Debates of Feb. 13th, 2024

Government Business No. 34—Proceedings on Bill C-62

[Tracy Gray, Conservative, Kelowna—Lake Country, BC]

Madam Speaker, we should not be talking about a delay. We should be talking about not expanding MAID at all to those suffering from mental illness as the sole underlying condition.

[James Maloney, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I will be sharing my time with the member for Saanich—Gulf Islands.

It is a pleasure to speak today to Bill C-62. The bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

There seems to be a telephone ringing. I am not sure if it is the member's telephone that may be ringing, but I would ask members, when they are taking the opportunity to speak, to ensure their telephones and earpieces are not on their desks, as they can cause problems for the interpreters.

The hon. parliamentary secretary.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Madam Speaker, I think it is my assistant calling me, telling me it is time to speak. She is very efficient.

As I was saying, the bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID, on the basis of mental illness alone would remain prohibited until March 17, 2027. In my remarks today, I will be addressing some of the concerns that have been expressed about allowing MAID for mental illness and the importance of ensuring that our health care system is ready before legalizing this practice.

As members know, Bill C-7 temporarily excluded MAID for mental illness until March 2023. Parliament extended the exclusion for an additional year after organizations such as the Association of Chairs of Psychiatry in Canada and the Centre for Addiction and Mental Health expressed a need for additional time. The Special Joint Committee on Medical Assistance in Dying, or AMAD, also supported the extension.

At the outset of my remarks, I want to emphasize that the government recognizes that mental suffering may be as severe as physical suffering. We know that not all individuals with a mental illness lack decision-making capacity. The extension of the temporary exclusion of eligibility for MAID is not based on these stigmatizing stereotypes.

I also want to announce my profound sympathy for anyone in Canada who is intolerably suffering because of a health disorder. My thoughts are with them.

While the federal government believes that MAID eligibility should be expanded to those whose sole condition is a mental illness, this process cannot be rushed. Over the past year, important progress has been made to prepare for the expansion, but provinces and territories are at varying stages of readiness. The federal government has listened to its partners and introduced this bill as a direct response to their concerns.

A cautious, deliberate and rigorous framework is essential to ensure the safe provision of MAID where a mental illness grounds a request for MAID. Debate about the parameters of the MAID regime has been taking place since before the Supreme Court of Canada's 2015 decision in Carter, in which it held that the absolute prohibition on physician-assisted dying was unconstitutional. This is a sign of a healthy democracy.

Most recently, the Special Joint Committee on MAID witnessed the diversity of views and expertise first-hand. Some witnesses who testified, such as Dr. Trudo Lemmens, chair in health law and policy at the University of Toronto, expressed concerns about permitting MAID where the sole underlying condition is a mental illness. Others, including the members of the Canadian Association of MAID Assessors and Providers, thought the country was ready for the current March 17, 2024 deadline.

Still others supported expanding MAID for mental illness, or accepted that it would become legal but recommended a delay. This recommendation came from Dr. Jitender Sareen of the University of Manitoba on behalf of eight chairs of psychiatry departments in Canada. The chairs of psychiatry outlined several reasons, including concerns about a need for further safeguards and accepted definitions of irremediability in mental disorders, before moving forward.

I would like to acknowledge the important contributions that have been made on this topic. While not everyone agrees, it is clear that we all care deeply about the well-being of those seeking MAID and the protection of the vulnerable.

Let me now get into some of the specific concerns that have been raised. Members will recall that certain eligibility criteria need to be met to qualify for MAID. This includes having a grievous and irremediable medical condition, which requires that a person be in an advanced state of irreversible decline.

Some doctors, such as Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre, have said it is impossible to predict which patients with a mental illness will get better; in other words, we cannot determine whether their illness is irremediable. However, other experts, including members of the expert panel on MAID and mental illness, suggest that the evolution of the illness and the response to past interventions can be used to assess irremediability, as is done with some physical conditions such as chronic pain.

