Bill C-218

An Act to amend the Criminal Code (medical assistance in dying)

This enactment amends the Criminal Code to provide that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.

Criminal Code

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, a few psychiatrists use anecdotal, unsubstantiated claims to assert that every mental illness is treatable or curable, but they also say that psychiatry is wrong about both prognoses and diagnoses. Those psychiatrists cannot explain why we should rely on anecdotal, unsubstantiated accounts involving patients whom they say would have met the MAID eligibility criteria and safeguards set out in the expert panel report when those psychiatrists have no experience with MAID, either as assessors or providers, and when they are are effectively opposed to track 2 or MAID in general.

The report by the expert panel that proposed the conditions under which MAID could be expanded to mental disorders is clear. Just because a patient makes a request does not mean they will be eligible. During her testimony, Stefanie Green explained that the following individuals are ineligible: a person in a suicidal crisis; a person who has recently been admitted for treatment and diagnosed; a person whose request is based on structural vulnerabilities; and a person who refuses, without justification, all treatments that could improve their condition. A person is also ineligible if accessible and effective treatments are available or if the assessors are unable to determine eligibility based on all or part of the criteria.

Evidence of de facto accessibility, linked to a level of preparedness for the safe and appropriate provision of medical assistance in dying for people with mental disorders, was demonstrated in the recent study by the Special Joint Committee on Medical Assistance in Dying. Those who oppose MAID must do so for other reasons.

The Bloc Québécois opposes Bill C-218 and proposes that the dispute over whether the exclusion of patients constitutes discrimination be clarified by the Supreme Court.

In the meantime, we ask that the sunset clause not be removed prematurely and indefinitely. The final recommendation is that recommendation 16 of the expert panel report, which calls for establishing prospective monitoring at the conclusion of the assessment process, be implemented as an additional clinical safeguard.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Madam Speaker, I rise in strong support of Bill C-218, the right to recover act, introduced by my friend, the member for Cloverdale—Langley City. The title of the bill fully reflects the substance of the bill. It is the right to recover: to give persons struggling with mental health challenges hope and help, instead of state-sanctioned, state-administered death, by putting an indefinite pause on the Liberal government's ill-thought-out expansion of MAID where mental illness is the sole underlying condition.

I commend the member for Cloverdale—Langley City for bringing forward the bill, because it is absolutely needed. We need legislation to be passed by Parliament. Otherwise, this ill-thought-out expansion will take effect in March 2027.

I have to say that it should never have been this way. It should never have come to this. The planned expansion is a master class in how not to do policy and how not to legislate.

Back in 2021, the then Liberal justice minister David Lametti, at the eleventh hour, accepted a radical Senate amendment, which he initially opposed, that set the train in motion for the expansion of MAID for mental illness, effective March 2023. There was no meaningful study, no meaningful consultation and no meaningful debate. The Liberals simply rammed it through. This was on a question of life and death concerning among the most vulnerable persons in Canadian society. It could not be more reckless than that.

Here we are, more than five years later, and the planned expansion has been nothing short of a mess. It has been completely shambolic, including the fact that the government has been all but forced to introduce two emergency bills to delay implementation because it did not do its homework at the outset.

Had the Liberals done their homework, they would have heard loud and clear what experts, including leading psychiatrists, have been saying, and that is that MAID for mental illness is a really bad idea, that it cannot be implemented safely for a multitude of reasons, not least of which include two unresolved clinical issues.

The first of those issues is that it is difficult, if not impossible, to predict irremediability. In other words, it is difficult, if not impossible, to predict whether someone suffering from a mental illness will get better. Indeed, many mental illnesses are remediable, and they are very difficult to predict in terms of a prognosis.

