeds—Grenville—Thousand Islands and Rideau Lakes, who continually referred to people as “addicts” throughout his speech.

In this House, we are leaders. Our words are important and we should not be furthering the stigmatization of people who suffer mental illness. I would caution my colleagues across the way to be careful in their language and to please not further marginalize people who are already suffering.

I will turn back to Bill C-62. As the Minister of Health and the Minister of Justice have emphasized, the government believes an extension of three years is necessary to provide individual clinicians as well as provinces and territories the time they need to prepare for this change.

I also believe a three-year extension of the period of ineligibility to receive MAID on the basis of a mental illness alone is necessary. Although significant progress has been made, more time is needed to ensure the safe assessment and provision of MAID in these circumstances. I have heard from psychiatrists in my riding of Hamilton Mountain who have said these very things. They need more time to get the system ready.

My remarks today will focus on the progress that has been made in preparing the health care system, and also what more needs to be done.

In 2021, as required by former Bill C-7, an expert panel examined the issue of permitting MAID where the sole underlying condition is a mental illness. It concluded that the existing legal framework of eligibility criteria and safeguards is sufficient, providing that MAID assessors apply the existing framework appropriately with guidance, through the development of MAID practice standards and specialized training.

Our government understood the importance of the panel's findings. To that end, we have been working in collaboration with the provinces and territories and other health care partners to implement consistent standards across the country and support a highly trained workforce to undertake these complex assessments.

For example, we supported the development of a model practice standard for MAID by individuals with clinical, regulatory and legal expertise. A model practice standard for MAID was released in March 2023 and has been adopted, or is in the process of being adopted, by most regulators across the country as a basis for assessment for clinical decision-making. The standard also provides guidance for MAID clinicians as they navigate more complex MAID requests.

We also supported the development of the first national, fully accredited bilingual MAID curriculum, which was launched in August 2023. The curriculum consists of seven training modules addressing various topics related to the assessment and provision of MAID, including how to do a MAID assessment, how to assess capacity and vulnerability, how to manage complex chronic situations and how to assess requests involving a mental illness. Over 1,100 clinicians have registered for the curriculum since August of last year.

This progress is the result of leadership and collaboration among health system partners, including federal, provincial and territorial governments, health professional organizations, regulatory bodies, clinicians and organizations like the Canadian Association of MAID Assessors and Providers. This collaboration and progress will continue to make improvements in approaches to safety and quality in assessments and provisions of MAID.

In terms of the future, I want to briefly speak to the Regulations for the Monitoring of Medical Assistance in Dying, which outline the reporting requirements relating to MAID requests. These regulations came into force in November 2018, but were recently revised to facilitate enhanced data collection and reporting on MAID activity. Most notably, the regulations now allow for the collection of data based on race, indigenous identity and the self-reported presence of a disability, where a person consents to provide this information.

The revised regulations came into force on January 1, 2023, and information on MAID activity in 2023 will be released in Health Canada’s annual MAID report this year, in 2024. This information will provide valuable insight into who is requesting and receiving MAID, including those under track 2, whose natural death is not reasonably foreseeable.

Despite all this work, we have heard that the provinces and territories are at various stages of readiness for the lifting of the exclusion of eligibility and that they need more time to prepare their health care systems.

I know that the suffering caused by a mental illness can be just as severe as that caused by a physical illness, but I strongly believe that this extension is necessary to ensure that MAID can be safely assessed and provided on the basis of a mental illness alone. This extension does not question the capacity of people with mental illness to make health care decisions. It is about giving the health care system more time to adopt or implement some of these key resources to ensure that MAID practitioners are properly equipped to assess these complex requests, and that the provinces and territories have the necessary mechanisms in place to support them.

For example, both the expert panel that I referred to earlier and the special joint committee on MAID have emphasized the importance of case review and oversight of MAID, both to educate practitioners and to support accountability and public trust in the law. While the majority of cases of MAID, 90%, take place in provinces with formal oversight processes, other provinces do not have formal MAID case review and oversight processes in place beyond those already undertaken by professional regulatory bodies.

