Debates of Feb. 27th, 2020

Criminal Code

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, simply put, the record will show that the member's characterization of my remarks is not at all accurate.

Let me just re-emphasize a point that I made. The very purpose of safeguards is to deal with the exceptional case. I agree that the vast majority of health care practitioners are not only well-intentioned, but also are not trying to push the envelope in any way. However, the data I cited suggests that in other jurisdictions we have seen how a relatively large number of problematic cases can emerge from the actions of perhaps also well-intentioned but definitely envelope-pushing physicians, who go beyond the intention of the legislature with respect to this bill.

The parliamentary secretary had some points that I wanted to get back to very quickly.

It is true that the legislation excludes depression as a sole condition, but it does not exclude people who suffer from depression from accessing it. In a previous Parliament, the member for St. Albert—Edmonton tried to introduce an amendment, whereby if someone was suffering from depression as well as other conditions, there would at least be a psychiatric assessment—

[The Deputy Speaker, Conservative, Bruce Stanton]

Order, please. I prefer not to have to interrupt hon. members when they are in the midst of their speeches, but there are many members who wish to participate in this time for questions and comments. I am stopping the clock here right now, so we are not going to take any more time away from the member.

It would help if members would direct their attention to the Chair in the midst of questions and comments. It would give me a chance to signal where we are in timing. Although there is nothing codified with respect to the limit for the time members should take to pose their questions or to respond, we will usually gauge the time by the number of people who are rising. If members see a lot of people standing up in questions and comments, perhaps they could keep their comments a little shorter. We will do our best to regulate that so we can get more members participating.

Just as a final reminder, questions and comments are for that purpose. I appreciate that members are trying also to get time in debate, and we will try to honour that as best we can. However, it is not a time for speeches; it is more for posing a question or a reflection on what the member has just said in his or her speech.

Questions and comments, the hon. member for South Okanagan—West Kootenay.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, I need some clarification from my colleague. He finished his speech by talking about final consent. The act currently requires final consent at the time people are assessed and then they have to give final consent when that order proceeds. This has forced patients to make a cruel choice.

Once patients are assessed as being eligible for medical assistance in dying, they have to decide if they should do it right away, while they have the competence and can give an answer, or if they set a date in the future to allow themselves and their families to do all the things they want to do, but then risk that they are not competent and cannot answer and the procedure would not go ahead. I have a friend having to make that cruel decision.

Therefore, could the member clarify his statement about fixing advance consent?

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, I have two points in response.

In the context of advance consent, it is important to note that people do not know precisely what their experience will be. They may get a prognosis and think they will feel a certain way about things at that point in time. It is important to underline that the reason we generally do not have advanced consent is because people do not always know what their experience of that will be.

Nonetheless, I want to be very clear. What I would propose as a middle way between having no advanced consent and the advanced consent regime proposed in the legislation is to allow people to give advanced consent, but to still require, even at the point at which they may have lost capacity, some contemporaneous consultation with them, so even at a point of reduced capacity they are told what is happening and will be given the opportunity to assent or not. Even at the point at which they have lost capacity, it is still fair to them to give them some information about what is happening in order to give them the ability to express their objection, if they are able to in the context of limited capacity.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, it would appear to me that the very concept of medical assistance in dying is the concept to which my friend from Sherwood Park—Fort Saskatchewan objects. The courts have ruled that it is a violation of our charter rights as Canadians not to have access to medical assistance in dying. I know it is a very difficult and fraught topic.

I would ask the member this quite directly, not to a hypothetical. Thinking of Audrey Parker of Nova Scotia, who knew she was terminally ill and who choose to end her life earlier because she was denied an advanced directive, would he agree that these sets of amendments to the Criminal Code are fair and within the context of what the courts have directed us to do?

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, there have been various court decisions dealing with this broader topic, but I am not aware of court decisions dealing specifically with the issue of advanced consent.

Clearly the case of Ms. Audrey Parker should evoke a thoughtful response from us. I am not aware of all the medical details of the case. Many people have opinions about the case who also may not be aware of all the details, or the context or the information she received. Therefore, I do not feel comfortable giving an answer in the House of Commons about what should or should not happen in a particular individual's case.

