No, it's the first.
Evidence of meeting #5 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was health.
A recording is available from Parliament.
Evidence of meeting #5 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was health.
A recording is available from Parliament.
3:45 p.m.
Liberal
The Chair Liberal Ron McKinnon
That's the motion. It's been spoken to by Monsieur Thériault. Are there any comments?
Mr. Davies.
3:45 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
First of all, I'd like to say at the outset that I think every issue that comes before the committee is an important one, and I think this one is an important one as well. I think it's going to be up to the committee to prioritize and determine what is going to take priority with our limited time.
As an issue that I think is important to understand in the context of the physician-assisted dying, I think it's certainly relevant. My questions about whether or not it's prudent to open a study at this committee, though, are multiple.
For one thing, I understand that legislation is tabled today. I believe the government is tabling its response to the Quebec decision. If I understood Mr. Thériault correctly last time—and if I didn't, I apologize—he thought that this work we're doing in the committee might be able to inform that legislative response. I didn't think it would be done in time anyway, but now, with the legislation already tabled, there's no ability for this committee's work to influence the government's response to the Quebec decision.
The other thing, of course, is that the Quebec decision was limited to the issue of reasonable foreseeability. The part of the physician-assisted dying law that was struck down by the Quebec court was the part that required reasonable foreseeability. It did not in any way touch on the issues of mental illness, advance directives or, for that matter, mature minors. We already know that MAID has a mandatory statutory review upcoming. That is part of the law anyway. At the time that this law was considered, these issues of mature minors, mental health and mental illness and advance directives were thoroughly canvassed by that committee, and I have every expectation it will be thoroughly studied when that comes up again.
The other thing is that our research shows that this issue was just studied, not by a parliamentary committee, but by the Council of Canadian Academies in 2018. A report was issued in December 2018 specifically on the issue of mental illness and whether or not people suffering from it ought to have access to physician-assisted death. That's only 15 months ago that a report was issued on exactly this subject, although I realize it wasn't a parliamentary committee.
Finally, I wonder if Mr. Thériault might consider this. What I would say is that in the last Parliament, in many studies—as I'm sure my colleagues Ms. Sidhu, Mr. Webber and Mr. McKinnon will remember—the issue of mental health came up repeatedly in different aspects. When we were studying LGBTQ2IA health, for instance, the issue of access to mental health was front and centre, as it was in many other issues. I sort of view this as a very narrow issue. The issue of whether people who have mental health issues should have access to physician-assisted death is a very narrow slice of the much larger health issue of mental health in Canada and access to services.
I'm wondering if it might be just better for us to consider as a committee studying mental health in Canada. Now, on the other hand, the narrow focus of this study does have advantages as well. I think it takes a very discrete part of mental health and targets our thinking to one particular aspect, which is how it may impact a person's decision to end their life.
I would not be opposed to studying this if we wanted to, but for all those reasons I just don't think that it's the best use of the committee's time.
3:50 p.m.
Liberal
The Chair Liberal Ron McKinnon
I would also like to observe that during the subcommittee meeting tomorrow, which apparently is going to be in the afternoon, if that works for everyone, at 3:30—it's breaking news as we speak—there will be an opportunity for everyone to submit ideas such as on a mental health study and to prioritize them. That's why we want to meet. There are a lot of studies to do. There are great ideas out there. We have to focus and find one to start with, and then maybe a second and third to keep us going.
Monsieur Thériault is next.
3:50 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
My colleague is mixing things up a bit.
First, I didn't argue either last time or this time that I want the study to inform the bill. I want the study to be complementary. I did say that it would probably be difficult, in four months, to reach a consensus on the bill. I imagine that there will be a review if the legislation includes this measure. In any case, I've yet to see the bill. I think that we should carry out this reflection process, which I wanted to make very focused to avoid clouding the issue.
This has nothing to do with Quebec. Quebec has tabled a bill on end-of-life care. It had nothing to do with the Criminal Code. We're talking here about the Criminal Code, which falls under federal jurisdiction. The Criminal Code would be amended to extend medical assistance in dying by eliminating the criterion of a reasonably foreseeable natural death. Some people say that it should be extended to cases of mental illness. Even though I've been thinking about this issue and working in this field for 30 years, I don't know what to do with this.
We can't pass the next bill and leave it up to the people who are suffering to take their cases to the courts, which will make the decision for us. I think that we have a job to do as trailblazers and legislators. My colleague can make his point on the prioritization of motions by determining whether the issue is urgent and relevant.
As a health committee, if we drop a specific study when everyone here is completely out of the loop on the issue, we won't be very well placed to justify a position for or against the matter. I, for one, need some clarity, and I think that's the purpose of this committee. The same thing applies to the other motion.
I want people to consider it less relevant afterwards. If we extend access to medical assistance in dying to cases of mental illness, we may not get very far. Often, good legislation is enforceable legislation. A good report is a report that focuses on fundamental and specific issues. In science, we don't look at the entire universe when we want to describe a specific physics problem.