As Dr. Karin Neufeld, who is one of Canada's most renowned psychiatrists and is none other than the chair of the Association of Chairs of Psychiatry in Canada, put it in her brief to the Special Joint Committee on MAID, which is studying this very issue, “Psychiatric disorders lack reliable biomarkers, follow non-linear trajectories, and frequently improve after years of severe impairment.” Accordingly, Dr. Neufeld concluded that psychiatrists are poor predictors of long-term outcomes. Simply put, modern psychiatry lacks the tools to predict irremediability in individual cases of mental illness. It is so uncertain in terms of predicting irremediability, that studies show that psychiatrists get it right less than 50% of the time.

As Dr. Sonu Gaind, who is the past chair of the Canadian Psychiatric Association, told the special joint committee, one would be better off flipping a coin to predict irremediability. This is on a matter, again, involving life and death. What that means is that if this expansion were to go forward in March 2027, or at all, tens of thousands of Canadians who could get better, recover and lead productive lives will have their lives prematurely ended.

This prospect is untenable, and it is unconscionable. The uncertainty around predicting irremediability not only renders MAID for mental illness a completely reckless and dangerous policy, but also makes it impossible to administer in compliance with the law. This is because a prerequisite to qualifying for MAID is that an individual must have a grievous and irremediable condition. Given that it is difficult, if not impossible, to accurately predict irremediability in cases of mental illness, the legal basis for MAID cannot be satisfied, full stop. Therefore, we have not only a clinical issue, but also a major legal impediment to this expansion going forward.

The second major clinical issue identified is that it is difficult to distinguish, in cases of mental illness, a rational request for aid versus one motivated by suicidal ideation. This is because, in many cases, suicidal ideation, suicidal thoughts, are a symptom of the illness, and that is underscored by the fact that, in more than 90% of suicide deaths in Canada, mental illness is a factor. What that means is, if this were to go forward, long-standing suicide prevention efforts would be undermined. The mental health law would be upended, because given that suicidal ideation is often a symptom of mental illness, it begs the very practical question of which requests for MAID would merit intervention and suicide prevention versus the granting of MAID.

Given these unresolved clinical issues and other issues, and the clear opposition from the vast majority of psychiatrists, including the 17 chairs of psychiatry representing all 17 medical schools in Canada, who penned a letter to the Minister of Justice saying to put an indefinite pause on this, the Liberals twice, as I alluded to, introduced emergency legislation to kick the can down the road. They kicked the can down the road yet again with a new date of implementation, that being March 2027. Guess what. Nothing has changed. The same clinical issues remain unresolved, and there is no evidence that they will be or can be resolved in the foreseeable future, if ever.

This is why the special joint committee on MAID, which wrapped up its work in June, of which I was a member, of which the member for Cloverdale—Langley City was a member, recommended that the government stop kicking the can down the road and simply put an indefinite pause on this ill-thought-out expansion. I would note that the recommendation was a unanimous recommendation from Conservative and Liberal MPs on the committee.

The government likes to claim it makes decisions based upon evidence, that it make decisions based upon the facts. Well, if that is so, then to follow the evidence, there is only one, objectively speaking, reasonable course of action for the government to take, which is to admit it got it wrong in 2021 and to reverse course by putting an indefinite pause on this expansion. Bill C-218, the right to recover act, provides a clear path forward to do just that.

Let us pass Bill C-218.

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

Madam Speaker, I have a few thoughts I would like to share with the House on the legislation and what it is that the member is actually proposing. With what the previous speaker just mentioned, it is important for us to recognize that the government took action because of a superior court decision that was made in the province of Quebec.

Both the member and I have actually been around since the creation of the MAID legislation, so we are very—

[Some hon. members]

Oh, oh!

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

May I interrupt the hon. member?

While members were speaking on that side of the House, we had calm. Can we continue to have calm and let the member make his speech?

The hon. parliamentary secretary.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I think it is really important that we put into perspective why we are where we are today. This is not something for which a political party made the decision. The member who just spoke, as well as the members opposite who were around, back in 2015, like myself, just need to reflect back to that time and what was taking place. For example, the Supreme Court of Canada put it on the political agenda, so there was a need for the House of Commons to respond to it. It was the Carter v. Canada case, which obligated all of us at that time to deal with the issue.