Work is being planned to explore best practices through a federal-provincial-territorial working group, with a view to encouraging more consistent and robust mechanisms across the country.

The expert panel and the special joint committee also identified engagement with indigenous partners as a priority. The Government of Canada has launched a two-year engagement process on MAID to hear the perspectives of first nations, Inuit and Métis, including urban indigenous people, indigenous people living off-reserve with or without status, indigenous people living with disabilities, and two-spirit, LGBTQQIA+ and gender-diverse indigenous people.

The proposed extension under Bill C-62 would provide the necessary time to have these discussions with indigenous partners. It is an essential process to appropriately inform implementation as well as guidance and training material for clinicians to support enhanced integration of cultural safety in MAID practices.

Health Canada will provide its first official update to Parliament on this work in March 2024, just next month.

In conclusion, the Government of Canada remains committed to ensuring that laws reflect the needs of people in Canada, protect those who may be vulnerable, and support autonomy and freedom of choice. While we have made significant progress in the study of MAID and mental illness, and in the development and dissemination of key resources, we are not yet ready. We need to act prudently and not rush this change without the necessary resources in place.

This decision is not an easy one, but I want to assure the House that we will continue to work collaboratively with our partners to improve the mental health of Canadians.

I thank all members for the opportunity to speak today as we debate this important bill.

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

Mr. Speaker, I rise today to speak to Bill C-62 which seeks to delay the expansion of medically assisted death to individuals whose sole condition is a mental illness until March 2027.

Yesterday, in anticipation of these remarks, I sent an email to about 10,000 constituents, and I heard back from 95 of them on the subject we are debating today, medical assistance in dying, or MAID. I heard from parents who have lost children, as well as those who have suffered from depression and were able to overcome their illness with treatment.

The majority of respondents agreed with the position I am about to outline, but there were some who did not. Many of those who disagreed with my stance came from Mission—Matsqui—Fraser Canyon's very large and diverse Dutch community. Given its history in, and our connections to, the Netherlands, people in the Dutch community have a deep understanding of this issue. I appreciated hearing their thoughtful comments.

Among those who disagreed, the most common concerns raised were about access and advance requests for those suffering from dementia. Concerns were also raised about the challenges many Canadians face in accessing mental health supports and treatment, which can leave some feeling hopeless. In fact, it nearly brought me to tears, hearing from constituents who asked, “How dare you try to take away the right for me to access MAID when I am suffering from mental illness?” They did not see a pathway out for the circumstances in their life. That is a horrible position to be in.

One thing, however, was unanimous: Our health care system is failing to meet the needs of Canadians suffering from mental health challenges. This must be addressed. I am grateful to everyone who took the time to share their thoughts and concerns in a compassionate and respectful way.

Almost a year ago, I stood before my colleagues in this House and expressed my concerns about the Liberal government's decision to extend medically assisted death to individuals suffering solely from mental illness. I highlighted the stark contradiction between our efforts to promote mental health awareness and services and those to offer death as an option to those struggling with mental health challenges.

Mental health affects every family in our country, and it pains me to see the government contemplating the provision of death as an option to individuals who are at their lowest point. I shared the heartbreaking story of a member of my community of Abbotsford, who received medically assisted death without her daughters being informed, despite her documented mental health condition. Regrettably, such stories are becoming too common under our existing MAID regime.

Retired corporal Christine Gauthier, who represented Canada at the Paralympic Games, testified before the Special Joint Committee on Medical Assistance in Dying that she had tried for five years to get a wheelchair ramp installed in her home through Veterans Affairs Canada. Instead, she was offered MAID by a VAC caseworker. A week before her testimony, the Minister of Veterans Affairs confirmed that at least four other veterans had been offered MAID as well.

Now, after eight years of the Liberal government and with the cost of living soaring, some Canadians are seeking MAID in fear of homelessness. Most recently, a member of my community from the Family Support Institute of BC raised deep concerns about the expansion of MAID. They stated that, even with the current restrictions, our most vulnerable populations are gaining access to MAID without adequate precautions, social services, expertise, professional supports and wraparound social networks to consistently represent their interests and voices.

