Justice Committee on Feb. 14th, 2023

[Sharon Harper]

MAID oversight is, in fact, something that.... The federal government does MAID monitoring through collecting data about MAID and providing annual reports. That's how we do the MAID monitoring. The oversight of the implementation of MAID is at the provincial and territorial level, and they do that in a number of different ways. The provinces and territories take different approaches to that.

Some of them, like Ontario and Quebec, review every single provision of MAID that has happened. They review it, and they oversee that. Others take different approaches to doing that. One thing we're doing with them is providing leadership in terms of talking about oversight and encouraging quality assurance and more oversight in terms of how MAID has been provided.

There are also informal methods of oversight that happen as well. There are case conferences among professionals, so they talk about how MAID takes place. There are also discussions with the Canadian Medical Protective Association and CAMAP to make sure the practice is safe and works according to established measures.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Could you tell us a little or elaborate on how the Government of Canada is engaging with the provinces and territories?

[Sharon Harper]

Yes.

We have a very long-standing working group with the provinces and territories. It's been around since 2016, and we've worked very closely with them throughout the years on the interface between the criminal law and the implementation of medical assistance in dying. We continue to work with them at this point. We plan, in the coming weeks and months, to discuss with them various issues that have come up in the expert panel's report and to understand how they see their systems responding to those recommendations.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Thank you so much.

Could you talk to us a bit about those with mental illness and their families are made a part of the discussion?

[Sharon Harper]

Made a part of the discussion...?

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Yes. How can they be part of these discussions?

If anyone else can answer....

[Sharon Harper]

Made part of the discussion.... The federal-provincial-territorial working group is basically a group that works together to consider how MAID can be implemented in the provinces and territories based on the criminal law that exists at the federal level.

I think families and people and individuals can be involved, in a sense, with practitioners. During the assessment period, especially for track two cases, they are encouraged to consider talking...to find out as much information as they can about the individual to understand what is resulting in the request for MAID.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Can you tell us a bit about why it was also important to consult medical experts and members of the medical community when it came to this issue?

[Sharon Harper]

It's definitely very important to understand that, because the medical community has been working on MAID cases since 2016, and also working with complex cases since 2021—cases we call track two cases, where death is not reasonably foreseeable—they understand very well the complexities that are being brought forward by them. We really needed them to weigh in, for example, on the clinical practice standards. They were sent out to a wide range of people to get feedback on those standards, and that feedback is being incorporated now and will be ready by March 2023.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Thank you.

Am I out of time?

[The Chair, Liberal, Randeep Sarai]

You have 30 seconds.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Would you be able to quickly tell us how the Government of Canada is putting in place ways to improve mental health supports?

[Sharon Harper]

Certainly.

There are a number of different approaches that the federal government is taking on mental health supports. One thing that's quite relevant to what we're talking about today is a suicide hotline. That is very relevant to the work we're doing. There is also Wellness Together Canada, which has been put in place to help support Canadians and health care providers in their efforts to improve mental wellness. Those are two very important pieces.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Thank you very much.

[The Chair, Liberal, Randeep Sarai]

Thank you, Ms. Dhillon.

Next we'll go to Mr. Thériault for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

People with a chronic mental disorder will have faced stigma and discrimination throughout their lives, so much so that even someone from a comfortable background will live out their years and probably have little when they die. People with a serious chronic mental disorder usually can't find a job because they are victims of discriminatory hiring and so on. The legal experts will argue that they are aware of the situation and that it's unfortunate. However, as a government, we think that the public interest warrants discrimination against those individuals when it comes to their ability to decide when they have reached their breaking point—the point at which they can no longer tolerate their suffering.

Legal experts have told us that, if the government opted to completely exclude people with chronic mental illness for whom treatment is unavailable, it would amount to discrimination and would not pass the test under section 1 of the Canadian Charter of Rights and Freedoms.

What do you think?

I'm not sure what's happening. No one seems to have understood my question.

Will I get more time?

[Matthew Taylor]

I think I understand your question.

[Luc Thériault, Bloc, Montcalm, QC]

If you put in your earpiece, you will hear the interpretation.

[The Chair, Liberal, Randeep Sarai]

I'll grant the extra time.

[Matthew Taylor]

It's not for me to say. There are diverse views on these issues. Minister Lametti has expressed his views on the charter and its relationship to cases where mental illness is the sole medical condition. Some of the committee members have spoken to the letter from the law professors, who have expressed different views. There is a diversity of views on that.

What I would say, and I know it's not a complete answer, is that the charter statement that will be deposited by the department will provide some information on the effects of this legislation on the charter rights of individuals.

[Luc Thériault, Bloc, Montcalm, QC]

We are talking about an increased risk. The expert panel didn't rule that out.

The experts made it clear that general rules should not be applied across the board. Cases should be reviewed individually, on a case-by-case basis, as the experts referred to it. The history and progression of the disease need to be considered, as does the number of treatment attempts. The assessor should not be the treating provider or a member of the care team; the assessor should be independent from the treating team. Lastly, the case should also be examined by a psychiatrist, who would also assess the situation. All that to say, the risk is high.

All of those elements are implemented with precautionary principles in mind, as well as measures that require stakeholders to follow a different process.

Medically speaking, Ms. Gladu's condition was easy to assess. No one is saying that a mental disorder is easier to assess. That's why the issue was entrusted to a panel of experts. That's why we created a joint committee, which reviewed the expert panel's report, heard from witnesses and asked questions. There seems to be an appreciation of the increased risk.

What do you think?

[Matthew Taylor]

It's a good question.

Ms. Harper will answer your question, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

You can take turns answering, if you like. I'm fine with that.

[Sharon Harper]

Yes, I think you are very correct in terms of how the risks will be addressed through a case-by-case understanding of the individual, bringing to the situation all the different social determinants of health and all the different things that can be made available to the person to help address the risk, as well as seeking out experts who can bring their expertise to the question.

Does that speak to your question?

[Luc Thériault, Bloc, Montcalm, QC]

I'll ask a simpler question.

You are lawyers, as well.

Do you consider it discrimination to exclude someone with a serious chronic mental disorder?