House of Commons Hansard #283 of the 44th Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was illness.

Topics

Criminal CodeGovernment Orders

11:35 a.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, I will start with an assertion whose veracity will become clear. With Bill C-62, the cowardly Liberal government brought forth a mouse.

If we are talking about Bill C‑62 today, it is because Bill C‑7 created the Special Joint Committee on Medical Assistance in Dying when it passed. The committee's mandate was to review the medical assistance in dying legislation, in particular as regards the issue of advance requests. Because we knew that the problem was more difficult in cases of mental illness, the government set up an expert panel to help MPs do their job. The panel was to issue a report to the special joint committee.

The expert panel was indeed set up. The problem is that, instead of putting everything in place following the adoption of Bill C‑7, the government decided to call an election in 2021. That delayed the process.

Immediately after the useless election, we would have expected the special joint committee to sit but, no, we had to wait. They took their sweet time. The committee was finally convened, but it had a huge mandate. Its mandate was so huge that Bill C‑39 on mental illness had to be introduced, delaying the committee's recommendation.

Since February 2023, the committee has been very clear on the issue of advance requests. In fact, that was its most widely held recommendation. During the entire debate on Bill C‑62 in the House, the government said that we needed to be cautious and proceed slowly. That is fine, but when caution involves making patients suffer, I cannot agree. I think we need to be diligent.

The government took its sweet time. Here we are in 2024, and it introduced legislation seeking to postpone the issue of mental illness. Fine, but what is happening with the main recommendation the committee made in February 2023? The government knew very well that Quebec was laying the groundwork on the issue of advance requests. It knew very well that Quebec would bring in its own law. Instead of taking inspiration from that and seeing what measures could be included in the regulation accompanying Canada's MAID legislation, it did nothing.

I have stood in the House many times to ask the Minister of Justice and the Minister of Health why the government did nothing. Why does the bill not include a component on advance requests, which should have been prepared over the past year? After all, the government introduced legislation enacting the special joint committee's February 2023 recommendation on mental illness. On the issue of advance requests, however, it did nothing, despite the majority recommendation.

Yesterday, I got my answer. The Minister of Health demonstrated in front of the whole committee that he was unfamiliar with the Quebec law, yet he rises in the House and says he has enormous respect for Quebec's process. The Liberals do not even know what they are talking about. The minister told me that the issue of advance requests is more difficult than the issue of mental illness because, for example, there might be family quarrels at the patient's bedside.

I realized that the minister had not read section 29.6 of the Quebec law, which stipulates that, as soon as patient is diagnosed, they can appoint a third party. The third party will not determine when the person can access medical assistance in dying, but will advocate for their wishes, which will be included in the advance request, or the person's criteria.

People in my riding have told me that, when they become incontinent and can no longer control their bowels, when they have reached the point where they no longer have any appetite and it becomes a chore for their caregivers to feed them, although they are well compensated for their troubles, when they are no longer able to recognize their friends and family members and when they can no longer maintain relationships, they would like to have access to medical assistance in dying. The third party in whom they have placed their trust will then ask the care team—because patients are indeed cared for by entire teams—to evaluate whether they are meeting the criteria, if they are there yet.

If people make advance requests, it is because they want to avoid shortening their life. They want to live as long as possible. We could be good to them and take care of them until they cross their tolerance threshold.

The minister does not even know what I am talking about right now. Do members think it is normal that people say they respect Quebec, that they have great admiration for Quebec's progress on this issue, but that they do not even know what is in Quebec's law?

It is no surprise that they come out with a bill like Bill C‑62, that does not address this at all. Then they have the gall to say that Quebec has made good progress, but that not all Canadians are ready for that, so they have to wait and watch their patients suffer. Quebec is not the only province that supports advance requests. According to an Ipsos survey, 85% of Canadians from coast to coast support advance requests.

The Conservatives claim that they want to do good, they want to take care of Canada's most vulnerable. I, too, want to take care of the most vulnerable, but who is more vulnerable than a patient who is about to cross their tolerance threshold, who is suffering and who is being told no by the government?

