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

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Mr. Speaker, I listened with great interest, and a lot of the member's speech was about housing. It is false to describe the housing crisis we are in now as starting only a year ago, eight years ago or the length of the government. I would argue that it has been caused by consecutive governments, both Liberal and Conservative, ignoring the investments that needed to be made into housing over the last 30 years. I would like to hear the member's explanation for that.

We are now at this arbitrary 30-day deadline, and there are other things that governments were apparently totally in support of but did not do. I think of my colleague from Timmins—James Bay bringing forward a national palliative care motion. Everybody supported it, but nothing was done. In 2019 in this place, we brought forward the national suicide prevention strategy. Everybody believed in it, but nothing has been done.

Now that we have these 30 days, we are again in a crisis. What does the member have to say about the other protections we need to bring forward that have been presented in this place?

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

Mr. Speaker, first of all, about housing, I would point out that, under a Conservative government, housing was difficult, but it was not the crisis that it is today. That is the point that we have been making, and that the leader of the Conservative Party has been making, time and time again. The crisis has been brought on by the mismanagement of the Liberal government.

I would also say, about housing for the most vulnerable, that provincial governments around the country have cut back on psychiatric hospitals and put people into the community, which sounds like a great idea, except that the community supports are not there. That is what is fundamentally missing here. The man whom I gave as an example fits right into that. His concern was the lack of stable housing. If he had had housing, he would not have asked for MAID. That is the point I am trying to make.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Mr. Speaker, I will be splitting my time with my colleague from Thunder Bay—Rainy River.

Here we are down to the last minute. Liberals will be supporting this bill, not because we think it is a great bill, but because it postpones this decision for three years. It puts it down the road to another Parliament. I am not quite as confident as the previous speaker, my honourable friend, that there will be a government of his persuasion at that time, but, nevertheless, it is a decision that will have to be dealt with by another Parliament, which is quite regrettable under the circumstances.

The ostensible reason we are supporting the bill is because the medical system is not ready. The hospitals are not ready, and the health care systems are not ready. My view is that they will never be ready, that no one can be ready for this kind of thing. I take the view that doctors have misplaced faith in the ability of politicians and legislators to achieve a state of readiness and legislative harmony. I also take the view that legislators and politicians have an elevated view of doctors' ability to manage the requests in this kind of system. The reason for that is, basically, 25 years of walking a path with one of my sons.

I am blessed to have five children and five grandchildren, which are the reward for the five children in the first place. They are delightful to both Carolyn and me. One of the boys has schizophrenia. We started on that journey when he was about 14 or 15. He was, shall we say, acting out. It took us three years to get a diagnosis, which was pretty tough on the family. It was not optimal to go home from this place and there would be a police car parked in the driveway. We had quite a number of incidents. It took us about three or four years to get a proper diagnosis.

I want to emphasize that we live in the greater Toronto area, one of the most, if not the most, prosperous areas in the country. We have access to the best doctors and are a well-resourced family, but we were flummoxed as to what to do. Nathan had a psychotic break. He is a bright lad and was in university, but, consistent with the literature, he had a psychotic break in his first year. Then we went into this deep, dark hole of the mental health system in the best-resourced area in all of the country.

Nathan spent time at CAMH and quickly figured out how to scam the system and how get out onto Spadina Avenue to get what he thought he needed. He also figured out how to play the emergency system. All anyone has to say is that they are thinking about suicide. “Suicidal ideation” is the phrase. That gets people into the system. When they think they need access to medications and cannot get them, particularly street medications or drugs, that is a good way to get in. They can get meals and people caring for them, a clean bed, all that sort of stuff, and the family starts to walk this journey.

It is not a pretty journey because the nurses are harassed, overworked and exhausted, and the doctors are not too far behind. There are medications that kind of calm people down, but, frankly, do not actually deal with the problem. It takes people a while for their bodies to adjust to the medications. Nathan had some resistance to finally being in that agreed upon regime. Then there was a period of time when he was fine, or as fine as he could be, given he had voices in his head all the time.

We went from CAMH to Whitby Psych. Again, great people and a great facility, with overworked people who are trying their best but, frankly, have limited tools. We went from there to Scarborough Health Network, the third-largest medical facility in Ontario. Again really good people, but the system and the state of medication has limited ability to deal with a person like Nathan, who kind of goes in and goes out.

Nathan has been irremediable four or five times in the past 25 years, and at any one time, he frankly would have figured out how to shop the doctor. That is what we fear based on our experience.