We can, as members of Parliament, try to work together to find consensus, or to have our cake and eat it too, to use the expression. If it is the will of the majority, we can have some mechanism of advanced consent, but still require contemporaneous consent at the point at which somebody's life will be taken. That is very important. We would not want a situation where some people have their lives taken while they are unaware they are being taken or do not want it to happen.

I will just tease the member a little by pointing out that there was a court of appeal decision in Alberta opposing the carbon tax, and I hope she shares my enthusiasm for court decisions in that case as well. Some dialogue with the courts is maybe reasonable.

[Patty Hajdu, Liberal, Minister of Health]

Mr. Speaker, I am very pleased to rise in the House today to address Bill C-7 and to speak to our proposed changes to Canada's medical assistance in dying legislation.

The proposed measures respond to the Superior Court of Quebec's Truchon decision, in which it ruled that it is unconstitutional to deny access to medical assistance in dying to individuals who meet all the other eligibility criteria but are not near the end of life.

In responding to this ruling, the Government of Canada has had the opportunity to consider some additional measures for which there is strong support. That is why we are proposing changes that will help clarify and add precision to Canada's medical assistance in dying legislation.

Over the past few months, I have had the honour of listening to many Canadians, and it was important for me as the Minister of Health to hear first-hand what they had to say. My colleagues and I hosted a series of round tables and heard from more than 125 experts, academics, ethicists, doctors, nurse practitioners, members of the disability community, indigenous groups and key stakeholders. I also engaged my provincial and territorial colleagues, and my officials worked closely with their counterparts across the country.

In January, I was in Calgary and spoke to Cynthia Clark, who saw her husband through the process of medically assisted death last summer. Her perspective, as well as those of so many others with first-hand experience were invaluable.

I also listened to practitioners who have been providing medical assistance in death in a very thoughtful, compassionate way over the last four years. They had a lot to say about what was working well but also about what was not working well.

We heard many personal stories like Cynthia's, and they helped shape the changes that we are proposing today. In addition, the feedback received from our online consultation was astounding. In two weeks we had more than 300,000 responses.

It is clear that certain aspects could be improved in order to facilitate access, protect the vulnerable and respect personal choice.

With this bill, I think we have achieved a balanced approach that reflects the best interests of all Canadians.

Protecting the safety of vulnerable people while respecting the autonomy of Canadians remains our central objective. That is why the bill proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.

Reasonable foreseeability of natural death would no longer be a requirement for determining whether a person can access medical assistance in dying. It would, however, be used to guide practitioners in determining which safeguards to apply. This is consistent with what we heard at the round table meetings.

Providers involved in assessing the eligibility of applicants for a medically assisted death told us they have a good understanding of the concept and are comfortable applying it. Under the amended law, they would use reasonable foreseeability of natural death to determine not eligibility, but rather which safeguards would apply.

For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards. Under the current system, there is a requirement for a 10-day reflection period. We are proposing to eliminate this reflection period. For those who are at the end of their life, the decision to request medical assistance in dying is well considered, and this additional period only serves to prolong suffering unnecessarily.

The current system also requires that two independent witnesses confirm that the person who has signed a request for medical assistance in dying is who they claim to be and that no fraud has occurred, such as the forging of someone's signature. During our consultations, we heard that this requirement was a significant barrier for many people at the end of their life.

We propose requiring only one witness and allowing this witness to be a paid personal or health care provider. These individuals naturally would be excluded from acting as a witness if they are a beneficiary of the person's will or if they would receive a financial or material benefit from the person's death. Anyone involved in assessing or providing medical assistance in dying would continue to be ineligible to serve as a witness.

For those whose death is not reasonably foreseeable, we would create a new, more robust set of safeguards. We think it is important, even while improving access, to ensure that people who are suffering but who are not dying are given full and careful consideration as they assess whether or not to pursue an assisted death.

Strengthened safeguards would also serve to protect vulnerable individuals. For example, the bill proposes a minimum period of 90 days for assessing a MAID request in the case of a non-imminent death. This period would allow for exploration, discussion and consideration of options to alleviate suffering by the person seeking medical assistance in dying and with the practitioner.