Some claim that there could be abuses, as if the Criminal Code did not provide for punishment of abuses. They seem to believe the medical system to be inherently evil. I heard my Conservative colleague earlier. Listening to the Conservatives, one would think everyone working in the health system wants vulnerable people euthanized. I heard another Conservative member say there is an opioid crisis, there are people in the streets, and we are going to euthanize them. That is absolutely false. It is really far-fetched. That kind of rhetoric is meant to scare people; it amounts to spreading misinformation on a crucial topic.

When we care, we do not infringe on individual autonomy. The role of the state is not to decide matters so personal as how someone wishes to cross their threshold of tolerance. It is not to tell patients what is right for them. It is to provide the conditions so they can make a free and informed choice.

Criminal CodeGovernment Orders

11:45 a.m.

Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I have to say that I find the position of the Bloc to be somewhat curious insofar as it is inconsistent with the position taken by the National Assembly, which rejected the policy of the government to expand MAID in cases where mental illness is the sole underlying condition.

I understand that the position of the Bloc members to oppose Bill C-62 is on the basis they would like to see the policy implemented in one short year from now.

Can the member explain why the Bloc is taking a position that is inconsistent with that of the National Assembly?

Criminal CodeGovernment Orders

11:45 a.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, I have said it repeatedly, the Bloc Québécois wants Bill C‑62 to include a section on advance requests for MAID. This is our main objection.

We tried to introduce amendments in step with Quebec's request and that of the whole National Assembly. Where mental disorders are concerned, we start from the premise that psychiatry is unable to ease the suffering of every patient stricken by a severe mental disorder.

Psychiatrists told us that 50% of their diagnoses are wrong. It is a wonderfully precise science. However, one thing is true. Although there is no exact diagnosis and a diagnosis can change, what is clear, straightforward, specific and a constant in a patient's journey over the decades is that they suffer. Psychiatrists cannot deny that their patients suffer, and that all they can offer them is a path to palliative care. In fact, Dr. Gagnon told us we had to develop palliative care for people afflicted with mental disorders because that is all we can offer them.

Quebec made its decision in 2021. It did not have the opportunity to work off the expert report that the Special Joint Committee on Medical Assistance in Dying had in 2022.

Criminal CodeGovernment Orders

11:45 a.m.

Green

Elizabeth May Green Saanich—Gulf Islands, BC

Madam Speaker, this morning is my first opportunity to take part in this debate.

I have heard a few comments from people who think the Government of Canada is going to have a hand in murdering Canadians.

I know it has come up in a point of order. We are stuck, but it does not mean that anyone wants to murder any Canadians.

I think we need to be concerned, with a choice and a debate this deeply personal and moral, and with such complicated questions. Given the constraints of Supreme Court decisions and the work of the Senate, how do we keep the focus here not on the partisanship of this place but on making and passing good laws?

Criminal CodeGovernment Orders

11:45 a.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, I challenge anyone to find petty partisanship or political calculation in any of my speeches. I always focus on the issue at hand. Since 2015, what I have come to realize is that, unfortunately, parliamentarians here in the House are not on the same page as Quebec parliamentarians. Time for reflection is sorely lacking here.

We could have had some time for reflection—since 2021, actually—but the government dragged its feet. That meant that we had less time and less of an opportunity to do thorough work.

The issue of mental disorders is now being postponed until 2027, which basically amounts to choosing not to deal with this issue. I would like us to work on this issue immediately after royal assent, but that is not going to happen.

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11:50 a.m.

Bloc

Simon-Pierre Savard-Tremblay Bloc Saint-Hyacinthe—Bagot, QC

Madam Speaker, I congratulate my colleague for his responsible speech. Scaremongering is absolutely deplorable. That said, even though the Conservatives make a habit of scaremongering, I consider it our duty to address any reasonable apprehensions that the public may have.

Obviously, MAID is a permanent and irreversible solution. Could my colleague briefly tell us how MAID precludes the possibility of rash decisions and how it will be implemented in a structured, responsible and reasonable way?

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11:50 a.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, first of all, we have to start from the premise that all health care workers are basically caring and compassionate people. The premise of MAID's opponents is based on their belief that certain fundamentally malevolent and evil people want to get rid of vulnerable members of our society.