3:55 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Thériault.
I have Mr. Jeneroux, Mr. Davies and Mr. Webber.
Mr. Jeneroux.
3:55 p.m.
Conservative
Matt Jeneroux Conservative Edmonton Riverbend, AB
Thank you, Mr. Chair.
Just quickly, I think I echo a lot of the sentiments raised by my colleague from the NDP.
If Member Thériault is open to expanding this, to look at more aspects of mental health, I believe it would certainly be relevant to this committee.
I didn't have the privilege of sitting on this committee last time, but I certainly think, through past experience, that mental health did permeate through a lot of the discussions. We even see it in a number of mandate letters. I think pretty much every minister has a reference to mental health in their mandate letter.
If we're able to expand it to look at a broader mental health study, I would encourage Member Thériault that perhaps at that point in time this wouldn't preclude his inviting any witnesses whom he may see fit to participate in that study.
My second point is about the legislation that was just tabled.
Mr. Thériault has a seat on the subcommittee, which we're intending to meet tomorrow. I think perhaps if he's okay with at least going through that legislation first, if he still wants to pursue the motion as it's worded here, then I think that's something we could consider at the subcommittee. However, until we have a chance to look through that legislation, as he had admitted to hearing of but not quite reviewing, we could then perhaps pick up that discussion tomorrow afternoon.
Thanks.
3:55 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
I have one specific comment and a general one.
Specifically, the other thing we have to bear in mind is that the legislation that's tabled today is going to go to a committee. The exact same issues that we could be discussing here can be discussed at that committee. For instance, I suspect that the legislation will not contain anything on increasing access to those with mental illness, but that can be thoroughly canvassed at the other committee.
We will have two parliamentary committees seized with the same issue. I just throw that out for consideration.
On a general subject, I'm a little confused, Mr. Chair, about the procedure you want to adopt.
Typically, motions are moved at this committee to propose certain studies. If they pass, they are then referred to the subcommittee, which then determines things like how many meetings to hold, when they will be scheduled, etc. If there are more motions passed—if we have three, four or five studies passed at the main table—the subcommittee will come up with a plan to put those in order, and bring that back to the full committee, recommend it, and then the committee as a whole will determine if they accept that. That's a way to have the detailed discussions, which bogged us down last time, figured out at the subcommittee level.
It has never been my experience that brand new issues, or issues that have not been passed at the committee, can be proposed at the subcommittee level.
I guess we could do that, but I want to be clear that it's not the way it has ever worked in the past. It could be the way we want to work in the future, but I want clarity on that, if I could.
4 p.m.
Liberal
The Chair Liberal Ron McKinnon
To clarify, I guess we need to have a study we can work on. Once we get under way, and we're doing bills and studies and whatever, we can come up with a decent work plan for things as we go. Right now, we're stuck with what we are going to do in the next several meetings. I want us to be effective.
As you say, we can use the subcommittee basically how we want. What I'm proposing right now is that we go through the first round where everybody gets a chance to submit a substantive topic. We will go to the subcommittee to deal with any other topics and let the subcommittee recommend a priority and report back to us on Wednesday.
That way, by Wednesday, we should know what our first study will be. We can get the witnesses organized. We can start to schedule the meetings that we need. That would give us some time over the coming constituency break to start organizing the meetings. That's my plan.
Mr. Webber is next.
February 24th, 2020 / 4 p.m.
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you, Mr. Chair.
The motion that has been forwarded to us is Mr. Thériault's motion regarding a specific study on mental illness and why or why not assisted dying should be extended to those with mental illness.
I absolutely agree that we should do a study on mental health. I'm not going to reiterate what Mr. Davies had suggested, or Mr. Jeneroux. However, we can perhaps agree on having a study on that and get a motion put forward, whether it's here or in subcommittee, on a study on mental health and mental illness. If that's approved, then we can certainly bring in the witnesses and have the testimony here and specifically ask questions on MAID and whether or not we should extend MAID to people suffering from mental illness.
It certainly would integrate the motion that Mr. Thériault has put forward here, but I guess currently we have this notice of motion up for debate and a vote.
If I can get confirmation that we would have that overall mental illness study, then perhaps I would not support this motion. If I can't get confirmation on a motion for a mental health study, then I would certainly support Mr. Thériault's motion to have a study specifically on MAID and extending it to patients suffering from mental illness.
I would like to hear where the committee is with respect to the study on mental health. I will leave it at that.
I'm still trying to determine whether or not to support the bill, which I would like to see studied, but it can be studied under a motion on mental illness and mental health care, or this particular motion right here.
4 p.m.
Liberal
The Chair Liberal Ron McKinnon
We have Mr. Thériault next. Do you want to speak now, or do you want to wait until after we have some more comments on your motion? You may speak now if you wish.
4 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Okay.
My Conservative colleagues surprise me. It's a good idea to propose a general study on mental health. First, health care falls under the jurisdiction of the provinces, including Quebec. Mental health falls under Quebec's jurisdiction. We don't have to wonder how Quebec manages mental health.
