Debates of Feb. 15th, 2024

Criminal Code

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, it is something that I also think about. The member mentioned courts, and sometimes, I feel that these court decisions should apply for six months to the judge who makes them before they apply to the rest of the public. I sometimes wonder, when they think these things through, that it goes back to too much legal information that clouds their judgment at times. This is where I worry that it is exactly that contagion effect. Does it then become permissible, broadly, that suicide and suicidal ideation are the go-to? Is that the type of society we want to, I do not think “encourage” is the right term, but do we want an acceptance of it? We have companies that promote things like Bell Let's Talk. What is the point of doing that when we have MAID provisions being expanded consistently through a series of legislation and court decisions?

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

Mr. Speaker, we have heard from a lot of people in the disability community, advocacy groups, who advocate for persons with disabilities. They have come out very strongly against expanding MAID for people where the sole underlying condition is mental illness. I wonder if the member can speak to that, if he has heard that as well, and also to the concept that it should not be easier to get MAID than it is to access mental health and addiction treatment.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, the member raises a great point. There are a lot of vulnerable, disabled Canadians who have expressed themselves through not only their associations but also as individuals by communicating to their elected representatives that they do not want to see this expansion because they are worried. It comes from their experience when they go into a clinical setting or into a hospital setting, where the law says that because it does not have to be patient-initiated, medical professionals can give up on their patients.

As someone who has been in a lot of hospitals with my children, both living and those who have passed, I can say that, sometimes, ER doctors and specialist nurses and physicians, who are at the end of their wits and are tired, take on a lot of patients. They have a lot going on and have complex patients with complex needs. It is easy to see how it could lead to a situation where they are maybe not giving the best advice and are looking for a path that requires less care in the long term. That is the worry that a person with a disability has.

That is the worry every parent has when they have children with a disability. When they are adults, will they be able to advocate for themselves? How will the medical system stream them, and where will it stream them? As a parent, I worry about that.

[Dan Albas, Conservative, Central Okanagan—Similkameen—Nicola, BC]

Mr. Speaker, I want to thank the member for sharing his experiences. I am a big fan of the Yiddish proverbs that he says, so maybe he has one he can share in addition to the one he shared already.

Getting back to the subject at hand, I worry most that there was an amendment put to the legislation that would basically allow for an expansion of medical assistance in dying to persons with mental disorders. The government had a choice where it could just simply say no to that amendment and just leave things as they are until, at the very least, the provinces which run the health care systems, and the mental health professionals could say “we are ready”. Does the member believe that the government really made a mistake and that this does have a bit of “the dog ate my homework” kind of approach to it? The government is simply relegislating over and over and making the same mistake.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, I obviously agree with the member. The dog that ate the government's homework has been fattened up over the last nine years, because it had a lot of homework to eat that the government has not done or pretends not to have done.

However, we had an opportunity to close the door completely with the bill from the member for Abbotsford, Bill C-314. I think it was a grave mistake of the House not to have voted in favour of it. There would have been no expansion of MAID to those with mental illnesses. The House and future Parliaments could have reviewed the situation and redecided on the matter in five, 10, 15 or 20 years. Then, there would be more data and more people looking at how the system had been used, what the demand was like, and whether there had been advances in the psychiatric and mental health services provided to Canadians. If we do not provide the service at the front end, so that a person could choose to get healing and have the ability to live a fulsome life the way they want to live it, then we cannot really be pushing MAID on the other side as the only path available to those who are vulnerable or suffering from mental illness.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, I rise today to speak to Bill C-62 which seeks to delay the expansion of medically assisted death to individuals whose sole condition is a mental illness until March 2027.

Yesterday, in anticipation of these remarks, I sent an email to about 10,000 constituents, and I heard back from 95 of them on the subject we are debating today, medical assistance in dying, or MAID. I heard from parents who have lost children, as well as those who have suffered from depression and were able to overcome their illness with treatment.

The majority of respondents agreed with the position I am about to outline, but there were some who did not. Many of those who disagreed with my stance came from Mission—Matsqui—Fraser Canyon's very large and diverse Dutch community. Given its history in, and our connections to, the Netherlands, people in the Dutch community have a deep understanding of this issue. I appreciated hearing their thoughtful comments.