Despite our repeated calls to protect the most vulnerable, I believe the Liberal government has failed to act responsibly on this point.

Around this time last year, instead of cancelling the expansion of MAID for mental illness, the Liberals introduced last-minute legislation to impose a temporary one-year pause. Now, a year later, I am here again to see that the government wants to add another pause of three years to the mental illness expansion, delaying it until March 2027.

This past fall, the Liberals had an opportunity to get rid of this expansion altogether. In February, my colleague, the hon. member for Abbotsford tabled Bill C-314, which would have cancelled the expansion of MAID to those with mental illness as the sole condition. When the bill came up for a second reading vote in October, most Liberals, along with the Bloc Québécois, defeated it.

The government is seemingly only choosing to delay the expansion again after the significant backlash it has received from mental health experts, doctors and advocates across Canada. It seems that the government wants to recklessly push aside this issue instead of listening to what Canadians and, indeed, our mental health professionals want.

For many years we have heard about the fast expansion of assisted suicide in Europe. Now, Canada has infamously become a global leader with its progressive euthanasia policy. The Netherlands was the first country in the world to legalize euthanasia, and it took the country over 14 years to reach 4% of the total population's death from assisted suicide. Other countries with similar policies, such as Switzerland and Belgium, have not even reached the 4% mark. Canada's MAID regime has only been around for six years and has outpaced these countries with euthanasia, accounting for 4% of total deaths in 2022. Health Canada reported that 13,241 Canadians received assisted suicide just in the past year. That is more than a 30% increase from 2021 deaths.

Belgium allows euthanasia to children of any age. Most recently, the Netherlands expanded its euthanasia policies to include terminally ill children. The Liberals have met with the largest pro-MAID lobbying group, Dying with Dignity, many times. This group is advocating for assisted suicide to be expanded to mature minors. If the government continues to take us down this slippery slope, will it lead us to a path that expands euthanasia to all children? Youth in this country are already falling through the cracks, with suicide being the second leading cause of death for youth and young adults. How can youth struggling with mental illness even think of having a better future if they become eligible for MAID and it is normalized? The Liberals, in my opinion, are inadvertently creating a culture of death.

Delaying the expansion of MAID for mental illness is not enough. The government must immediately and permanently halt the expansion of MAID to those with mental illness. The reports from the committee echo what Conservatives have been advocating for years, which is that expanding assisted suicide to those suffering from mental illness will lead to the premature death of individuals who could have recovered with proper support and treatment.

The government is taking an ideological stance, and it is not listening to the experts working in the field. Last year, the country's largest psychiatric teaching hospital, the Centre for Addiction and Mental Health, said that it is not ready for this expansion and emphasized the need for more mental health resources.

The chief of the psychiatry department at Sunnybrook Health Sciences Centre in Toronto, Dr. Sonu Gaind, has said that it is irresponsible for us to provide “death to someone who isn't dying before we ensure that they've had access and opportunity for standard and best care to try to help alleviate their suffering.”

We cannot overlook the inherent dignity and value of human life, especially when individuals are at their most vulnerable. It is our duty as lawmakers to prioritize the well-being and protection of everyone in Canada, particularly those facing mental health challenges.

As the member of Parliament for Mission—Matsqui—Fraser Canyon, I believe in upholding the principles of compassion and support for those struggling with mental illness. Yes, I also acknowledge that we need to do a lot more; efforts to date have not been sufficient, whether in terms of the government response or the societal response.

Delaying the expansion of MAID for mental illness is not the solution; it merely postpones the inevitable reckoning of the profound ethical and moral implications of such legislation and the broader implications we are faced with here today. Those struggling with their mental health deserve support and treatment, not death. We know that recovery is possible when treatments are more readily available.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am glad to be joining debate on Bill C-62. Off the top, I will mention that I will be voting for it. Like the shadow minister for justice on the Conservative side said, this is about protecting the vulnerable. Though the federal government has dropped the ball in this latest iteration of its legislation, these three years, I hope, will be taken to basically fix the mistakes that were made all the way back to Bill C-14. I want to talk a little about what brought us to this moment, and then refer to some constituents of mine who have emailed me over the last few months on the issue of assisted suicide.

