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.

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

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, the member for Salaberry—Suroît is a tough act to follow. This is not easy, because we all have someone in mind when we talk about this. We have all lost loved ones over the past few months and years. We all have gone through different experiences. Some people request medical assistance in dying, others do not, but one thing is certain: this is a very sensitive topic. It is with great humility and sensitivity that I rise today to speak to Bill C-62, an act to amend An Act to amend the Criminal Code (medical assistance in dying), no. 2, something we have been talking about for a long time.

We must act by considering the fact that, currently, the Government of Quebec's Bill 11 does not include non-neurocognitive mental disorders as being eligible for medical assistance in dying and that Quebec wants to fill the administrative void surrounding the federal government's position on the subject of mental disorders relative to neurocognitive disorders. Therefore, I am not here to repeat my whip's testimony. I am here to provide some background and talk about Quebec's specificities. I will close by going into more detail about the Bloc's position.

First, in 2014, Quebec passed the Act Respecting End-of-Life care after five years of consultations and of working together across party lines. I want to emphasize that the work was non-partisan. In 2015, the Supreme Court ruling in Carter indicated that some provisions of the Criminal Code that prohibited medical assistance in dying contravened the Canadian Charter of Rights and Freedoms. In 2016, the Liberal government passed Bill C-14, in response to Carter. In 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, who claimed that excluding people whose death was not reasonably foreseeable from eligibility for medical assistance in dying was discriminatory. As a result, the court ordered that federal and provincial laws be amended before December 18, 2020.

In 2021, after a pandemic-related delay, Parliament passed Bill C‑7, which created two pathways to medical assistance in dying: One for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable. Quebec simply chose to drop the end-of-life criterion. Bill C‑7 required that an expert panel be created to review MAID and mental illness. The Expert Panel on MAID and Mental Illness was formed in August 2021 and produced a final report containing 19 recommendations. Recognizing that the legislation was flawed and that issues related to medical assistance in dying remained unresolved, Bill C-7 created the Special Joint Committee on Medical Assistance in Dying, composed of members of the Senate and members of the House of Commons, which had a five-part mandate.

The joint committee tabled an interim report on June 22, 2022. There was not much time between the tabling of the joint committee's report, which was initially expected in 2022, and the March 17, 2023, deadline for excluding people from MAID for mental illness, so members postponed eligibility for one year to allow the committee to finish its work. The goal was to give the professions involved more time to develop standards of practice. At last, in February 2024, the joint committee produced its final report. The report contains only one recommendation. Bill C‑62 implements the report's recommendation by postponing eligibility for MAID MD-SUMC, for mental disorders, for three years and by forcing the creation of a joint committee one year before the report.

Sections 241.1 to 241.4 of the Criminal Code govern medical assistance in dying in Canada. What is more, under the law, the government is required to oversee the use of medical assistance in dying via the Regulations for the Monitoring of Medical Assistance in Dying. I am providing all of this background to illustrate that the government could have and should have taken action a long time ago.

Second, in Quebec, medical assistance in dying is governed by the Act Respecting End-of-Life Care. The activities surrounding medical assistance in dying are supervised by the select committee on end-of-life care. In June 2023, the National Assembly of Quebec passed Bill 11 to expand access to medical assistance in dying in Quebec and harmonize Quebec's legislation with the Criminal Code. There are some notable changes to Quebec's legislation. Minister Sonia Bélanger and her colleagues Roberge and Jolin‑Barette held a press conference on February 7 calling on the government to include a provision in the Criminal Code that would allow Quebec to move forward with advance requests, because, even though Quebec's legislation allows it, the Criminal Code does not.

Although doctors who choose to go ahead with advance requests are unlikely to be prosecuted by Quebec's attorney general, the risk of a civil lawsuit is still there, and that will make many doctors think twice about granting advance requests. Quebec's National Assembly has passed a unanimous motion demanding that the federal government legislate on the issue.

Third, the Bloc Québécois will vote for the bill on the condition that the postponement is for one year, not three. The Bloc Québécois believes that eligibility for people suffering from mental disorders must be postponed so that Quebec, the provinces and professional bodies can create a framework for their MAID practices. However, it should not be postponed indefinitely. The Bloc Québécois believes that postponing eligibility by three years will prolong the suffering of individuals who could be eligible for MAID and is contrary to their rights as guaranteed by the charters. The Bloc Québécois wishes to point out that the report of the Expert Panel on MAID and Mental Illness, as well as the Collège des médecins du Québec, emphasized that the safeguards—namely irremediability, severe physical or mental suffering, and free and informed consent—currently provided for in the Criminal Code are sufficient to allow access to MAID where mental disorder is the only underlying condition.

In our supplementary opinion attached to the report of the Special Joint Committee on Medical Assistance in Dying, the Bloc Québécois points out that, even though preparations on the ground for medical assistance in dying when a mental disorder is the sole underlying medical condition are not yet complete across Canada, this does not change the fact that several professional associations, including the Collège des médecins du Québec and the Association des médecins psychiatres du Québec, would still like it to be made available in the future.

The Bloc Québécois also acknowledges the requests made by several provinces to postpone eligibility. It should be noted that many countries have adopted policies on medical assistance in dying specifically for mental disorders.