Among those who disagreed, the most common concerns raised were about access and advance requests for those suffering from dementia. Concerns were also raised about the challenges many Canadians face in accessing mental health supports and treatment, which can leave some feeling hopeless. In fact, it nearly brought me to tears, hearing from constituents who asked, “How dare you try to take away the right for me to access MAID when I am suffering from mental illness?” They did not see a pathway out for the circumstances in their life. That is a horrible position to be in.

One thing, however, was unanimous: Our health care system is failing to meet the needs of Canadians suffering from mental health challenges. This must be addressed. I am grateful to everyone who took the time to share their thoughts and concerns in a compassionate and respectful way.

Almost a year ago, I stood before my colleagues in this House and expressed my concerns about the Liberal government's decision to extend medically assisted death to individuals suffering solely from mental illness. I highlighted the stark contradiction between our efforts to promote mental health awareness and services and those to offer death as an option to those struggling with mental health challenges.

Mental health affects every family in our country, and it pains me to see the government contemplating the provision of death as an option to individuals who are at their lowest point. I shared the heartbreaking story of a member of my community of Abbotsford, who received medically assisted death without her daughters being informed, despite her documented mental health condition. Regrettably, such stories are becoming too common under our existing MAID regime.

Retired corporal Christine Gauthier, who represented Canada at the Paralympic Games, testified before the Special Joint Committee on Medical Assistance in Dying that she had tried for five years to get a wheelchair ramp installed in her home through Veterans Affairs Canada. Instead, she was offered MAID by a VAC caseworker. A week before her testimony, the Minister of Veterans Affairs confirmed that at least four other veterans had been offered MAID as well.

Now, after eight years of the Liberal government and with the cost of living soaring, some Canadians are seeking MAID in fear of homelessness. Most recently, a member of my community from the Family Support Institute of BC raised deep concerns about the expansion of MAID. They stated that, even with the current restrictions, our most vulnerable populations are gaining access to MAID without adequate precautions, social services, expertise, professional supports and wraparound social networks to consistently represent their interests and voices.

Despite our repeated calls to protect the most vulnerable, I believe the Liberal government has failed to act responsibly on this point.

Around this time last year, instead of cancelling the expansion of MAID for mental illness, the Liberals introduced last-minute legislation to impose a temporary one-year pause. Now, a year later, I am here again to see that the government wants to add another pause of three years to the mental illness expansion, delaying it until March 2027.

This past fall, the Liberals had an opportunity to get rid of this expansion altogether. In February, my colleague, the hon. member for Abbotsford tabled Bill C-314, which would have cancelled the expansion of MAID to those with mental illness as the sole condition. When the bill came up for a second reading vote in October, most Liberals, along with the Bloc Québécois, defeated it.

The government is seemingly only choosing to delay the expansion again after the significant backlash it has received from mental health experts, doctors and advocates across Canada. It seems that the government wants to recklessly push aside this issue instead of listening to what Canadians and, indeed, our mental health professionals want.

For many years we have heard about the fast expansion of assisted suicide in Europe. Now, Canada has infamously become a global leader with its progressive euthanasia policy. The Netherlands was the first country in the world to legalize euthanasia, and it took the country over 14 years to reach 4% of the total population's death from assisted suicide. Other countries with similar policies, such as Switzerland and Belgium, have not even reached the 4% mark. Canada's MAID regime has only been around for six years and has outpaced these countries with euthanasia, accounting for 4% of total deaths in 2022. Health Canada reported that 13,241 Canadians received assisted suicide just in the past year. That is more than a 30% increase from 2021 deaths.

Belgium allows euthanasia to children of any age. Most recently, the Netherlands expanded its euthanasia policies to include terminally ill children. The Liberals have met with the largest pro-MAID lobbying group, Dying with Dignity, many times. This group is advocating for assisted suicide to be expanded to mature minors. If the government continues to take us down this slippery slope, will it lead us to a path that expands euthanasia to all children? Youth in this country are already falling through the cracks, with suicide being the second leading cause of death for youth and young adults. How can youth struggling with mental illness even think of having a better future if they become eligible for MAID and it is normalized? The Liberals, in my opinion, are inadvertently creating a culture of death.

Delaying the expansion of MAID for mental illness is not enough. The government must immediately and permanently halt the expansion of MAID to those with mental illness. The reports from the committee echo what Conservatives have been advocating for years, which is that expanding assisted suicide to those suffering from mental illness will lead to the premature death of individuals who could have recovered with proper support and treatment.