Concerns have also been raised, by Dr. Sareen and others, that it is too difficult to distinguish between suicidality and a rational request for MAID when the request is based on a mental illness alone, because suicidality may be a symptom of the mental illness itself. Dr. Stefanie Green acknowledged that this can be complicated, but testified before the MAID committee that clinicians have a duty to assess every patient for suicidality. It is something that doctors do regularly in clinical practice. In addition, MAID assessments may involve suicide prevention efforts where warranted.

Another concern expressed by Dr. Tarek Rajji, the chair of the medical advisory committee at the Centre for Addiction and Mental Health, is that there was no consensus within the medical community about whether MAID should be available for persons whose sole underlying medical condition is a mental illness. However, others, including Dr. Green, note that the lack of consensus in the medical community is not unique to MAID.

A last concern that I want to address is that individuals are requesting MAID due to a structural and systemic vulnerability, such as lack of income and social supports. I want to be clear that the law requires that the suffering be due to illness, disease or disability, not poverty or unmet needs.

Our government is confident that the existing safeguards will ensure that only those who meet the eligibility criteria receive MAID. We are also determined to invest in social programs that can alleviate non-medical suffering and bolster social supports. Our MAID framework contains two sets of safeguards, one for requests where natural death is reasonably foreseeable and the other, more robust set for requests where natural death is not reasonably foreseeable.

The second set of safeguards would apply to cases where a mental illness is the basis of a MAID request. These include a requirement for a doctor or nurse practitioner with expertise in the condition to be involved in the assessment, a longer assessment period of 90 days, a requirement that the patient has been informed of the means available to relieve their suffering and has been offered consultations with relevant professionals, and a requirement that both assessors and patient agree that the patient has given serious consideration to the reasonable and available means of relieving their suffering.

In addition to these stringent safeguards, there is other guidance for doctors, nurse practitioners and regulators, including a model practice standard. Implementation of robust regulatory guidance and additional resources is ongoing, as is uptake of the nationally accredited bilingual MAID curriculum.

We are confident that, with more time, we can achieve readiness to ensure the safe provision of MAID in circumstances in which a mental illness grounds the request for MAID. We have made important strides, but work remains to be done to prepare health care systems and for more doctors and nurse practitioners to benefit from the available training and supports.

Our government thinks that three years is enough time to complete this work, so that our health care system is prepared when MAID for mental illness is permitted. In addition, we are proposing to add a requirement for a parliamentary review by a joint committee of both Houses of Parliament, to start within two years of this bill's receiving royal assent.

The committee will have six months to submit a report, including a statement of any recommended Criminal Code changes. This review will inform government action and ensure that they move forward only once the Canadian health care systems are ready.

With the March 17, 2024 deadline fast approaching, I urge everyone to work together to see that this bill is adopted before that date.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is a rather accurate summary of what happened in committee. The government decided to include in legislation the committee's main recommendation on mental disorders. My colleague sat on the committee that produced the report tabled in February 2023, which recommended allowing advance requests.

Why has his government not introduced a section on advance requests after a year of waiting? I think that would have been good for people who are currently suffering and who cannot make an advance request. Why is this not included in Bill C‑62?

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Madam Speaker, I will start by saying how much I enjoyed working with the hon. member on the special joint committee, not just on this occasion but last year as well. He is well aware of this looming deadline. We need to focus on the issue at hand and get this bill passed. Any additional layers of discussion that we add to that could potentially impact our ability to get this bill through the House and through the Senate. It is important that we get this done before the March deadline, and I think we agree on that. I think he will agree with me, and in fact I know he agrees with me, that the process at the committee has been very positive and constructive.

[Lori Idlout, NDP, Nunavut, NU]

Uqaqtittiji, I wonder if the member could share with us what would happen if we missed the deadline. What kinds of challenges will be experienced by Canadians and the system if we do not get this passed before March 17?