The Bloc Québécois deplores the government's failure to be proactive and the Conservatives' obstruction on the issue of medical assistance in dying when a mental disorder is the sole underlying medical condition and on the issue of advance requests. We fear for the patients who will have to turn to the courts to assert their rights while also bearing the burden of their illness.

Finally, the Bloc Québécois condemns the fact that this bill does not distinguish between mental disorders and neurodegenerative diseases, such as Alzheimer's and Parkinson's. Quebec's law makes that distinction. It would allow people suffering from the latter category to access medical assistance in dying, as advocated by the Quebec government. In the Bloc's opinion, the social consensus on these illnesses is stronger, and it would have liked to see the Criminal Code brought into line with Quebec's end-of-life care law by allowing advance requests.

In his supplementary opinion on MAID, the member for Montcalm, whom I would like to congratulate for all his work on this issue, went into great detail on the reasons that justify MAID when a mental disorder is the sole underlying condition. The position of the Collège des médecins du Québec perfectly sums up the importance of allowing advance requests for medical assistance in dying, as well as medical assistance in dying when a mental disorder is the sole underlying condition. While admitting it needs more time to ensure its members are ready, the Collège des médecins du Québec has established five guidelines for assessing eligibility for medical assistance in dying.

In conclusion, the Bloc Québécois has a humanist view of medical assistance in dying that is grounded in philosophical principles and ethical arguments that reflect the evolution of Quebec society. Medical assistance in dying recognizes the right of individuals to choose for themselves, to determine the conditions for a healthy and dignified life. Medical advances allow us to sustain life, but that does not preclude the need and right of the individual to define what is an acceptable life. Section 1 of the Quebec Charter of Human Rights and Freedoms states that every human being has a “right to life, and to personal security, inviolability and freedom”.

Quebec society believes that the right to life includes the right to die. In that context, we need to see medical assistance in dying as a right that gives the individual the option of avoiding terminal suffering and medical paternalism in order to maintain their dignity. By allowing medical assistance in dying, we allow people to choose how, when and where they want to pass away.

Medical assistance in dying only makes sense if the person's free and informed consent is respected. The word “free” means voluntary and without constraint, and the word “informed” means with all the information needed to make such a decision. Meeting this condition is necessary for accessing medical assistance in dying.

The principles we stand for concerning medical assistance in dying are equally valid in cases of mental illness. Let us not forget that the possibility of access to MAID does not mean automatic eligibility. However, when the Quebec select committee was doing its work, it made a distinction between mental disorders and neurodegenerative diseases. The commission concluded that although there was no consensus on mental disorders, there was a consensus on neurodegenerative diseases. With that in mind, the Quebec government opened the door to advance requests. Advance requests allow an individual to determine the conditions under which MAID should be administered when they have lost the capacity to consent because of their illness.

In its second report, the Special Joint Committee on Medical Assistance in Dying expressed its support for advance requests. All parties, except the Conservatives, who are against any form of medical assistance in dying, voted in favour of the recommendations.

As a final point, the federal government therefore has no reason to drag its feet or to deny Quebec's request.

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

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

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

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

[Majid Jowhari, Liberal, Richmond Hill, ON]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Mr. Speaker, I thank my colleague for his question.

Partnership with provinces, including Quebec, is extremely important in order for the legislation around MAID to be applied properly. As we know, delivery of health care is a provincial responsibility. It is really important that our provinces have all the tools and the time necessary to administer MAID in an appropriate manner.

That is why the work that is happening around setting of curriculum, training and the tools that regulatory bodies need to ensure that the training and curriculum is being met, as well as that the safeguards are being complied with, is important. This is also why the three-year extension under Bill C-62 is absolutely necessary.

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

Mr. Speaker, I appreciate being recognized to speak to a very sensitive and emotional issue.

Today, I am pleased to be speaking to Bill C-62. This bill proposes extending the temporary exclusion from MAID for people whose sole underlying medical condition is mental illness.

We are proposing that the exclusion be extended by three years. To understand why an extension of this exclusion is so important right now, we need to look at how we got to this point in the legislative process.

As members know, former Bill C-7 was enacted in response to the Quebec Superior Court Truchon ruling. The ruling found that the original MAID legislation, which required a person's natural death to be reasonably foreseeable, contravened the Charter of Rights and Freedoms.

The former Bill C-7 received royal assent and became law on March 17, 2021. This law included a temporary two-year exclusion of eligibility for individuals suffering solely from mental illness, which meant that such persons would become eligible to receive MAID starting March 17, 2023, if they met all other eligibility criteria. The intent of this two-year delay was to allow an expert panel to undertake an independent review and to provide recommendations respecting any protocols, guidance and safeguards that should apply to requests for MAID by persons with a mental illness.

I will be sharing my time with the member for Richmond Hill.

On May 13, 2022, the “Final Report of the Expert Panel on MAiD and Mental Illness” was tabled in Parliament and released publicly. The expert panel noted that MAID clinicians are already assessing very complex cases and concluded that certain assessment challenges, such as determining incurability or assessing decision-making capacity, are not unique to MAID requests from persons with a mental disorder, nor are they applicable to every requester who has a mental disorder. The expert panel also concluded that the existing MAID eligibility criteria and safeguards in the legislation provide an adequate structure for MAID where a mental disorder is the sole underlying medical condition, as long as they are interpreted and applied appropriately.

