Evidence of meeting #50 for Justice and Human Rights in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was illness.
A recording is available from Parliament.
Conservative
Tako Van Popta Conservative Langley—Aldergrove, BC
I just wanted to confirm that there is no charter statement in connection with the revised Bill C-7, in the way it came back from the Senate.
General Counsel and Director, Criminal Law Policy Section, Department of Justice
That's correct. As I've said, there's no requirement in the Department of Justice Act to update charter statements to reflect changes passed by Parliament.
Conservative
Tako Van Popta Conservative Langley—Aldergrove, BC
That's even though there was a very substantial change.
General Counsel and Director, Criminal Law Policy Section, Department of Justice
Regardless of the amendments, there's no requirement.
Conservative
Tako Van Popta Conservative Langley—Aldergrove, BC
Thank you for that.
I'm going to turn to the health department officials.
Bill C-7 was passed two years ago. It allows that medical disability will be included for a MAID provision, but there was a two-year suspension. In those two years, we were to come up with safety guidelines and regulations. What is the status of that?
I'm going to just refer quickly to a letter dated October 22—just a few months ago—from the Minister of Health to the special committee. In it he says, “By March 2023, we expect there will be practice standards and training modules in place”. We haven't seen those yet, and now we're facing a year's delay, presumably because those practice standards and training modules are not yet in place. Could you comment on that?
Director General, Health Care Programs and Policy Directorate, Department of Health
Certainly.
We expect the practice standards to be in place in March 2023. At this point they are incorporating the feedback they got from a number of people and a number of regulatory bodies and clinicians across the country. They're incorporating that feedback. They will be ready by March 2023, at which point there will be a broad dissemination approach for the practice standards.
Conservative
Tako Van Popta Conservative Langley—Aldergrove, BC
That's good. Thank you.
In his statement earlier, the minister said that he is fully confident that in the next 12 months we will be completely ready for medical assistance in dying for people with mental disability.
I wanted to put this question to him, but he's not here. I'm going to put it to you. I don't mean it in any sort of political or partisan way. How will we know that we are, in his words, completely “ready”, when there is so much resistance from the medical profession?
Liberal
Director General, Health Care Programs and Policy Directorate, Department of Health
I'm sorry, but I didn't hear what you said.
Liberal
The Chair Liberal Randeep Sarai
I was saying, “very briefly”, but it's a very deep question, so I will be liberal with my time.
Director General, Health Care Programs and Policy Directorate, Department of Health
Thank you.
Conservative
Director General, Health Care Programs and Policy Directorate, Department of Health
I think that is a good question.
I think we will have a very good sense when the clinicians feel that they are well supported, that they have the resources they need to make the assessments, and that they understand what they need to do in order to make the assessments for people with mental illness as a sole underlying condition.
I think that's a really crucial step.
It will take time, because they will need to be able to take up the clinical practice standards. The provinces, territories and regulators will be able to adopt and adapt those, and then the providers will be able to take them on and try them in various situations.
The interesting thing is that because the expert panel said that the cases of mental illness were not, in some ways, that different from other track two cases, they will also be able to bring these clinical practice standards to questions of cases that they're working with right now.
I think it's going to be a really instructive year. They will be able to take those clinical practice standards and understand how to bring them to life.
Liberal
The Chair Liberal Randeep Sarai
Thank you, Mr. Van Popta.
Next, we'll go Madame Brière for five minutes.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you, Mr. Chair.
I will ask my question in French.
Mr. Taylor, is it possible to know whether something is constitutional without a court ruling?
General Counsel and Director, Criminal Law Policy Section, Department of Justice
I think you're right.
At the end of the day, in our system of law, it is the courts that will decide in a constitutional democracy whether something is or is not constitutional.
As we know, there are different perspectives on all areas of law, and there is charter compliance with those areas of law, but ultimately it is the courts that are responsible for making those final determinations.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you.
We want to do things right and we also want to protect the most vulnerable groups, while respecting people's autonomy and freedom of choice. Misinformation has been rampant.
What do you say to those who associate suicide with medical assistance in dying?
February 14th, 2023 / 8:05 p.m.
Director General, Health Care Programs and Policy Directorate, Department of Health
We agree that there needs to be.... That is a very difficult question.
We recognize that suicidality is a concern, and we agree that it's important to distinguish between suicidal intent and a rational, well-considered request for MAID from someone with a long-standing mental disorder.
