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.

Message from the Senate

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

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

Criminal Code

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Gerald Soroka, Conservative, Yellowhead, AB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The House resumed consideration of the motion that Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, be read the third time and passed, and of the motion that the question be now put.

Business of the House

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

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

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

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

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

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

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

Criminal Code

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I will stop here and await my colleagues' questions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Tom Kmiec, Conservative, Calgary Shepard, AB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, my colleague is quite right. With Bill C-7, but for the passage of Bill C-62, the impact would be profound on our health care system, on individuals suffering with mental illness and on the message we send Canadians suffering with mental illness. I can say only that the government has moved forward in this dangerous direction while ignoring at every turn the advice of experts, including, as I quoted extensively, the Society of Canadian Psychiatry, medical experts and legal experts, about the merits of moving forward. It is our job to debate these things, to consider them and to hear from experts. Unfortunately, because the government dropped the ball, it is up to us to pass the legislation before us to protect Canadians suffering with mental illness.

[Rob Moore, Conservative, Fundy Royal, NB]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I turn to their recommendations:

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

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

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

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

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

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

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

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

I move:

That the question be now put.

[Chandra Arya, Liberal, Nepean, ON]

Madam Speaker, I will be sharing my time with the member for Fundy Royal.

I am pleased to have the opportunity to speak in the House today in support of Bill C-62, the bill that proposes to extend the temporary exclusion of mental illness as an eligible condition for medical assistance in dying by three years, until March 17, 2027. I will speak today about the importance of a delay before lifting this exclusion to provide more time for the provinces, territories and their health care partners to prepare for this critical juncture in the evolution of medical assistance in dying, which we refer to as MAID in Canada.

The legal framework for MAID is set out in the federal Criminal Code. However, it is the provinces and territories who have the responsibility for health care delivery, including MAID implementation. We have been working in close collaboration with the provinces and territories to support the safe implementation of MAID since before the original legislation permitting MAID was enacted in the Criminal Code in 2016. This is an important relationship built on the mutual goal of ensuring quality health care for the people of Canada.

Both the expert panel on MAID and mental illness and the Special Joint Committee on Medical Assistance in Dying emphasized the importance of clear practice standards and consistent implementation of guidelines across the country, training for physicians and nurse practitioners, and case review and oversight to support best practices and trust in the appropriate application of the law.

Provincial and territorial governments and their stakeholders, such as health care professional organizations, regulatory bodies and practitioners, have been actively planning for eligibility for MAID for persons whose sole medical condition is a mental illness. As has been recognized across the board, critical progress has been made in this regard. However, the provinces and territories face different challenges within their jurisdictions and are at varying stages of work in implementing these key elements and consequently their readiness for the lifting of the exclusion.

For example, a model practice standard for MAID was developed by an independent task force group made up of clinical, regulatory and legal experts as a resource for physician and nursing regulatory authorities to adopt or adapt in their development or ongoing revision of MAID standards. In addition to the model standard, the task group also released a companion document entitled “Advice to the Profession”.

Practice standards are developed and adopted by regulatory bodies responsible for ensuring that specific groups of health professionals operate within the highest standard of clinical practice and medical ethics. While some provincial and territorial regulatory bodies have successfully implemented MAID practice standards into their guidance documents for clinicians, others are still in the process of reviewing and updating their existing standards. To support the safe implementation of the MAID framework, health Canada supported the development of a nationally accredited bilingual MAID curriculum to support a standardized approach to care across the country. The Canadian Association of MAiD Assessors and Providers has created and is now delivering a training program that has been recognized and accredited by the appropriate professional bodies.

The MAID curriculum includes a series of training modules to advise and support clinicians in assessing persons who request MAID, including those with mental illness and complex chronic conditions, or who are impacted by structural vulnerability, as well as help with the practical application of the MAID legislative framework. The curriculum will help achieve a safe and consistent approach to care across Canada and ensure access to high-quality MAID training for health practitioners. So far, more than 1,100 clinicians have registered for the training, which is impressive given the curriculum was just launched in August 2023. This is only a portion of the workforce. More time would allow additional physicians and nurse practitioners to register and participate in the training, and to internalize these learnings and put them into professional practice.

Now let me turn to case review and oversight of MAID. In Canada there is a process of self-regulation within the medical and nursing professions. The provincial and territorial regulatory bodies, which I spoke of earlier, have a mandate to protect the public for all health care, and MAID is no exception. In addition to the presence of health professional regulatory bodies, several provinces have implemented formal oversight mechanisms specific to MAID. For example, in Ontario, the Chief Coroner reviews every MAID provision, as does Quebec’s end-of-life commission. Both of these bodies have strict policies regarding the timing and type of information to be reported by clinicians, and the Quebec commission issues annual reports.

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

All provinces and territories were united in their request to delay the lifting of the exclusion in order to have more time to prepare their clinicians and health care systems to manage requests where mental illness is the sole underlying condition, and to put the necessary supports in place. Provincial and territorial governments must ensure not only that practitioners are trained to provide MAID safely but also that the necessary supports are available to clinicians and their patients through the assessment process.

Both the expert panel and the special joint committee on MAID emphasized the importance of interdisciplinary engagement and the knowledge of available resources and treatments. Experts and practitioner communities have also expressed the need for support mechanisms to be in place for providers undertaking assessments and persons who request MAID, irrespective of their eligibility.

While some jurisdictions have robust coordination services to manage requests and provide ancillary services, other jurisdictions take a decentralized approach, which can result in less coordination across services and disciplines. The availability of necessary support services for both practitioners and patients is also variable, depending on the region. For example, we have heard about the challenges of accessing health care services generally in rural and remote areas of the country. Additional time would allow more work to be done to support patients and clinicians involved in MAID.

The Liberal government is committed to supporting and protecting Canadians with a mental illness who may be vulnerable, while respecting personal autonomy and choice. The provinces and territories are ultimately responsible for the organization and delivery of MAID and supporting health services. Given their responsibility for how MAID is delivered, moving forward before provinces and territories are ready would not be the responsible course of action.

We believe that the extension of three years proposed in Bill C-62 would provide the time necessary to work on these important elements for the safe and consistent application of MAID for persons suffering solely from a mental illness.

[Lori Idlout, NDP, Nunavut, NU]

Uqaqtittiji, the member highlighted the ravages of what colonial systems continue to do to indigenous peoples, but I wanted to ask specifically about Bill C-62 and the amendment that has been inserted about the creation of a joint committee of both houses of Parliament designated for determining eligibility.

What does the member think about that amendment, which would require discussions on ensuring the eligibility of a person whose sole underlying medical condition is mental illness? Does he think that is an urgent task that needs to happen after Bill C-62 is passed?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I have said it repeatedly, the Bloc Québécois wants Bill C‑62 to include a section on advance requests for MAID. This is our main objection.

We tried to introduce amendments in step with Quebec's request and that of the whole National Assembly. Where mental disorders are concerned, we start from the premise that psychiatry is unable to ease the suffering of every patient stricken by a severe mental disorder.

Psychiatrists told us that 50% of their diagnoses are wrong. It is a wonderfully precise science. However, one thing is true. Although there is no exact diagnosis and a diagnosis can change, what is clear, straightforward, specific and a constant in a patient's journey over the decades is that they suffer. Psychiatrists cannot deny that their patients suffer, and that all they can offer them is a path to palliative care. In fact, Dr. Gagnon told us we had to develop palliative care for people afflicted with mental disorders because that is all we can offer them.

Quebec made its decision in 2021. It did not have the opportunity to work off the expert report that the Special Joint Committee on Medical Assistance in Dying had in 2022.

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

Madam Speaker, I have to say that I find the position of the Bloc to be somewhat curious insofar as it is inconsistent with the position taken by the National Assembly, which rejected the policy of the government to expand MAID in cases where mental illness is the sole underlying condition.

I understand that the position of the Bloc members to oppose Bill C-62 is on the basis they would like to see the policy implemented in one short year from now.

Can the member explain why the Bloc is taking a position that is inconsistent with that of the National Assembly?

[Luc Thériault, Bloc, Montcalm, QC]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Madam Speaker, from my perspective and that of my party, the substance of Bill C-62 is to ensure that we never discuss this again. By choosing to extend the exclusion by three years, there could well be a Conservative government─possibly a majority government─in power. I would be amazed if that government chose to follow up and move in the same direction.

Let me remind my hon. colleague that Canada is a federation that includes several nations. The Quebec nation has a unanimous position on advance requests but cannot implement it because the federal government refuses to amend the Criminal Code.

We understand that the rest of Canada may have other debates. That is the idea of a federation, to bridge different cultures and perspectives. There is unanimity in Quebec. We are not asking for a unilateral approach or for the Quebec model to apply from coast to coast, but for Ottawa to stop blocking what Quebec has unanimously decided.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

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

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

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

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

—Mr. Doherty made an objection, which I agreed with at the time. We're not here talking about advanced requests. We're here talking about Bill C-62. It's a piece of legislation with a very specific outcome.

As much as I appreciate Mr. Thériault's passion, it's not on topic.

[Mark Holland, Liberal, Ajax, ON]

As somebody who has suffered greatly and who has spoken publicly about my own mental health challenges, I do not believe that suicidality is at all incidental. What I'm trying to do is to make a distinction between the folks we're talking about in Bill C-62 and folks who are having a mental health crisis.

[Arif Virani, Liberal, Minister of Justice]

Thank you very much, Mr. Chair. I'm pleased to be here to speak to Bill C-62, which proposes to delay for three years, until March 17, 2027, the expansion of the eligibility of MAID to persons whose sole underlying medical condition is mental illness. As members will be aware, this bill also requires that a joint parliamentary study be undertaken on the topic, by a mixed committee of Senators and MPs, approximately one year before the new date of expansion.

I will start by expressing my sympathy for anyone experiencing intolerable suffering. I acknowledge that mental illness can cause the same level of suffering as physical illnesses, and that having a mental disorder does not mean that an individual does not have decision-making capacity. Everyone deserves dignity and respect.

As this health committee is aware, the Supreme Court of Canada's decision in the Carter case led to the legalization of medical assistance in dying in Canada. In that decision, the Supreme Court declared the Criminal Code's absolute prohibition at the time on physician-assisted death to be unconstitutional, noting that it should be available to competent adults who clearly consent to the termination of life and who have a grievous and irremediable medical condition. That led to Canada's first MAID law in 2016. Many members were here with me in 2016 when we enacted that law, which restricted eligibility for MAID to persons whose natural death was “reasonably foreseeable”.

A few years later, in the Truchon decision, a trial court in Quebec ruled that the reasonably foreseeable natural death requirement was unconstitutional.

The federal government didn't appeal the decision. Instead it made the general political decision to introduce Bill C-7 to expand eligibility for medical assistance in dying to persons whose death wasn't reasonably foreseeable. When it was introduced, the bill permanently excluded from eligibility for MAID persons whose only underlying health issue was a mental illness.

During consideration of the bill, the Senate introduced an amendment to make that exclusion temporary. The House of Commons supported the amendment, and the bill, as adopted, would automatically have nullified the mental health exclusion two years later.

I want to be clear about something, which is that the government's decision to go forward with those expansions at the time was a matter of social policy. I appreciate, though, that there are those who believe that the charter required us to act in this regard on mental illness, and I want to address this point directly.

MAID is a complex and deeply sensitive topic, and there are important charter-protected interests that arise in this area. On the one hand there is the autonomy and dignity of individuals in making end-of-life decisions. On the other hand, there is the protection of those who are vulnerable and who might be at risk in a permissive regime. In its decision in Carter, the Supreme Court recognized the complexity of legislating in this area and suggested that Parliament's choices on how to balance these competing interests would be given a high degree of deference.