The expert panel's recommendations provide guidance to support complex MAID assessments. In its final report, the expert panel made 19 recommendations, laying out a broad set of principles that could structure the practice of MAID not only for persons with a mental disorder but also for those with other conditions where concerns may arise related to incurability, irreversibility, decision-making capacity, suicidality and/or the impact of structural vulnerability, regardless of the person's diagnosis.

The government supports the insights and general advice emerging from the panel's work. Let me take a few minutes to highlight some of the key achievements.

The expert panel report recommended the development of national practice standards on MAID for mental disorders and other complex cases. Practice standards help regulatory bodies evaluate the appropriateness of the clinical decisions of health professionals who assess and provide MAID. They also provide clarity to MAID clinicians regarding their professional obligations. In March 2023, a model practice standard for MAID was released along with a companion document of advice to the profession, which provides a series of questions and answers that elaborate upon specific clinical questions raised by the model standard.

That is not all we have done to help prepare a safe approach to providing medical assistance in dying across Canada.

We are providing $4.9 million to the Canadian Association of MAiD Assessors and Providers to develop and deliver an accredited, Canadian-made curriculum to support practitioners. This consists of seven training modules that address various topics related to the assessment and provision of MAID, including guidance in how to assess capacity and vulnerability, how to navigate more complex cases and how to assess MAID requests with mental illness as the sole underlying condition. The MAID curriculum was launched in August 2023. Over 1,100 clinicians have registered for it.

From when MAID legislation was enacted in 2016 to the end of 2022, over 44,000 Canadians received MAID. The vast majority of these individuals were at the end of their life. In fact, numbers from 2022 show that 96.5% of individuals accessing MAID were terminally ill, and two-thirds had a cancer diagnosis. Many more requested MAID but were ruled ineligible based on the strict eligibility criteria and safeguards, withdrew their requests or died before receiving MAID. This is not unexpected.

The government recognizes that public reporting is critical to ensuring transparency and public trust in the legislation. Both the original MAID legislation of 2016 and the amended law passed in 2021 set out obligations for the collection of data and public reporting on important aspects of MAID. As of January 1, 2023, we have expanded our collection of information on MAID.

I would like to take this opportunity to highlight the achievements of the provinces and territories, as well as key partners in the system, such as health care professionals, who are working to safely implement MAID within their health care systems.

We have come a long way, but we have heard clearly that there is more work to be done. More preparations are required within the provincial and territorial health care systems to support the wraparound activities that may be necessary for the management and assessment of MAID requests where mental illness is the driver.

We also know that some Canadians and members of the medical community are concerned about expanding eligibility for MAID to people suffering solely from mental disorders.

We will continue the work with the provinces, territories and key health system partners to support the safe implementation and delivery of Canada's framework for MAID, while protecting those who may be vulnerable. The expert panel also recommended consultations with first nations, Inuit and Métis people. We recognize the importance of meaningful engagement and ongoing dialogue with indigenous peoples to support the culturally safe implementation of MAID.

Working in partnership with indigenous communities, we have developed an extensive plan for indigenous engagement. Our approach involves both indigenous-led community engagement and federally supported activities, such as an online tool, which has already been launched, and knowledge-exchange round tables, which will be taking place this February to April. We are working closely with indigenous partners to design a process with them at their pace.

I recognize that there is a lot of hard work being done in order to show that MAID is accessible to people who need it, with appropriate safeguards in place. However, we need to make sure that we do not rush into that decision. This is why it is really important that we extend the application of this particular bill, as it relates to people with mental disorders, by at least three years; as a result, all provinces and territories can have the appropriate training and assessment tools ready.

A year ago, we extended the exclusion period for one year, until this March. As we approach that date, we have heard unanimously from all provinces and territories that their health care systems are at various stages of readiness, and there is more to be done.

The decisions we are making about MAID are not easy to make, nor should they be.

These are life-and-death decisions and we must get this right.

In Bill C‑62, the government has put forward a three-year extension of the exclusion from eligibility for MAID for people suffering solely from mental illness.

I urge all members of this House to support Bill C-62.

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

Mr. Speaker, following up on the question from the member for Fredericton, I was a member of that special joint committee, and I agree with her that its work was quite important. I think that every member, both from the House and the Senate, approached the subject matter with the responsibility and gravitas it demanded. However, I will put an asterisk beside that because the committee, in its last iteration, was afforded only three meetings of three hours each with witnesses. Unfortunately, there were a lot of witnesses we could have heard from. We did not even have time to go over the briefs that were submitted because there were so many of them and there simply was not time to translate them into both official languages.

This is mainly a comment for the parliamentary secretary to respond to: I am glad to see that we actually have a legislative requirement built into Bill C-62 that the special joint committee would be reconvened. I hope it would be done with plenty of runway to give this particular subject the time it deserves, which I frankly would say most Canadians expect.

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

Mr. Speaker, I appreciate the fact that the member emphasized how this is a deeply personal issue, to use her words. That is why, at the beginning of my comments earlier today before question period, I tried to amplify why it is so important that the House reflect on what brought us here today.

