Evidence of meeting #102 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was illness.
A video is available from Parliament.
Conservative
Michael Cooper Conservative St. Albert—Edmonton, AB
You're playing with people's lives, and that's absolutely disgraceful.
Liberal
Mark Holland Liberal Ajax, ON
No. What is disgraceful is mis-characterizing my position or mis-characterizing the position of any member of Parliament, sir. Saying that any member of Parliament doesn't care about human life is a disgraceful thing that I will not tolerate.
For you to step into this committee and make an accusation of any member of Parliament that they do not care about the life of another human being is absolutely beyond reproach, sir. I have spent my entire life, as you have, fighting for the good in this world. To accuse a good person of not caring about human life...shame on you.
February 14th, 2024 / 9:45 p.m.
Liberal
Arif Virani Liberal Parkdale—High Park, ON
Mr. Chair, I will just point out that the safeguards that I mentioned are in the Criminal Code of Canada. That is a legislated safeguard. We also have protections, save for exceptional circumstances, against compelled treatment in this country. That is protected under the charter.
Thank you.
Liberal
Yasir Naqvi Liberal Ottawa Centre, ON
Thank you very much, Chair.
I want to go back to the safeguards, because I think that's a very important conversation to have.
Starting with you, Mr. Virani, why don't you outline the legislative safeguards that are in place?
Perhaps, Minister Holland, you can then talk about the safeguards that are being put in place for the medical community in order to administer MAID properly.
Liberal
Arif Virani Liberal Parkdale—High Park, ON
Let me start with the legislated safeguards that are in the legislation called the Criminal Code of Canada. We're talking about track two, which is where death is not reasonably foreseeable.
You must make the request in writing. Two independent doctors or nurse practitioners must provide an assessment. The person must be informed that they can withdraw their request at any time and in any manner. The person must be informed, to Mr. Cooper's point, of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services and palliative care, and must be offered consultations with professionals who provide those services. The person and the practitioners must have discussed reasonable and available means to relieve the person's suffering and agree that the person has seriously considered those means. This assessment must take at least 90 days. You can pause it. What I have heard anecdotally is that, in the context that mental illness is the sole underlying condition, it would likely take much longer than 90 days. Last, you must provide final consent immediately before MAID is provided.
All of those safeguards are legislated. These are not practice guidelines or practice standards, etc. Those are in the Criminal Code of Canada under the MAID provisions.
I'll turn it over to Minister Holland.
Liberal
Yasir Naqvi Liberal Ottawa Centre, ON
Just very quickly to cap that part off, “legislated” means, being in the Criminal Code, we have the full force of the law as it relates to the Criminal Code of Canada behind those safeguards.
Liberal
Mark Holland Liberal Ajax, ON
Thank you so much.
As I get an opportunity to talk with clinicians, doctors and nurses across the country, all of them are trying to get this right and are deeply concerned about their patients. That's why I get so upset, because I think that, as parliamentarians, casting aspersions on people's motives and trying to insinuate that somehow anybody is not caring about human life is just deeply irresponsible.
In my experience, those who developed the national accredited MAID curriculum, those who developed the practice standards and those who are in the system are trying deeply to work with people who are in extraordinary pain. When a doctor has a patient who has been coming to them for decades in unspeakable pain and that doctor says, “I can't do anything for this patient; we've tried everything,” and that patient is asking for a way out, it is extraordinarily painful to hear that.
You could have an ideological position that you don't want to deal with that, but I think that understanding and navigating this and trying to work with the provinces and territories so they have appropriate safeguards, and looking at CAMH suggestions around clinical guidelines, are entirely appropriate, because we have to make sure that those safeguards are as strong as possible and that we are only dealing with those remote and most unusual of cases.
Liberal
Yasir Naqvi Liberal Ottawa Centre, ON
It is a very difficult place for us, as parliamentarians, of course, to make sure that those who are responsible to administer the system feel confident that they have all the systems in place. I believe, personally, that it is prudent for us to grant this extension so there is no doubt that the system is available across the country with the equity that we want to be sure of.
I give a fair bit of credence to the letter that is before us, which you received from seven provinces and three territories. The part that got my attention is, “It is critical that all jurisdictions, health authorities, regulations and MAID practitioners have sufficient time to implement these safeguards and to address capacity concerns that are expected to result from the expansion of MAID eligibility. The current March 17, 2024 deadline does not provide sufficient time to fully and appropriately prepare all provinces and territories across Canada”.
How much was that an influence in your decision to bring forward this particular piece of legislation?
Liberal
Mark Holland Liberal Ajax, ON
Certainly it was a significant contributing factor, as I indicated earlier. I have a very good working relationship and talk nearly every day with my provincial and territorial counterparts, so when they say that their system needs more time, I take that very seriously. They put that in a letter to us. It had been clear that they wanted to look at additional safeguards, potentially saying that they want a psychiatrist to be present and involved in every instance and asking again about the issue of clinical guidelines.