The government is taking an ideological stance, and it is not listening to the experts working in the field. Last year, the country's largest psychiatric teaching hospital, the Centre for Addiction and Mental Health, said that it is not ready for this expansion and emphasized the need for more mental health resources.

The chief of the psychiatry department at Sunnybrook Health Sciences Centre in Toronto, Dr. Sonu Gaind, has said that it is irresponsible for us to provide “death to someone who isn't dying before we ensure that they've had access and opportunity for standard and best care to try to help alleviate their suffering.”

We cannot overlook the inherent dignity and value of human life, especially when individuals are at their most vulnerable. It is our duty as lawmakers to prioritize the well-being and protection of everyone in Canada, particularly those facing mental health challenges.

As the member of Parliament for Mission—Matsqui—Fraser Canyon, I believe in upholding the principles of compassion and support for those struggling with mental illness. Yes, I also acknowledge that we need to do a lot more; efforts to date have not been sufficient, whether in terms of the government response or the societal response.

Delaying the expansion of MAID for mental illness is not the solution; it merely postpones the inevitable reckoning of the profound ethical and moral implications of such legislation and the broader implications we are faced with here today. Those struggling with their mental health deserve support and treatment, not death. We know that recovery is possible when treatments are more readily available.

[Chandra Arya, Liberal, Nepean, ON]

Mr. Speaker, in his speech, the hon. member mentioned the 31% increase in the number of Canadians using the assistance of this MAID legislation.

I know this number of a 31% jump, when seen in isolation, is big. However, does the member agree that, because the legislation is fairly new, all the people who had been waiting and suffering for such a long time started utilizing these MAID legislation provisions? Does he agree that, going forward, when these MAID provisions are normalized, the rate of growth he quoted will not be so huge in the future?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, I would like to thank the member for Nepean for a very fair question and for some of the points he made.

Are we simply catching up in Canada as it relates to the availability of MAID? Perhaps in some cases, but under the current legislation, there has to be a foreseeable death.

I believe that the way information is exchanged, access to MAID, and the access to information that people have, has led to a rapid increase, yes. However, I will also note that there was an individual in my community of Abbotsford who accessed MAID because she did not feel she had a place to live. That story was well documented in Canada. She did not believe that she had the support she needed to live a life that was respectable. I believe that with the normalization of MAID, for people who do not feel they have a lot of hope in life, it has become a more readily available option. My message today is that all people should have hope.

[Caroline Desbiens, Bloc, Beauport—Côte-de-Beaupré—Île d’Orléans—Charlevoix, QC]

Mr. Speaker, I am a little thrown off by my colleague's comments.

I have a friend who had a second kidney transplant, and complications ensued. She was told to go home, that her days were numbered. She was told that they could not give her any more anti-rejection drugs for her kidney and that her kidney would waste away, and so would she. At that point, in a panic, she asked if she could at least have access to MAID. She was told that she could access it in due course and was told to call to schedule an assessment.

As if by some miracle, she got an unbelievable break: The transplanted kidney continued to thrive without the anti-rejection drugs, which she had stopped taking. She is still with us today, and she is listening. She did not need MAID. She always said that she was able to be at peace because she knew that she would always have that option, no matter what happened.

I cannot understand why members are referring to all kinds of nonsense today, using big words like “assisted suicide” and “euthanasia”, when we are not the experts. We are here simply to lay the groundwork so that experts can have their say in due course. That is what happened to my friend.

I would like to know where our colleague is going with his speeches on euthanizing children. That is horrifying, and I do not understand his point. Can he explain it to me?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, I will try to answer the question in French.

In this specific case, the person was eligible for MAID.

More broadly, with respect to that question, I do not believe that the legislation before us today relates specifically to that issue. That was related to kidneys, and there was a foreseeable death, but, thankfully, that individual did not have to face that situation.

The legislation we are debating here today relates solely to mental health and a government decision to expand MAID to those suffering from mental health illnesses for three years. The experts who appeared at the joint committee between the House and the other House outlined that we are not ready for that expansion. So, the Conservative Party is in fact listening to the experts and taking the position that we have today.

[The Deputy Speaker, Conservative, Chris d'Entremont]

The hon. member for Calgary Heritage is rising on a point of order.

[Shuv Majumdar, Conservative, Calgary Heritage, AB]

Mr. Speaker, yesterday was Valentine's Day. I misspoke in the House, and I retract my comment.