I perfectly understand when medical systems say they are not ready, they have to write their protocols. Protocols are subject to interpretation, and the interpretations by physicians can be pretty extensive in their variations. Nathan, being a bright lad, he would figure that out pretty quickly. Then some doctors are more enthusiastic about this procedure than are others, and he would have that figured out pretty quickly. If he was determined, and he is irremediable and this is a condition that causes a lot of suffering, he would have figured it out. That would have left us pretty bereft as a family, with a lot of guilt.

At this point, I have to say there are two saints in our family: Nathan's mother, my wife; and his stepmother. But for them, I do not think he would be here today. I want to go back to the point that we are a well-resourced family. We live in one of the most affluent areas of Canada. We have access to the best and we have two saints in the family, one of whom is a physician, and that is probably why he is still with us.

My concern is that, whether it is this bill, whether it is three years from now or whenever it is, the protocols may be be written and the protocols may or may not be subject to interpretation that would allow some people who have irremediable conditions to leave.

I am sorry we are here. This is one of the more critical decisions of legislators. It is one of the more critical decisions of the health care system writ large. The problem is that the consequences are irreversible. Within our family experience, there are several points along the way where that kind of irreversible decision could have been made, it is entirely plausible, and we would be in an entirely different situation than we are today as a family.

I am thankful for the House's time and attention. I regret to be in the situation where we are dealing with this legislation, which I think is just a postponement, but I will support the legislation because that is what is on the table.

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

Mr. Speaker, I have spoken and shared, probably a little too much at times, in this House, regarding my own family's struggles and my own struggle with suicide, and why I fight so passionately on this issue and others. I want to say a heartfelt “thank you” to my colleague across the way. I have only known him for eight and a half years, but for me that is perhaps the most profound speech or intervention that he has made.

I do want to offer this. From the testimony we have heard from the medical community, we know that seven provinces and three territories have asked the Liberal government, not for a three-year pause but, for an indefinite pause.

How does our colleague feel about that? Is that something we should look at?

[John McKay, Liberal, Scarborough—Guildwood, ON]

Mr. Speaker, I thank my colleague for sharing. Really, only families who have gone through this actually understand the reality of the situation.

One of the frustrations we run into is that Nathan is an adult. The family is cut out. Family cannot tell the physician, if the physician does not want to listen, about what they are observing. They are only getting one side of the story, which is another problem.

If it was up to me, we would not be dealing with this three-year postponement. It would be otherwise. My view is that we can never write a protocol that covers all contingencies. We can never assure ourselves that a physician could not be persuaded to do whatever needs to be done. It is a decision that people will never recover from.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Mr. Speaker, I would first like to thank my colleague for his very touching testimony.

Quebec currently approves MAID for certain conditions, notably those for which death is foreseeable. There are certain circumstances in which, we know, it is acceptable.

In this case, we are talking about mental disorders and neurodegenerative diseases. I understand that, because of his family situation, this is a very sensitive topic for my colleague.

When it comes to mental disorders, there is no consensus among experts, and we have obviously agreed to push back the deadline for including the issue of mental disorders.

However, when it comes to neurodegenerative diseases, which are diseases of the central nervous system, which are incurable and some of which, like Alzheimer's, lead to certain death, is it not possible that these illnesses are similar to situations in which MAID is already acceptable? Quebec is working on this and, I should point out, there is a consensus within Quebec society.

Have we not correctly distinguished the question of mental disorders, which are not subject to consensus, from that of neurodegenerative diseases, which are currently being studied by Parliament?

[John McKay, Liberal, Scarborough—Guildwood, ON]

Mr. Speaker, I do not live in a world of expertise. I live in a world of family experience.

The distinction between a mental illness and neurodegenerative disease is one that my colleague, who will be speaking next, would probably be able to answer much better than me.

I do think that members need to be cognizant of the transference from physical infirmities, pathologies and access to medical assistance in dying, to a diagnosed mental illness, pure and simple. There is a red line there. That is what we are dealing with today: what is on the other side of that red line.

I take his question as a good question. My colleague from Thunder Bay—Rainy River could maybe answer it much better than I.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, I also want to thank the member for sharing his personal family story with us. It takes a lot of courage to do that, and I really do appreciate it.

In part of his speech he also noted that his family is well resourced, with heroes in his family as well as with financial resources. It is fantastic, to be able to support a family member in this way. With that said, in my community of Vancouver East we have many family members who do not have those kinds of resources, so what I fear is that people might look at MAID as an option, and of course it is not an option. When we need to do is ensure that the proper resources are in place to support people through difficult times.