MAID is particularly complex in the context of mental illness. As noted in the various MAID-related charter statements, these inherent complexities are the basis for the mental illness exclusion. Some of the complexities include that the course a mental illness may take is more difficult to predict than that of a physical illness and that many people with a poor prognosis will improve, at least in terms of their suffering, which may alter or impact their wish to die. Moreover, distinguishing routine suicidality and a valid request for MAID becomes particularly challenging when suicidality may be a symptom of the mental illness that led the person to request MAID in the first place.

The MAID mental illness exclusion is not based on harmful assumptions nor stereotypes about mental illness. We recognize, as Minister Holland just said, that the suffering mental illness can cause is on par with the suffering that physical illness can cause. This exclusion is not a denial of this fact. We also accept, as I said at the outset and as I repeat here again, that the decision-making capacity of those who are mentally ill is well established.

As we have said, we do believe the exclusion should be lifted when the health care system is ready to manage the inherent risks and complexities of assessing requests for MAID that are based on mental illness alone. Our provincial and territorial partners agree that more time is needed. Medical experts agree that more time is needed. The lack of consensus on this issue proves that more time is needed.

This bill reflects the caution required to ensure the safety of Canadians and to get this right. As the interests at stake are significant and the consequences, Mr. Chair, are permanent, we must get this right.

Thank you very much.

[Mark Holland, Liberal, Minister of Health]

Thank you very much, Mr. Chairman. It's good to be back in front of the health committee.

We did just have a very productive session, the last couple of hours, with the Senate, getting an opportunity to talk about what is a very delicate and sensitive issue, one that requires a lot of calm, patient deliberation.

I appreciate the members of this committee for their input and work. I certainly appreciate the work of the joint committee as we attempt to navigate this very difficult issue.

I think I'll start by making a very clear and important distinction between mental health and mental illness. Mental health, not only in Canada but across the world, is in a state of crisis. Coming out of the pandemic and dealing with the rise of very devastating wars, global economic uncertainty and the existential crisis of climate change, these are difficult times to be a human being.

However, the challenges we're facing in mental health are completely separate and apart from the issues that we're talking about in Bill C-62 with respect to mental illness. That distinction is an important one, because a conflation is both dangerous and, I would represent, irresponsible.

When we talk about mental health, there are the historic investments we're making in mental health across this country, co-operating with governments of every stripe. I had an opportunity just yesterday to be in the Northwest Territories and announced our bilateral agreement on both aging with dignity and working together. Just the day before that, I was in British Columbia announcing our aging with dignity agreement there. Of course, I've already announced the working together agreements with B.C., Alberta, Nova Scotia, P.E.I. and many more to come, with specific and detailed plans of how we're going to take on the challenges we're facing in mental health.

When we're talking about mental illness, we have to recognize that there are some people who are trapped in an irremediable situation, where their state of illness is not able to be remedied through medical intervention, so we have to ask the question, as a society and indeed as Parliament, of at what point we allow a person, of their own recognizance, if they have an irremediable condition, to be able to make the choice to access MAID.

If somebody has suffered for 10 years, 20 years, 30 years or 40 years, where they've tried absolutely everything, where they've gone to medical practitioner after clinician after expert and have never been given the opportunity to escape that mental health illness—not a momentary mental health crisis—what do we do as a society? That's what we've been trying to navigate.

The decision we have in front of us now is to ask for more time to prepare the system. I've had opportunities to talk with health ministers. We had a very constructive conversation in Charlottetown when I was together with all the health ministers, Mr. Chairman, in your home province, discussing how we navigate that and how we get the system ready.

Frankly, we need more time.

We need more time for indigenous engagement. We need more time to work with the provinces and territories to make sure they have appropriate safeguards. Talking with CAMH, we want to make sure that, if there's a possibility that clinical guidelines are required to create uniformity across the country, we have an opportunity to explore that. We need more time to work with the disability community and with the community of folks with lived experience, so a three-year pause is appropriate so that we can deal with mental illness, which is separate and apart.

I would welcome the conversation on mental health, but hopefully tonight people will not be conflating those two because they are two separate conversations.

We do need time and I'm appreciative of the opportunity to be before committee tonight to have that conversation and to take the questions of the committee.

Thank you very much.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you very much, Chair.

This is obviously a very sensitive, emotional and, for many, personal issue that we're discussing here today.

I don't profess to have the depth of knowledge on this particular issue, especially as it relates to MAID that applies to people with mental disorders, that many members of this committee do, given the extensive amount of work that has been done. My engagement on issues on MAID goes back to 2016 and 2017 when the Carter decision was being implemented. I served as the attorney general for the Province of Ontario and worked along with the minister of health at that time to apply the federal law in the provincial space.

What I do know from that work is that there needed to be a fair amount of work that had to be done in terms of the health care system being ready to apply MAID in a manner that, from a legal perspective, protected people's rights, but from a health care perspective, ensured there was appropriate training, curriculum and safeguards in place so there was no abuse of any kind.

That's where I'm coming from. For me, BillC-62 is about whether or not the system is ready to apply the laws being passed by Parliament. It is the view of the government, based on what we have heard from experts, based on what we have heard from the requests we have received from the provinces and territories, that the system is not ready and we need more time, hence, the extension for three years.

I will go to Dr. L'Espérance first and then to Ms. Long.

In your view, is the system ready to administer MAID for people with mental disorders as early as March 17 of this year, or is it appropriate and prudent to have an extension of time before we are sure that the health care system across the country, and not just in certain parts of the provinces but across the country, is sufficiently ready to administer MAID to people with mental disorders?

I will start with Dr. L'Espérance first.

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

Thank you, Mr. Chair.

Thank you to our guests for being here.

Dr. Gagnon and Dr. Gaind, you said some things that are resonating with me. Last night, in my intervention on Bill C-62, I shared for the first time something that I had not shared previously. While I have spent every minute of being elected for the last eight and a half years fighting for mental health supports for our frontline personnel, whether it's those who are struggling with PTSD or OSI, and I've been fighting tooth and nail for the country to adopt a national, three-digit suicide hotline, there was a time in my life when I struggled. The thoughts of death consumed my whole being. I attempted suicide twice. I'm living proof today that life is worth fighting for.

When I speak about fighting for those who don't have a voice and about my concerns about what Ms. Long is saying, I don't believe there are enough safeguards we can put in place to ensure that somebody who, like I was, is in a dark spot and finds a permanent solution for a temporary problem....

I appreciate your comments and all of your testimonies. I can respect all of the testimonies. My worry is that there will be many people, if we expand this to those who are struggling with mental illness, who say that they want to die, but they don't want to be dead. It's such a final act.

I also have a loved one who has recently chosen MAID. While we hear about the safeguards that are in place—a cooling off period and what have you—I also know that if that loved one of ours wanted it right away, they could get that.

My worry is for those who are struggling with mental illness and want to die because of whatever situation they're in. If only we can provide hope for the helpless and care instead of despair, I think we can really make a difference.

I thank you for your testimony.

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

Thank you very much, Mr. Chair.

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

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

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

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

Thank you very much, Mr. Chair.

Thank you to all of our witnesses for helping to guide us through this part of the study of Bill C-62.

I've been a member of the Special Joint Committee on Medical Assistance in Dying from the beginning, and I'm very familiar with the subject matter that's before us.

Ms. Long, I'd like to start with you, if I could.

Thank you for your opening statement and for representing Dying with Dignity. Of course, ever since our special joint committee tabled the report in the House of Commons and in the Senate with our single recommendation, we are also in receipt of a letter that was signed by the health ministers from seven out of 10 provinces and all three territories.

If you look at that letter, you can quote from the middle of it, where it says, “The current March 17, 2024, deadline does not provide sufficient time to fully and appropriately prepare all provinces and territories across Canada”. Further down, they ask the Minister of Health and the Minister of Justice to “indefinitely pause the implementation of the expanded MAID eligibility criteria to enable further collaboration between provinces, territories and the federal government”.

Ms. Long, when I look at the signatories, I see that they include ministers of health and ministers responsible for mental health and addictions. You can see that they are widely across the political spectrum. They include the NDP government in British Columbia and several Conservative governments in other provinces.

I want to know from you how Dying with Dignity responds to this letter, given that these are all cabinet ministers, they have executive-level functions within their respective governments and they are responsible for the systems of health that are actually going to be overseeing this process. If they are publicly asserting that their systems are not ready, how do you respond to that with your opening statement where you said that we are ready?

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

Dr. L'Espérance, the committee tabled its first report in February 2023. We had to look at all the possible scenarios for expanding the eligibility criteria for medical assistance in dying, and the committee made a strong majority recommendation in favour of advance requests. It may have been a good idea for the government to wait to see what could be done for people with mental disorders, but, at the last minute, it decided not to include this recommendation in Bill C‑62, whereas it included, word for word, the recommendation of the Expert Panel on Medical Assistance in Dying and Mental Illness.

Did that surprise you? How do you explain that?

Could you shed some light on how advance requests work in Quebec, so that people understand what it is all about?

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

First of all, I'm going to make a comment about our two psychiatrists.

It seems to me, from what they have told us this evening, that they are of the same opinion. They are testifying as individuals to tell us that they are at odds with the Canadian Psychiatric Association, the Canadian Bar Association, the Association des médecins psychiatres du Québec, the Federation of Medical Regulatory Authorities of Canada, the Canadian Association of MAiD Assessors and Providers—we have a lot of comments on that—and the Collège des médecins du Québec.

According to Dr. Gaind, the members of these organizations are ideologically motivated activists. We used to see that in the former Soviet Union, where science was pitted against ideology. When someone disagreed with the other person's opinion, they accused the other person of basing their position on ideology. It's called “scientism.” That said, this is not the place for an epistemological debate.

The fact remains that I am interested in Bill C‑62, but I haven't heard anything on the bill, which contains a very important provision. Do you believe that we should postpone the provision indefinitely? Do you agree with the three-year period? I would just like to know what you think.

Dr. Gagnon, you have the floor.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

I want to echo Dr. Ellis in thanking the witnesses for gathering, not just on Valentine's Day but in the evening and on short notice, and being able to provide us with this really useful testimony.

Obviously, there have been years of deliberation on this, including the recent committee meetings. I'm trying to put my questions into a framework of “what now?” What do we do after Bill C-62 in terms of next steps? How do we best prepare?

I'd like to start with Dr. L'Espérance. I want to understand more about what we can learn from the experience of Quebec and how you see the direction in Quebec, particularly for MAID eligibility for mental illness. I understand from Bill 11 that this is a permanent exclusion. Is there anything we can learn as a country from the deliberations of Quebec?

Where do you see Quebec's health system in terms of readiness for mental illness as a sole underlying medical condition? How do you reconcile that with the direction of the legislation in Quebec?

[Helen Long, Chief Executive Officer, Dying with Dignity Canada]

Thank you very much for having me.

Good evening, members of the committee.

I appreciate this opportunity to testify on a matter of profound concern to the people across the country who are afflicted with severe, treatment-resistant mental disorders. I'm drawing upon a submission we made to the special joint committee in November 2023.

This is an issue that concerns us deeply at Dying with Dignity Canada because it speaks to the rights of persons who have both historically and presently been deprived of section 7 and 15 charter rights to make autonomous and lawful decisions concerning their end-of-life choices simply because their illness is psychiatric in nature and not physical.

The bill before you would extend the denial of access to MAID assessment for those whose sole underlying condition is a mental disorder for a further three years, until March 2027.

Given that Bill C-7, which brought in the right to a MAID assessment for those whose death was not imminently foreseeable, passed in 2021 with a sunset clause excluding that access for those with a mental disorder for two years, which was extended for a further year, means that persons in this category will have been denied for six years the same set of MAID entitlements as those with a physical illness.

It is outrageous to suggest that the development of a regime for MAID MDSUMC needs six years. It is especially egregious given that all of the metrics the government set for readiness in its last delay have been met. We have a nationally accredited curriculum and willing, competent assessment providers. We have practice standards against which regulators of physicians and nurse practitioners can oversee that conduct.