[The Deputy Speaker, Conservative, Chris d'Entremont]

I appreciate that.

Continuing debate, the hon. Parliamentary Secretary to the Minister for Women and Gender Equality and Youth.

[Lisa Hepfner, Liberal, Parliamentary Secretary to the Minister for Women and Gender Equality and Youth]

Mr. Speaker, I will be sharing my time today with the member for Lac-Saint-Louis.

I am very pleased to have the opportunity to speak in this House today in support of Bill C-62, particularly after listening to some of the debate this morning and hearing some of the language used in this House today.

For example, the member for Abbotsford, throughout his speech today continually used the words “the mentally disorded” I believe in reference to people who are suffering from mental illness. A little later in the day, we then heard from the member for Leeds—Grenville—Thousand Islands and Rideau Lakes, who continually referred to people as “addicts” throughout his speech.

In this House, we are leaders. Our words are important and we should not be furthering the stigmatization of people who suffer mental illness. I would caution my colleagues across the way to be careful in their language and to please not further marginalize people who are already suffering.

I will turn back to Bill C-62. As the Minister of Health and the Minister of Justice have emphasized, the government believes an extension of three years is necessary to provide individual clinicians as well as provinces and territories the time they need to prepare for this change.

I also believe a three-year extension of the period of ineligibility to receive MAID on the basis of a mental illness alone is necessary. Although significant progress has been made, more time is needed to ensure the safe assessment and provision of MAID in these circumstances. I have heard from psychiatrists in my riding of Hamilton Mountain who have said these very things. They need more time to get the system ready.

My remarks today will focus on the progress that has been made in preparing the health care system, and also what more needs to be done.

In 2021, as required by former Bill C-7, an expert panel examined the issue of permitting MAID where the sole underlying condition is a mental illness. It concluded that the existing legal framework of eligibility criteria and safeguards is sufficient, providing that MAID assessors apply the existing framework appropriately with guidance, through the development of MAID practice standards and specialized training.

Our government understood the importance of the panel's findings. To that end, we have been working in collaboration with the provinces and territories and other health care partners to implement consistent standards across the country and support a highly trained workforce to undertake these complex assessments.

For example, we supported the development of a model practice standard for MAID by individuals with clinical, regulatory and legal expertise. A model practice standard for MAID was released in March 2023 and has been adopted, or is in the process of being adopted, by most regulators across the country as a basis for assessment for clinical decision-making. The standard also provides guidance for MAID clinicians as they navigate more complex MAID requests.

We also supported the development of the first national, fully accredited bilingual MAID curriculum, which was launched in August 2023. The curriculum consists of seven training modules addressing various topics related to the assessment and provision of MAID, including how to do a MAID assessment, how to assess capacity and vulnerability, how to manage complex chronic situations and how to assess requests involving a mental illness. Over 1,100 clinicians have registered for the curriculum since August of last year.

This progress is the result of leadership and collaboration among health system partners, including federal, provincial and territorial governments, health professional organizations, regulatory bodies, clinicians and organizations like the Canadian Association of MAID Assessors and Providers. This collaboration and progress will continue to make improvements in approaches to safety and quality in assessments and provisions of MAID.

In terms of the future, I want to briefly speak to the Regulations for the Monitoring of Medical Assistance in Dying, which outline the reporting requirements relating to MAID requests. These regulations came into force in November 2018, but were recently revised to facilitate enhanced data collection and reporting on MAID activity. Most notably, the regulations now allow for the collection of data based on race, indigenous identity and the self-reported presence of a disability, where a person consents to provide this information.

The revised regulations came into force on January 1, 2023, and information on MAID activity in 2023 will be released in Health Canada’s annual MAID report this year, in 2024. This information will provide valuable insight into who is requesting and receiving MAID, including those under track 2, whose natural death is not reasonably foreseeable.

Despite all this work, we have heard that the provinces and territories are at various stages of readiness for the lifting of the exclusion of eligibility and that they need more time to prepare their health care systems.

I know that the suffering caused by a mental illness can be just as severe as that caused by a physical illness, but I strongly believe that this extension is necessary to ensure that MAID can be safely assessed and provided on the basis of a mental illness alone. This extension does not question the capacity of people with mental illness to make health care decisions. It is about giving the health care system more time to adopt or implement some of these key resources to ensure that MAID practitioners are properly equipped to assess these complex requests, and that the provinces and territories have the necessary mechanisms in place to support them.