It seems rather surprising that the Conservatives, as economic libertarians, believe that the state should get mixed up in such a personal decision as an individual's death. The reason is that other determinants are at play. I have asked them repeatedly why they think that they are in a better position to make that decision than the person who is suffering. Today, I will say the thing they lack the courage to admit: it is because of religious beliefs.

Criminal CodeGovernment Orders

11:50 a.m.

NDP

The Assistant Deputy Speaker NDP Carol Hughes

Order.

The member for Saint-Hyacinthe—Bagot rose on a point of order earlier. I checked the record.

The member for Leeds—Grenville—Thousand Islands and Rideau Lakes' comment was not directed at the member. It was a general comment. When he repeated his remarks, I heard him clearly that time. I then mentioned that such comments should not be made in the House. It can cause disorder, but I am also certain that no member in the House wants to kill anyone.

I checked the record. It was a general comment that went: “If there are members in this place...who would rather have the government kill people”.

I just wanted to add that.

The hon. member for Saint‑Jean is rising on a point of order.

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11:50 a.m.

Bloc

Christine Normandin Bloc Saint-Jean, QC

Madam Speaker, in response to the ruling you just made, I would invite the Chair to possibly consider the fact that using unparliamentary language about members in general is no less harmful than using it about one member in particular, in my opinion.

I would like to hear the Chair on that because even if the comments were not directed at one specified member, they are no less harmful. I think that the ruling should be made regardless of who the comments are about, whether it is someone specific or members in general. It is the comment itself that is harmful.

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11:50 a.m.

NDP

The Assistant Deputy Speaker NDP Carol Hughes

I appreciate the hon. member's comment, and I will discuss it with the other occupants of the chair. These sorts of comments have been a number of times, and we need to stand up and say whether that is acceptable or not. We also heard many such comments yesterday. This is not the first time. This sort of thing has been happening for years.

We also need to ensure that the members who are rising to speak think about what they want to say or what they are going to say before they say it. It is not just the Speaker's responsibility to manage the House. It is the responsibility of all members to ensure respect for the House and how it works.

Resuming debate, the hon. member for Timmins—James Bay.

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11:55 a.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, as always, it is a great honour to rise in this House, as I have done many times over the past 20 years. I mention the 20-year mark because I have always been a great political optimist, a great believer in Canada and a believer in our fundamental goodness when it comes to working things out.

However, we are in a very dark time for democracy. We see the rise of disinformation and social conflicts in all aspects of life. On the international stage, we see the uncertainty coming out of Putin's aggression and the mass killing of innocent people in Palestine. I do not feel that the House of Commons is rising to what Canadians expect us to be. Too often, we are dealing with very profound issues through glib press releases or slogans and bumper sticker politics.

Every now and then we are confronted with legislation that forces us to go deeper, and this is certainly such a moment. There is nothing more profound in the human community than birth and death. How we address the rights of people as they are dying, as well as the supports that need to be in place, not only defines who we are as a society but also goes right down to who we are as families, as neighbours, as spouses, as parents and as children.

We are in a very unfortunate moment in terms of the failure to put the guardrails in place to protect people at this most profound moment. The issue of MAID is very personal, and it is of societal importance that we get this right.

I have certainly struggled with this issue. I wanted to make sure that what we did was done for the benefit of all, in the best interest of the human community, considering the right not only of the individual but also of the people who love them to be part of something special.

I am coming up on the anniversary of my sister Kathleen's passing. Nobody blew through our family more like a summer storm than Kathleen, and I have never seen anybody suffer greater pain. She was fearless right until the very end. Kathleen was always wanting one more gathering, song or story. She would never have accepted MAID, because her will to live was so powerful even as she knew she was not going to live.

I am not saying that her death was any more profound than anyone else's. How she went was her choice, as well as our choice. My mother said the rosary; I sang Danny Boy. That is how we do things in our family. We had one of those great Celtic wakes afterward. There were people there who had never even met my sister, but they all told stories about her. That is the way we do things in the Celtic tradition.

I have also had friends, who had cancers they could not beat, phone me to say goodbye. MAID allowed them the opportunity to choose, with their family and their community, a dignified way to go. I respect that. It is a very profound choice.