The government worked collaboratively and there was a high sense of co-operation on the issue. After all, what could be more personal than having to deal with the issue of medical assistance in dying, and having to make difficult decisions as to when to say no to a medical treatment, or to have a medical treatment that would ultimately lead to the death of an individual? It is very much a personal decision. I think that we need to amplify that. Those personal decisions are best made by the individual working with the experts they have access to, and having those heartfelt discussions with family members and often close friends.

I think we often underestimate the important contributions and understanding that health care providers, in particular, and others provide while dealing with the difficult issue of death. For those who are dealing with it on a more frequent basis, if they go to hospice care facilities or personal care facilities, they will often find those health care professionals and others in situations where they have to deal with death on a regular basis. As we all know, it is a part of life. If we then factor in the difficult complications that come to the table with individuals who have a desire to seek MAID, there have been a great deal of arguments brought forward. The decision was made in February or maybe March 2015, but the Supreme Court started hearing about it in 2014.

The passion was very real. We got to see some of that passion. If members recall, we had a special committee of the House. I believe it might have even been a joint committee that included members of the Senate. Whether members were on the committee or not, there was a great deal of discussion that took place between committee members and other members of different caucuses. I can recall members inside the chamber delivering speeches on MAID, even talking to some of the individuals who were involved in the lobby rooms. We would often see tears while listening to their personal stories. All one needs to do is to review Hansard during the second reading. Even back then, I spent a lot of my time on the floor of the House here.

However, I can say that the committee that studied it after second reading, and even prior to second reading, was deeply engaged. It went on at great length, for hours and hours, with personal stories of witnesses who appeared before it. It was not an easy decision. Sitting back, what I witnessed was some members of the Conservative Party advocating one way and others advocating another way, as it was with the Liberal Party and other entities within the House, because it was based on sharing our free thoughts, having a free vote and so forth.

It was difficult, but ultimately a vast majority of members of Parliament voted in favour of Canada's having MAID legislation. That is something that was not done lightly or taken lightly, and I think we need to emphasize that in this debate. It was very thorough, and ultimately, members from all political entities ended up voting in favour of Canada's having MAID legislation.

A number of years after that, as I alluded to at the very beginning and as the previous speaker was making reference to, was the issue of mental illness and whether it should or should not be part of MAID. Once again that was put on the table, brought to the House of Commons, because of a decision from a superior court.

[Some hon. members]

Oh, oh!

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

Can we allow the hon. member to finish his speech?

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, the issue of MAID came before the House again because of a superior court decision in Quebec. That we can say.

[An hon. member]

Oh, oh!

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, they can call it what they want. It is still a superior court in Quebec.

Moving forward, the issue has been brought to the House, and a decision has been made. There is a sunset clause within the legislation that does need to be addressed.

On the issue of mental illness, ever since I have been a parliamentarian, I can remember Dr. Gulzar Cheema, one of my colleagues in the Manitoba legislature, arguing and articulating on why it was so important that we have not only a department of health but also a department of mental health, because we need much more to recognize mental health as part of our health system. There are severe files within mental health that I believe, if this legislation were to pass, would never, ever get any consideration, and I do not believe that would be appropriate.

Given the very importance of the issue of mental health, let us have more discussions. I would like more provinces to establish departments of mental health, but at the end of the day, I do not necessarily believe the exclusion is the way to go.

[Jeremy Patzer, Conservative, Swift Current—Grasslands—Kindersley, SK]

Madam Speaker, it is always an honour to rise in this place on behalf of the great people of southwest and west central Saskatchewan.

Canadians sent us here to deal with many problems affecting them personally and impacting the country as a whole. There is no doubt that what we are debating right now is a very serious issue facing our society. I first want to thank my colleague the member for Cloverdale—Langley City for her leadership in bringing forward the right to recover act, Bill C-218. She has already brought hope to so many people and approached such a difficult topic with the compassion and the urgency that it deserves.