To that end, my question is this: For the government to consider all of these issues, how important is it to ensure that all families have access to resources to properly support them through difficult times?

[John McKay, Liberal, Scarborough—Guildwood, ON]

Mr. Speaker, I was trying to make the point that we are a well-resourced family living in an affluent community with access to the best, and I am perfectly cognizant that thousands, and literally millions, of Canadians are not. In that case, they would not be able to explore all of the other options that well-resourced families can. I take the member's point entirely, and arguably, again, that is a good reason this should not be accessible for people with mental illness under the present circumstances.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, let me start by apologizing to the four or five people who might have listened to my last speech and who are here listening again today, because this is going to sound a little repetitive.

I certainly support the legislation, and I know there are a lot of people out there who are really worried about allowing MAID for mental illness. There are people who are worried about their friends. There are people who are worried about their parents. I am most sympathetic to people who are worried about their children. I have six children, and I know that they are going to, at some point in their life, go through difficult times. I would certainly be a little worried for them if we were to allow MAID for mental illness to be implemented with the current safeguards.

I know that there are also many psychiatrists who are worried about and/or oppose the legislation. In fact, the latest statistic I heard was from a survey that showed that about 75% of psychiatrists were against it. They are worried that their patients who would otherwise get better would instead resort to MAID.

Let me take a step back and look at the arguments coming from the other side. People are going to say, “Why not? Is it not a matter of personal autonomy? Is it not my body and my choice?”. This is not about the state's dictating to the individual what they can do with their own body. It does not criminalize trying to commit suicide or committing suicide. This is about what role, if any, the state should have in assisting people to commit suicide.

I am going to come back to the issue of whether MAID for mental illness is the same as assisting suicide.

The question of whether the state ought to take a role in assisting people in ending their lives is, I think, a little like the question of whether the state should try to prevent people from killing themselves. This is a topic I know something about, having worked a lot of years as an emergency room physician. In that role, my job, if somebody came before me and was suicidal, was to keep them in the hospital, even against their will, to prevent their suicide from happening.

Occasionally people would ask why I should I have that power, saying, “ Is it not my body, and my decision to make?” I think that there are two legitimate reasons for the state to try to prevent people from killing themselves. One is to protect someone from themself. When one is in the depths of depression, they cannot realize that things will get better; that is partly why someone is so depressed and wants to kill themself. The reality for most people is that they do in fact get better.

The other legitimate reason for the state's intervention is to protect the family. The person who commits suicide is dead. The rest of the family lives on and lives with the pain, but it is not only that; they are constantly haunted by whether the death was because of something they did or did not do.

Some people are going to say that, no, MAID for mental illness is not the same as assisted suicide, that we are talking about a small group of people who have intense, prolonged suffering and have tried every form of treatment but nothing has worked, and that it is cruel and unconstitutional to not allow those people access to MAID. I disagree. The Canadian law is far more permissive than, for example, the Dutch law. There is absolutely no requirement that all forms of treatment have been tried and been unsuccessful. Our law does not even require patients to have tried any treatment at all; it requires only that the patient have no other treatment that is acceptable to them. There are going to be people who refuse all forms of treatment altogether.

I know that there are people who support MAID for mental illness who will say that the safeguards are going to come from the medical profession, that they are going to require someone to have tried all forms of treatment beforehand. Unfortunately, I do not have the same sort of faith in the medical profession's doing that. Why do I not? If we look at what has happened with the MAID regime for people with physical illnesses, we see that there are a lot of MAID practitioners who are very zealous about its being all about one's personal autonomy and saying it is not for them to question someone's suffering, and who are quick to approve people.

Let me give some examples from the media. The Fifth Estate aired a program that said that a 23-year-old diabetic going blind in one eye was granted MAID. Another person, a 54-year-old man, had back problems, but his main problem seemed to be that he was worried about losing his housing and ending up on the street. He too was granted MAID.

CTV published a couple of relevant articles. A 51-year-old woman was actually granted and got MAID for multiple chemical sensitivities. Again, from CTV, a 31-year-old woman who seemed to use a wheelchair from time to time and had multiple environmental allergies, applied and was approved for MAID; again, however, her main problem seemed to be that she could not find suitable housing.

There are those who have such faith in my fellow doctors to come up with the system and all the safeguards, but I do not share the same sort of faith. I, as someone with a lot of children, realize it is inevitable that at times in their life they are going to go through a hard time, the breakup of a relationship or financial hard times. I am really worried that they would walk through the door of a zealous practitioner who will tell them it is all about personal autonomy and is their decision to make, because who is the doctor to question their suffering. There is not any requirement in the current legislation that the MAID practitioner talk to the family or the previous treating practitioner to find out whether in fact the depression was motivated by, for example, the breakup of a relationship.