When Parliament was confronted with the need, because of the Supreme Court ruling, to put a regime in place, we did so and then said that there would be a review. We needed a review because we were going to a place we had never been to as a society. The review would happen after we saw how MAID was working. Was it working as it was supposed to? Were there abuses? Were the rigours that Parliament said had to be put in place not paid attention to?

Then we had the Quebec Superior Court decision, the Truchon decision. I felt at that time that it was the obligation of the federal government to appeal. I am not going to argue the merits of the Truchon decision, but the obligation of the federal government was to make sure that, if we were to apply this at the national level, we had really done all the due diligence. That was not done.

The Liberals moved a change to MAID before the review that was supposed to happen. Suddenly, things were already changing from what we had agreed on. Then it went to our colleagues in the Senate. I will never say much that is positive about the Senate, but today I will certainly say how dismal and appalling the attitudes of the senators were.

Stan Kutcher, whom I had to sit with on the special committee, showed disrespect and arrogance. Senators, who are not elected, who have no accountability, who do not have to go back to their communities when they are dealing with a suicide crisis like I and other people have to, said that they wanted an arbitrary date to extend MAID to people suffering from mental illness and depression. That was an extraordinarily outrageous and poorly thought out overreach, and it was the job of the Parliament of Canada to simply say, no. All the other provisions of MAID would have stayed in place, but that did not happen. What happened was the Liberals agreed, and then it dawned on them that we were going down a very dangerous road and things had not been thought out.

There is my colleague from Abbotsford, whom I have sat with on many committees. We probably disagree on a lot in politics, but we share the same integrity of coming to the House to do the right thing, bringing what we can bring to bear. He brought forward legislation to deal with this provision, and it was voted down. Therefore, we are now some 30 days from a profound change in legislation that would change Canada forever, and we are scrambling on a question of life, death and body autonomy. This is not how we should be dealing with these issues.

I used the words “body autonomy”, because it is one of the profound human rights, the right to control one's body and the right to make a decision, but it is not an absolute right. There are societal factors that go into that right. When people are deeply depressed, when they are suffering mental illness and feel alone, their body autonomy has been compromised as has their ability to make decisions.

It is really important for us to always remember that nobody dies alone. They may die in grief. They may die in isolation. They may die in the blackest hole of their personal pain, but the impacts of that death affect family, neighbours and people beyond what the poor person who suffered that dark moment could ever understand. If people have ever sat down and worked with people whose loved ones were lost to suicide, they want to say, again and again, “If only they had known how much they were loved.”

In the northern communities I work in, children as young as 10 years old are giving up and killing themselves. What kind of nation sits back and lets children give up hope at age 10?

I would have thought that when we had those kinds of suicide crises at Cross Lake, Attawapiskat, Pikangikum, and Wapekeka, and we cannot even mention how many of those communities have suffered, that there would have been a national consensus to look at what we needed to put in place, but that did not happen.

When I sat on that special committee and heard some of the medical experts say that they were really pleased that the Liberal government had put in place all the steps necessary to help this through, it made me think that we were putting resources in place to push ahead the ability of people, who are severely depressed, to make a decision to die without getting a second opinion from their loved ones, their families or their spouses, even. The government would do that, but it would not put in place the broader supports we need for mental illness.

This is not a whataboutism issue; this is about the crisis we are facing, with 4,000 suicide deaths a year. The mental health crisis is extreme. In 2016, I brought forward the national palliative care strategy, because it is not applied fairly across the country. When we cannot die in dignity, it is a terrible thing.

We have talked with doctors and nurses across the country about the palliative care approach. The federal government agreed and said it would put a strategy in place, that it would work with the provinces and territories, yet nothing was done. In 2019, I brought Motion No. 174 on a national suicide prevention plan, which was based on the incredible work that was done in Nunavut. We know that Quebec put a suicide prevention plan in place and cut the suicide rate by 50%.

Once one starts to map it out, these factors are not difficult to find, the patterns of where those suicide clusters form, with respect to areas of age and economic crisis. That was part of what the suicide action plan would be. Parliament would provide the resources so we could to start to map out where these crises occurred and put the mental health services in place.