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Madam Speaker, I really appreciate that question because it goes to the core of the reason we are moving this bill forward.

If we do not get this bill through the House and if we do not get this bill through the other place, this law will take effect on March 17. That, then, triggers a situation where we have multiple jurisdictions that have made it very clear that they are not ready to proceed, but it will be the law of the land.

A scenario could be created in which there is, I will not use the word “chaos”, but a situation which would be unsettled and inconsistent across the country. We cannot have that happen. When we are dealing with an issue that is so significant and so serious and that has permanent implications, we have to make sure that we are ready and that we have it right. That is why we have to get this bill passed.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Madam Speaker, there is wisdom in life, in our decisions, but fear should never dictate our actions. I do not want use the word “chaos”, but I think we need to recognize all the work that has been done on this file.

Today's bill adds a three-year delay to the inevitable question that arises when mental health comes into play. It seems to me that re-establishing the Special Joint Committee on Medical Assistance in Dying and giving it an extra year to do a more in-depth study might have been a better solution.

This is just going to postpone suffering. Psychological suffering exists. Some people who have it talk about cancer of the mind. That is also a reality.

That said, it is 2024. Much progress has been made, such as being able to make an advance request for MAID for certain illnesses.

Why has the progress made at the special joint committee not been moving forward? Can my colleague tell us why—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

The hon. parliamentary secretary.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Madam Speaker, on the member's first point, she is right. Fear should never dictate and reason should, particularly when we are dealing with issues of such importance.

This bill is not about delay; it is about getting it right. This issue is so important. If we do not have the system in place and the structural integrity to make sure that it is ready to go, we are not doing our jobs as parliamentarians. It is as simple as that.

I sat on the special committee on both occasions. The work it has done has put us in a position where we can deal with this in a reasonable, rational and timely way. It was the committee that recommended, last year, that the special committee be put together again this year, which is again recommended. We do not want to be put in a position 12 months from now of having the same discussion and again being rushed.

Postponing this for three years is rational and reasonable, but it does not mean the discussion does not continue in the interim.

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

Madam Speaker, I appreciate the opportunity to speak to this. Having been in this place for all the debates we have had, I have been trying to figure out the best way to explain to Canadians, if there is an argument here, why it is not between Liberals and Conservatives, or between Greens and NDP and Conservatives and the Bloc. It has actually been, from the very beginning, a struggle for Parliament to actually deal with an issue we have been kicking down the road for too long.

I mentioned earlier in debate, as the member for Saanich—Gulf Islands, the quiet and extraordinary courage of a single woman, Sue Rodriguez, who took her irremediable medical condition of suffering all the way to the Supreme Court of Canada and was denied the opportunity for what is generally called death with dignity. She had the procedure illegally. Those who were with her at the time would have been subject to criminal penalty as well, including my friend Svend Robinson, who at the time was member of Parliament in a different party from a different place.

It was a very fraught time, and the issue of medical assistance in dying kept coming back to me from constituents who were heartbroken that their parents or loved ones had to go through suffering. Quite often people would say to me they would not let a family pet go through this kind of suffering so why do we allow our moms and our dads to go through this when there is no prospect they are going to recover.

This finally went back to the Supreme Court of Canada for a different decision that came out of the Carter case. The Carter case, back in 2015, said that refusing to allow someone the legal option to seek medical assistance from their doctor in a situation where their illness is terminal is really a violation of section 7 charter rights. I only mention this because that was also with a deadline. We have to take action on this; we cannot just leave the matter. The Supreme Court of Canada has said that this provision of the Criminal Code is actually a charter violation. That means one cannot let it just sit there anymore.

It would take too much time, and my colleagues will be relieved to know I will not go through this chapter and verse, but it is a tough, tough issue for parliamentarians. At the time, as we started debating the first iteration of allowing for death with dignity, in Bill C-14, our first Minister of Justice to deal with this was the very honourable Jody Wilson-Raybould. She had to struggle with this. Our Minister of Health at the time, also very honourable, Jane Philpott, was struggling with this.