I also want to talk about what I think is a really fundamental and perhaps fatal flaw in the current regime with allowing MAID for mental illness, which is the problem, the impossibility, of determining irremediability: Who is not actually going to get better? I have spoken previously about the inability of suicidal individuals to appreciate the fact that they are going to get better. Some people would ask whether there are people who are not going to get better, who are irremediable. That is in fact the requirement of the legislation. The problem is that doctors do not have a crystal ball. They are not really good at being able to determine who really is irremediable.

In fact, a recently published study looking at the ability of clinicians to determine irremediability for treatment-resistant depression concluded:

Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard of irremediability cannot be met....

Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of [MAID] assessments.

For me, as a long-time medical doctor, it is absolutely mind-boggling that there are medical practitioners and psychiatrists who are not particularly bothered by the fact that they really cannot say whether the illness is irremediable, and would grant MAID. If we allow MAID for one such person who would actually get better, to me it would seem tantamount to the same sort of tragedy as the state's hanging someone who later turned out to be innocent. We in this place cannot let that happen.

Last, let me address the assertion of proponents of MAID who say that it is inevitable that the Supreme Court would find not allowing MAID for mental illness unconstitutional because it is allowed for physical illness. I think that, yes, there would be a finding that such a provision would violate section 15 or section 7, but as always, the question comes down to the section 1 analysis and whether the state's actions constitute a reasonable limitation as prescribed by law that “can be demonstrably justified in a free and democratic society.” I do not think the answer to that is clear. It is not just me; there was a letter written by 32 law professors who came to the same conclusion: it was not clear whether it would be found unconstitutional.

I am not going to say that we should never allow MAID for mental illness; in fact, I know personally of a case where this might have been the ethical thing to do, but I think we are a long way now from being in a situation where we should start to allow it. I would prefer the pause be indefinite, but so be it. We have what we have. Let us look at it in two years and see what has changed. I doubt very much will have changed.

[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?

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, I absolutely support that. What a humane society does when someone who is suffering comes before it is that it tries to help them. Maybe that means better psychiatric care, but maybe it means addressing their socio-economic problems. Certainly I do not think that a humane society's first response to that person ought to be to offer them death. That is an absolute failure and a solution of an inhumane society. We ought to be helping people who are suffering, not ending their lives.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, we have heard that a lot in this debate. We all want to be on the side of the angels. We all want to improve socio-economic conditions. The expert report does take structural vulnerabilities into account, and no assessor is authorized to grant a request for medical assistance in dying if there is any possibility that the request came about because of a structural vulnerability.

I paid close attention to my colleague's speech. Judging from the examples he gave, I gather he was in favour of Bill C‑14 for cases involving reasonably foreseeable death, but that he is against Bill C‑7 for people suffering from an incurable degenerative disease who are forced to cut their life short by suicide because their suffering has become intolerable. If Bill C‑7 is implemented, those people will be able to live until they reach the threshold of what they feel is tolerable.

Did I understand correctly that my colleague is against Bill C‑7 as it relates to degenerative diseases? I am curious, and I would like him to answer this question. He talked about it in his speech.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, I am not against MAID for physical illnesses. That is a totally different situation. The problem with MAID for mental illness is the inability to determine who is not going to get better. The unfortunate reality is that there are a lot of doctors who have a very cavalier attitude toward taking someone's life, and that there are people who could or would get better with a little time and with better treatment who would otherwise have their lives foreshortened by one of these zealous practitioners.

Certainly it is very different from, for example, the Carter situation, or someone who has ALS and is terminally ill with a neurodegenerative disease. That is a totally different story, and in those cases I certainly approve of MAID if that is what the person wants.

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

Mr. Speaker, I will pick up on the comment that my colleague just made, that essentially there are instances of zealous practitioners who may be going very far in terms of determining that someone is eligible when they should not be. Part of the problem with the euthanasia regime we have is that it allows doctor shopping. It allows somebody to find two doctors who may not be representative at all and may not be the attending physician, and asking them, “Would you sign this, please?” They may get approved even if they should not meet the criteria.

Conservatives proposed in the last election platform that we should require MAID assessors to complete MAID assessor training to ensure full awareness of and compliance with the laws and best practices around MAID. Would the member be supportive of the proposal that we put forward to have specific MAID assessor training to try to have more consistency and less arbitrariness and fewer instances of people shopping around?