For example, both the expert panel that I referred to earlier and the special joint committee on MAID have emphasized the importance of case review and oversight of MAID, both to educate practitioners and to support accountability and public trust in the law. While the majority of cases of MAID, 90%, take place in provinces with formal oversight processes, other provinces do not have formal MAID case review and oversight processes in place beyond those already undertaken by professional regulatory bodies.

Work is being planned to explore best practices through a federal-provincial-territorial working group, with a view to encouraging more consistent and robust mechanisms across the country.

The expert panel and the special joint committee also identified engagement with indigenous partners as a priority. The Government of Canada has launched a two-year engagement process on MAID to hear the perspectives of first nations, Inuit and Métis, including urban indigenous people, indigenous people living off-reserve with or without status, indigenous people living with disabilities, and two-spirit, LGBTQQIA+ and gender-diverse indigenous people.

The proposed extension under Bill C-62 would provide the necessary time to have these discussions with indigenous partners. It is an essential process to appropriately inform implementation as well as guidance and training material for clinicians to support enhanced integration of cultural safety in MAID practices.

Health Canada will provide its first official update to Parliament on this work in March 2024, just next month.

In conclusion, the Government of Canada remains committed to ensuring that laws reflect the needs of people in Canada, protect those who may be vulnerable, and support autonomy and freedom of choice. While we have made significant progress in the study of MAID and mental illness, and in the development and dissemination of key resources, we are not yet ready. We need to act prudently and not rush this change without the necessary resources in place.

This decision is not an easy one, but I want to assure the House that we will continue to work collaboratively with our partners to improve the mental health of Canadians.

I thank all members for the opportunity to speak today as we debate this important bill.

[Adam Chambers, Conservative, Simcoe North, ON]

Mr. Speaker, not every person who jumps off the Golden Gate Bridge actually dies, and in fact a study tracked down 29 individuals who survived. Some 98% of jumpers, by the way, do not survive the jump. A study of 29 individuals who survived their jump off the Golden Gate Bridge revealed that every single one of them regretted their decision to jump the moment they jumped.

I was just wondering if my colleague could reflect on the fact that suicide is a permanent solution to a temporary problem.

[Lisa Hepfner, Liberal, Hamilton Mountain, ON]

Mr. Speaker, I would like to, first of all, say that we cannot equate suicide with medical assistance in dying. They are two completely different issues. Second, I would say that yes, we absolutely need to take the time to make sure we get this right. That is why this legislation is so important. We need these three years to get our medical system up to the level where we can make sure that everyone who is granted the MAID provision truly is someone who has gone through the medical system, has taken all of the medical treatments that are available and has still reached this conclusion.

We need more time, and that is why we need this legislation.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, I have the pleasure of working with the member at the Standing Committee on the Status of Women, and I thank her for the question.

We have many values in common, but, in this case, she is talking about consultation with various communities. She mentioned continuing the consultation process, but what does she make of Quebec's clear request for legislation and action now?

Does she realize that this delay and her party's lack of political will will cause women like Sandra Demontigny to continue suffering?

[Lisa Hepfner, Liberal, Hamilton Mountain, ON]

Mr. Speaker, I, too, enjoy working with my colleague at the Standing Committee on the Status of Women.

To be clear, conversations with the Province of Quebec are very important. We need to pass Bill C‑62 now to ensure that we have a program in place. This is not the end. We will keep talking with the Government of Quebec. We will keep learning from the Government of Quebec.

I very much appreciate my colleague's comments.

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

Mr. Speaker, we are about 32 days away from a legal deadline that was arbitrarily thrown at us by the unelected, unaccountable Senate, forcing us to allow people who are depressed, people who are isolated and alone, to die through medical assistance in dying. Now my colleagues are saying to give them a couple of years and they will make it all work.

What I found profoundly disturbing was that my colleague said they would support this. They figure that if they have another year or two, if they can meet just a few more people and just tick all the boxes at consultation, then people who are depressed and alone should be allowed to die. I find that an appalling position of the government. The government put us in this position through its cavalier approach to MAID, and its refusal to look at the issues and hear that this is really not a road we want to go down, that this is a line in the sand with respect to the human community.