I reflect on the debates that took place in early 2016, which were conducted in more of a non-partisan approach where members of all political parties talked about what is a very important issue. Nothing has changed in the sense of the importance of the issue. We are talking about an issue of death, and we see that Conservatives are putting a twist on it in an attempt to politicize the issue to the degree that there is some silliness as to what is being implied.

I like to think that anyone who is even entertaining the idea of accessing MAID takes it very seriously. That is the reason why, in good part, I believe that every member of the House, party politics aside, should be looking at what the Supreme Court of Canada right back to 2015, and the Charter of Rights, said our responsibility is as legislators: to come forward with good, sound public policy. I believe that over the years, including today with Bill C-62, we have been addressing a very important issue and that the three-year extension is needed because of the response we are getting from stakeholders, in particular our provinces.

Alleged Inadmissibility of Amendment to Motion, Government Business No. 34

[Andrew Scheer, Conservative, Regina—Qu'Appelle, SK]

Mr. Speaker, I appreciate your accommodating the timing of this. I apologize to the members who are involved in debate, but because the matter is currently under consideration by the House, I think giving the Speaker as much time as possible to consider it would be appropriate.

I am rising to ask that you rule the amendment made to the motion, Government Business No. 34, out of order, since according to Bosc and Gagnon, at page 541, it introduces a new proposition which should properly be the subject of a separate substantive motion.

The main motion proposes two things in relation to Bill C-62. Part (a) would establish committee meetings on the subject matter of Bill C-62. It proposes one hour to hear from a minister and two hours to hear from other witnesses.

Part (b) deals specifically with the time and management for each stage of the bill. Part (b)(i) would order the consideration by the House of a second reading stage and provides for the number of the speakers, length of speeches, length of debate and deferral of the vote at second reading. It would also restrict the moving of dilatory motions to that of a minister of the Crown. Part b(ii) would deem that Bill C-62 be referred to a committee of the whole and be deemed reported back without amendments, and it would order the consideration of third reading on Thursday, February 15, 2024.

Nowhere does the motion deal with the substance or the text of Bill C-62; it is a programming motion dealing with process, not substance. While this can and has been done by unanimous consent, it cannot be done by way of an amendment. The consequence of an amendment to allow for the expansion of the scope of Bill C-62 and, at the same time, proposing to amend the text of Bill C-62, is that it would, if accepted, expand the scope of the motion.

The process to expand the scope of the bill outside of unanimous consent is to adopt a stand-alone motion after the proper notice and procedures were followed. Page 756 of Bosc and Gagnon describes that procedure as follows:

Once a bill has been referred to a committee, the House may instruct the committee by way of a motion authorizing what would otherwise be beyond its powers, such as...expanding or narrowing the scope or application of a bill. A committee that so wishes may also seek an instruction from the House.

Alternatively, a separate, stand-alone bill would suffice to introduce the concept of the subject material that is under the amendment for MAID. It is not in order to accomplish this by way of a simple amendment to a programming motion dealing with the management of House time on a government bill.

If you were to review the types of amendments to programming motions, and I am not talking about unanimous consent motions, they all deal with the management of House and committee time, altering the numbers of days, hours of meetings, witnesses, etc. As recently as December 4, 2023, the House disposed of an amendment that dealt with the minister's appearing as a witness and the deletion of parts of the bill dealing with time allocation. This was also the case for the programming motions for Bill C-56, Bill C-31 and Bill C-12.

Unless the main motion strays from the management of time and routine procedural issues and touches on the actual text of the bill, an amendment that attempts to amend the bill is out of order. For example, on May 9, 2023, the House adopted a programming motion for Bill C-21, the firearms act. Part (a) of the main motion then stated that:

it be an instruction to the Standing Committee on Public Safety and National Security, that during its consideration of the bill, the committee be granted the power to expand its scope, including that it applies to all proceedings that have taken place prior to the adoption of this order...

The motion went on at some length, instructing the committee to consider a number of amendments to the act. This in turn allowed the Conservative Party to propose an amendment to the programming motion and offer its own amendments to the bill itself, which addressed illegal guns used by criminals and street gangs and brought in measures to crack down on border smuggling and to stop the flow of illegal guns to criminals and gangs in Canada, to name just a few.

The point is that if the main motion does not address the text of the bill, an amendment cannot introduce the new proposition of amending the text of the bill to the programming motion, which should properly be the subject of a separate substantive motion.

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

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, members of the Conservative Party might not like what I have to say, but it is the truth, and sometimes the truth hurts. If we go back to the original debates in May, we would find a great deal more compassion being expressed on the floor of the House of Commons, on all sides. Whether they were Liberals, Conservatives, New Democrats or any others, members demonstrated very clearly the difficulty of what Parliament had to do in bringing in MAID to respect the Supreme Court of Canada decision. Today during the debate, we witnessed the leader of the Conservative Party standing on a point of order on something completely irrelevant to the debate, to attempt to table a document. Why did he? He just could not wait until question period, I guess, which begins after statements by members that start in about 15 or 20 minutes.