It occurred to me as the debate went on that what we had in Canada on this issue was essentially a professional dispute. The lawyers in Canada wanted to make sure that the charter was respected. The doctors in Canada said they did not want to be asked to figure out what “irremediable” meant and were not exactly ready for that. Therefore, subsequent revisions kept happening because, after all, in our first attempt to get medical assistance in dying right, we did not allow for advance directives. Therefore, we had subsequent court cases where people who had terminal cancer could not access MAID because they decided they better ask for it now, which was maybe months before death would occur naturally and months before a doctor could say, “Okay, you're ready now. Nod.” One had to be able to physically sign; the day of, one had to confirm one's procedure.

Again, I better not go back through all of this, but essentially the professional views of doctors pleading with parliamentarians outweighed the lawyers dealing with parliamentarians to say that we were probably still going to have charter violations, but it is better that we listen to the doctors and that they are ready. All of this ended up taking us back to fixing medical assistance in dying again to try to make it more humane, to try to respond to the concerns of Canadians from coast to coast that they wanted to be able to access an advance directive in a situation that fit the MAID template. This brought us to Bill C-7.

To some of the comments that were made in this place earlier today, the government and Parliament were under a deadline that was court imposed, not politically imposed, to oblige ourselves, as parliamentarians, to meet what the Supreme Court of Canada said the charter required us to do. We had a very tight timeline, and then the Senate did something I do not think anyone in the House expected.

Again, we had a professional dispute going on here. Doctors were saying they were not ready to extend this to people whose sole irremediable condition is mental illness. Public health professionals in addiction and mental health were saying they were not ready. However, with strong pressure and strong professional advice from the psychiatric community, the Senate decided we should extend MAID to those with an underlying condition that is only, and I do not say “only” as if it is a marginal or trivial matter, a crushingly painful and life-ending threat from mental illness.

We are walking this fine line. The line is even finer when we start realizing who is more likely to not be able to access mental health supports; they are the marginalized and the poor. Who is more likely to not be able to imagine continuing on in life with a crushing mental illness? It is again the marginalized communities. The disability community spoke with a loud voice saying not to extend MAID as they were worried enough that it was a slippery slope when Bill C-14 first came in, and now Bill C-7.

Here we are again with a court-imposed deadline. Let us be clear to Canadians watching today. Certainly, the provinces and many doctors and mental health professionals have spoken with one voice. If we do not act quickly to pass this legislation and if the Senate does not act quickly to get it to royal assent come March 17, then as a matter of reality, we are up against March 17, and medical assistance in dying would become available to people where mental illness is the sole underlying condition.

Is it irremediable? We are told by the experts that no one really knows how to answer that question. Yes, some of the psychiatric community says the safeguards are there and if three psychiatrists say that it is irremediable, then that is enough. However, we are all asking where the mental health supports are, particularly for those who are marginalized. Where is the access?

This is one that particularly perturbs me. I have had many people come to me from a community that has experience with using psilocybin, conventionally known as magic mushrooms, as a way to alleviate a mental health condition, which might otherwise be irremediable, with remarkable results. We know that Health Canada is currently accelerating trials on psilocybin. It strikes me as beyond a catch-22 that the authorities would say to those people and to their doctors, who think psilocybin could help them, when the alternative is that they are more likely to commit suicide, or if we do not act by March 17, they will have access to legal medical assistance in dying, and it would be too dangerous to let them try psilocybin, but the alternative is death. It seems to me that any medical risks from psilocybin pale in comparison to the irreversible reality of death. How can we let this happen? We cannot.