We need to be doing that as a Parliament instead of scrambling at the eleventh hour to come up with a fix, a temporary fix, another temporary fix on a temporary fix, on a decision that was put forward by a non-elected, unaccountable Senate, which had no backing, no credibility and no support, other than the fact that a couple of arrogant senators, who have never been elected and have no accountability, decided that Parliament would go along with this, and the government put up with that.

It was an absolute failure of public policy, to unelected senators like Pamela Wallin and Stan Kutcher dictate health policy for people in crisis. We would never allow that for anything else, yet here we are, 30 days from the deadline.

We have had letters telling us not to do this. Seven out of 10 provinces say to not do this. We had the medical community saying that it had no way to even properly assess and not do this. We have had really profound, thoughtful witnesses come forward to talk about the complexities of the issues of mental illness. Who is one to say whether it is irredeemable? Who is one to say that this suffering is so bad that it warrants death, when there are options?

We also have the issue of people in increasingly desperate situations, who feel alone. It tells us who we are as a society when we say that it is really too bad that one is homeless. It is really too bad that one is suffering the nightmare of addiction. It is really too bad that there are young people in a northern indigenous community and they have never, ever been able to get proper medical attention. However, if they want to die, we will set up a process.

MAID was not meant for that. MAID was meant to deal with people who could make the choice, an informed adult choice as they suffered pain that would not go away, with their loved ones and their families.

I remember when my good friend Liz from Vancouver Island called me. We were good friends. She used to drive me around Vancouver Island in this old Jaguar with wood panelling that she got for $4,000. I kept saying, “Liz, if this car breaks down on the mountains, I'm not going to have to get out to push it to the other side am I?”

Liz played blues music for me in the car. She talked about the Catholic saints and about queer politics. She was her own person, and she smoked. As she was dying, she called me and said that this was the moment, that she was taking the moment because this was the last one she may have to make that decision. It was a very profound way to go. MAID is for that.

MAID is not for people who feel they have no hope, without a back-up, without a robust, multidisciplinary team to walk the issues through with them. It is not something they can make a second choice.

I think of Dr. Valorie Masuda, a palliative care physician, who said to the committee:

If this special joint committee on MAID recommends proceeding with allowing access to MAID for chronic mental conditions, I would recommend that there be a robust, multidisciplinary review process involving physicians, psychiatrists, social workers and ethicists involved in a patient's MAID application, and that there be a transparent review of MAID cases shared between health authorities and provincial and federal oversight so that we ensure we are not treating social problems with euthanasia.

Imagine if someone with mental illness and depression were able to get a multidisciplinary team of physicians, psychiatrists, social workers and ethicists, we would not have a mental health crisis. Those people are not there. Those teams are not there.

The government made a commitment to transfer $4.5 billion for mental health to the provinces to deal with the crisis that is unfolding before us, but it has not done that.

Therefore, again, we are in a situation where we are being asked to vote. The bill that the Liberals have brought forward is gutless, because it will punt this down the road for three years, and we will be back at it in three years.

We had punted it down the road for a year over the fundamental failure of the former attorney general who simply let it pass. However, the Senate made a completely unreasonable, undemocratic and unwise pronouncement that overrode the work of the democratically-elected House, a House whose members, as dismal as we are sometimes, dumbed-down, sloganeering and fighting over the stupidest things, have to go back to our constituents and talk to them. We have had to go the funerals of people who have died from suicide because of depression. We bring that experience into the House.

We can disagree on the extent of MAID, we can disagree on many things, but we have a democratic right and a duty to do the right thing here. The Senate has no democratic accountability to anyone. Therefore, the fact that we are having to pick up the pieces from its arrogance and the failure of the Liberal government to hold it to account is concerning. We need to reflect on that. I would urge the members in the other chamber to not play games with this.

On March 17, the deadline changes, the law of Canada changes, and the amount of people who could die without proper support would change. It would change forever the legal framework of Canada. My message to those unelected senators is not to play games with the work we are doing. We are picking up the pieces. We are trying to fix the damage they did, and we need to do so this, because a bigger principle is at stake, the stake of human dignity in a country.

We have to also extend this conversation to our ongoing failure as a nation on mental health; our ongoing failure to offer young people a better future; and our ongoing failure to recognize that if the weakest people in our society are allowed to kill themselves because there is no hope, then we have failed, and we are failing.