The bill would also require that the person requesting MAID be provided with information on available counselling, mental health supports, disability supports and palliative care as part of the informed consent process.

We know that the majority of practitioners are already ensuring that their patients are aware of all of the supports and options that are available to them. This provision underscores the importance of the doctor-patient relationship. It allows for a practitioner and a patient to decide whether medical assistance in dying is the right step and provides sufficient time for the patient to discuss and consider other treatment options, which is crucial for patients weighing this kind of decision. This provision supports fully informed decision-making and individual autonomy.

Under the current legislation, those who become incapacitated lose their eligibility for medical assistance in dying because the person must give their consent immediately before the procedure. This means that some individuals deemed eligible for medical assistance in dying have chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive this service.

That is why we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable and who have been assessed and approved to receive medical assistance in dying. Individuals at the end of their life who risk losing their decision-making capacity before their chosen date would have an avenue to receive MAID without worrying that loss of their decision-making capacity before their chosen date would disqualify them. Support for this amendment is strong among stakeholders, Canadians and health practitioners.

Canada has had four years to reflect on the current MAID legislation passed in June 2016, and there are many complex issues that require further study.

In December of 2016, the Government of Canada asked the Council of Canadian Academies to conduct independent reviews on three specific types of requests for medical assistance in dying that are currently outside of the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying medical condition.

The Council of Canadian Academies convened a multidisciplinary panel of 43 experts to review an extensive body of evidence, including Canadian and international academic and policy research.

We tabled those reports in Parliament in December 2018. They provide us with a thorough, thoughtful examination of these very difficult subjects. I encourage all members to read those reports as we continue our deliberations on the proposed legislative amendments and the parliamentary review that will be conducted later this year.

There is agreement among experts that allowing advance requests for people with illnesses such as Alzheimer's disease well before they would otherwise be deemed eligible is very complex and will require careful consideration and consultation before it could be included in legislation.

During the round tables I heard directly from health care providers who expressed discomfort because they have seen patients who, as their position progressed, might not have the same desire for medical assistance in dying as when they were first diagnosed. The Council of Canadian Academies' expert panel report on advance requests came to the same conclusion.

At the same time, we know that many Canadians have expressed an interest in advance requests so that they could have the comfort of knowing that they could avoid extreme suffering at some future date.

For all these reasons, we believe this issue deserves deeper examination through parliamentary review. That will be our opportunity to tackle questions that are profound and difficult to answer, even for practitioners who have been providing this service over the past four years.

The proposed changes to the medical assistance in dying legislation would exclude persons if mental illness is the sole underlying medical condition.

This does not mean that people with mental illness are ineligible; it means that mental illness cannot be the sole underlying condition. This is another complex aspect that warrants a more thorough discussion.

Since the federal legislation came into force in 2016, Health Canada has released four federal interim reports that provide more information on how the legislation is being implemented across the country.

In November 2018, we implemented regulations that resulted in the creation of a permanent monitoring regime that sets out obligations for reporting on medical assistance in dying cases by doctors, nurse practitioners and pharmacists. The first monitoring report under these regulations is expected to be released in spring 2020 .

Since MAID legislation was enacted in 2016, more than 13,000 Canadians have chosen this option of a medically assisted death. This is not unexpected. We have seen a gradual increase in the numbers over the last three years. The number of MAID deaths in Canada, slightly under 2% of all deaths, is in line with international regimes. The increasing use of MAID is largely a result of enhanced awareness of it as a legal option and greater acceptance by Canadians.

The federal government recognizes that public reporting is critical to ensuring transparency and also to ensuring public trust in the legislation. That is why we are proposing changes to expand data collection to help provide a more complete picture of medical assistance in dying in Canada.

Under the current legislation, only practitioners who receive a written request for MAID and pharmacists who dispense a MAID substance are required to provide information, but it has become clear that capturing information based solely on written requests for MAID received by physicians and nurse practitioners has resulted in an incomplete picture on who is requesting MAID across the country, and why.