We should listen to what some of the Conservative speeches have been about. Some Conservatives, the last couple in particular, have stood in their places and given a false impression that the legislation would be like suicide on demand. The member for Battlefords—Lloydminster said that today someone feeling depressed due to mental health issues could go to a doctor and book an appointment to commit suicide, with the government's support, on Friday. Members of the Conservative Party are spreading misinformation on such a sensitive issue. These are very difficult things that Canadians have to deal with every day.

Yesterday the member for Cumberland—Colchester referred to 12,000 or 13,000 people being killed in a very ad lib fashion, implying that the legislation just allows people to be killed. From my perspective, the decision to access MAID is not easy; it is a very difficult one. Family members and individuals are experiencing some very difficult times in dealing with a real-life situation. Conservatives, yesterday and today, are virtually making a mockery of it and spreading misinformation on such an important issue. What happened to the compassion of 2015-16 and even 2017? At that time, there seemed to be a sense in the chamber that, yes, at times there are going to be disagreements if members feel very passionate about an issue, as they should, but there was also a much higher sense of co-operation as members shared the experiences they were being told about by their constituents.

The member for Portage—Lisgar said that people are going to food banks and are thinking of committing suicide because of the cost of living. There are a number of things that come to my mind that speak to the manner in which individuals across the way make those types of stupid statements. That is, quite frankly, what they are; they are not legitimate contributions, such as discussion about supports and services would be, to the debate on such an important issue that the House is having to address.

In the debates taking place in 2015-16, we heard a great deal about issues like hospice and palliative care. We wanted to ensure that MAID legislation would not in any way be utilized as a direct result of not having proper services and systems in place to provide assurances to those individuals who were feeling so compelled to actually access MAID. Those are the types of things that I think really contributed a great deal back then.

Today, in contrast, Conservatives will say, “What about the $4.5 billion that the Liberal Party made a commitment to?” Members are right in that there was a substantial commitment by the government to deal with the issue of mental health, and the commitment was significant: several billions of dollars over five years. It is one of the reasons that the health care agreements we have put into place, which were highlighted last year, of just under $200 billion over 10 years, are to support health care not only today but also in future generations that will benefit by that sort of investment. Furthermore, the Minister of Health is working with provinces, coming up with agreements that deal with things like mental health and services. We recognize how important it is to ensure that these services are being supported.

Unlike a number of members from the Conservative Party, and I do not want to label them all, at least not at this point, this is a government that has continued to work with, in particular, provincial jurisdictions and other stakeholders in different forums in order to provide assurances that the people who are accessing MAID are, in fact, being informed in a very tangible way of the types of services available. In no way whatsoever is it as simple as their just saying, “I want this and I will get it”, and then two days later receiving it. We can look at the amount of public attention and debate that has taken place on issues such as palliative and hospice care since the MAID introduction, which I believe have been greatly enhanced.

I would like to think that provinces, which are ultimately responsible for the public administration of health care services, have taken note and understand that they too have a responsibility because they are the ones delivering the services that Canadians expect. The federal government has recognized that by supporting things such as the encouragement of long-term care standards and by providing substantial finances to ensure that provinces are better able to meet the demands on health care services. With respect to what I said earlier in regard to mental health, there are serious commitments that we continue to live up to and work on with other jurisdictions.

I have confidence, as I indicated yesterday, in the health care professionals, the social workers and the other individuals who have the expertise and confidence in the individual who feels that MAID might be the avenue for them to pursue. There is a great deal of effort put into every situation, and I have confidence in the system.

Members can correct me if I am wrong, but I cannot recall one province or premier in Canada that has clearly said that MAID is not working. The provinces are asking for the three-year extension in one aspect of MAID: where mental health is the sole reason for the request. The issue of the sole underlying medical condition being a mental illness was added to the original MAID legislation, then brought in as a form of legislation and allowed a period for provinces and jurisdictions to have time to get what is necessary in place so Canadians could be served.

We then found that the provinces required more time. There were a number of provincial governments not saying to get rid of MAID, but rather saying that they needed more time for the implementation of that aspect of it. That is in essence why we have the legislation that we have before us today.

However, if we listen to members of the Conservative Party, we will find that they give no indication of supporting Bill C-62. It will be interesting to see how they actually vote. Logically, I would think they would vote in favour of the bill. If they do not vote in favour of Bill C-62, and, for whatever reasons, the legislation were not to pass, ultimately the criterion of sole underlying medical condition of mental illness would take effect on March 17 of this year. Therefore, it is important that members, no matter what side of the debate they happen to be on, would be in favour of the legislation because it is a direct response to what is being asked of the Government of Canada by our partners that are ultimately responsible for administering the legislation.

Members opposite will often try to say that it is up to the government. It is important to highlight what I mentioned at the very beginning: The reason we have MAID legislation today is that in 2015, the Carter decision by the Supreme Court in essence said we had to bring it in. There was no choice, if, of course, we respect the Charter of Rights and Freedoms. I will repeat what I said yesterday: There was a great deal of consultation, literally hundreds of hours of different types of meetings, including standing committees, chamber debate, outside meetings in ridings, canvassing and petitions. Even though there were all sorts of mechanisms to provide input, at the end of the day, I believe that the legislation met a threshold to, in good part, deal with the concerns of the Supreme Court of Canada and to respect the Charter of Rights.