Not only has the member for Elgin—St. Thomas—London South seconded the bill, but along the way he has done a lot of work advocating for it. He had the courage to share his own personal story of battling years of severe depression and surviving suicide attempts. While telling his full story, which includes a challenging process of recovery, he shone a light on a struggle facing thousands of Canadians and their loved ones.

To give us more perspective, here are some of the latest numbers from the federal public health website. Each year in Canada, there are 4,750 deaths by suicide and 20,000 hospitalizations caused by self-harm. There are 100,000 reported suicide attempts, along with 250,000 people who make suicide plans and 840,000 people with serious thoughts of suicide. That means every single day there are 250 Canadians who make reported suicide attempts, 700 who make suicide plans and 2,300 who have serious suicidal thoughts. Let us allow all of that to sink in for a minute.

We often talk about having better awareness about mental health, but we also need to build on that by actively meeting people's needs and providing real protection for those who are vulnerable. With this bill, both of these MPs have moved us forward in that important goal.

At the moment, we are in a situation where the current law would allow access to MAID for people who have a desire to die solely on the basis of their mental illness. If we think about it for a second, we can start to imagine how that creates an opening in the medical system where it becomes easier for a suicidal person to end their life. In other words, it is pretty clear that we are really talking about assisted suicide.

As Canadians learn that this is happening, they are increasingly against the idea, but currently, if nothing changes, the Criminal Code would allow eligibility for assisted suicide on the basis of mental illness alone starting next spring. As disturbing as it is to think about, it is not too far in the future. However, Bill C-218 provides a simple solution. By a short amendment to the Criminal Code, it would stop the expansion of MAID for mental illness before it takes effect.

Just recently, the Special Joint Committee on Medical Assistance in Dying studied this exact issue and came to the same conclusion. Based on the consistent testimony of witnesses and experts, the committee's report officially recommended an amendment to the Criminal Code to exclude mental illness as the sole underlying medical condition for MAID. This recommendation reflects a consensus across party lines, and now that we have Bill C-218 in front of us, it just makes sense for us to proceed with it to achieve the final result we would like to see.

Earlier this year, I had the chance to work with the special joint committee as it carried out the study. That happened because I ended up filling in for one of the regular members, the member for Cariboo—Prince George—Omineca, who was supposed to be on that committee but had to spend some time away to recover from surgery he had on his knee.

I want to make a special mention of something here. It made perfect sense for him to participate in the study because he has been one of Canada's strongest advocates for mental health. He has worked tirelessly for years to make the 988 suicide prevention hotline a reality. After his motion passed unanimously in the House, it still took a few years before it finally launched, thanks in large part to his persistent efforts with introducing legislation, setting timelines and helping to keep up the pressure on the government to get the job done.

It needed so much time and effort to accomplish, even though it was a project that already had broad support across parties. It was worth doing because we know that 988 has made a real difference and has been saving people's lives.

We all support suicide prevention. We have a good idea of how important it is to be prepared so that we can respond with compassion and provide resources to people who are suicidal. On the other side of the equation, we also need to be extremely cautious of sending the wrong signals or messages, which could push a vulnerable group of people in a worse direction.

We had a representative from 988 appear as a witness in this study on assisted suicide for mental illness. She provided data to us based on her team's experience:

...on frontline signals from 988, up to 7% of interactions on the service refer to MAID. Critically, among those who reference MAID, 74% endorsed thoughts of suicide in the past two days, compared with 48% among other contacts. In short, interactions with our national suicide crisis line that reference MAID are associated with substantially higher suicidal ideation. That's not a theoretical concern; it's a real, measurable, elevated risk among people who mentioned MAID to Canada's suicide prevention service.

The same witness also went on to say:

My recommendation is straightforward. Do not expand MAID to cases where the sole underlying condition is a mental disorder. This recommendation aligns with the position of the International Association for Suicide Prevention that the overlap between MAID requests and suicide makes distinguishing between them impossible. MAID for mental illness will undermine suicide prevention by positioning MAID as a viable alternative to treatment.