I will also mention that I am sharing my time with the member for Mission—Matsqui—Fraser Canyon. I am sure he will add more to this debate.

To go back to the beginning, not too far to the beginning because I could get into Genesis, the Carter decision is what kicked off multiple debates that I have now been a part of. I have now seen this debate go from Bill C-14 to Bill C-7 to Bill C-62, and the attempts by my hon. colleague from Abbotsford, who, I think, tried to do right by vulnerable Canadians all across Canada to make sure that we would not see an expansion of the MAID provisions to those who are still suffering with mental health conditions.

The great thing about Hansard is that I was able to go all the way back and review what I had said on Bill C-14. I spent quite a bit of time complaining that the reasonably foreseeable clause would be knocked down by a court. It was knocked down by a court in the Truchon decision, because all our deaths are reasonably foreseeable; that is what living is all about. At the time, I had said that all of us who are born are born with one foot in our grave. One is assured one will die; one does not know just what it is, but it is reasonably foreseeable. I am just repeating it now. I know that it is morbid, but it is the truth. A lot of what we are dealing with here are issues of life and death and how one's death will happen. Therefore, at the time, this reasonably foreseeable clause would get knocked down, and it was knocked down in the Truchon decision.

My issues, just generally, are that, in a perfect world, this would not be necessary because people would not suffer. However, because this world is not perfect, people do suffer. People suffer in deep and different ways. Members know that I had a disabled daughter who passed away a few years ago. Had she lived longer, and I know at least one little girl in Calgary who has lived much longer with the same conditions my daughter had, she would be one of those vulnerable Canadians who would be facing the possibility that her physician, her specialist, might push for and might offer MAID.

I say “offer MAID”, but it seems so weird to say “offer MAID”, to offer something that I do not consider to be a medical service and to rush one's death sooner. Although we all die, as I said many Parliaments ago, the act of dying is not one that one does alone; it is done as a family, as a group of friends and with those loved ones around.

It is not something that happens in solitude. There are others who will miss one when one is gone. I know that it is difficult in a moment of suffering and a moment of great pain, or chronic pain, to believe it, to know it. A lot of the emails, the correspondence and the meetings I have had were with people who are worried about the assisted suicide MAID provisions, which the government has ineffectually dealt with through successive pieces of legislation. I think it was a grave error not to appeal the Truchon decision. I really do. I think it was a mistake. I said it to constituents at the time.

I have a Yiddish proverb, because I always do. They are great proverbs, and everybody should live by them and should know more of them. I just wish I could pronounce them in Yiddish: The truth never dies, but it is made to live as a beggar. This legislation is a beggar. This legislation should have been a permanent fix to the issues.

I think that Conservatives have suggested, both in committee and outside of committee, what some of those fixes would be. Although I disagree with an acronym, I will use RFND, reasonably foreseeable natural death. It should be limited to those who are terminally ill, where their death is foreseeable within the next six months, where there is a prognosis from a medical professional saying that one will indeed pass away.

For those most terrible conditions, I am thinking of a lot of cancers. My grandfather passed away from brain cancer in Canada, which brought my family to Canada. His death was very much reasonably foreseeable when it was terminal. There are others who have mental health conditions, which are caused by a physical condition. The mental health condition alone should not be the reason to seek assisted suicide.

Different Conservatives have mentioned, and I very much agree with this, that patients should be the ones requesting it. These are all things the government could have legislated into law. These are things that experts have said, and I want to read some of what the experts said in different committees.

Professor Trudo Lemmens and Mary Shariff persuasively rebutted a bunch of arguments that were made in Truchon. They noted again that reasonably foreseeable natural death applied to “all” persons, “not only to persons with disabilities”. “The judge in Truchon failed to appreciate how such a restriction reflects a constitutional duty to protect the equal value of the lives of all Canadians.”