The amended legislation would authorize new regulations to be developed in partnership with provinces and territories to allow for the collection of data on all assessments for MAID, and this would include those undertaken by other health professionals on the care team. It also clearly aligns with the original intent of the legislation to collect information on all requests for, and cases of, MAID in Canada.

I think we can agree that Canadians with life-limiting illnesses deserve the best quality of life possible as they approach the end of their lives. Palliative care and end-of-life care provide patients with relief from the pain and distress associated with a life-threatening illness. Supporting home care and palliative care is a key priority in our ongoing efforts to improve our health care system.

Through budget 2017, we made historic new investments in health care to improve access to mental health and addiction services, as well as home and community care, including palliative care.

To further support access to palliative care across the country, the government worked closely with provinces, territories, and stakeholders to develop the framework on palliative care in Canada, which we tabled in Parliament in 2018. We have released an action plan to support each of the priority areas identified in the framework.

I want to assure the House that the proposed bill responds to concerns identified by practitioners and experts through the round table discussions.

I will continue to work closely with the provinces, territories and key partners to support the implementation of the proposed legislative amendments, if they pass in Parliament.

This includes working with provinces, territories, health system partners and regulatory bodies to support best practices and information sharing on clinical guidance and other aspects of implementation, which includes training and retrospective reviews.

I have a great deal of respect for the practitioners who have been providing this service over the last four years with immense diligence and a huge amount of compassion. Their experiences have helped us craft legislation that much better meets the needs of Canadians. This law is constructed in a way that supports autonomy, but it includes the flexibility to allow a practitioner and a patient to work more closely together.

Medical assistance in dying is a complex and deeply personal issue. In tabling these changes, our government has considered carefully the need for personal autonomy and the protection of vulnerable people.

There is strong public support for change, and I believe we have found an approach that reflects the best interests of all Canadians. I urge all members of the House to support the proposed changes.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Mr. Speaker, the minister said Canadians who are deciding whether they wish to receive medical assistance in dying are often experiencing prolonged suffering. The problem is that their prolonged suffering is due to a lack of palliative care. We were promised $3 billion would go to palliative care. Our dear member Mark Warawa spent nine days in hospital before he even saw a palliative care doctor.

I am wondering how on God's green earth we think that loosening these guidelines is a better way to ensure the best quality of life for Canadians.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, as the member opposite knows, we have made historic investments through provinces and territories to improve a range of health care services, including palliative care.

As I mentioned in my speech, it has been an honour to be part of a government that understands that having a strong framework and having actions that we can take together to improve palliative care at the end of life are very important to all of us, especially since we have an aging population that will require more of those services.

It is also equally important to recognize that Canadians have very loudly said, and courts have agreed, that they deserve to have autonomy at the end of their lives, and that includes the choice to use medical assistance in dying.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I just want to comment on access to palliative care, which is indeed very important.

I would remind the House that the Conservatives were the first to cut health transfers. If health transfers had been as high as 25 cents per dollar, there might have been even greater access to palliative care.

That being said, the minister has introduced a bill that responds in all respects to the Baudoin ruling and to the condition raised with regard to the state of health of Ms. Gladu and Mr. Truchon, who were denied the possibility to choose. True freedom of choice requires that there be options.

The minister says that practitioners are able to discern when people with Alzheimer's who initially seemed in favour of medical assistance in dying may have changed their minds along the way. If doctors are able to discern that these people have changed their minds along the way, then why are they not eligible, like Ms. Gladu and Mr. Truchon?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I thank my colleague for the question.

I agree with him that it will take a long time to recover from a decade that lacked investment in health care across this country under the former Conservative government. We are doing our best to make up for lost time.

In the case of conditions such as Alzheimer's, where people have to anticipate how they might feel if they have a condition, it is much harder to do those assessments. We heard this from practitioners who work very closely with patients in all kinds of situations. They said that when people anticipate how they might feel when suffering from a particular condition, they can be dramatically wrong. When people arrive there, they do not have the kinds of feelings they might think they have when they have, for example, a traumatic injury.

For this reason, we believe that advance requests require further study so we understand the implications from a patient perspective and a practitioner perspective.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, I would like to thank the hon. minister for her work on the coronavirus crisis. She has been very clear on a number of issues.