However, we're the people who must change the Criminal Code or say that mental health will never be included in the medical assistance in dying issue. There will be no access to medical assistance in dying. This falls under our jurisdiction. It's a specific and current issue. Regardless of whether the issue is included in the bill, and it may not be, what problems upfront related to mental health would make us, as legislators, say that we won't extend medical assistance in dying to mental health?
It seems that we can and should conduct this study, instead of saying that we'll talk about mental health in general and then see. What are you trying to address or accomplish by conducting a study on mental health?
If someone tells me what will be done with this very broad study on mental health, what we're looking for, and what we want to demonstrate, with the limited time that we have for our work, I'm ready to listen. However, it seems that, with the motion that has just been introduced, we're losing a great opportunity to hear from experts, people and patients who would tell us what they think of the proposal to extend medical assistance in dying to mental health, and why it would be advisable or inadvisable. My motion doesn't say that we want to extend medical assistance in dying. It proposes that we look at why it would be advisable or inadvisable to do so.
I need to know this, regardless of whether the issue is included in the bill. I've heard that the issue wasn't included. Can anyone here tell me why? I think that we need to hear from people. This is a great opportunity to talk about mental health in a specific way. That's why I wrote this motion in a very specific way. This doesn't mean, if you want to demonstrate something else in mental health, that I'm not open to doing so. However, we would then need another motion.
I'm convinced that, since the issue concerns the final moments in the life of a person suffering from mental illness, everything that we're looking for in terms of the adequacy or inadequacy and accessibility or inaccessibility of mental health care will come out of our study on the extension of medical assistance in dying to mental health.
4:05 p.m.
Liberal
4:05 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
In defence of Mr. Thériault, I think it's right that if you're going to study mental health, that will be a gigantic study. You could spend years, and there are so many different subjects under the rubric of mental health, whereas the question he's asking and wants addressed is quite specific.
I want all parties to have the opportunity to choose something, and that's what he said.
With the agreement of all parties, I'd like to offer him the opportunity to choose something. If that's the one he wants, that's okay; I'm fine with it, but I think mental health in general is too broad.
I want to say in passing that I think our willingness to discuss a subject depends a little bit on what we want to see as the answers. For the sake of some of you who weren't here the other day, I think Mr. Thériault was questioning whether we really wanted to extend MAID to people who are suffering from mental illness. On that basis, I have no problem agreeing with his proposal.
4:05 p.m.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Just let it be known that this might be the first time I've ever agreed with everything you just said, Marcus.
I think that what you said, Mr. Chair, made sense. We had a motion from the NDP, a motion from the Conservatives, a motion from the.... Put four studies forward. If we come over to this side next for the next possible substantive study by the subcommittee for it to discuss further, I think that would make sense. I also think that what Matt and Len—Mr. Jeneroux and Mr. Webber—said is something this committee should look at or could consider as another motion on another day, or at another time. Certainly you can't move a motion at the subcommittee for the committee to consider, but you can move a motion here at the full committee for the subcommittee to consider on another day. As Marcus said, it would be a very broad study, but it's something that would be of interest, I think, to most of the committee members. In deference to Mr. Thériault, I would think that this sliver that he wants to pull out....
Now, there is a five-year review of MAID that will no doubt consider this, but it will be a broad review as well. I'll support Mr. Thériault in this, and then certainly consider support for our friends across the way on another motion at another time, Mr. Chair, if that's what your plan is, to still stick with all four parties suggesting a potential motion, which I think is more than fair. Thank you.
4:10 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair. Thank you for your report.
I do believe it's a study that we need to look at. Perhaps the avenue here is that we can expand it, even within the study, to look at other aspects of mental health, depending on the witnesses we bring forward. There's an opportunity to bring that in.
As Dr. Powlowski says, it's an extremely broad topic. We're trying to contain it somewhat, but I think there are a number of overlaps within the study. It's worthwhile that we can open that up.
4:10 p.m.
Liberal
The Chair Liberal Ron McKinnon
Okay. Are we ready for a vote? Are there any more comments?
(Motion agreed to [See Minutes of Proceedings])
Now we will go to Mr. Kelloway, who I believe has a motion for a study.
4:10 p.m.
Liberal
Mike Kelloway Liberal Cape Breton—Canso, NS
I do, Mr. Chair, and thank you.
The motion to put forward is on a studies around primary care models.
I'd ask someone to pass these around. We'll wait till you get a copy before I read the motion, if that's okay, Mr. Chair.
4:10 p.m.
Liberal
Mike Kelloway Liberal Cape Breton—Canso, NS
I am, Mr. Chair. I'll certainly read the motion if that's what you would like. It's around primary care models, as mentioned:
That, pursuant to Standing Order l08(2), the Committee undertake a study on Primary care models, and updated models on team-based care, and that the Committee report its findings and recommendations to the House.