This was one of the key concerns raised during the committee study. As this witness said, which was a point echoed by others, it is impossible to distinguish a desire for death inspired by mental illness from being suicidal.

Dr. Sandip Singh Gandham expressed, “I worry that in some cases, we may not be responding to an autonomous, enduring request for assisted dying, but rather to the voice of the illness itself.”

We also heard the story of Donna Duncan in B.C. Her daughter, Alicia, appeared as a witness and has been raising the alarm on her mother's case, which is directly related to the issue before us today. Donna was approved for and died by MAID in British Columbia in 2021, only hours after being released from a psychiatric unit and following a suicide attempt.

Donna was clearly suicidal and facing a mental health crisis, and all her blood tests came back normal. She had no terminal condition. She should not have been a candidate for MAID, yet the system deemed her eligible for track 1 MAID because, under the influence of a mental disorder, she was starving herself. In this case, the existing safeguards failed despite the family's best efforts and despite Donna's own admission that she did not want to die. She just felt deprived of proper care.

If a mistake was made in this case or any others, what is the remedy supposed to be? Death is irreversible. As the Duncan family found out, the only person authorized to access Donna's MAID assessment records is Donna herself, and Donna has died. Neither her family nor even the police can access the records, and neither the regulators nor the B.C Privacy Commissioner is prepared to override that. Realistically, then, how is anyone supposed to investigate whether the law was followed?

There are also concerns about new conflicts with providing patient care in the relationship that therapists have with clients. Are Canadian care providers there to fight relentlessly for every last person who can be helped or are they there to process people according to their requests and wishes, even if they could eventually recover in the future from their mental illness?

Dr. Jitender Sareen put his finger on this when he said, “This goes to the core psychiatric practice, which is grounded in assessing and treating hopelessness and preventing suicide.”

Is the psychiatrist there to help prevent suicide or enable it? What does it do to a psychiatrist's ability to do the former if the patient knows all the time that all they have to do to have their life ended is refuse to co-operate on therapeutic help that might work?

In that context, if MAID is available as an option, it becomes a factor on its own, which can undermine the effectiveness of therapy. Along with the general problem of recognizing suicidality for what it is, medical and psychiatric professionals also share deep concerns with the idea of irremediability and predicting patient outcomes while considering all the complexity of treatments for mental illnesses.

Dr. Karin Neufeld testified about a middle-aged patient of hers who had been suffering from a major depressive illness since childhood. He was seeking a referral for MAID and would have qualified, but after undergoing treatment with this particular therapist, he has now recovered the will to live. We have heard about similar cases as well.

Across Canada, people struggling with a mental illness are contemplating MAID not because they want to die, but because they are not getting proper support. They come from all walks of life. In this area, we heard about particular concerns related to indigenous communities and people with disabilities.

Our approach to allowing assisted suicide for mental illness is something that medical professionals, psychiatrists, advocacy groups and the United Nations have called on us to rethink. Parliament has itself pushed the deadline back multiple times and our special committee has now recommended indefinitely suspending it. We should listen to Canadians and listen to the committee and finally reverse this expansion. Let us pass Bill C-218.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, it is my honour and privilege to rise today to speak to Bill C-218, a bill that would repeal the coming into force of MAID for mental illness as the sole underlying cause for concern.

Canada is becoming a parable. It is becoming an example of what not to do for the world. The United Kingdom recently had a discussion about introducing euthanasia or MAID to the country. It looked at Canada and said, “That is not what we want to do”, and it actually rejected it.

I remember back in 2016-17 making arguments in the discussion about introducing MAID into Canada and calling it a slippery slope. I can say that I was wrong when I said it was a slippery slope. It turns out that it was a cliff. We had no idea that we were going to fall off this cliff. One-fifth of people who die in Canada die because of MAID. This is a major cause for concern.