No new metrics are set in Bill C-62. What more is left to do? We need to look to those who are doing the work of providing MAID assessments and provisions; the regulatory bodies charged with the oversight of clinicians' conduct; the 127 physicians and nurse practitioners across this country who have confirmed in writing that the MAID system, MAID assessors and providers and psychiatrists who wish to be involved in MAID MDSUMC and who have testified that they are ready; the regulatory authorities; and, most importantly, patients with severe, treatment-refractory conditions who are ready for MAID MDSUMC.

No new metrics have been established for this delay. Adequate safeguards are in place, including the requirement for a minimum 90-day assessment period, the need to consult with an individual with expertise, a psychiatrist in these cases, and so forth.

We endorse the coming into force of MDSUMC because we have a duty to safeguard the rights of all Canadians. In this case, it's a small group of people tragically afflicted with acute, treatment-resistant mental disorders who, despite many interventions over long periods of time, have experienced unremitting suffering in their lives that cannot be relieved.

At DWDC, we hear from those who, for reasons of fear, embarrassment or stigma, are reluctant to speak publicly about their afflictions but who know only too well what deep, unrelenting suffering means. Even more regrettably, we hear from those who will not speak publicly for fear of being ostracized by their own communities. Often their voices are drowned out by those purporting to speak for them.

You're likely all familiar with the story of John Scully, who has spoken publicly for several years about his mental disorder, but I also hear from Jane and Cathy and others who are not able to speak publicly.

Canada regrettably has a long history of paternalism and arbitrary denial of rights for those with mental disorders, and we have often unfairly conflated mental illness with a lack of capacity. In Starson v. Swayze, the Supreme Court of Canada, discussing the need to redress decades of unfair presumption of incapacity in relation to the mentally ill, wrote, “For this reason it is particularly important that autonomy and self determination be given priority when assessing individuals in this group.”

Every year we hear from thousands of people across Canada who are seeking information or navigating the MAID coordination program across the country. Since Bill C-7 passed, the proportion of these individuals who identify as having a mental disorder as either a sole underlying medical condition or a comorbidity continues to rise.

We anticipate that many of these individuals will likely never be found eligible for MAID MDSUMC, but we cannot continue to deny them the right to apply. Doing so only serves to create further distress and angst. They have been left in an untenable position, unable to apply and suffering grievously.

[Dr. Georges L'Espérance, President, Association québécoise pour le droit de mourir dans la dignité]

Thank you, Mr. Chair and members of the Standing Committee on Health.

The Association québécoise pour le droit de mourir dans la dignité is grateful for the invitation.

I'm a retired neurosurgeon, an active MAID provider and president of the association.

With respect to Bill C‑62, I will focus on a few main points on the new delay in accessing medical assistance in dying for people with mental illness, and then speak about advance requests for cognitive neurodegenerative diseases.

Excluding mental health disorders will only lead to legal challenges, which are cumbersome and unacceptable to affected patients. This is a political decision that goes against the interests of the few patients who could have been assessed, as is their right.

And yet expanding medical assistance in dying to those affected would make it possible to comply with the Supreme Court of Canada's decision of February 6, 2015, as noted by the Senate in 2021. Judges have never unanimously ruled out mental disorders. This exclusion forces patients, who have already been leading broken lives for decades, to go back to the courts request that their constitutional right be upheld by the government.

To give you some context, let me remind you of paragraph 252 of Superior Court of Quebec Justice Baudouin's decision, handed down on September 11, 2019, which reads as follows:

[252] Vulnerability should not be understood or assessed on the basis of a person’s belonging to a defined group, but rather on a case-by-case basis, at least for the purposes of an analysis under section 7 of the Charter.

This bill means an additional three years of suffering for people with mental disorders on top of the three years that have already passed since March 2021.

Further delays continue to stigmatize people with mental disorders, even though the federally mandated pan-Canadian expert panel on MAID and mental illness released its report in May 2022 and very clearly laid out its recommendations.

On the issue of advance requests for cognitive neurodegenerative diseases, the federal Minister of Health, Mark Holland, has stated that he has no plans to act on advance requests in the near future. However, in Quebec, this right has been enshrined in law since June 2023, and the Criminal Code must be amended so that patients who want to exercise their right can be assessed by providers who will not have to fear criminal prosecution. Our association urges the federal government to take concrete action on this issue.

While Ottawa dillydallies, patients are suffering. Every year, there are 14 new cases per 1,000 people aged 65 and over, and 70 new Alzheimer's cases per 1,000 people aged 90 and over. More than 15 people are impacted every hour of every day by neurocognitive disorders. By 2030, Canada could have nearly one million people living with neurocognitive disorders.

To delay the expansion of medical assistance in dying for advance requests is to dash the hopes of many citizens. Those who are struggling with the terrible loss of their personality are forced to shorten their lives while they are capable of making a decision so as not to find themselves locked in indignity.

In its February 2023 report, the Special Joint Committee on Medical Assistance in Dying already recommended that you move forward by approving advance requests.

The majority of Canadians are in favour of this measure.

Quebec developed its law on advance requests for medical assistance in dying after an in‑depth consultation process that reflects the specific values and concerns of our province, which are in keeping with those of more than 80% of Canadians.

We ask you to consider any approach that would enable Quebec to follow through with its humanist legislation as of this spring, and thus meet the expectations of thousands of Quebeckers. By allowing advance requests, you have the opportunity to demonstrate your commitment to participatory democracy, Quebec institutions and respect for individual end-of-life rights, in addition to showing humanity and compassion.

It is important to note that eligibility for medical assistance in dying brings serenity and peace of mind, and enables people with disabilities to live fully in the present without the anguish of seeing long road ahead, paved with suffering and loss of dignity from a disease that inevitably leads to death.

Thank you.

[Dr. K. Sonu Gaind, Professor of Psychiatry, Faculty of Medicine, University of Toronto, As an Individual]

Thank you, Mr. Chair.

My name is Sonu Gaind. I'm a psychiatrist, professor and governor at the University of Toronto, the chief of psychiatry at Sunnybrook, a past president of the Canadian and Ontario psychiatric associations and now the president of the new Society of Canadian Psychiatry. I'm not a conscientious objector and was the physician chair of my previous hospital's MAID team. My roles inform my expertise, but I'm here as an individual. I'm not representing any group.

I want to first express appreciation for the decision to pause the planned expansion of MAID for mental illness. In all honesty, this was the only responsible choice to make because there remain three critical unresolved issues.

First, MAID is for irremediable medical conditions—ones that can be predicted to not improve. Worldwide evidence shows we cannot predict irremediability in cases of mental illness—meaning that the primary safeguard underpinning MAID is already bypassed—with evidence showing such predictions are wrong over half the time. Second, scientific evidence shows we cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests. Overlapping characteristics suggest there may be no distinction to make.

Combining these inconvenient truths with the fact that those with mental illness have higher rates of social suffering, like homelessness and poverty, means that MAID assessors would be wrong most of the time when predicting irremediability. They would wrongly believe they are filtering out suicidality and would instead be providing death this March to marginalized, suicidal Canadians struggling with social distress who could have improved.

People talk of false hope. This would be assessors colluding with the patient's mental illness symptoms and providing false despair. They would be wrongly reinforcing that the situation is hopeless to the most marginalized who could have gotten better. That would be the ultimate discrimination.

How did we get here—twice being at the brink of providing MAID for mental illness and twice saying we are not ready? I think it's because those entrusted to provide evidence as experts have pushed ideology instead.

Senator Kutcher's sunset clause in 2021 never asked if we could responsibly provide MAID for mental illness, but set an agenda predetermining that we would. The CAMAP mental illness module claims to train assessors to weed out suicidality from psychiatric MAID requests, yet it does nothing of the sort and there is no evidence that we can actually do that.

The expert panel tasked with providing safeguards refused to recommend any additional legislative safeguards, despite Canada lacking a due care requirement before providing death by MAID. One-sixth of that panel resigned, yet the panel chair doubled down on pushing expansion, testifying that she is not concerned by the two-to-one gender gap of more women than men getting psychiatric MAID where it is allowed. It's remarkable.

Now, the dissenting senators, unhappy with the pause to expand, aim to convince the Senate to disregard Bill C-62's call to pause, with Senator Kutcher saying they need to “protect against the tyranny of the majority”. Wow.

While citing their historical medical credentials and claiming they are addressing medical and procedural issues of the report, the dissenting senators neglect to provide any evidence to address the key medical issues of the inability to predict irremediability, the inability to filter suicidality and the risks to the marginalized when providing MAID for mental illness.

We're an outlier among peer nations in not even having a national suicide prevention strategy, and these dissenting senators are pushing easier death for mental illness. With any due respect to the dissenting senators, zealotry should not trump reality.

I'm confident that this committee, and I hope the rest of the Senate, will not follow the dissenting senators in their march against evidence.

I must point out the impact that expansionist activism has already had. After Bill C-7's expansion of MAID for any disability in 2021, MAID deaths shot up by 30% to over 13,000 Canadians in 2022, and 2023 will no doubt be higher. Of these tens of thousands of Canadians, over one-third cite that feeling like they are a burden is a suffering that leads them to MAID. Nearly one-fifth cite loneliness, and for over half it was a loss of dignity.

The debate about providing earlier, easier death has sucked all the oxygen out of the room. What are we now providing death for?

As I wrote in the Toronto Star recently, I hope this focuses us on the real issues of our fellow Canadians' suffering and propels us somewhere better than pushing death to solve life suffering. “If we're serious about addressing these issues,” to quote that piece, “Canada has a chance to be a forerunner in the world by, instead of striving to be number one globally in assisted suicide, establishing the world's first portfolio for a Minister for Living with Dignity.”

Thank you again for your thoughtful review of this issue.

I'm happy to answer any questions.

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 102 of the House of Commons Standing Committee on Health. Happy Valentine's Day, everyone. This is a wonderful way to spend Valentine's evening. I am feeling the love here already.

Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders.

To the folks who are participating virtually, you have interpretation available to you. You have the choice on the bottom of your screen of floor, English or French. Please don't take any screenshots or photos of your screen during the meeting.

In accordance with the routine motion, I am informing the committee that all remote participants, except one, have completed the required connection tests in advance of the meeting. We will test Ms. Long, if necessary, when we get to her.

The subject matter of this meeting is Bill C-62. Pursuant to the order of reference of Tuesday, February 13, 2024, the committee is commencing its study of an act to amend An Act to amend the Criminal Code, regarding medical assistance in dying, no. 2.

I'd like to welcome our first panel of witnesses.

Appearing as individuals, we have Dr. Pierre Gagnon, psychiatrist, by video conference, and Dr. K. Sonu Gaind, professor of psychiatry at the faculty of medicine at the University of Toronto, who is here with us in person.

Dr. Georges L'Espérance, president of the Association québécoise pour le droit de mourir dans la dignité, will also be testifying by video conference.

Dying With Dignity Canada is also with us virtually, represented by CEO Helen Long.

Thank you all for taking the time to appear today. As it was explained, you will each have five minutes for your opening statements.

Dr. Gagnon, we will start with you.

You have five minutes to give your presentation.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I declare the motion carried.

Pursuant to order made on Tuesday, February 13, Bill C‑62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, is deemed referred to a committee of the whole, deemed considered in committee of the whole, deemed reported without amendment and deemed concurred in at report stage.

(Bill read the second time, deemed referred to a committee of the whole, deemed reported without amendment and deemed concurred in at report stage)

The House resumed from February 13 consideration of the motion that Bill C‑62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, be read the second time and referred to a committee, and of the amendment.

[Joël Lightbound, Liberal, Louis-Hébert, QC]

Mr. Speaker, I apologize to the parliamentary secretary. He is used to this, but I think he can make room for others.

I fully agree with my colleague on many things. We need more mental health resources and more access to care. There are several socio-economic factors that can exacerbate mental illness.