That was followed by a decision in appeal court in Quebec giving us another obligation to improve the legislation and that is exactly what we did.

We continue today to look for ways to improve the legislation. I believe it is a reflection of the Canadian Charter of Rights and Freedoms. If members of the Conservative caucus are saying that they do not support the MAID legislation, then I would question whether they actually support the Canadian Charter of Rights and Freedoms.

I would further add that the leader of the Conservative Party's general attitude—

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

Madam Speaker, I am not too sure if the member actually understood the question that was just posed to him. It points out a major issue within the Conservative Party. The Conservatives have said that they do not support it, yet they did not vote in favour of the motion that ultimately, by it passage, will guarantee that this motion is able to pass Bill C-62.

What is the essence of Bill C-62? It is to provide a three-year waiting period, so the concern that he has does not take effect come March 17 this year. If this legislation does not pass, what the Conservatives are complaining about will actually turn into a reality. One would think that they would understand that. I can appreciate that a majority, in listening to the discussion, is of the same opinion as the member across the way. If they support what they say, then they should support Bill C-62. If they do not vote for Bill C-62 and the bill does not pass, there will be no three-year extension.

I am very disappointed in the manner in which this issue is being debated. It is a very serious issue. I remind members that the reason we have the debate today is because of a Supreme Court of Canada decision back in 2015, which the then prime minister Stephen Harper did not act upon. That was back in early 2015.

After the 2015 general election, when we assumed office in November 2015, one of the first things we did was look at the legislative agenda. We did some positive things, but one of the things we had to deal with was the Supreme Court of Canada decision, which the Conservatives actually ignored. That meant we had to bring in MAID legislation. It was not an option.

Is there a member of the Conservative Party today who would stand up and say that there was an actual option, that we did not have to respect the Charter of Rights, the rights that are guaranteed to Canadians from coast to coast to coast?

If one reflects on the debates that took place back then, it is quite the opposite with respect to what we are witnessing today. Back then—

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Madam Speaker, the decisions made in this place have a direct impact on the lives of Canadians. That impact can be no greater than when it is a matter of life or death, and this is exactly the case with this piece of legislation. As members of Parliament, we have a duty to serve in the best interests of Canadians; this duty must extend to the protection of the most vulnerable in society.

I should note that I will be splitting my time with the member for Portage—Lisgar.

The expansion of medically assisted death to those suffering from mental illness is dangerous and, simply, reckless. It is inevitable that the expansion of MAID to those suffering solely from a mental illness would result in the deaths of Canadians who could have gotten better. This is not to say that those with mental illness should be left alone to suffer. Recovery is possible, and we cannot give up on these individuals and their loved ones. Canadians suffering from mental illness need and deserve support and treatment. They may feel that their situation is hopeless, but the antidote is hope, not death. They deserve government policy and a health care system that are compassionate and responsive to their needs. Where there are gaps or shortfalls in our care system, we should prioritize working alongside our provincial partners to address them. That, not expanding MAID, should be the priority.

The Special Joint Committee on Medical Assistance in Dying heard loud and clear from the mental health experts and advocates that the planned expansion of MAID was dangerous. The current Liberal government has already had to introduce eleventh-hour legislation to delay the expansion of MAID by one year from the date that it had arbitrarily set. We find ourselves, ironically, now in the same position as we were in last year. Bill C-62, once again, would only offer a temporary delay in the expansion of MAID to persons suffering from mental illness. The risks and dangers that exist today would continue to exist in three years. However, the Liberal government is intent on its expansion.

It is truly frightening to see that the Liberal government wants to continue to expand the access to MAID, despite clear concerns about safeguards of vulnerable people. The Liberals' careless approach was already evident when the Liberal government decided not to appeal the Truchon ruling and, instead, introduced legislation that went much further than the ruling had required.

What we have seen repeatedly from the current Liberal government is the willingness to offer MAID to more and more Canadians, without prioritizing supports or treatment. This continues to be the case with those in the end stages of life. Through pain management and psychological, emotional and practical supports, palliative and hospice care provides relief from pain, stress and symptoms of serious illness. Palliative care has proven to improve the quality of life not only for the patient but also for their family. However, access to this is not universal here in Canada.

The government's own report on the state of palliative care in Canada, released this past December, confirms that access to palliative care is indeed not universal. We do not have the necessary safeguards in place to protect vulnerable Canadians when access to MAID is more universal than access to palliative care is. When Canadians suffering from serious illness do not have access to appropriate care, they can be left feeling hopeless. Personal autonomy is not increased when a person feels as though they have no other choice.

When the current Liberal government removed the “reasonably foreseeable death” clause from the MAID framework, it opened up to persons with disabilities who are not close to death. Disability advocates raised alarm bells with this decision, and the news stories that have emerged in recent years have underscored the risks and the danger in that decision. Reports showing that poverty, not pain, is driving Canadians with disabilities to consider assisted death are truly heartbreaking.

For persons with disabilities, the pressures of the cost of living crisis are compounded. Their basic living costs are generally much more significant. As the prices go up on everything, their costs are even greater. It is unacceptable that there are persons with disabilities turning to MAID because of their cost of living situation.

