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.