I would like to think that we can come together across party lines to say that there has to be guardrails that protect the autonomy of the individual, and also places individuals who are in mental crisis and depression within the context of their family, their loved ones and their society. When one dies alone and in darkness, the effects are felt for years and years after.

Going into some communities after a suicide crisis is like walking into shockwaves of grief that play out for years and years to come, and it takes so much work to come back from that for a community, for a family. Here we are as a society making that decision. Therefore, let us do this right and let us do this with respect for the people who expect us to do the right thing.

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February 15th, 2024 / 12:10 p.m.

Liberal

Francis Scarpaleggia Liberal Lac-Saint-Louis, QC

Madam Speaker, as always, I appreciate the member's interventions, his insights and all that he brings to the table. I would agree with the member in that one of the sticking points for me in this process is the fact that the agenda, and this is undeniable, has been driven by the Senate.

There is a big difference between government legislation and Senate legislation, and we are talking about a Senate amendment. The government has all kinds of resources. It has access to all kinds of experts to consult. It has access to legal experts, it does charter analysis and everything else. However, the Senate side does not have those same resources.

Therefore, how could the Senate approach this with such a degree of certainty and, in some cases, one might say, a sense of infallibility when it does not really have the resources that the government has? The government, with all those resources, never intended to go ahead. I would like the member's comment on that.

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12:10 p.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, if people are not elected and cannot be fired, it does not just give them a sense of infallibility; it gives them a sense of absolute arrogance, because they can do whatever they want, for better or worse for Canadians.

I was certainly appalled. I had the honour to sit in for my colleague for Nanaimo—Ladysmith for one of the meetings, and I was super careful asking questions, even for the people with whom I did not agree. I wanted to get this right. However, I felt this sense of lazy arrogance. Senator Kutcher so much as said that they had already agreed they would not hear all the witnesses, that they had already agreed they would just push ahead. The Senate blew this. It did not do the due diligence. Senators were not even interested in hearing the witnesses. We should never have been put in a situation to let that lot make a decision as profound as this.

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12:15 p.m.

Conservative

Kevin Waugh Conservative Saskatoon—Grasswood, SK

Madam Speaker, that was a passionate speech by the member. He spoke in particular about northern Canada, where maybe the resources are not the same as those Canadians enjoy in metro areas. He also brought up the Senate situation.

I think we are seeing in the House of Commons these days that we are having issues with the Senate, in particular with Bill C-234, which we have brought back several times here, and the MAID legislation. This is a concern. As the member said, they are not elected. They are appointed. It has caused some strain on families, not only with the MAID legislation but also for the agriculture sectors with Bill C-234.

I just wanted to point that out and have the member comment on the issues we are having with the Senate. It looks like we could have these issues for a number of years with the Senate, compared to the House of Commons.

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12:15 p.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, we certainly know that the Conservative record on the Senate is pretty dismal too. I mean, they put Mike Duffy, the Come-From-Away senator, in there. Why was that? Was it because he was a hack who raised money for Stephen Harper? Pamela Wallin and Patrick Brazeau can be included in a rogue's gallery of people who are not accountable.

The issue today is that we now have, as a Parliament, a democratic body, the obligation to fix something very profound. I would love to debate and talk about how we deal with that unelected, unaccountable lot where it seems that, if they flipped pancakes for the Liberal or Conservative parties, they get a job for life. There has to be a better way of running a democracy.

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12:15 p.m.

Bloc

Christine Normandin Bloc Saint-Jean, QC

Madam Speaker, a few weeks ago, I attended the funeral of a friend's mother who had decided to avail herself of MAID. In her farewell speech to her mother, my friend said the following: Mom, when you told us about your decision, I did not agree because it was going to deprive me of a mother, but I had no choice but to respect your decision, because it was yours to make.

I thought it was a testament to her generosity of spirit.