I think we need to discuss another thing in this place, which is societal assistance in living. We know what medical assistance in dying looks like, but what does societal assistance in living look like? It means ending poverty and bringing in a guaranteed livable income for all. It means access to mental health services in this country. It means a compassionate and caring approach that says to every Canadian, whether in the disability community, the indigenous communities or the youth who are struggling with addictions, that we hear them and will not fail them. That means, no matter how members feel about it, we have to pass this legislation expeditiously.

[Pierre Poilievre, Conservative, Carleton, ON]

Madam Speaker, as we are debating this measure today, a huge scandal is unfolding.

We learned from the Auditor General yesterday that there is evidence of corruption and wasteful spending. That is why we are announcing that we want the RCMP to expand its investigation in order to find the truth and shed light on the possibility of criminal activity in the arrive scam scandal. I have letters to that effect.

I am asking the RCMP to expand its investigation into the arrive scam affair, and I am tabling this letter—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I thought the hon. member was rising on questions and comments, but his intervention does not relate to the debate.

[Pierre Poilievre, Conservative, Carleton, ON]

Madam Speaker, I am rising on a point of order.

The arrive scam scandal has exploded into public consciousness after the Auditor General revealed evidence that senior government officials got gifts, such as fancy whiskies, in order to give out contracts. I would like to table in the House of Commons a letter to the RCMP commissioner asking for the investigation into arrive scam to be expanded.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Is there consent?

[Some hon. members]

Nay.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Questions and comments, the hon. member for Châteauguay—Lacolle.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Madam Speaker, I have a question for the hon. member for Saanich—Gulf Islands—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Order. I cannot hear what the hon. member is saying. If members want to have conversations, I would ask them to please take them out into the lobby or outside the chamber.

The hon. member for Châteauguay—Lacolle.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Madam Speaker, I greatly appreciated the comments, just as I have all the discussions in this debate today.

Going back to 2015, I too sat on the first joint committee to study medical assistance in dying. It was a difficult time for me as a new member. As a practising Catholic, I was profoundly touched by the issue, but I was able to understand, through expert testimony, that it is important for people to have choices.

I would ask my hon. colleague, since I know she is also a person of faith, to talk about that. Even though we may personally have very strong values, is this not something on which Canadians deserve to have a choice?

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

Madam Speaker, I must say, I was very disappointed that the hon. leader of the official opposition was not rising to ask me a question. It would have been a first, and I was so looking forward to my response to him.

The hon. member for Châteauguay—Lacolle has asked me a very important question. I am a person of faith. I struggled with this. My constituents convinced me. I spent a lot of time talking to people in Saanich—Gulf Islands, who begged me to support legalizing, removing criminal sanctions for, medical assistance in dying. My view is very personal and a matter of conscience; I do not expect others to agree with me, when they passionately and firmly believe otherwise. I believe all life is sacred, of course. I believe that taking a life, including one's own life, is also a profound matter of deep moral conflict. However, I have no doubt at all that the Christian impulse to compassion is not to allow people to suffer needlessly.

Medical science is now allowing us to extend our lives beyond what my grandparents and their peer groups would have experienced. As we extend our—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I have to allow for other questions and comments; I am sure the hon. member can continue to elaborate.

The hon. member for Montcalm.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I am sure my colleague's intention is not to exploit the pain of people who have been enduring irremediable suffering for decades. However, she is repeating an argument that we have heard often in this debate and that I feel is something completely separate.

The issue of access to primary mental health care has nothing to do with the decision we must make on whether to expand medical assistance in dying since, with regard to access to care, these people would not qualify under the criteria and guidelines of the expert report.

I do want us to advocate for better care. I wholeheartedly agree with that, but that is another debate. However, there are people who have been receiving care for decades and who are suffering, and the government wants to tell them to keep suffering for three years.

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

Madam Speaker, I believe access to care really is a key issue. I agree that having a continuum of suffering is unacceptable.

I am not against MAID eligibility for people who are suffering due to a disease and who have shown that their suffering is real. We must act. However, we do not have to act immediately, on March 17.