Justice Committee on Feb. 14th, 2023

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Actually, we went to visit a group in Sherbrooke that works with people suffering from mental illness. The members of this group were disappointed that this provision of Bill C‑39 will be pushed back. They were ready to go forward with it. The people that the group works with are suffering tremendously, and some of them would have wished to have access to MAID, because they had made a well-considered decision of their own volition.

Obviously, members of the group wanted to help so that the system would be ready. They were disappointed. However, I told them that we would give our all so that everyone will be ready. I have a lot of empathy for this organization and its clients.

[The Chair, Liberal, Randeep Sarai]

Thank you, Ms. Brière.

Next, we'll go to Monsieur Thériault for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Six minutes is not much time for an issue that is so sensitive.

Minister, you have given me an opportunity and I am taking it. Unlike you, I do not believe that what you have tabled will allow us to do more in the field of mental health; nor do I not believe that this will help us to take care of our fellow citizens over the next 10 years.

We have to take note of the meaning of mental health in this debate. Experts have told us that we should stop talking about mental illness because this is not a clinical term. We should refer to mental disorders. If we are going to agree on this issue, we should adopt the terms used by the experts.

Experts have indicated in their final report that practice standards need to be established in the case of mental disorders.

In a letter sent to committee members, the deputy minister of Health stated that a working group had been created to work on practice standards for medical assistance in dying. This group is made up of people with clinical expertise. Who are they?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

I can provide you with a list of the members of that working group.

I can also send you the letter from Mr. Stephen Lucas, the deputy minister, for the benefit of the other members of the committee who are not sitting on the Special Joint Committee on Medical Assistance in Dying.

[Luc Thériault, Bloc, Montcalm, QC]

Are members of CAMAP, the Canadian Association of MAID Assessors and Providers, part of this working group?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

That would be a question for the representatives from Health Canada.

[Sharon Harper, Director General, Health Care Programs and Policy Directorate, Department of Health]

We do not have those names with us today.

[Luc Thériault, Bloc, Montcalm, QC]

No, that is not my question.

I would like to know if members of CAMAP are part of the working group.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Obviously, that is a question for the representatives for Health Canada.

[Luc Thériault, Bloc, Montcalm, QC]

No, it is not a question for the representatives from Health Canada.

It is a question for the people that are working with the minister, the same minister who is telling us that the process will be pushed back one year so that work can be done on the ground in order to be ready on March 17, 2024. I expect those people to be able to tell us about the working group's progress.

In your statement, you spoke about the work in progress. I am asking you questions on this. CAMAP is a community of practitioners. I want to know if they are involved in the development of practice standards. I know that they were working on the training module, but it would be important to know who is involved in the standards of practice. You will need to have practitioners on board, people who have the necessary knowledge.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

You are right.

Two other ministers have been involved in this bill, the Minister of Health and the Minister of Mental Health and Addictions. That is the reason why public servants from Health Canada are here with me. Your question falls under the remit of the other ministers.

Mr. Thériault, I will provide you with an answer through my colleagues Mr. Duclos and Ms. Bennett.

[Luc Thériault, Bloc, Montcalm, QC]

Alright.

The final report of the Expert Panel on Medical Assistance in Dying and Mental Illness contains two key recommendations, numbers 10 and 16, which deviate from what is currently being practised in terms of MAID.

Recommendation 10 states that in order to proceed with a request for MAID, the assessment must be conducted by two psychiatrists who are not part of the care team. Do you think that is realistic?

From what you have been hearing on the ground, will the deadline allow more people to be trained so that the necessary resources are available to meet this requirement, which is a much stronger safeguard than what is provided for by the usual practice?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

The expert panel made this recommendation while stating that the current act's provisions were sufficient. Provinces can decide to add this measure if they have the resources, that is to say the capacity to obtain an assessment from two psychiatrists in a particular case.

This will give the provinces time to look at the recommendation and to establish a framework based on what is contained in the report. We will be there to support them if need be. We will see what funding will be set aside for mental health in the bilateral agreements.

[Luc Thériault, Bloc, Montcalm, QC]

I also mentioned recommendation 16 which talks about prospective oversight.

Quebec set up its Commission on End‑of‑Life Care to review what has been done, that is to say cases where MAID has been offered. Here, the expert panel is recommending another measure, i.e., real time monitoring.

In the first instance, experts are telling us that this would not be used to confirm eligibility. However, when we read the report, it says that prospective oversight would have three objectives: improve the quality and security of assessment in real time; support practitioners in the practice of MAID by providing direct and immediate comments on that practice; and reassure practitioners that the work they're doing complies with legal requirements.

Are you intending to implement this recommendation?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

That decision would have to be made with the provinces. Obviously, that falls under provincial jurisdiction.

We are ready to help in each case. The expert panel has recommended that we work together and that we provide leadership.

The experts from Health Canada can perhaps add to my answer.