In his speech, the member for Timmins—James Bay talked about respect. Since he is so knowledgeable on the subject, I would like to ask him a question that I did not have the opportunity to ask earlier. Although it is not necessarily the subject we are debating today, I would like to know why he decided to vote against the amendment to allow Quebec to offer advance requests. The purpose of this amendment was to allow the Government of Quebec to proceed with the safeguards we have in place, and this request did not require a specific provision for Quebec in the Criminal Code. The purpose was to ensure that all provinces could use the program if they wanted to. I would like to hear why the member for Timmins—James Bay—

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12:15 p.m.

NDP

The Assistant Deputy Speaker NDP Carol Hughes

The hon. member for Timmins—James Bay.

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12:15 p.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, I thank my colleague for her thoughtful question.

Parliament needs to put a process in place to examine all these issues. Personally, I think it is an important issue, and members of Parliament need to work together to make the necessary changes to this bill.

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12:15 p.m.

NDP

Lori Idlout NDP Nunavut, NU

Uqaqtittiji, the member highlighted the ravages of what colonial systems continue to do to indigenous peoples, but I wanted to ask specifically about Bill C-62 and the amendment that has been inserted about the creation of a joint committee of both houses of Parliament designated for determining eligibility.

What does the member think about that amendment, which would require discussions on ensuring the eligibility of a person whose sole underlying medical condition is mental illness? Does he think that is an urgent task that needs to happen after Bill C-62 is passed?

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12:20 p.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, we know that a joint committee was struck, and we heard a lot of testimony, in particular, that the process in place to make this work is not there. We need the legislation to say that the right of someone to die because there are no other options out there for them is not good enough. We need to close this loophole.

We need a committee to be struck, I think, to examine how MAID is rolling out to make sure that it protects rights. Also, I think we need a conversation about proper mental health services, which are being denied to people across the country.

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12:20 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Madam Speaker, I acknowledge the member's work with his palliative care motion, which led to my bringing the palliative care bill to Parliament. He may be aware that the five-year review shows an increase in people who have accessed palliative care from 30% to 58%. There is still a long way to go.

My question for the member has to do with the Truchon decision, which he talked about. I agree that it should have been appealed to the Supreme Court, but the government today can still ask the Supreme Court to weigh in on it. I think that is what the government should do. Does the member agree?

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12:20 p.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, the problem was that the government accepted the decision and changed the law. Now we are dealing with it.

My message to government is that, from here on in, we cannot be cavalier about this. We cannot just allow unelected bodies, or even a superior court, to make a decision on something so profound. Our duty as parliamentarians is to test the law, check the law and make sure that any changes from here on in are done within a broader framework of rights, dignity and the protection of the vulnerable.

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12:20 p.m.

NDP

Laurel Collins NDP Victoria, BC

Madam Speaker, I thank the member for his advocacy on this issue.

I have heard from constituents who have given up hope, who are struggling with the housing crisis and the high cost of living and feel like that they have been legislated into poverty. They are worried about the expansion of MAID and what that means for them and the people they love who are in the same situation.

I am wondering if the member can talk about the responsibility of successive Liberal and Conservative governments in putting people in this dire situation.

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12:20 p.m.

NDP

Charlie Angus NDP Timmins—James Bay, ON

Madam Speaker, I have spent my career believing in the great hope of Canada and the fundamental goodness of Canada, but as a nation, we are failing people. We are failing people in a time of growing climate uncertainty and international uncertainty. People are afraid. They need to know that what we do in the House brings their concerns forward and tries to put reasonable solutions in place because people cannot be left feeling hopeless and uncertain at this time.

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12:20 p.m.

Liberal

Chandra Arya Liberal Nepean, ON

Madam Speaker, I will be sharing my time with the member for Fundy Royal.

I am pleased to have the opportunity to speak in the House today in support of Bill C-62, the bill that proposes to extend the temporary exclusion of mental illness as an eligible condition for medical assistance in dying by three years, until March 17, 2027. I will speak today about the importance of a delay before lifting this exclusion to provide more time for the provinces, territories and their health care partners to prepare for this critical juncture in the evolution of medical assistance in dying, which we refer to as MAID in Canada.

The legal framework for MAID is set out in the federal Criminal Code. However, it is the provinces and territories who have the responsibility for health care delivery, including MAID implementation. We have been working in close collaboration with the provinces and territories to support the safe implementation of MAID since before the original legislation permitting MAID was enacted in the Criminal Code in 2016. This is an important relationship built on the mutual goal of ensuring quality health care for the people of Canada.