I think that listening to the provinces, who are responsible for the administration of those programs, is critically important, and certainly it played a significant role in the decision to also listen to the joint committee's work.
Liberal
The Chair Liberal Sean Casey
Next, we have Monsieur Thériault.
Mr. Thériault, you have the floor for two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Yes, there are legal and clinical safeguards that must be considered.
Shouldn't recommendation 10 of the expert panel report be referred to in the act or the regulations that will be made under the act? I think it's important to do that. I know that what we'll eventually adopt will be completely different from what we now have because we haven't come up with the final bill. However, it seems to me that, if we want to have a discussion and do good work in the short term, we should mention recommendation 10.
The other recommendation that I consider important regarding mental disorders is recommendation 16, which concerns prospective oversight, not retrospective oversight. Quebec has established a committee to monitor medical assistance in dying acts and to report retrospectively on those acts.
Consequently, there should be a prospective provision regarding mental disorders and thus an additional step that would have to be taken before acting. If the request is admissible and the patient has gone through all the steps, a committee would review the process to determine whether it's satisfactory and complies with all the safeguards, both clinical and legal. I think it's important to do this properly in the case of mental disorders, given the fact that the experts are divided on the matter. We will have to proceed this way if we want to establish a system in a calm manner.
The question I would ask is as follows.
It's all well and good to postpone passage of this bill, but, from the moment it's passed, once it has been passed by the Senate, what intermediate steps will have to be taken? What will you have to do right away once this bill is passed? That's the problem that we've had since we started this study on medical assistance in dying. We delayed action, again and again, and wound up with deadlines that were too short and requests for extension.
What will you do immediately after royal assent so that we can continue our work?
Liberal
Mark Holland Liberal Ajax, ON
It's not just a matter of what happens immediately after the bill is passed in the Senate. This concerns a situation that we're studying now; we're working every day with every province and territory to improve our system's capacities.
We're still discussing issues such as advance requests and the other aspects of medical assistance in dying. We definitely have to continue training to ensure we have a system that's ready for these changes.
This isn't a subject that's easy to address. It's a subject that's emotionally charged, as we can see today.
Liberal
The Chair Liberal Sean Casey
Mr. Thériault, it took more than two minutes for you to ask your first question. You don't have any more time.
Minister, if you have a few thoughts to share, go ahead briefly.
Liberal
Liberal
Liberal
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you, Chair.
I want to ask one question of each of you in the two and a half minutes, so please respect the time I have.
I will address you first, Minister Virani.
I've heard the constitutional arguments thrown on both sides of the equation. As Minister of Justice and Attorney General of Canada, is there is an interest from your department in referring this issue to the Supreme Court of Canada?
Liberal
Arif Virani Liberal Parkdale—High Park, ON
The matters of complex social policy are for Parliament to determine and for courts to evaluate after the fact. There is no interest in pursuing a reference right now, and an abstract reference question can even be denied to be answered by the court.
NDP
Alistair MacGregor NDP Cowichan—Malahat—Langford, BC
Thank you for answering that.
Minister Holland, I understand the differentiation between mental health and mental illness, but when I go around my riding of Cowichan—Malahat—Langford in particular sections and particular communities, it's quite obvious that many people are suffering from a mental illness. You can see it right on the streets.
I take the point of the legislative safeguards that exist in the Criminal Code, but there still is a very real concern that, because of an individual's circumstances, such as the fact that they may come from a disadvantaged population and may not have had the same access to services throughout their life, they may still be able to satisfy the legislative safeguards in the Criminal Code but they may have been sent down that path because of the life circumstances they find themselves in.
As the Minister of Health, given the great needs we have and are very evident across our country, how do you resolve that as a minister and with it being such a very sensitive issue?
Liberal
Mark Holland Liberal Ajax, ON
Thank you so much for the question. I acknowledge that to be true. Often there is a direct correlation between those who have suffered the most and those who are in the worst state of mental health. Sometimes when somebody has a mental illness—which, again, is different—it can certainly be greatly exacerbated by trauma or by those very difficult circumstances of which you speak.
One of the reasons I think we need time is that we need to make sure we get that line exactly right. To the point you're making, we don't want to wind up in a circumstance where somebody has a mental illness and they push, and there was something we could have done.
We have to exhaust everything, and it can really only be at the end of the road, after we have tried everything. If we have been unable to find a solution, then I think we're left with the question of what we as a society can do if somebody has tried absolutely everything and is at the end of their rope in terms of pain and they wish, of their own volition, to end that. It's a complicated and difficult question. That's why I think we have to take time.
However, I acknowledge the circumstances you're taking about. That's one reason I said at the outset that I think those conversations with many of those disadvantaged communities are so essential, to make sure they are fully comfortable that the controls are in place and that we're proceeding in the appropriate way.
Liberal
The Chair Liberal Sean Casey
Thank you, Minister.
Thank you, Mr. MacGregor.
We are at almost exactly one hour. I propose one question each for the Conservatives and the Liberals. Please keep the questions and answers short. It has been a long day for everyone.
I'll turn it over to the Conservatives for one question.