As far as today's bill is concerned, I would like us to look at things from another angle. Let us look at the genesis of what brought us to include mental illness as grounds to request medical assistance in dying. It came from a Senate amendment that, in my opinion, should not have been accepted by the government. I do not want to make any assumptions, but we are hearing rumours that senators might try to block what could be the will of the House to delay this for three years, as Bill C‑62 seeks to do.

What is my colleague's opinion about the role the Senate should play with respect to the House, whose members are duly elected to make decisions?

[The Deputy Speaker, Conservative, Chris d'Entremont]

I appreciate the help, but that is descending into debate. I would also suggest to people here this evening to stick to the bill at hand, Bill C-62, which we are counting down to really quickly.

Questions and comments, the hon. member for Louis-Hébert.

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

Mr. Speaker, I agree with the member that many Canadians are struggling right now. I would challenge her to reconsider her participation in the confidence and supply agreement with the government as a result. Maybe we will have to agree to disagree on whether more federal spending on federal bureaucracy, sticking its nose into provincial jurisdiction, is actually going to improve the lives of, for instance, kids who are hungry in schools.

I want to ask the member about the bill before us, Bill C-62, and the situation around euthanasia and facilitated suicide in Canada. Because of the challenges we are seeing, with people facing pressure and people being offered or having euthanasia pushed on them, in our last election platform, Conservatives proposed that we would protect the right of patients to choose to receive care in a MAID-free environment. That is, by protecting the conscience rights of physicians and health care institutions, we would preserve the right of patients to choose to be in a hospice or a health care facility where they know they would be offered life-affirming care.

There are many Canadians, I think, who want that. They do not appreciate being in a situation where government bureaucrats, health care officials or bureaucrats in other departments are pushing, promoting or encouraging them to choose a path they do not want to take.

Does the NDP support our proposal to protect the right of patients to choose to receive care in euthanasia-free or MAID-free spaces?

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

Mr. Speaker, I listened to the member and I wonder, if he were to apply the same principles that he talks about with regard to Bill C-62 to MAID as a whole, whether he would actually support the legislation with that particular amendment, even if it were taken out. Would he apply those same principles that he was talking about to the MAID legislation as a whole?

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I thank my colleague for the great discussion that we had on this subject recently.

I agree with him. That is what Bill C-62 is for. This is a very controversial subject. Like my other colleagues, I get letters from various institutions and groups that show that there are differing opinions in our society about people whose only underlying medical condition is mental illness. We need to make sure that everything is in place, including standards, tools and practitioner training, so that patients' eligibility is properly assessed and practitioners are comfortable applying this measure.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Mr. Speaker, I thank my colleague for his two questions. I would also like to acknowledge his exemplary and always highly professional work on this issue. Having sat in on several meetings of the Special Joint Committee on Medical Assistance in Dying, I have personally witnessed his passion for this subject.

As far as mental health transfers are concerned, we continue to make very significant investments. We are always working with Quebec to ensure that the money flows and is put to good use.

With regard to the second question, I would say that I truly and sincerely hope that the next government will be a Liberal government and that we can continue to move forward with the implementation of Bill C-62 and medical assistance in dying, both for advance requests and for people whose sole medical condition is a mental illness.

I agree with him that Quebec is truly one step ahead.

[Élisabeth Brière, Liberal, Parliamentary Secretary to the Minister of Families]

Mr. Speaker, I am pleased to have the opportunity to rise in the House this evening in support of Bill C-62.

I will note, in particular, the government's commitment to respecting people's autonomy and personal choices, while supporting and protecting Canadians living with mental illness who may be vulnerable. I will also talk about the major investments that our government has made to improve access to mental health services for all Canadians.

We recognize that mental illness can cause suffering that is on par with suffering that results from a physical illness. That is not up for debate. We also know that persons with a mental illness are capable of making decisions with respect to their own health, unless individualized assessment suggests this capacity is lacking.

However, while we respect the autonomy of those who choose MAID in response to severe and irremediable suffering, we have an equally important responsibility to protect Canadians who may be vulnerable, including those suffering from mental illness or who are in crisis. That is why federal legislation provides rigorous safeguards and criteria that must be applied to all MAID assessments.

The experts who made up the expert panel on MAID and mental illness were of the opinion that the existing legal safeguards provide an adequate structure for assessing cases where a mental disorder is the sole underlying medical condition, provided those safeguards are interpreted correctly and applied appropriately. In its final report, the group made 19 recommendations, including the development of model MAID practice standards and training for clinicians.

Our government has made significant progress, in collaboration with the provinces and territories and other health care stakeholders, to implement the recommendations of the expert panel and to prepare for the expansion of MAID eligibility. However, the provinces and territories have expressed concerns regarding the current March 2024 timeline and are asking for more time.

The Special Joint Committee on Medical Assistance in Dying also recognized the progress made in preparing for the expansion of eligibility for MAID. However, as noted in the committee's recent report, it is recommended that additional time be provided to ensure that eligibility for medical assistance in dying can be safely assessed for individuals whose sole medical condition is a mental illness.

The three-year extension we are proposing in this bill will allow more time for the adoption and integration of the necessary resources, such as the model MAID practice standards and the training program recommended by the expert panel. This will ensure that MAID assessments for people with complex conditions, such as people suffering solely from mental illness, are conducted with the appropriate level of rigour.

I believe that any Canadian who is suffering grievously and wishes to consider MAID as an end-of-life option should be free to do so. I also think that, in parallel with the implementation of MAID for those who are assessed and deemed eligible, we also need to commit to improving our mental health care system.

As such, it is important for all Canadians who are struggling with mental illness and/or thoughts of suicide to have timely access to critical mental health resources. As parliamentary secretary, I am pleased to speak about our ongoing and future investments as well as progress being made on key interventions to support the needs of Canadians with regard to mental health and substance use care.

Budget 2023 confirmed the government's commitment to invest more than $200 billion over 10 years starting in 2023-24 to improve Canadians' health care. Of that amount, $25 billion will go to the provinces and territories through adapted bilateral agreements that will focus on four key pillars, including improving access to mental health services and addictions-related services. Other key investment include $598 million for a mental health and well-being strategy with distinction-based funding for indigenous communities, and $350 million for the substance use and addictions program since 2020.

Thanks to the mental health promotion innovation fund, the Public Health Agency of Canada is investing $4.9 million a year in community-based programs for mental health promotion focused on reducing systemic obstacles.

I am also very proud to recall that we have recently taken an important step to provide suicide prevention support for people who need it, when they need it most. Canada's new three-digit suicide crisis helpline, 988, launched on November 30, 2023. It is available to call or text, in English and in French, 24 hours a day and seven days a week across Canada. An experienced network of partners, as trained responders, are ready to answer 988 calls and texts. Responders provide support and compassion without judgment. They are here to help callers and texters explore ways to keep themselves safe when things are overwhelming.

We understand that the past few years have been hard and that many people have been struggling to cope. There is still a lot more to do, and we are committed to continuing to work with our partners to address Canadians' needs in the areas of mental health and substance use. In the future, we remain determined to improve access to mental health care services and to help those with substance use issues.

To that end, the Minister of Mental Health and Addictions and I met with a wide range of partners and stakeholders, including the provincial and territorial ministers responsible for mental health and addiction, to discuss their priorities and needs. This commitment will ensure that mental health and substance use services and programs are based on core expertise.

We have been listening to Canadians with lived and living experiences, to health care professionals on the front lines and to experts to make evidence-based investments and interventions to support timely access to mental health care needs. However, we recognize that no matter what treatments and services are available, sometimes they are not able to relieve intolerable suffering in a manner acceptable to an individual. That is when MAID may be an option for individuals who make a request and who are deemed eligible by two independent medical practitioners.

Ultimately, we are committed to respecting the personal autonomy of each and every Canadian, while protecting the interests of those who may need more care. The three-year extension we are proposing will enable us to do all we can to train and support clinicians who will assess complex cases, including those in which mental illness is the sole medical condition. In the meantime, we will continue to invest in resources and support for mental health and substance use problems.

The House resumed from February 7 consideration of the motion that Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, be read the second time and referred to a committee.

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

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

Madam Speaker, it has been reported in the media that some senators have been openly musing about blocking Bill C-62. Given that we are dealing with such a short timeline, I am just wondering whether my colleague has any thoughts about the unelected Senate's openly voicing blocking the democratic will of the House of Commons on such an important issue. What does he think the government should be doing to try to prevent that from happening when the bill makes its way to the red chamber?

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Madam Speaker, there is no danger of Bill C-62's not passing this House. I think perhaps there has been some failure of the combined party leadership negotiations to come up with an arrangement that would have expedited this.

I am not concerned about the bill's not passing. The programming motion is there. I certainly never had any intention to deliberately delay the passage of this bill. That is not what any Conservative has attempted or is attempting to do.

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

Madam Speaker, the New Democrats actually also voted against what I thought was an ill-advised Senate amendment to Bill C-7. There is plenty of blame to be thrown around. I understand that. I have done more than my fair share this week against the Liberals, but the fact of the matter is that we are at a moment right now when time is critical. We have about a week and a half left, in terms of sitting weeks, until the March 17 deadline. It is imperative that this bill gets passed through the House this week, so that it can go to the Senate.

I am glad to hear the member's support for that measure, but I am curious as to why, when we had a vote on time management of this motion, which is programming the bill, the Conservatives voted against it, knowing that it could have actually jeopardized the time we had available to us this week to get Bill C-62 passed.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Madam Speaker, it is quite difficult to follow the incredible words we just heard from the member for Cariboo—Prince George. Nevertheless, I am going to give it a try.

I am here tonight of course to speak to Bill C-62 and the self-inflicted debacle that has been unfolding in Parliament since it passed its radical expansion of legal medical assistance in dying to include persons for whom the sole underlying health condition is mental illness.

I will remind members of the House and my constituents that I supported and still support the principles of the 2016 bill, which was a necessary response to a 2015 Supreme Court ruling that struck down the blanket prohibition against MAID. That bill was not perfect, but it was a reasonable response to the Supreme Court's decision and was certainly better than the free-for-all on MAID that would have surely followed had there been no law.

It is my view that people who are suffering intolerably from a terminal disease without any hope of recovery or any prospect for improvement and are spiralling into a certain death as a result of illness or disease ought to be able to seek medical assistance in dying as long as they are not coerced, have received an option of proper palliative care, are not proactively offered MAID as an alternative to treatment, and most importantly, as long as the patient is a mentally competent adult.

Part of the criteria laid out in the original 2016 law was the reasonable foreseeability of death of the applicant. This clause was a problem from the start. It was challenged in court and struck down by the Quebec Superior Court. The Truchon case presented the Liberals with a decision point. The decisions the government has made since then have all been wrong.

The first thing the Liberals could have done, but did not, was defend their own existing law and appeal the Truchon decision to the Supreme Court. If they believed that their 2016 law was charter compliant, like they claimed it was during the debate in 2016, they should have stepped up and defended it. Not doing so was their first mistake.

The second mistake was that the then minister of justice was so eager to expand the law, they used the Truchon case as an opportunity to open up and expand access to medical assistance in dying and tabled Bill C-7 in the fall of 2020. That was their second mistake.

As I said before, I support MAID for competent adults who are grievously and irremediably ill and suffering cruelly from intolerable pain and anguish in the late stages of a terminal illness. I have consistently said there are important conditions for my support for legal access to MAID: the availability of quality palliative care as an option; the existence of robust safeguards for the vulnerable, especially minors, the disabled and the mentally ill; conscience protection for practitioners who oppose MAID; and any expansion of the availability of eligibility for MAID be well thought out, carefully considered and not rushed.