I am concerned with this debate. When I was working on the palliative care motion, our Parliament voted and everyone supported the issue of palliative care. I met with groups across the country about end of life. What we heard again and again about dignity in dying and the rights of people was they needed the right to access palliative care. I heard that from every group I met with. However, the only movement we have seen from the government was mandated by the Supreme Court.

I understand we had to put this legislation in place, but I am still concerned. The Parliament of Canada voted on a national palliative care strategy to work with the provinces and territories and put in place the opportunity for people to truly die with dignity next to their families in a much more healing and holistic manner, yet we have only heard a lot of talk about that and only as an addendum to the conversation about assisted dying. We have seen no resources or commitment on palliative care.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, I remind the member that, through budget 2017, Canada made historic new investments in health care, which included $11 billion over 10 years to improve access to mental health and addiction services, as well as home and community care, including palliative care. In August of 2019, Health Canada released an action plan that defines federal activities and the next steps linked to the framework on palliative care in Canada.

There are a number of actions we need to take collaboratively with the provinces and territories. We will continue to work with everybody, including the provinces and territories, to ensure that we improve the quality and availability of palliative care for all Canadians.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, the minister mentioned there are safeguards in place for the mentally ill or people who only suffer from mental health issues. What specific protections have been put in place? From my review, there is no requirement that an assessment by a psychiatrist be done on someone who might be experiencing, for example, severe depression.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, the proposed legislation excludes people whose sole condition is an underlying mental illness. That is because we still do not know enough about how a desire to receive medical assistance in dying might interact with a mental illness. This in no way negates the suffering felt by people who are struggling with mental illness. I have personally worked with people who have severe mental illness and I fully understand that their suffering can be immense. However, we know that, as part of the expression of a variety of different mental illnesses, the desire to end one's life is one of those components.

For that reason, we believe this is deserving of extra review through the parliamentary review scheduled in June.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, this topic has come up quite often in the round of questions to the hon. minister. The legislation before us includes, where appropriate, ensuring that a patient has been informed of other means of alleviating suffering, including mental health services, counselling services and palliative care.

I wish to ask the minister again for some specifics. We clearly are nowhere near making any of these areas adequate. It is fine for the legislation to say that patients may be advised of access to these things, but access is inadequate.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, as the Minister of Health, part of my job is to improve access to health care across Canada. It certainly would not be in my mandate letter to improve this if we thought that everything was perfect.

We know that work is under way with the provinces and territories. I mentioned the $10-billion investment that happened a couple of years ago. Obviously, access to primary care and improving supports for addiction and treatment in communities are the kinds of things the Prime Minister has asked me to do in my mandate. We also know that Canadians want autonomy at the time of their death, so there is an important balance we have to strike.

We have to make sure that we continue to work on ensuring that Canadians have equal access to services all across the country. The legislation says that people need to be made aware of services available to them in their communities so that they are fully aware that the choice they are making truly reflects their own particular circumstances.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Mr. Speaker, I certainly applaud the intent and where we are going with the changes to the legislation.

At the end of the day, we pass a lot of money to the provinces and we expect them to do certain things with it. Ensuring that palliative care and all of the other services are available is important.

Is there a federal-provincial group ensuring that a fair amount of the funding we continue to transfer gets to the very areas we want so that people have access to palliative care and other resources?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Speaker, absolutely. There is a federal-provincial-territorial working group that works very closely to determine how we can create equal access to services across Canada and how to make sure the investments we make result in differences in people's access to care independent of where they live. The group ensures we work together to uphold the Canada Health Act.

As we know, the Prime Minister takes this very seriously, as do I. As I have recently tabled my findings under the Canada Health Act, we will be pursuing with provinces and territories their obligation to make sure they are providing the services that have been afforded to all of us throughout the history of health care in this country.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before resuming debate, I would like to compliment hon. members on their participation and co-operation during the period for questions and comments. It was excellent.

The hon. member for Dufferin—Caledon.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I am happy to stand today to add my voice to this debate. I think it is a particularly important debate. It is an important subject, and I think there are a lot of issues that need to be discussed.