We've heard from practitioners that psychiatrists are well trained to do this. They have indicated that suicide assessments are already part of the current MAID assessment practices, as are suicide prevention efforts when these are warranted.
The expert panel has made recommendations to assist practitioners in discerning a rational request for MAID, including doing many assessments over a period of time, “including when possible, during periods of remission or reduced symptoms, and not during periods of acute emotional distress or crisis.” The panel advises that “suicidal ideation must be considered and evaluated to best determine whether the requester's wish to end their life by MAiD represents a capable appraisal of their situation rather than a potentially treatable symptom of their mental disorder.”
The MAID practice standards, which will be available in March 2023, will assist in this regard.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you.
A psychiatrist from Ontario, I believe, told the Special Joint Committee on Medical Assistance in Dying that, over her roughly 30-year career, she had granted MAID access to two people whose sole underlying medical condition was a mental disorder.
Do you have a sense of what the demand will be once the option is available?
Director General, Health Care Programs and Policy Directorate, Department of Health
I'm going to answer in English, if you don't mind.
We actually expect the demand to be quite low, based on international comparisons. For 2021 and 2022, we've been able to determine that of all of what we call track 2 MAID cases, only 2.2% involved death that was not reasonably foreseeable. Now, we expect that, based on the cases in the Netherlands, where the number was 1.5% of the assisted-dying cases, those actually involved psychiatric conditions.
We expect something similar with respect to our MAID law in terms of track 2 cases.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Did you take into account what happened in Quebec, where the demand for MAID was higher than expected?
Do you take those specific or provincial considerations into account?
Director General, Health Care Programs and Policy Directorate, Department of Health
Yes. In our monitoring reports we break down all the information by province and territory. In fact it's quite an extensive report. Right now we would not look at MAID in cases of mental illness, because of course that's not yet legal, but of course this year it will look at all the track 2 cases over a full year. I think there will be quite a bit of information in that report that will be very useful.
Liberal
The Chair Liberal Randeep Sarai
Thank you.
Thank you, Ms. Brière.
Last we'll go to two three-minute rounds.
Mr. Thériault, go ahead for three minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you.
We talked about vulnerability. Is there anyone more vulnerable than someone who has an incurable illness causing them so much suffering that they have reached their breaking point? That is why I think the government wisely decided not to take the issue to the Supreme Court. People were going on hunger strikes in an attempt to satisfy the reasonably foreseeable natural death criterion because they could no longer take their suffering and desperately wanted access to MAID. That's horrendous.
My fellow members over here are critical of the judge's decision, but it established that the government's position infringed on the individual's right to life because, instead of providing assistance when the person could no longer tolerate their suffering, the system waited for them to commit suicide. The message that sends people is that suicide is their only option. It amounts to telling them to commit suicide because it's not our problem. On top of it all, those individuals had to take their fight all the way to the Supreme Court despite the intolerable suffering they were experiencing because of their illness. I don't think that is a government's role. A government's role is to make sure the conditions are in place so that people can exercise their freedom of choice.
That said, how many MAID bills, other than Bill C‑39, were private members' bills? None. Bills C‑14 and C‑7 came about in response to court decisions, because citizens were forced to defend their rights in court.
My Conservative colleagues say that, had they been in power, Ms. Gladu and Mr. Truchon would have never had access to MAID, nor would all the others who suffered and were granted access to MAID precisely thanks to Bill C‑7. It's probably worth asking who the most vulnerable members of society are. In my view, the vulnerable ones are those suffering from incurable illnesses who are denied MAID because the right-thinking government knows better than they do what's good for them. For what reason should they be denied that?
Throughout their lives, their right to self-determination is recognized. In biomedical contexts, they are told that no intervention can be provided without their free and informed consent. Then, at the most intimate moment of their lives, meaning death, the Conservatives would have the government make the decision for them because it knows best. It is not the government or their neighbour dying, it is the person themselves. I'm sorry, but I do not agree. I think the passage of Bill C‑7 was a good thing.
However, we need to make sure we are truly ready, because people have mental disorders and are suffering. Implementing this across the country isn't easy. There will be pushback, as there has been in Quebec. Some institutions don't want to provide MAID to people who are terminally ill, even though that criterion is the subject of a countrywide consensus. Patients are prevented from accessing MAID by those institutions. It's scandalous. It's shameful. We have to avoid that.