If the member thinks that in three years she will have consulted enough people, but, at the end of the day, she will support people dying because they have no support, then the government has very poor vision and it needs to explain that to the Canadian people.

[Lisa Hepfner, Liberal, Hamilton Mountain, ON]

Mr. Speaker, I do not think consultation is simply checking boxes. It is extremely important, particularly when we are talking about our vulnerable and about our medical system.

As I mentioned, I have personally consulted with psychiatrists in Hamilton. These people study and work at some of the best institutions in Canada. They are the experts. They have told me that, while the idea behind MAID for mental illness is a sound one, we are just not ready yet. We need to have all the proper safeguards in place before we move forward with this legislation. I think that is fair and I think it is reasonable.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, I am rising for the second time this week to speak to this issue. As I said at the beginning of my speech at second reading, I was so interested in this issue that I offered to sit on the Special Joint Committee on Medical Assistance in Dying when it dealt with the question of mental illness. I felt it was my duty to take part in a debate that is so important for our society. This is a crucial and extremely complex social debate. As a legislator, I wanted to learn more about this hot-button public policy issue that is so important to my constituents. Many of them have written to me about this.

I attended much of the debate on the issue this week, and I was very impressed by the tone. It is true that emotions can sometimes get the better of us, but that is to be expected when we are debating such a crucial matter, a matter of life and death. I must say that I was impressed that the debate was conducted in a respectful manner. That is impressive, and we should adopt that same tone when we discuss the many other issues addressed here in the House.

I heard arguments that I do not want to call fallacious, because that is a pejorative term and I do not want to criticize anyone, but let us just say that I heard a few contradictions during certain speeches.

First, someone claimed that we could have simply amended Bill C-62 to include advance requests. I do not think we are ready to make a hasty amendment to open the door to something as complex—if not more—as medical assistance in dying, namely, medical assistance in dying for persons with a mental illness. It took much effort, much debate, much discussion and several committee meetings for us to be able to talk about medical assistance in dying for patients with a mental illness.

Moreover, the idea that we can move an amendment in committee is wrong, because such an amendment would certainly be ruled out of order, since the scope of the bill is not that broad. The bill deals with a specific question, namely, medical assistance in dying for persons with a mental illness.

People claim we are taking too much time to debate this issue, that it has already been three years and that we should end the debate. We are not talking about policies like affordability or the need to build housing as quickly as possible. We are talking about something very serious. We really are going beyond the more practical issues, and I think it will take the time it takes because there is no consensus among the experts. If there is no consensus, we cannot force the issue, suddenly demand consensus and insist we move forward because time is running out. The issue of how long it will take to reach a good conclusion is unfortunately not a problem for me.

As I was saying, this is not simply a technical medical issue, it is a moral and ethical issue for society, certainly.

The matter of caution was also raised. Some claim that the government is too cautious, too timid, on this issue, that it is not acting as quickly as people would like, that it has not addressed the issue fast enough or lacks political will. It does in fact lack political will because there are too many uncertainties. In this case, it is not a bad thing to lack political will in order to forge ahead as soon as possible.

However, on this idea of being too cautious, I would say that this is true even for the Bloc Québécois, because it has accepted the framework we have established. For the moment, we are not implementing this framework. Nevertheless, under the framework, not everyone who requests medical assistance in dying on the grounds of a mental illness will receive it. We are talking about a mere 5% acceptance rate. Even if we went ahead, we would do so with a lot of caution, given the 95% of people who would request medical assistance in dying on those grounds.

We should then not talk as if caution were not an issue. Caution is an issue, even if we agree to move forward. I would like to ask my colleagues who keep disparaging the government for its caution whether it would be too cautious to require that, in these cases, a psychiatrist be involved in assessing the person's request. Right now, it is not necessary for a psychiatrist to be involved in the assessment. In the Netherlands, where medical assistance in dying is legal, a psychiatrist must give an opinion on the request. There is caution built into the process, but it is not unreasonable. I would say that my colleagues in the Bloc Québécois agree that some caution is required.

There is also talk about freedom. Some say that this is a matter of freedom, as if they were talking about absolute freedom. It is not a matter of absolute freedom, because 95% of those requesting medical assistance in dying would not have access to it on the grounds of a mental illness. We need to make things clear and add nuance to this debate to avoid giving the impression we are talking about absolute concepts.