For these reasons, I voted to send Bill C-7 to committee, but voted against it at third reading because it failed on at least two, maybe three of my four conditions for support. I concluded that access to palliative care is not adequate in Canada. I have also become alarmed by the cracks in what should be the protections for vulnerable Canadians, as we have experienced in my own family. It was my view, even before the Senate amendment, that Bill C-7 was flawed and unworthy of support.

Then the House made a terrible decision when it passed the amendment that came back from the Senate. It was rightly opposed by all of my Conservative colleagues, who knew then that medical professionals cannot, with the certainty required for what is literally a life-and-death decision, determine irremediability of a patient in a case of mental illness. Conservatives opposed it, but it was passed nevertheless, and this expansion, which was not necessary to conform to any court decision, was to come into effect last year. The government had to introduce emergency legislation this time last year to give the medical system more time for this extraordinary change. That was the next mistake it made.

The Liberals could have used that opportunity to deal with this once and for all and simply strike this portion of what was then Bill C-7. However, they did not do it and here we are, another year later, and this country is no more ready for this expansion than it was this time last year. Here we are again in an eleventh-hour panic to kick this further down the road until after the next election; the next mistake.

Now, the Liberals could have tabled a bill that would have removed this from the bill that passed in 2021, but they have chosen not to and so said that the next government will have to deal this. However, the good news is that a Conservative government, which will surely be formed after the next election, will not recklessly expand the application of MAID to include vulnerable Canadians whose sole underlying health condition is a mental illness.

MAID is for people who cannot get better. It is for people who have no reason to hope that they can get better because they are in an irreversible, terminal state. It is for people capable of making a rational decision and not as a means of potentially fulfilling suicidal ideation.

The impossibility of creating a regime that could determine appropriate MAID for mentally ill but otherwise healthy people who are not in the final stages of a terminal illness seemed intuitive to me, but, of course, I am not a medical professional. However, I can also point to the clear message that was sent from the joint committee that studied this. Its recommendation to Parliament was very simple: Do not do it. It was the shortest list of recommendations I have ever read in a parliamentary report. It just said: Do not do it. That was the recommendation based on months and months of testimony from experts.

My recommendation to this government is to listen to the committee and strike it from the bill that passed. This time last year, the Liberals could have done that, but they kicked it ahead until this year, and nothing has changed. We find ourselves here where a full 80% of members of the Ontario Psychiatric Association do not believe that Canada can safely implement MAID for mental illness. Here we are just pushing this back a couple of years.

I want to share with the House the words of one of my constituents who met with me in November. She said in a letter to me, which I got before I met her, that, “Twenty-three years ago, age nineteen...I made the desperate decision to try and escape what appeared to me to be a dark world.... While taking a course in Pharmacology, I calculated the quantity of poison needed to arrest the heart of an adult male, multiplied it by three, and chose to ingest it.... I felt compassion for the suffering of others and the weight of constant, terrible news...though I formerly had the capacity to deal with this, the ingestion of a single pill coerced upon me by a well-intending physician inadvertently plummeted my thoughts into despair.”

What she told me later was that the side effect of the medication that she had been prescribed caused her to immediately become suicidal, and her survival was described as miraculous by the professionals who attended her.

She is now a wife and a mother and lives a productive, meaningful life. She is convinced that had MAID been available to her earlier in her life, she would have sought it and potentially have been granted it. She told me that the sufferings earlier in her life may well have been thought to be irremediable and thus would have made her eligible.

So, this government has failed to defend its original law. It failed to focus the new law on the narrow constraints of the Truchon decision. It used the Truchon decision in Quebec as an excuse for a reckless expansion of MAID. When it was obvious that it made a mistake, its members dithered instead of acting decisively and they are dithering now by pushing this two more years down the road. That is not leadership. This is just bizarre enthusiasm for the most radical expansion of MAID possible, which has now run amok.

So, I do support swift passage of the bill. Given the extensive debate that has already taken place, I was prepared to let it pass unanimously, but here we are. I had an opportunity to get some of my thoughts on the record, and I am happy to take questions.

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

Madam Speaker, my hon. colleague is mixing up the timelines here. He keeps referring to eight years; in fact, the essence of the bill we are talking about happened three years ago.

Now, if the member wants to talk about someone suffering from stage 4 cancer and just taking some painkillers, I will let him defend himself. However, on what Bill C-62 is doing, we are dealing with a March 17 deadline. This morning, the Conservatives voted against time management of the bill. However, he must understand that we only have two sitting weeks to get the bill to the Governor General's desk.

Why did Conservatives vote against that when we are dealing with a hard deadline, understanding that the law will change if we do not get the bill passed?

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

Mr. Speaker, I believe it was the member from the Green Party who was just finishing his comments. I appreciate the fact that he put a great deal of emphasis on priorities. He mentioned a few issues, and I want to be sensitive to those issues concerning mental health, and the housing-related issues and so forth.

The motion today on Bill C-62 is important for us to get to the next stage. Whatever one's position is on the issue, we need to recognize, whether it is the Supreme Court of Canada or the Quebec Appeal Court, the need to address the issue.

I wonder if the member could pick up where he left off, before the debate came to an end, and give his personal opinion on why it is important, when we are communicating with people outside of the Ottawa bubble, that we be as factual as possible on the legislation.

Alleged Inadmissibility of Amendment to Motion, Government Business No. 34—Speaker's Ruling

[The Deputy Speaker, Conservative, Chris d'Entremont]

I am now prepared to rule on the point of order raised earlier today by the House leader of the official opposition. It concerns the admissibility of an amendment made to Government Business No. 34, namely the inclusion of a substantive amendment to Bill C-62, an act to amend an act to amend the Criminal Code, medical assistance in dying, no. 2.

The member argued that the amendment was inadmissible insofar as it was attempting to introduce a new proposition to the motion. He stated that the motion deals with programming and timetabling of the House consideration of the bill, while the amendment to the motion seeks to amend the bill itself. He claimed that such a proposal should take the form of a separate motion, following the necessary notice requirement.

Normally the House leader would be correct. Substantive motions to amend a bill would be moved at specific steps in the legislative process. It would thereby be possible to move a distinct motion of instruction to the committee or propose specific amendments during the clause-by-clause study or at report stage. However, government Motion No. 34 deals with passage of the bill at several of the stages simultaneously, including committee stage and report stage.

The provisions of this motion, if adopted, would not offer members any other opportunity to amend the bill itself. The member for Montcalm, wanting to offer his amendment to the bill, proceeded in the only way available to him, which was by amending the text of the government motion to include the specific legislative text he wishes to include in the bill. Due to the constraining effects of the motion and not having any other option available to the member to amend the bill, the Chair allowed the proposal amending the motion on Government Business No. 34.

On the argument that the amendment was beyond the scope of the motion because it veered away from straightforward programming or timetabling of the House’s consideration of the bill and into substantive alterations to the bill itself, the Chair’s view is that the scope does not need to be cast so narrowly. In this instance, the scope of the motion can be ascertained as an effort to direct the proceedings on Bill C-62 in a particular fashion, including in relation to its consideration at committee and report stage, which may or may not include legislative changes.

If it is the will of the House to adopt an alternate but still compatible course of action, that is to instead refer the bill to committee with instructions and include specific provisions amending the text of Bill C-62, the Chair finds that it is within the scope of the motion.

To support this conclusion, I refer the House to a similar programming motion that was adopted following a recorded division on April 28, 2021. It is found on page 853 of the Journals. An amendment to that programming motion had been agreed to. It specifically proposed amendments to a bill. In my opinion, the amendment to Government Business No. 34 is not much different from the example I just gave.

For these reasons stated above, the Chair finds that the amendment to the motion on Government Business No. 34 is in order. I thank members for their attention on this matter.

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

[Mike Morrice, Green, Kitchener Centre, ON]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, it is always an honour and a privilege to rise in the House on behalf of the wonderful residents of my riding of Vaughan—Woodbridge and all of the residents in the city of Vaughan.

I will be sharing my time with my friend and colleague from the wonderful riding of Kitchener Centre.

Before I begin my formal remarks, this is a debate on Bill C-62, medical assistance in dying, which is obviously highly personal to all members in the House. Remarks are being delivered today with much passion, substance and thought. I will add a few words on that front. I have provided my personal beliefs on medical assistance in dying, which I am obviously in favour of. I know many individuals in many families who made tough decisions that were not with regard to mental illness. That gives me great consternation and much thought.

I am glad that a pause will be put in place because mental illness is a complex subject. I am not an expert and will not profess to be an expert, but we all know someone who has struggled with mental illness. We all know family members or friends for whom mental illness continues to be an issue. Unfortunately, many folks have taken their lives, and we need to make sure there is a system in place that is robust, where people can get the help and assistance they need to live their full lives, which God has blessed them with.

I am convinced that our current MAID system is working well. I would like to take the next ten minutes to explain why Canadians should have confidence in our MAID legislation and its application over the past seven years. I also want to describe some of the activities that will help sustain that confidence when eligibility is expanded in March 2027, as proposed in Bill C-62.

When the law authorizing medical assistance in dying was originally passed in 2016, it included a number of mandatory eligibility criteria for anyone requesting MAID. The person must be an adult of at least 18 years of age and capable of making health-related decisions. The request must be voluntary. Their request must be fully informed, and the person must have knowledge of the options available to relieve their suffering. They must have a grievous and irremediable health condition, meaning it cannot be cured, which is defined as follows: They have “a serious and incurable illness, disease or disability; they are in an advanced state of irreversible decline in capability”, and they are experiencing “enduring physical or psychological suffering” that cannot be relieved under conditions that they consider acceptable.

In 2016, the law also required that the person's natural death be reasonably foreseeable. In 2019, the Quebec Superior Court ruled that this criterion violated the Charter of Rights and Freedoms. In March 2021, a revised version of the federal law was passed, extending eligibility for MAID to people whose natural death was not reasonably foreseeable as long as they met other eligibility criteria.

In addition to these eligibility criteria, the law also sets out many procedural safeguards that a clinician must meet before administering medical assistance in dying. Here are a few of them: Two independent practitioners must provide a written confirmation of the person's eligibility. The person who is requesting medical assistance in dying must be informed that they can change their mind at any time and in any way and that their wishes must be respected. Also, the person must reconfirm their desire to receive medical assistance in dying immediately before receiving it.

When a person's natural death is not reasonably foreseeable, a series of enhanced safeguards must be respected. I will talk about some of those critical safeguards.

First, at least one of the two MAID assessors must have expertise in the person's medical condition. If they do not have that expertise, they must consult another practitioner who does. Second, the person must be informed of the means available to alleviate their suffering and be offered meaningful consultations. Third, these means must have been discussed, and both MAID assessors must agree that the person has seriously considered these means. Fourth, at least 90 days must pass between the beginning of the eligibility assessment and the day on which MAID is administered. These are legislated safeguards that all practitioners must abide by.

We know that MAID practitioners across the country exercise considerable professional judgment in providing this service by keeping patients' interests and wishes at the forefront.

Practitioners work hard to ensure that MAID is a last resort. They compile essential information about the person's medical condition, their treatment history and their use of support services. They have the necessary conversations to ensure that their patients are aware of the services available to them that might alleviate their suffering. It is about exploring treatment options, facilitating referrals and following up on the results.

If the person who wants to receive MAID consents to involving family members and loved ones, the practitioners will encourage their involvement and include them in the discussions that are part of the overall assessment process.

Practitioners are also aware that they do not always have the necessary expertise in the patient's condition to conduct a full assessment. In these situations, they have to consult the relevant experts and other health professionals who have the necessary expertise to make an informed decision. Some provinces or regional health care authorities have put in place MAID care coordination services or case consultation mechanisms that rely on a team or network of doctors, nurses and other professionals, such as social workers and spiritual leaders, to support the assessment process.

What does that mean for the future, once we begin allowing MAID requests based on enduring and intolerable suffering resulting solely from mental illness? Are our existing legislative safeguards sufficient? How can we be sure that the same level of care, diligence and consistency in the provision of MAID will be the norm?