I am going to confine my comments to issues I have with the bill, things I am concerned about, and my genuine belief that the government will take a very collaborative approach to this legislation. If we take a collaborative approach to this legislation, Canadians will have trust and faith that we developed legislation to actually address their needs and protect their concerns.

Speaking of concerns, I have a number of them. I will start off by talking about what I consider to be a significant lack of consultation.

This legislation will come up for review in June. It is the five-year mandated review of the legislation. My understanding is that the government has applied for a four-month extension with respect to the implementation of this legislation, which the Quebec court struck down.

If we have this four-month extension and have the mandated review of the legislation scheduled in June, what is the rush? Why have we rushed to introduce legislation prior to that mandatory review, which would, of course, be extensive and broad and far more in depth than any consultation that has been done with respect to the current legislation? My understanding is that there was only about two weeks of public consultation for this legislation. In my opinion, that is woefully deficient given the gravity of the topic we are discussing today.

This is my first real concern. What is the hurry? What is the rush? The court has given us more time to do this, and I believe we should be taking the time to go through the mandatory review and consult with Canadians, and then decide on the path forward. That is my number one concern.

I want to mention that I will be sharing my time with the member for Langley—Aldergrove. My thanks to the page for bringing that to my attention. She is doing an excellent job.

The next thing I want to talk about is palliative care. The minister has made comments in the House today espousing the great investments that are being made by the government in health care, but has not really talked about any specific investments with respect to palliative care. I think that is a critical thing to look at when we discuss this legislation. I want to remind the minister that Bill C-277, an act providing for the development of a framework on palliative care in Canada, was passed in the previous Parliament in 2017, and clearly states in the preamble:

Whereas the Final Report stated that a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person’s suffering;

This was passed by Parliament, so if we are looking to expand the scope of medically assisted death without also expanding the availability of palliative care, we are doing an incredible disservice to Canadians, because the availability of palliative care in this country is poor at best. I am going to speak about this personally just for a moment.

Both of my parents suffered from terminal cancer. My mother was not able to get into a palliative care facility because there was no palliative care facility available for her, so she passed away in the hospital. My father was also not able to get into palliative care, but fortunately his illness was longer than my mother's, or unfortunately, depending on how one looks at it, and we were able to get private home care that eased his suffering and made sure he was being taken care of. However, there was no way that he was going to be able to get into palliative care within the scope of his illness.

This is affecting Canadians from coast to coast to coast, and the minister has rushed to introduce this bill. Why would the minister not have introduced corollary legislation, or legislation in tandem, or announced increases in funding for palliative care?

In my riding of Dufferin—Caledon, there is a fantastic hospice for palliative care. It is called Bethell Hospice. It only has approximately 15 beds. That is the palliative care option in my riding. For approximately 200,000 people, there are 15 palliative care beds.

Members can imagine that there is a significant number of people who are not able to get into palliative care. Therefore, the option of medically assisted death becomes far more attractive for someone who is not able to enter into a palliative care facility.

I will repeat that it is clearly a violation of legislation that was passed by the House. When people do not have the option for proper palliative care, their consent for a medically assisted death is significantly in question. I am extraordinarily concerned by the lack of any plan by the government to deal with investments in palliative care.

The minister has suggested that there are significant safeguards in place for people who suffer from any type of mental illness. However, I am not sure what those safeguards are. She suggested that just having that condition would exclude someone from obtaining a medically assisted death. What is the definition of that? How are we proving that is the only issue?

There is no requirement for individuals to go to a psychiatrist in order to assess that they are not suffering from a severe bout of depression. In my own life, I have gone through extraordinary stages and phases of depression during which I actually did not want to live anymore. I was not seeing a psychiatrist at the time. Would I have then been able to avail myself of these services while I was in a period of particular darkness? We know that mental health is an issue that is rampant throughout this country.

Again, I will go back to my first point, which is: Why are we rushing to do this? Why are we not taking the time to go through the five-year review? We need to take the time to find ways to make sure we are safeguarding all Canadians in providing them the option of medically assisted death, if they want it, but also ensuring that people who are choosing this, maybe because of a lack of palliative care, or maybe because of underlying mental health issues, are going to be protected.