We can look to other jurisdictions that are very similar to Canada. California has demographics similar to Canada's, has similar political understandings and has a similar population, yet in the same time frame, we saw that 13,000 people in Canada used the MAID program and only 300 people used the assisted suicide program in California. Something is seriously wrong with our system.

When MAID was brought into Canada, there were two criteria for it. Someone had to have a reasonably foreseeable death, something that we argued against. We said that was nebulous; we did not know what that meant. Most people's death is reasonably foreseeable. We will all die. That was one criterion for MAID, along with the fact that a condition had to be grievous and irremediable.

That was then challenged in the courts. I recall that we had just passed the MAID regime through Parliament. Parliament had spoken as to what the law ought to be in Canada. Just a couple of years later, it was challenged by two people from Quebec, and it was overturned at the first level of court in Quebec.

David Lametti, the justice minister at the time, refused to defend the work of Parliament. His personal opinions on MAID and the direction it should go were well known, but as the justice minister of Canada, it was his responsibility to defend what Parliament had put in place, and he refused to or was negligent and did not do that. He did not challenge the lower court decision in Quebec.

Therefore, that decision stood, and that then placed an arbitrary deadline upon Parliament to come up with a solution. That is how we got the so-called track 2 MAID, and along with that came the idea, which they put in in 2026 and then extended out to 2027, that MAID for mental illness should become a thing here in Canada.

There has been a committee study since then that looked at this. I tried to answer this question: Is Canada ready for MAID for mental illness? We heard over and over from people who said that if somebody is suicidal and wants to die, we cannot determine who will get better and who will not get better. There is no test for this. That is reason it was extended for one more year, because they said we had to continue to work on it.

Here we are, about a year out from that, and there is still no test today. When somebody calls the suicide prevention hotline, there is no test to say that someone is going to come around, that we can put them into treatment, they will recover and have a desire to live again and we should put them into a suicide prevention program.

There is no test for people to say they will send one person to the suicide prevention program and another person will be offered MAID. There is no test to say one person is going to recover and another person is not. We just do not know. The default should be that people having suicidal ideations will get better. We will give them treatment, support them and try to remove the things in their lives causing the suicidal ideation.

I would point Canadians to the work by my colleague, the member for Elgin—St. Thomas—London South, and the many speeches he has given on this, saying that, if this had been the law several years ago, he would not be here today because he would have availed himself of it. Today, he is a member of Parliament and a high-functioning individual. He is laughing at that. It is a true story. I thank him for being vulnerable with us, sharing these stories over and over again, telling this story and being a champion for Bill C-218.

Bill C-218 would make it so that we have suicide prevention in this country and only suicide prevention in this country. It is not for the Government of Canada to set up a program where some people get suicide prevention treatment and some people do not get suicide prevention treatment. That is not a country any of us want to live in, where we say suicide prevention is good for one person but not good for another person. We heard over and over again at committee that there is no test to determine the difference.

With that, I look forward to voting on this bill. I will be voting for it. I am very hopeful this bill will pass and we will once again restore suicide prevention in this country.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Madam Speaker, this is a bill that is very personal. It is an issue that is very personal. Through the course of the work of the Special Joint Committee on Medical Assistance in Dying, we heard from a number of experts who have worked with patients going through challenges, much like those I went through 15, 16 years ago, people who felt that they were better off dead than alive. These are people who deserve support. These are people who deserve treatment. These are people who should be welcomed into wanting to live, not assisted with end of life.

The bill from my colleague from Cloverdale—Langley City, who so eloquently called it the right to recover act, is a bill that would do exactly what the title says. It would offer people a right to recover. It would offer hope. It would offer light to people in the darkest moments of their lives. I was so honoured, with my story, to be able to be a champion for this, even before my colleague introduced her bill. I was equally honoured to be named to the Special Joint Committee on Medical Assistance in Dying, at which we were able to tackle—

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

I have just been informed that the hon. member has already spoken to this bill and it is not appropriate that he speaks to it again. My apologies.

I would invite the hon. member for Cloverdale—Langley City to rise for her right of reply.