This NDP-Liberal government's inflationary spending and taxes are fuelling the affordability crisis in this country, and what is even more shameful is that, despite the pain and suffering it is causing Canadians, there has been no course correction for this costly coalition. It has continued to mismanage tax dollars. It is intent on quadrupling the carbon tax, which is increasing the cost of just about everything.

Let us not forget that not a single disability payment has gone out to those who want it and have been asking for it. Bill C-22 was sped through the parliamentary process, but those who are desperate for financial assistance are still waiting.

The affordability crisis is continuing to surge across the country, and it is further putting persons with disabilities in a vulnerable position. Medically assisted death should not be more readily available to persons with disabilities than the supports and accommodations they need to live a full, healthy and dignified life.

Repeated reports that Canadians are being offered medically assisted death without first requesting it is also very alarming. It suggests that safeguards have not been put in place to ensure that vulnerable people are not being pressured or coerced into seeking medically assisted death. No person should feel that the health care system, the infrastructure that is meant to provide care and support, sees no value in their lives.

There are serious concerns with the existing MAID framework and the framework's ability to protect the most vulnerable in our communities. These are concerns that are not being addressed by the Liberal government and that ultimately should be the priority of the government on an issue such as medically assisted death. When the risks and concerns that exist with the current framework are already proven to be warranted, we should certainly heed the clear warnings against its expansion.

Experts have said that it is impossible to predict in any legitimate way that mental illness is irremediable. This means that individuals suffering solely from mental illness can recover and can improve. Their mental health state is not destitute nor without hope. If medical assistance in dying is offered to persons suffering solely from mental illness, it is inevitable that vulnerable Canadians will die who could have gotten better.

Experts have also made it clear that it is difficult for clinicians to distinguish between a rational MAID request and one motivated by suicidal thoughts. Persons with mental illness are already disproportionately affected by suicide and suicidal ideation. To extend access to medically assisted death to this group of individuals contradicts and undermines suicide prevention efforts. Every single person's life has value and purpose. It is not acceptable to have government policies in place that devalue the life of a person, and the Liberal government's intention to expand access to MAID fails individuals suffering from mental illness in this country.

Whether it happens in March of this year or in three years, the expansion of MAID will still be dangerous and reckless. The delayed expansion of MAID will ultimately still fail vulnerable Canadians. Bill C-62 does not go far enough to protect those suffering with mental illness. The Prime Minister must immediately and permanently halt the expansion of medical assistance in dying to persons with mental illness. We cannot give up on an individual who is suffering. They deserve support and treatment, not death.

Common-sense Conservatives know that recovery is possible for persons suffering from mental illness. We do not support policies that abandon people when they are in their most vulnerable state. Death is not a treatment for suffering. We will stand with them and their loved ones. Above all else, when we consider medically assisted death, we must be gripped by a resolve to protect the most vulnerable because, in matters of life and death, there is simply no room for error.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is a rather accurate summary of what happened in committee. The government decided to include in legislation the committee's main recommendation on mental disorders. My colleague sat on the committee that produced the report tabled in February 2023, which recommended allowing advance requests.

Why has his government not introduced a section on advance requests after a year of waiting? I think that would have been good for people who are currently suffering and who cannot make an advance request. Why is this not included in Bill C‑62?

[James Maloney, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I will be sharing my time with the member for Saanich—Gulf Islands.

It is a pleasure to speak today to Bill C-62. The bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID—

[Gord Johns, NDP, Courtenay—Alberni, BC]

Mr. Speaker, it is an honour to rise today on the unceded lands of Tseshaht and Hupacasath on Vancouver Island in Nuu-chah-nulth territory to speak to Bill C-62, which is calling for the extension of the temporary exclusion of eligibility for medical assistance in dying for persons suffering solely from a mental illness by three years, until March 17, 2027.

Clearly, without an intervention by Parliament, this expansion would come into effect on March 17, 2024, in just one month. New Democrats agree with the majority decision made by the Special Joint Committee on Medical Assistance in Dying, also known as the AMAD committee, which I will refer to it as in my speech. It reported that Canada is not adequately prepared to deliver medical assistance in dying to individuals whose sole underlying medical condition is a mental disorder.

The bill would allow more time to implement the necessary safeguards and address the capacity concerns that are expected to be the result of the expansion of medical assistance in dying for those with the sole underlying medical condition of a mental disorder. It would give medical practitioners more time to become familiar with available training and supports, while providing time for the public to become more aware of the robust safeguards and processes in place. I know this is a very sensitive and very personal matter to so many people around this country. Especially in my riding of Courtenay—Alberni, I have heard from many people about this.

We also need to ensure that we have the understanding and compassion to respect the right of an individual's choice of dignity when they have deep, prolonged and ongoing suffering. I will speak to that. Suffering from mental illness is extremely serious, and it is just as real as suffering from a physical illness. In our health care system, we clearly do not have parity when it comes to mental and physical health, and I will speak to that as well.

We must also affirm and protect the most vulnerable when we do any sort of decision-making on such a serious piece of legislation as expanding medical assistance in dying. This additional delay is necessary and needed right now to ensure that we have a health care system in place that can safely provide medical assistance in dying for those whose sole underlying medical condition is a mental disorder.