In 2021, as mandated by the former Bill C-7, an expert panel reviewed the issue and concluded that the existing legal framework for eligibility criteria and safeguards is sufficient, provided MAID assessors apply the existing framework appropriately, with guidance from MAID standards of practice that have been developed as well as specialized training.

In the time I have left, I would just like to say that we all rise in this most honoured House on many topics. One of these topics, probably one of the most personal ones that we have risen on in the number of years I have been here, is medical assistance in dying. I look forward to questions from the hon. members in the House, who have been sent here by their constituents. This is an important debate for us to have, and it is an important topic to discuss.

[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?

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

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

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

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

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

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

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

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

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

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

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

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

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, let us try to calm down a bit.

In this debate, the government is basing itself on the Special Joint Committee on Medical Assistance in Dying for its amendment to Bill C‑62.

The Bloc Québécois would have liked to lend its support. The problem is that we believe that we should not indefinitely delay the possibility of medical assistance in dying for people with an irremediable mental disorder, when no psychiatrist worth their salt has been able to treat them or relieve their suffering. After 10, 20 or 30 years of suffering, the decision whether or not to request MAID should not lie with this person, who is supposed to determine whether the patient is eligible.

We asked for an amendment to the bill. Why take three years when, last year, we were told that it would take a year to make sure that MAID for people with mental disorders could be set up in a safe and appropriate manner? The main issue we have is that, in 2015, there was an election, but there was also the Carter decision. The government and this Parliament passed terrible legislation, similar to the one Quebec adopted a year earlier.

Quebec passed a law that only covers end-of-life cases, people who are terminally ill. I want to reiterate that, in the terminal phase of life, the process of dying has begun and is irreversible. People can be well taken care of in palliative care. Good palliative care, as described by Cicely Saunders at the time, is full, comprehensive, holistic support for people as they are dying. It involves adequately managing the person's pain and suffering, both physical and emotional, and supporting their family. All of this should be done in an environment that resembles a normal environment as much as possible. However, it is possible that, all of a sudden, in the midst of this process, the patient, who is slowly dying, will request MAID because, one day, they are feeling at peace and ready to let go. That is not a failure, in my opinion. It can be seen as successful palliative care. When my colleagues are about to depart this life, I hope that they will be calm and at peace. That is what I would wish for everyone.

So Quebec had taken those steps. Then in Parliament came the Carter decision, which stated that Ms. Carter was not at the end of her life, but she was suffering a great deal. It was therefore decided that depriving her of medical assistance in dying impinged on her right to life. Why? She was being forced to end her life prematurely, when the fact is that letting her decide what happened next would empower her. It was up to her to define when her suffering became intolerable.

It was a bad law. Bill C‑7 had to be introduced. When we began studying Bill C‑7, there was another factor that had to be considered; that was in 2021.

The Carter decision states that there cannot be an absolute prohibition on MAID simply because people belong to a particular group, one that is vulnerable. It must be assessed on a case-by-case basis.

The reality is that people can and do struggle with irremediable mental disorders. Irremediability is established through a rigorous process. During that process, practitioners must be certain that the person has never refused treatment that we know would have absolutely improved their situation.

There are indeed people whose mental disorders cause intolerable suffering, and psychiatry does not help them. If anyone here wants to claim otherwise, I would say that they lack intellectual integrity. Psychiatrists cannot cure everyone; it is impossible. That said, psychiatry is rife with medical paternalism.

That being said, what we wanted was for the government, whose Bill C‑62 is based on the work of the Special Joint Committee on Medical Assistance in Dying, to plan ahead for when it might have to introduce Bill C‑62 and include another key recommendation of the special joint committee in the bill. That recommendation was presented a year ago and was the subject of a consensus. One Conservative member even joined the majority. There is a consensus in favour of advance requests.

Why was that not included in the bill? It should have been anticipated. The government knew that the date would have to be pushed back. It had a year to introduce a measure in the House that would have also covered people suffering from dementia and Alzheimer's. Why did the government not do that? We asked the government why it was not doing so when it had the chance. Quebec drafted its own legislation. It is structured, rigorous and unanimously supported in Quebec.

An Ipsos poll shows that 85% of the Canadian population supports advance requests. In British Columbia, 84% supports advance requests. In Alberta, it is 84%; in Saskatchewan and Manitoba, it is 81%; in Ontario, it is 84%, in Quebec, it is 87%; in Atlantic Canada, it is 81%. I could go on. There are other figures. They vary. The results are based on a sample of 3,500 people. That is not nothing. When will the government take action? Why has it not heard this request? Why has it not spoken with Quebec, who has worked on this issue? Why did it not hear the unanimous will of the National Assembly, just last week? Why is it afraid of its own shadow? Why do the Liberals lack courage so?

The last time they lacked courage, we ended up with Bill C‑14. What is the problem with Bill C‑14? The real problem with Bill C‑14 is not a legal problem. The problem is for a patient who is suffering, who, to satisfy the reasonably foreseeable natural death criterion, has to go on a hunger strike. We have seen that. The problem is for people who, like Ms. Gladu and Mr. Truchon, have to fight for their constitutional rights in court. When I say there is a lack of courage, that is what I mean.

My only viewpoint is the viewpoint of patients who are suffering. The only thing I am standing for here is the suffering patients' right to self-determination. Patients had to fight an uphill battle against medical paternalism when it comes to MAID.

As I mentioned last week, there was a time when the palliative care that is so dear to the heart of my Conservative friends and that I personally consider to be very important was called passive euthanasia. Doctors obstinately used aggressive life-support measures because their duty was to save their patients. As we know, every doctor thought that they could save every patient back then. It was actually doctors suffering from cancer who started to assert their right to refuse treatment. Today, cessation and refusal of treatment are part of what are considered to be good medical practices.

Why are we not studying the bill today? The government is imposing a gag order. We will not be overly critical of this decision. I understand that this has to be done before March 17. We are not getting too worked up about this, but still, we have not consented and will not consent to this. Why not? It is because we wanted a bill that was based on the recommendations from the Special Joint Committee on Medical Assistance in Dying. I want answers from the government in that regard.

Why the delay in expanding medical assistance in dying to people with mental health issues? We did what the committee asked. Bill C‑62 even provides for the Special Joint Committee on Medical Assistance in Dying to reconvene in order to determine whether the groundwork has been laid. That is what we are doing. We basically took the recommendation and inserted it into the bill. Then, there is the issue of advance requests. There is a consensus on that across the country, but the government lacks the courage of its convictions.

The Liberals are afraid of demagoguery because there has been a lot of it on this issue. They are lumping everything together. However, at some point, they need to be consistent in their approach. The Liberals are well aware that the state's role is not to decide for the patient what is best for them when it comes to a decision as personal as one's own death. The state or the patient's neighbour is not the one who is going to die. The state's role is to determine the proper conditions and ensure that they are put in place so that patients can make a free and informed choice. If people are worried about abuse or the slippery slope when it comes to advance requests, then they should look at Quebec's law, which is a model to follow.

The government could have easily inserted elements of the Quebec law into its regulations. It is all well and good to say that the law is a little vague, but the amendment we are making to the medical assistance in dying legislation, expanding section 241 of the Criminal Code, is followed by a procedure, regulations on enforcing regulations. That is where the various safeguards are put in place.

There are standards of practice when it comes to mental disorders. A year ago, a committee began looking at standards of practice, and they will be sent to the regulatory bodies in each province, namely the colleges of physicians. Once we have clear guidelines and standards of practice and the criteria I was talking about earlier are met, someone in a suicidal crisis will not have access to medical assistance in dying.

It bears repeating, because I am hearing a lot of confusion over this. A suicidal person is not eligible for medical assistance in dying, even if they suffer from a mental disorder and are in suicidal crisis, and even if they have recently been admitted to care and diagnosed. I have often asked psychiatrists if they thought that giving access to medical assistance in dying to people with mental disorders could also provide an opportunity for prevention. Some people commit suicide and no one sees it coming. No one knows those individuals today, no physician took them on.

For example, knowing that MAID is an option, a person might come forward because they are suffering and want to exercise that option. Well, that person would not qualify. However, they would then be taken care of and get the treatment they need, since suicidal ideation is reversible. There is no question about that. However, it is not about those patients. When we asked the chair of the expert panel, psychiatrist Mona Gupta, how many patients in her practice would have been eligible, she told us of two or three patients over her entire practice. Still, these are people who are suffering.

When people talk about the fact that the resources are not there—the resources in terms of someone to assess capacity, for an independent psychiatrist to look at a case—I would point out that right now, the decision-making capacity of a person struggling with a mental disorder, but who has cancer, for example, is verified. Psychiatrists are currently assessing the decision-making capacity of people with a mental disorder and a comorbidity. Depending on their condition, practitioners are able to determine the decision-making capacity of these people who have a mental disorder.

The Supreme Court was clear: Not allowing these people to access MAID creates stigma. Not only does it stigmatize them, it discriminates against them. Why infantilize and weaponize people who have a mental disorder and who, in their entire existence, have not found treatment that can alleviate their suffering?

I rather like having discussions and debating with my Conservative colleagues. They have a sense of conviction, but there are some Conservatives who use scare tactics and conflate everything. It is not enough to repeat some 20 times that someone came to say that irremediability is hard to address. Everyone agrees. Even the expert panel starts with that. They did not hide that fact. In fact, they say that because irremediability is hard to establish there must be safeguards and precautionary principles put in place.

I therefore move the following amendment:

That the motion be amended in subparagraph (b)(ii):

(a) by adding after the words “be deemed referred to a committee of the whole,” the words “that an instruction be deemed to have been given to the committee granting it the power to expand the scope of the bill so as to take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care,”;

(b) by replacing the words “deemed reported without amendment” with the following: “deemed reported with the following amendments:

That the bill be amended by adding the following new section 241.21 to the Criminal Code:

New section 241.21

Medical assistance in dying eligibility criteria for advance requests

“241.21 The government of a province may establish a medical assistance in dying framework for advance requests from persons who have an illness that could deprive them of the capacity to consent to care, in accordance with the laws of that province.””; and

(c) by replacing the words “deemed concurred in at report stage” with the following: “deemed concurred in at report stage, as amended”.

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

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

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

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

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

It is unbelievable.

Madam Speaker, at the end of the day, these are not easy decisions, and the member opposite feels these 13,000 were just killed.

The government puts in a great deal of effort to get things in a state of readiness, so that we are able to provide the types of services Canadians want and need.

I make reference to the 988 suicide crisis line. Some might try to give the impression that because this is just a three-digit number, all we have to do now is say that we are going to have it and click our heels, and then it appears. The idea came up a number of years ago from, I believe, a member of the Conservative Party, who was being very genuine. That does not take away from the fact that other members, associations and stakeholders were also talking about it. As a government, the minister responsible ultimately did the sharing and the networking that were necessary in order to be able to present to the House of Commons a program that ultimately received the funding that was necessary, and worked with the different provinces, territories and stakeholders to turn it into a reality.

Today, the 988 number is live. People having suicidal thoughts can feel comfortable knowing there will be someone at the other end of the line when they call 988 who can help them in different languages and understand and appreciate different cultures. I would suggest this is an example of how things come to the government, actions are ultimately taken and then something is put in place.

The same principles have applied here. The Supreme Court makes a decision based on the Charter of Rights; the government brings in legislation, which is thoroughly debated and on which amazing consultation and input take place, with hundreds of hours of dialogue; and the legislation is passed by a majority. It is passed by members of all political parties and then ultimately put into place.

It is a policy that is then administered and, as I pointed out earlier, there is at times the need for changes. We saw that need. One of them was amplified through the Quebec court. We make the change. We listen to what the Senate said. The issue of mental health is something that was brought to our attention. This legislation, Bill C-62, like the previous one that delayed the implementation, is going to continue that delay. To that end, I believe we will in fact have sound, solid legislation, and hopefully it will not have to be revisited. Time will tell us on that.