[The Chair, Liberal, Randeep Sarai]

Please be very brief.

[Venetia Lawless, Manager, End-of-Life Care Unit, Department of Health]

It's up to the provinces and territories. The regulatory bodies will take that on. It's not up to the federal government to dictate.

However, we have seen some very good response so far from the provinces, territories and regulatory bodies, saying they are looking forward to receiving the final copies and to either adapting or adopting versions of the practice standards.

[Luc Thériault, Bloc, Montcalm, QC]

Recommendation 1 says that you should facilitate the work, which brings me to my question.

Will you be facilitating the work? Is that objective one you will strive to meet?

[The Chair, Liberal, Randeep Sarai]

I will let them add to that in the second half, when you come back to that.

Thank you, Monsieur Thériault and Mr. MacGregor. Welcome to both of you, by the way. I forgot to welcome Monsieur Thériault.

Mr. MacGregor, you have six minutes. The floor is yours.

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

Thank you very much, Mr. Chair.

It's good to be back on the justice committee. I don't think I've been since the 42nd Parliament.

Thank you, Minister Lametti, for being here today.

I just want to go back to the Bill C-7 conversation you had with Mr. Moore. I was in the House serving with you at that time. We had the third reading of Bill C-7 on December 10, 2020, so the version we sent to the Senate was in line with your charter statement. Mental disorder still would not have qualified for medical assistance in dying.

The Senate went through the bill fairly quickly. They were able to get to their third reading vote by February 17, 2021, so in a little over two months. They reported it back to us with that amendment.

I just want to narrow it down. You're telling us that in that two-month period, that's when you converted your thoughts on this. I just want to know your thought process. You were fine with the version we sent to the Senate, but then when they sent it back, just in that space of two months, you had a conversion and accepted what they had done to the bill.

I believe they inserted that amendment not at the committee stage but at the report stage of the bill. It was done from the floor of the Senate.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

The only thing that changed was the timing of when. I had always believed—as I have said to my honourable colleagues from the Conservative Party—that we would get to this point and that we were required to get to this point; that people with mental illness and mental disorders were suffering; that people with mental disorders had the capacity to ask for medical assistance in dying, as any other Canadian did; and that the courts would eventually force us there.

The only thing that changed was whether we—in 2021, as originally framed—not put the committee work in the bill and do the expert committee work necessary to get it to a point and then pass a law, or do we accept the Senate's reversal of that, which is to say we're going to put this in with a sunset clause in order to force ourselves to do the committee work within what one would argue is the same time period—

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

If I can just interject—

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

—so that the substance doesn't change. The substance didn't change, in my view. I had always thought we weren't ready in 2021. I think we're very close to being ready now, and with another year we will be ready. I'd always envisaged something like this time period in my head.

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

If I can just interject, I think there's been a pattern here, and that's why it's caused so much consternation among different members of Parliament. You introduced Bill C-7 before the statutory requirement of Bill C-14 had been met. There was a requirement in that bill for a statutory review of the legislation, but Bill C-7 came in.

I was a member of our Special Joint Committee on Medical Assistance in Dying in the 43rd Parliament and in this Parliament. It didn't get its work under way. It was interrupted by the election in 2021, so I can tell you, Minister, that in working on that committee we always felt under the gun having that sunset clause hanging over us. It was always hanging over us. That was a real issue.

However, I want to change to the expert panel that was convened by your government. The panel, in its report, said:

the existing MAiD eligibility criteria and safeguards buttressed by existing laws, standards, and practices in related areas of healthcare can provide an adequate structure for MAiD MD-SUMC so long as those are interpreted appropriately to take into consideration the specificity of mental disorders.

I want to know about that, because of course, in our existing Criminal Code, in order to meet all the eligibility requirements in section (e), they have to give “informed consent” and only after they have been informed of the means that are available.

I just want to get your interpretation of that, because being informed of something is one thing, but we know from many people who have testified that in many areas of Canada, some of these services just are not available or not available in a sufficient quantity.

Do you think your government might approach a change in the Criminal Code to change that term “informed”, or are you quite satisfied with what the expert panel has provided you?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

We have been consistent, both in the law and among experts, that being informed is a meaningful process. One has to be meaningfully informed when asked to assess what one has been told and to have the capacity to do so. All of those represent, we think, a very adequate set of safeguards.

The question of the kinds of social services and social supports in palliative care, mental health supports and other supports, is a different question. It's one that our government is committed to. I think it's one that we probably share in terms of our own values, in terms of getting that better. It's something that provincial governments and the federal government need to do by working together. In most cases it's primarily a provincial responsibility, but we need to work with provinces and territories with respect to leadership and resources in that regard.

I think it's a separate question, it needs to be improved in a variety of different places. As a member of Parliament and as a cabinet minister, I've been committed to that and I remain committed to that, but it is a separate question.