I have read the Carter decision twice now. As many in the House know, this is something I take pride in saying that I am not a lawyer. I am not burdened with a legal education. I know the member for Fundy Royal is disappointed and that the member for St. Albert—Edmonton will be disappointed too, so I come to this as a layperson. Even the Carter decision did not say he had a right to die. It goes back to this idea, like I have said, that all of our deaths are reasonably foreseeable. It will happen; it is unavoidable in life.

These two experts said that the judge in Truchon made a mistake. This concept, this expertise, was then repeated in observations made by 72 disability rights organizations that penned a letter to the then justice minister. They said that reasonably foreseeable natural deaths are the ones where there is terminal illness that is coming up very quickly, and that this idea is an equalizing effect, guaranteeing a common thread among persons accessing MAID, assisted suicide, namely that they are dying within a very short time window. That is how I think this legislation should work. I am not saying there should be no MAID.

The Carter decision stands as a Supreme Court decision in Canada, so there has to be a provision of it in a method. It should be rare and should be restricted to the very few people for whom it was originally intended. I feel that Bill C-14 to Bill C-7 to the situation we are in today do not address that. That is why we have this legislation that is a beggar. It is not in the original form that it should be. The truth lies in abiding by what Carter decided.

Another one reads, “From a disability rights perspective, there is a grave concern that, if assisted dying is made available...regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.” That is a terrible message to send to persons with disabilities. I am thinking of my daughter, had she lived. That would have been a terrible message to send to her.

All three of my living kids have a chronic kidney condition. My boys will likely need a kidney transplants. What a terrible thing to tell them, that they are a burden on the medical situation and that maybe they should seek faster death. Is that what specialists are going to tell them when they are adults? I will not be in the room, but they will be in the room. Will that be pushed onto them? For those who are on dialysis, it is hard on their bodies to go three to four days a week to get dialysis in a hospital setting. I am not speaking of peritoneal dialysis that can be done in the home.

There have been lots of experts. The member for Fundy Royal explained a lot of what has been said on the issue. The government keeps erring in the wrong direction with more expansive legislation to allow more people to access something that was not the original intention of Carter. We should abide by Carter, as I mentioned before.

I have had constituents write to me. I just want to make sure that I read some of their thoughts into the record. Leanna wrote, “Please Halt the expansion of MAID to include those facing mental illness.” Catherine wrote, “As a parent who has seen my own children experience mental health challenges while in their teen years and early twenties, I am writing to express my deep concern about people with mental illness alone becoming eligible for medical assistance in dying. The move towards this will put countless vulnerable people at risk.”

Joe, in my riding, is a regular writer. I respond to most of his emails. I will send this to Joe just to make sure he knows I read his emails. His second and third points read, “By offering MAID for mental illness governments may put less money into treating mental illness.... Canadians may wish for MAID because of despair. They have not have been offered treatment for their mental illness.”

Cameron talked about a friend of his who is a nurse working in a mental health unit in Calgary. Mental health for him is all about seeing the intrinsic value of every human being, as celebrating the person not for what they contribute but for the beauty of their existence. He feels that once we stop seeing the dignity of one person, we will doubt our own worth and validity.

I know my time is running short, so I will not belabour this. I have heard comments from some members of the House who have tried to impugn a person's faith, religion or philosophical affiliations with whatever beliefs; although, all of us come to the House with our different beliefs. Some of them are sacred. Some of them are secular. It really does not matter where they come from, but all of us try to ascribe value to life, what that life is and what autonomy should be like.

To those members, I note that I did abstain from one vote that was specifically on advance directives because I have a constituent, Jim, who communicated with me over email that he and his spouse saw the experience of his mother, who passed away from Alzheimer's, and how terrible it was. In situations like that, it is incumbent upon the government to find a way to meet the requirements of the original Carter decision so that Jim and his spouse, when that time comes, can have their wishes met.