Then they bring up the issue of the Quebec nation. I listened carefully to my friend, the hon. member from Joliette, with whom I enjoyed working on election reform. He is a seasoned parliamentarian who makes excellent speeches in the House. He said that there were many nations in Canada. Indeed, there is the Quebec nation, but there are also indigenous nations. There are indigenous nations within the Quebec nation as well. What I understand is that indigenous nations are not too keen to move this issue forward at this time. They say that they have not been consulted enough. They have concerns about the systemic racism that exists in health care systems across the country. Among other things, they are afraid that not enough thought will be put into processing the requests.

We should not focus too much on the idea of community when it comes to medical assistance in dying. When people get to that point, when they are on their death bed, I do not think they dwell too much on the community. Each person is a soul facing infinity alone. That is why we should not talk too much about nations when we are discussing medical assistance in dying. It is not a matter of being part of a community. I agree that it is a matter of individual rights. That is where it gets complicated, because we do not want people to suffer.

However, we do not want people to do things that have not been assessed with the utmost caution, because it is a matter of life and death.

I will stop here and await my colleagues' questions.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, first of all, we are not talking about advance directives. That has already been settled. We are talking about advance requests.

Second of all, in my speech this morning—because this is a reply to the speech I made this morning—I never said that not enough work had been done. The Bloc Québécois's position is that one year is enough and that we will see after one year, immediately after royal assent, whether we can start to work on the mental illness issue.

The member should have sat on the committee from the get-go. He has been an MP from Quebec since 2015. It is a bit strange for him to be so uninformed on the issue of MAID.

Since June 2023, the government could have included advance requests in the bill, taking into consideration any recommendation of the Special Joint Committee on Medical Assistance in Dying. We never said that not enough work had been done. We said that the government was dragging its feet when it comes to committee work. The Special Joint Committee on Medical Assistance in Dying was always convened at the last minute.

Does the member think that three meetings on an issue such as this were enough?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, indeed, I should have used the correct term, “advance requests”, instead of “advance directives”.

It seems to me that, during question period, the leader of the Bloc Québécois was just asking for an amendment to allow advance requests all of a sudden. Regardless of the government's timeline, I do not think the House is really ready to vote on this. Some members of the Special Joint Committee on Medical Assistance in Dying may be.

However, as I told him earlier, this is not something as straightforward as the Standing Committee on Finance studying a budget. In that case, the members of a given party recommend that all their fellow party members vote in favour of it because they have studied it and the party trusts them. Everyone wants to make the right decision, so this requires a much more thorough debate.

As the member himself said, Quebec did not put medical assistance in dying due to mental disorders in its legislation. The member said it was because Quebec had not studied it at the time. If Quebec is so sure, it can amend its legislation to include it.

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

Mr. Speaker, I am struck with how, during this debate, we have heard so much technical and bureaucratic language from the government. It masks what is fundamentally an ethical and moral issue, that is, the just way to treat the most vulnerable within our society. This discourse about maybe we are not ready or maybe we will be ready masks the more important underlying question of whether we should ever have the state involved in facilitating the suicide of those with mental health challenges. On this side of the House, we say a firm no, not now, not ever.

I want to ask the member if he is concerned about the dramatic growth in the rates of those opting for MAID in Canada, opting for it perhaps under pressure or in other circumstances. We have seen, since this practice started in Canada, dramatic increases every single year. Is the member concerned about that, or is he totally fine with this idea of exponential growth in the rates?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, I am concerned about it. I do not know what it means and there is much disagreement as to what it means.

I would ask a question of the member, which I know he will not have to answer under the rules. Is he okay with track one MAID? A lot of the psychiatrists who went before the committee who were not in favour of MAID for mental disorders were in favour of track one and track two. I would like to know if the member accepts MAID under any circumstance or not at all.

It is an important ethical and moral decision, I agree, but no one in the House wants people to suffer needlessly, and I think we are all grappling with this on moral and technical grounds. It may not be possible, I cannot say, but we want to separate out suicidal ideation. We want to be able to separate out psychosocial factors as motivating factors for requesting MAID in cases of mental illness, and we are not there yet.

We want to study treatment fatigue to see, if somebody says they are done and cannot take it anymore, whether we can guide them to another treatment. We have looked at treatment fatigue when it comes to HIV and type 1 diabetes patients, but we have not looked at treatment fatigue when we talk about psychiatric illnesses.