With those few words, I hope members can appreciate why the need for the programming of the legislation is being put into place and why the legislation is so critically important. Indeed, I would suggest that delaying it for three years is a reflection of what a vast majority of Canadians want and what the different stakeholders are requesting.

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

Mr. Speaker, it is a pleasure to rise to speak to a very important issue. This is a deeply personal and complex issue, one that has had a great deal of debate in the House for number of years now.

We are not directly speaking to that. Rather, we are speaking to the motion that would enable the government to get the MAID issue resolved for the next few years. The motion would ensure that the legislation actually passes. I will give a little background on that.

There is a time limit for us to ultimately get Bill C-62 passed in order to fulfill our commitment to the court. Obviously, we want to keep the law validated, appropriately. The motion we have brought forward today would allow for the House, while providing some time for the Senate, to pass and give royal assent to the bill before the House breaks in March for a couple of weeks. In essence, it allows for a little more debate this week, when it will ultimately pass.

It would then afford the Senate, in the week following the break, the ability to deal with the legislation and hopefully pass it without amendment. This is very important, as that would then enable the legislation to receive royal assent before the deadline.

I know some members may be a little uncomfortable with respect to this programming motion before us today, the limitations that it puts on members and the importance of the subject matter itself. As some members may recall, last week I stood in my place and asked for unanimous consent to sit late in the evening. That way, members would have had more opportunity to have debate on this issue. Unfortunately, we did not get unanimous consent. As a direct result, we have to work within the time frame of when the House allows us to sit. As a result, in order to meet the deadline, we have brought in a programming motion.

I made reference to the very beginning, about when we started to talk about the issue of medical assistance in dying. It came up in 2015. A Supreme Court of Canada decision, Carter v. Canada, made it very clear that we, as a government, and Canadians, through the Charter of Rights, needed MAID legislation. That was decided midway through 2015, but no action was taken, knowing full well that we had to bring in a law to address what the Supreme Court had put in place.

We all know that an election took place. Shortly after that election, it was made very clear that as a government we needed to bring in the legislation. An approach was made to the Supreme Court to take into consideration what had taken place over the last number of months following its decision, including an election.

The Supreme Court ultimately provided grace to the House of Commons so that we could, in fact, get the necessary legislation brought forward to the chamber and ultimately passed. We did have to ask for yet another extension back then. I do not think that surprised anyone.

From the day we can recall, in 2015, there was a great deal of discussion that had taken place. In fact, I suspect, if one were to take a look at the different pieces of legislation, today, we call it Bill C-62, and the original legislation was Bill C-14. We have had legislation in between those bills, which the government had to bring into the House.

On occasion, when the government brings in legislation for debate, there is fairly extensive debate not only in the chamber but also in committees. I can remember, quite vividly, a lot of the debate, the issue for which the special committee was put together to deal with the issue and to provide some thoughts, recommendations and ideas to the chamber and the members who were directly involved.

There is no lack of interest or input from the many different stakeholders, of all different natures, in every region of the country. Everyone had an opinion on the issue. In the end, the amount of dialogue that went into the legislation and the creation of MAID, was probably greater than 90% of all other forms of legislation that come to the House.

We saw that in the passion of the debates presented at the time by members of Parliament on all sides of the House. It was not just Liberals, New Democrats, Conservatives or the Bloc, or even the leader of the Green Party at the time, where one could see the emotional toll of the debate. That is why I talk about it being of a very deep, personal nature. There are complex choices and decisions that have to be made on this.

When I reflect on that debate, there were tears inside the chamber. There were all sorts of emotions as members tried, in the best way they could, to explain why they were taking their positions on it. Different members voted for different reasons and so forth.

In the end, Bill C-14 ultimately passed, after many hours of debate inside and outside. When I say outside, I go even further than outside of standing committees. There were emails, correspondence and discussions that I had on this issue, and it was fairly intense. People wanted to know how I felt about it. I am sure all members of Parliament were questioned about what they had to say on the legislation.

I do have differing opinions from members across the way and maybe even, quite possibly, within my own caucus. I genuinely believe that the need for MAID is there. There is no question about that.

However, where I fall on the side that it seems to be acceptable, at least for a good percentage of people I represent, is to have trust and confidence in our system of health care professionals, social workers and support people whom family members go to when the time comes to make difficult decisions, such as another family member, a local pastor or anyone else. Having that confidence has allowed me to feel comfortable as we have gone through this legislation, virtually from day one.

There was a need for changes. To bring in substantive legislation for the first time that so profoundly impacts the lives of Canadians and to expect that the legislation would be perfect and would not require change is somewhat naive. That is in fact what took place. There was a need to make some changes to the legislation. That is why, ultimately, we had the second go-round of the legislation.

There was a fairly wide discussion on that second attempt and, through amendments, something that is now very challenging was brought in, which deals with mental health as a sole condition for MAID. I know that has stirred the emotions of a lot of members and, ultimately, when the legislation passed to allow it, there was a lot more resistance to it than there was to Bill C-14. It did not surprise me, because of the delicacy of the issue.

Again, I fell back to what I believe a vast majority of my constituents are comfortable with, which are the health care professionals and others, because I am not a medical doctor. I do not understand the issue to the same depth as do the different professionals. As a direct result, I feel more comfortable taking the same position as the government took on the issue.

However, we also need to recognize the reality that other jurisdictions are very concerned about the implementation and about the degree to which we are ready to implement the legislation that was passed. That is really the crux of it. Therefore, we have Bill C-62 today, which would allow for that ongoing exemption to continue. That would enable the system, which is large and complex, to ensure that everything is ready. Then, if the legislation takes effect, people would not be let down, and we would still be able to meet the constitutional requirements. Let us remember that the amendment to the original legislation, in part, came from an appeal court in the province of Quebec, which obligated members of the House to bring forward other legislation.

I know my friend opposite, from the Conservative Party, says that we had a choice and that we could have appealed that decision to the Supreme Court of Canada. As a number of them said, we could have attempted to kick the can down the road. Ultimately, it was a decision made and supported by a majority of members of Parliament in the House. Even though the Liberal government had a majority, when it came to Bill C-14, members know full well there were members from all sides who supported it.

Today we have a minority situation, and the only way we can pass legislation through to have the support of other political entities inside the chamber. I would like to think that what we learned through this process has enabled us to look at other things we have been able to do directly.

During many hours of the debates, people talked about palliative care, hospice care and about the lack of that type of care being provided to the people of Canada. It has been a genuine concern for many years, probably a good 20-plus years, where we needed to see more invested in hospice and in palliative care.

Far too often we see individuals who are panelled in our hospitals because there is no place for them to go outside of the hospital. If we look at what took place during the pandemic, we saw that care facilities had to close the doors to people from outside to protect those on the inside. Those on the inside were often dying prematurely, and we know that as fact. Organizations like the Canadian Forces or the Red Cross were involved.

If we take a look at the bigger holistic picture, are we collectively, and contrary to what some might say, it is not just Ottawa, doing enough to be able to deal with these social issues that Canadians have a high standard for? They want politicians of all political stripes and of all levels of government to invest more resources. I am talking about not only money, but also time and debate.

There are probably better ways in which we could spend some of the money that is spent in areas such as health care, social services and so forth. One could take a look at the process for someone who might, first, end up in a hospital situation, and while in the hospital, they find out that things are not good and that their life is going to come to an end in a relatively short time.

One of the things that happen is that hospitals can provide only so much in terms of treatment. There is no consistency within a province, let alone the nation, as to which individuals are being kept in the hospital. Because there are not enough supports in a home atmosphere and there is no other place for an individual to go, far too often they become panelled in a hospital facility in one form or another. I believe the debates we have seen on MAID amplify that.

These are the types of discussions and debates that we should be having, not only here in Ottawa but also in our communities and at the different legislatures. Quite frankly, there are some fairly significant stakeholders out there who also have to play a role, like non-profit organizations. That is what I recall about some of the discussions we have been having over the years in regard to MAID legislation. Unfortunately, as I pointed out, the original thoughts in regard to MAID and the need for us to bring in legislation and the types of debates that we saw then are in contrast to today, as it is becoming more of a politicized issue. Politics seems to be more important than the issue itself in some ways.

That is why at the very beginning I referred to the fact that it is not a good thing that we had to bring in a programming motion, but it is important that we do it today, because we were not successful at getting the consensus required to be able to sit longer to allow for a consensus to emerge as to how the legislation could pass through the system. However, we still have an opportunity. The motion talks about going to the Standing Committee on Health as the subject matter.

When this motion passes, it will enable the Standing Committee on Health, as its first priority in terms of the resources of the House, to meet. A minister will in fact be there for a good hour. There will be an opportunity to have a few other witnesses. It will ultimately have to go through the committee. If we can get this motion passed, after this legislation goes through committee it will come back here to the House of Commons for third reading later this week, before being dealt with in the Senate in the last week of February to March 1. That time frame will enable it to ultimately get the necessary royal assent in order for it to be enacted into law.

Based on what the legislation would actually do, I would think that the Conservatives, in particular, would support it. The essence of the legislation is to put in a three-year extension. It provides for particular provinces and jurisdictions to be able to get things in a better state of readiness, so that, at the end of that period of time, we are able to provide the types of services that are necessary. This means, in good part, that there will be ample time for us to continue to have that dialogue and debate, and if there is a need to do and bring forward other things, whether it is through private members' business or government business, that there are opportunities. However, I suspect, by passing Bill C-62, that a sound majority of the House will be content with the modernization, if I can put it that way, of the legislation.

In one part, it reminds me of the issue of the suicide crisis helpline, and I say that for two reasons.

One reason is that some members often will make reference to how the legislation as a whole is enabling individuals to virtually have suicide upon request, which is just not the case. We know that is not the case, and the members who say it know that is not the case but unfortunately we still see some members give that false impression. I find that to be somewhat unfortunate, because it is definitely misleading and does a disservice in terms of the legislation and the thorough process that we have gone through. I cannot imagine the number of hours, and we are talking three digits and more of hours of different types of discussions in many different forums. To try to simplify it by calling it “suicide on demand” does a great disservice to the legislation and to the law that we currently have in place.

The reason I bring up the suicide helpline is that someone indicated to me that there are people who, at times in their lives, give it thought. When they heard about the MAID legislation, they made inquiries, and because of those inquiries they were able to get the type of assistance that made things better for them. In other words, MAID legislation, on occasion, I would ultimately argue, has actually even saved lives.

Business of the House

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

I would first like to thank my hon. colleague and his colleagues in the official opposition for finally letting Bill C-57, the Canada-Ukraine free trade agreement, come to a final vote. That is good news for Canada and our Ukrainian friends, with whom we stand in solidarity.

As for the business of the House, we will continue to have ongoing discussions that would see us dealing with Bill C-62, medical assistance in dying, next week. We are, of course, well aware of the deadlines that are looming. I remind all members of this House that there is a March 17 deadline attached to this very important legislation.

I would remind the House that we wanted to allow all parties in the House, as well as in the Senate, to participate in a process that could guide the government's choices on medical assistance in dying. We produced a report that resembled a consensus, and the bill reflects that consensus.

We will also give priority to bills that have been examined and amended by the Senate and are therefore now in the final stage of debate in the House. These include Bill C-29, which would create a national council for reconciliation, and Bill C-35 on early learning and child care in Canada.

As I said at the outset, we will continue to consult with the opposition parties. My door is always open. If necessary, we will make adjustments so that the House can continue to work in an orderly fashion.

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

Mr. Speaker, as it is Thursday, I am very excited to ask the Thursday question. I was wondering if the government House leader can update members as to the business of the House for the rest of this week and into the next week.

I will take this opportunity to ask how the government plans to manage Bill C-62. Bill C-62, as members will know, is the response to a court deadline to protect vulnerable people with mental health afflictions. The government has had over a year to deal with this, yet here we find ourselves again on the eve of an expiration of a court-imposed deadline with not a lot of House time.