These are some of the major concerns I have with respect to this piece of legislation.

Going back to the consultation, two weeks for online submissions with respect to concerns by Canadians is not anywhere near a sufficient amount of consultation. My understanding is that it was mostly online submissions. This is not a way to get the pulse of Canadians with respect to a very significant issue that is going on in this country. I will continue to ask why there was not a longer or broader consultation.

I know this matter will be studied at committee, but having been a member of Parliament now for going on five and a half years, I understand the extreme limitations at committee. We will often have a panel of six witnesses. Those six witnesses will each get their 10-minute statement, and then members of Parliament might get a six-minute intervention to try and raise an issue.

If one is going to suggest that a committee study will be far broader in scope, or somewhat more encompassing than the mandatory statutory five-year review, I will respectfully disagree with that submission.

Committees absolutely do great work, but they also suffer from an extreme pressure of legislation and time. To suggest that one or two weeks or three meetings at committee is sufficient time to analyze, debate and discuss this legislation, I do not think that is the correct answer. We should be putting this legislation off until we have the mandatory five-year review in June, which would allow us to have a far more expansive discussion with respect to all of the issues that are being discussed in the legislation.

These are my comments and concerns with respect to the legislation. I certainly hope the government will listen to these concerns, act collaboratively and co-operatively, and not try to drive this legislation through without listening to legitimate concerns that are being raised by members of the opposition.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, I want to pick up on the member's points regarding the issue of palliative care.

During the debates in the last session there was a great deal of emotion that was expressed, and I valued and appreciated the contributions by members. I think members from all sides of the House were really trying to get a better understanding of the important subject matter that we were debating.

The member is quite right when it comes to palliative care. Whether it is the national government or the provincial governments who ultimately administer health care, we need to do a much better job on palliative care.

I wonder if my friend from across the way can provide some additional thoughts. I would ask him to look specifically at areas of the country where palliative care is nowhere near where it should or could be compared to other areas of the country. I am thinking of rural versus urban and even variations between urban centres.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I appreciate the point being raised. Yes, access to palliative care across this country is a huge issue. In fact, we are making the situation worse with the government deciding to take away funding from palliative care centres that do not offer medically assisted death as part of the suite of services that they offer. We are losing palliative care beds across the country as a result of that decision.

I am hopeful that the members hearing this topic being raised by members of the opposition will take it back and look at reversing it. The last thing we need in this country is fewer palliative care beds.

I would encourage the member to speak to his leader and to cabinet and get them working on a national palliative care strategy and investing money to ensure we have equal access to palliative care across the country.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, I would like to reassure my Conservative colleague.

A psychiatrist must absolutely conduct a mental health assessment of the person who is dying or suffering. Family doctors are able to prescribe antidepressants to treat depression. Sometimes, a doctor may have to tell a patient that there are no further treatments available and then refer that patient to palliative care to ease their suffering. If the patient immediately says that they want to access MAID, the doctor will prescribe antidepressants, because there are steps to go through long before a patient can access MAID.

I have a hard time understanding the problem my Conservative colleague sees, since the bill excludes mental illness.

Everyone thinks that pain relief in palliative care is common practice, regardless of whether the patient is receiving care. This is called a good medical practice. Relief is provided for pain. No terminal patient receiving good care that manages pain is forced to ask for medical assistance in dying. Patients who request it do so by choice. This choice is necessary, and for there to be a choice, there need to be options.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Mr. Speaker, I am not disputing that people should have options. That is certainly the whole point of the legislation. I am not arguing against that. What I am suggesting is that there are not sufficient safeguards in place, from my perspective.

While the member might say that going to see a family doctor to talk about depression is an excellent way to be treated for depression, I can say from my experience that it is absolutely not a good option. My family doctor and most family doctors are completely incapable of treating someone for depression. Yes, they might be able to prescribe a medication, but medication is not the answer to all depression.

My concern, and we are here to raise concerns, is that this is not properly addressed in this legislation. I do not believe there are proper safeguards in place. That is something we should be discussing here during debate, at committee and certainly in the five-year review that will take place in June.