We know how we got here. The Liberal government made an ill-advised decision and did a complete 180° by accepting the Senate's amendment to Bill C-7 in the 43rd Parliament. That is what got us here. The government changed the law before any kind of comprehensive review had been conducted, and we have been trying to play catch-up ever since. I am going to speak about the important work that needs to be done, and I want us to be thoughtful in our approach to expanding medical assistance in dying.

As New Democrats, we take people's concerns and feedback very seriously. We are committed to helping find the best possible solution for Canadians in the policy of medical assistance in dying to ensure that it does what it was always intended to do. One of the biggest concerns New Democrats have with the expansion of medical assistance in dying is with the barriers that many Canadians face when they reach out for mental health treatment. Because of the Liberals, and the Conservatives before them, the chronic underfunding of our health care system has become even more apparent. It is now more than ever, as we see the disparity between mental and physical health and how people are taken care of.

We heard the Prime Minister promise to implement a new mental health transfer of $4.5 billion over five years, but he has still not done that. Even with the bilateral agreements, the Liberals are falling far short, and that would not even be enough. Everyone should be able to access mental health supports when they need it, but under the Liberal government, and that of the Conservatives before it, this has not been the reality. It is the same with all provinces and territories.

New Democrats wholeheartedly support the delay in expanding medical assistance in dying for those who have a mental disorder as the sole underlying condition, but the Liberal government needs to ensure that proper consultation happens between now and the expansion date, or it would need to be extended again. It needs to ensure that people will be protected while respecting their individual choice.

The Liberals cannot just delay the expansion either. They need to fund adequate supports and treatment options for people dealing with mental illness. Members have heard me say this repeatedly, but we need a pathway, a road map, to how we are going to achieve parity for mental and physical health and ensure people get the timely help they need when they need it.

Seven of the provinces and all three territories have said that they are not ready and have signed a joint letter to that effect, including my home province of British Columbia. That was signed by the ministers of health in those provinces and territories. They are calling for an indefinite pause on the expansion for individuals whose sole underlying medical condition is a mental disorder. That is what those ministers identified.

As New Democrats, we want to see a MAID regime where guardrails are in place to protect vulnerable populations while still allowing for personal bodily autonomy and end-of-life choices. We must make sure that people do not request medical assistance in dying because they do not have access to treatments, supports and services. This has to be absolute. The Liberals need to make sure everybody can access mental health supports. However, after nine years of carrying forward with the Conservative cuts to health care, this is where we are at right now right across the country. Help is out of reach for many people. This needs to change before medical assistance in dying can be expanded.

We know that the housing, toxic drug and mental health crises that are happening are not being addressed. I see that I do not have a lot of time left, but I want to ensure I outline that the AMAD committee heard from plenty of witnesses who cautioned the committee on expanding MAID in cases of persons suffering solely from a mental illness. I want to share what a couple of those experts had to say.

Professor Brian Mishara, who is with the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at Université du Québec à Montréal, said, “The expert panel report on MAID and mental illness states that there are no specific criteria for knowing that a mental illness is irremediable”, and that there is absolutely no “evidence that anyone can reliably determine if an individual suffering from a mental illness will not improve.” He warned us that “any attempt at identifying who should have access to MAID will make large numbers of mistakes, and people who would have experienced improvements in their symptoms and no longer wish to die will die by [medical assistance in dying].”

We heard from many experts. The CAMH raised similar concerns.

Because I see that I only have a couple of minutes left here, I want to talk a bit about the system and the lack of access. We are talking about a crisis going on from coast to coast to coast, according to a poll done just a year ago. The Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction released a report talking about postpandemic findings. It cited that 35% of respondents reported moderate to severe mental health concerns.

This is alarming. It should also be alarming to all parliamentarians that it found that fewer than one in three people with current mental health concerns accessed services. The report identified key barriers to accessing services as financial constraints and help not being readily available. We know that right now we are in a financial crisis, and I am sure those numbers have only gone up. It identified that one of the top stressors was between income and unemployment with mental health concerns.

We need to create a system of parity with mental and physical health. The government has not delivered when it comes to a plan, a road map, on how we achieve parity with physical and mental health. I hope in this budget, it is going to release funding on top of the bilateral agreements directly to community-based organizations as a COVID emergency recovery response because, post-COVID, we know some people are struggling financially, but the biggest concern right now and the biggest epidemic post-COVID is in mental health. I hope the government is hearing that.

I see that I have run out of time. I have a lot to say on this matter. I look forward to taking questions from my colleagues.

Motion That Debate Be Not Further Adjourned

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the minister did not answer one aspect of my question.

Why the double standard?

The minister had a full year to implement the recommendation of the Special Joint Committee on Medical Assistance in Dying concerning advance requests. An Ipsos poll of 3,500 people showed 85% support across Canada. If the minister does not know that, he is not staying on top of his file.

As far as postponement is concerned, the minister has implemented the recommendation to the letter. Three years is too long. He knows that. However, he could have added another dimension to Bill C‑62. He had a year to do it. Will he introduce legislation on advance requests, yes or no?

Bill C‑14 is bad legislation.

The minister says that he worked carefully. People have been forced to go on hunger strikes to meet the reasonably foreseeable natural death criterion. Is that what he means by protecting vulnerable people?