If the government could enlighten members as to how it foresees Bill C-62 will move through the House in time for that court-imposed deadline so that vulnerable Canadians are not in any way victimized by the regime around MAID, I am sure members from all sides would like to know that.

Criminal Code

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

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

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

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

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

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

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

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

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

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

The government identified the following in its charter statement:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Ya'ara Saks, Liberal, York Centre, ON]

moved that Bill C-62, an act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, be read the second time and referred to a committee.

Mr. Speaker, I am pleased to have the opportunity to speak today about Bill C-62. This is a sensitive and very personal subject for so many around the country.

We have debated many of the core issues, but today we are talking about the legislation that proposes to extend 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.

I want to be clear: The question we are debating today is not whether mental illness can cause irremediable and intolerable suffering on par with that of physical illnesses. We know that it can, and that is not up for debate. We must proceed cautiously and we must get this right. We must ensure that the appropriate measures are in place across this country to affirm and protect our most vulnerable.

We have heard significant concerns from partners, provinces and territories and the medical community, regarding health care system preparedness. In its latest report, tabled on January 29 of this year, the Special Joint Committee on Medical Assistance in Dying found that while considerable progress has been made in preparing for the expansion of eligibility for persons suffering solely from a mental illness, an additional delay is needed to ensure that the health care system can safely provide MAID in these types of complex cases.

These concerns must be addressed before we can move forward with extending eligibility to persons whose sole underlying condition is mental illness. While that critical work is happening, we must also take action to ensure that vulnerable people are protected. Unless Bill C-62 is passed by March 17, 2024, the exclusion of eligibility for MAID will be automatically repealed. That means that individuals suffering solely from mental illness could be eligible to receive MAID as of that date, without the system being ready.

Although progress has been made to support the safe assessment and provision of MAID in complex cases, now is not the time to extend the exclusion, as highlighted by the letter we received from provinces and territories.

Over the past few years, the Government of Canada has been collaborating closely and carefully with partners to support the implementation of MAID. We have taken a compassionate and careful approach to this in our support of the safe assessment of MAID in complex cases, including where the sole and underlying medical condition is a mental illness.

I would like to take a few minutes to highlight some of the key areas of progress that have been made. As required under former Bill C-7, we appointed an independent expert panel with a mandate to provide recommendations on protocol, guidance and safeguards to apply to requests for MAID made by persons whose medical condition is a mental illness.

The final report, tabled by the expert panel in the spring of 2022, included 19 recommendations for governments and health system partners to support the safe expansion of MAID for persons suffering only from a mental illness. The panel noted that the recommendations would benefit all complex track 2 MAID assessments and provisions, even those where mental illness was not a factor. At the same time, the Special Joint Committee on Medical Assistance in Dying was also studying the question, and concluded that, at that time, they believed additional work was needed before moving ahead.

Both the reports by the Special Joint Committee on Medical Assistance in Dying and the expert panel highlighted the importance of education and training, consistent professional guidance, enhanced data and analysis, meaningful indigenous engagement and strong oversight. The government has taken these recommendations very seriously and has worked diligently to advance them.

In September 2022, Health Canada convened an independent task group made up of clinical, legal and regulatory experts to develop model MAID practice standards based on the expert panel's recommendations. Its mandate was to create resources that could be used by regulators to operationalize the expert panel's guidance with respect to complex MAID cases, including those based on a mental illness alone. The task group's efforts resulted in a model practice standard for MAID and a companion document, “Advice to the Profession,” which were both published in March 2023.

To date, the majority of provinces and territories have indicated that their practice standards for MAID have been updated or are in the process of being reviewed using these materials as a guide. The supporting “Advice to the Profession” document is being used to support and inform regulatory bodies, public authorities and health professional organizations, and is intended to support a consistent and safe approach to MAID practice across Canada.

In addition, Health Canada has been working closely with the Canadian Association of MAiD Assessors and Providers, also known as CAMAP, on a number of key activities to support preparedness among practitioners. Among them include funding the development of a nationally accredited bilingual MAID curriculum to support access to high-quality MAID training and a standardized approach to care across the country, while recognizing that differences in the delivery of health care services among provinces and territories do exist. As of the end of January, more than 1,100 clinicians have already registered with CAMAP to take the training.

We supported a knowledge exchange workshop on MAID and mental disorders that took place in June 2023. The workshop brought together MAID assessors and providers, as well as psychiatrists, from across the country to discuss the assessment of MAID requests based on mental illness alone, to build a network for ongoing knowledge exchange and to inform future practice. Additional knowledge exchange sessions are being planned for May 2024 and 2025 to support ongoing interjurisdictional lesson sharing and clinical guidance for complex case assessment, including for mental illness as the sole underlying condition.

When it comes to the question of eligibility criteria for MAID, we must consider all situations and all outcomes. While important work has indeed been done, we have heard clearly from our partners that they need to have sufficient time to implement safeguards and address capacity concerns that are expected to result from the expansion. As my hon. colleague, the Minister of Justice, has pointed out, we are trying to calibrate two fundamental ideas: the autonomy of the individual in terms of dignified decisions about the timing of their own passing, coupled with protecting vulnerable communities and individuals.

As the deadline to lift the exclusion of eligibility for mental illness approaches, calls to further extend the deadline have grown louder. We understand from our engagement and outreach with health stakeholders that there are varying levels of readiness to manage and assess requests for MAID where the sole medical condition is a mental illness. All provinces and territories have indicated that they are not yet ready to move forward. More work needs to be done.

On January 29, the Special Joint Committee on Medical Assistance in Dying tabled its most recent report examining the degree of preparedness for the safe application of MAID for persons whose sole underlying condition is a mental illness. While recognizing the considerable progress that has been made in preparing for the expected expansion of eligibility, the committee recommended an additional delay to ensure that the health care system can safely provide MAID in these types of complex cases.

I want to be clear: I understand that suffering from mental illness is just as real and just as serious as suffering from a physical illness. That is why we provided a clear timeline of three years before the lifting of the exclusion, which the provinces and territories and our health care partners can continue to work toward, and a firm commitment for parliamentarians to evaluate the progress after two years. That work will continue in earnest, and we can be assured that all the necessary measures are in place to move forward safely.

I understand there will be people who have suffered over many years without finding relief, and for whom MAID may be a serious consideration based on deep and personal reflection. This new development may truly be distressing for them. I want to say to them that we are committed to moving forward. However, we must do so in the most compassionate, responsible and prudent way possible. The system needs to be ready, and we need to get this right. It is clear from the conversations we have had that the system, at this time, is not ready. As I have said, we have worked hard to make sure that the necessary supports are in place for practitioners and our provincial and territorial partners to permit the expansion of the MAID eligibility to people whose sole condition is a mental illness. However, they have also been clear that more time is needed to prepare; that is why we are proposing a three-year extension.

The availability of nationally accredited training modules for MAID assessors and providers would help ensure that providers were clear on the requirements of the legislation and good clinical practice. However, it is going to take some time for individual physicians and nurse practitioners to integrate and internalize these practice standards.

Provincial and territorial regulatory bodies need to complete the work associated with updating standards. They need to ensure that health care clinicians have the training to ensure a safe and consistent assessment before the MAID eligibility is expanded through the lifting of mental illness as an exclusion. Existing assessment and support mechanisms also need to be examined and revised to ensure that the robust measures needed for these types of complex requests are in place. On that point, we are committed to continuing to support the provinces and territories and help system partners to further strengthen and improve mental health care services and supports, as well as data collection, to better understand who is requesting MAID and why, and appropriate support and oversight for practitioners.

While the management and delivery of health services, including MAID, is an area of provincial and territorial responsibility, the provinces and territories have been regularly engaged through a working group to facilitate information sharing and collaboration on MAID implementation. Through this group, provinces and territories have been and continue to be engaged in the work on the federally led model practice standards and are working collaboratively with all of us on all aspects of MAID.

The government has also made significant investments to support the provinces and territories in the delivery of mental health services. Budget 2023 confirmed the government's commitment to invest close to $200 billion over 10 years, starting in 2023-24, to improve health care for all Canadians. This includes $25 billion to provinces and territories through tailored bilateral agreements, focused on four key priorities, including improving access to mental health and substance use services and the integration of these services in all other priorities. This is in addition to the $5 billion committed in 2017 to support mental health and substance use services.

Our government has also invested more than $175 million to support the implementation and operation of 988, which will provide people across the country with access to immediate and safe support for suicide prevention and emotional distress.

As MAID continues to evolve, we need to ensure that accurate information is available to the public by providing clear information. We also take the concerns raised by those who might face systematic disadvantages very seriously. That is why we have expanded data collection on MAID to provide a better understanding of who is accessing MAID and why, including the collection of data on race, indigenous identity and disability. We can only address potential risks if we can uncover them.

We are continuing to engage with indigenous peoples through both indigenous-led and government-led activities to better understand their perspectives on MAID. This will culminate in a “what we heard” report in 2025. This will support transparency, provide insight into how the legislation is working, and maintain public trust in how MAID is accessed and delivered in Canada.

Finally, both the expert panel on MAID and mental illness and the special joint parliamentary committee highlighted the importance of case review mechanisms and oversight to support the safe assessment and provision of MAID. Most provinces and territories already have systems in place to do this work, but we understand that more can be done. We are working with the provinces and territories to explore enhanced models of case review and oversight, and, in particular, for more complex MAID requests, to support consistency and quality assurance across the country.

I understand that medical assistance in dying is a complex issue about which there are deeply held beliefs and opinions. I understand the concerns that have been raised with regard to the expansion of eligibility for MAID to include circumstances where the person's sole underlying medical condition is a mental illness. This 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.

The Government of Canada has also committed to a joint parliamentary committee to undertake a comprehensive review within two years after the act receives royal assent. This measure would further serve to examine progress made by provinces, territories and partners in achieving overall health care system readiness.

In the meantime, our government will continue to work with the provinces and territories to support ongoing improvements of the system to continue to ensure our laws protect those who may be vulnerable, reflect the needs of the people of Canada, and support autonomy and freedom of choice. That is why, after much deliberation, we have introduced Bill C-62 to extend the temporary exclusion of eligibility for MAID for persons suffering solely from a mental illness to March 17, 2027.

To put it simply, we need more time to get this right. I urge all members of the House to support Bill C-62.

Presence in Gallery

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, there have been discussions among the parties and, if you seek it, I believe, or at least I hope, you will find unanimous consent to adopt the following motion. I move that, notwithstanding any standing order or usual practice of the House, for today's sitting, the ordinary hour of daily adjournment shall be midnight, and after 6:30 p.m., no quorum calls, dilatory motions or requests for unanimous consent shall be received by the Chair, and when no member wishes to speak on the motion for the second reading stage of Bill C-62, an act to amend the Criminal Code, medical assistance in dying, No. 2, or at midnight, whichever is earlier, the debate on the said motion shall be deemed adjourned, the House shall adjourn until the next sitting day, and the debate, pursuant to Standing Order 38, shall not take place.

Business of the House

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

Mr. Speaker, I thank my colleague from Quebec. I assure him that the House of Commons is in for a good time. There will always be interesting things to debate because we keep introducing good bills in the House.

Tomorrow, Bill C-57, an act to implement the 2023 free trade agreement between Canada and Ukraine, will be the subject of debate.

When we return on Monday, we will call Bill C-59, the fall economic statement implementation act, 2023.

I would also like to inform the House that Tuesday and Thursday will be allotted days. On Wednesday we will begin debate on Bill C‑62 on medical assistance in dying, which was introduced earlier today by my hon. colleague the Minister of Health.

Criminal Code

[Mark Holland, Liberal, Minister of Health]

moved for leave to introduce Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2.

(Motions deemed adopted, bill read the first time and printed)