Both the expert panel on MAID and mental illness and the Special Joint Committee on Medical Assistance in Dying emphasized the importance of clear practice standards and consistent implementation of guidelines across the country, training for physicians and nurse practitioners, and case review and oversight to support best practices and trust in the appropriate application of the law.

Provincial and territorial governments and their stakeholders, such as health care professional organizations, regulatory bodies and practitioners, have been actively planning for eligibility for MAID for persons whose sole medical condition is a mental illness. As has been recognized across the board, critical progress has been made in this regard. However, the provinces and territories face different challenges within their jurisdictions and are at varying stages of work in implementing these key elements and consequently their readiness for the lifting of the exclusion.

For example, a model practice standard for MAID was developed by an independent task force group made up of clinical, regulatory and legal experts as a resource for physician and nursing regulatory authorities to adopt or adapt in their development or ongoing revision of MAID standards. In addition to the model standard, the task group also released a companion document entitled “Advice to the Profession”.

Practice standards are developed and adopted by regulatory bodies responsible for ensuring that specific groups of health professionals operate within the highest standard of clinical practice and medical ethics. While some provincial and territorial regulatory bodies have successfully implemented MAID practice standards into their guidance documents for clinicians, others are still in the process of reviewing and updating their existing standards. To support the safe implementation of the MAID framework, health Canada supported the development of a nationally accredited bilingual MAID curriculum to support a standardized approach to care across the country. The Canadian Association of MAiD Assessors and Providers has created and is now delivering a training program that has been recognized and accredited by the appropriate professional bodies.

The MAID curriculum includes a series of training modules to advise and support clinicians in assessing persons who request MAID, including those with mental illness and complex chronic conditions, or who are impacted by structural vulnerability, as well as help with the practical application of the MAID legislative framework. The curriculum will help achieve a safe and consistent approach to care across Canada and ensure access to high-quality MAID training for health practitioners. So far, more than 1,100 clinicians have registered for the training, which is impressive given the curriculum was just launched in August 2023. This is only a portion of the workforce. More time would allow additional physicians and nurse practitioners to register and participate in the training, and to internalize these learnings and put them into professional practice.

Now let me turn to case review and oversight of MAID. In Canada there is a process of self-regulation within the medical and nursing professions. The provincial and territorial regulatory bodies, which I spoke of earlier, have a mandate to protect the public for all health care, and MAID is no exception. In addition to the presence of health professional regulatory bodies, several provinces have implemented formal oversight mechanisms specific to MAID. For example, in Ontario, the Chief Coroner reviews every MAID provision, as does Quebec’s end-of-life commission. Both of these bodies have strict policies regarding the timing and type of information to be reported by clinicians, and the Quebec commission issues annual reports.

While the provinces with formal MAID oversight processes represent over 90% of all MAID provisions in Canada, other provinces do not have formal MAID quality assurance and oversight processes in place to complement existing complaint-based oversight processes undertaken by professional regulatory bodies. Work is being planned to explore case review and oversight models, and best practices, through a federal-provincial-territorial working group, with a view to supporting consistency across jurisdictions.

All provinces and territories were united in their request to delay the lifting of the exclusion in order to have more time to prepare their clinicians and health care systems to manage requests where mental illness is the sole underlying condition, and to put the necessary supports in place. Provincial and territorial governments must ensure not only that practitioners are trained to provide MAID safely but also that the necessary supports are available to clinicians and their patients through the assessment process.

Both the expert panel and the special joint committee on MAID emphasized the importance of interdisciplinary engagement and the knowledge of available resources and treatments. Experts and practitioner communities have also expressed the need for support mechanisms to be in place for providers undertaking assessments and persons who request MAID, irrespective of their eligibility.

While some jurisdictions have robust coordination services to manage requests and provide ancillary services, other jurisdictions take a decentralized approach, which can result in less coordination across services and disciplines. The availability of necessary support services for both practitioners and patients is also variable, depending on the region. For example, we have heard about the challenges of accessing health care services generally in rural and remote areas of the country. Additional time would allow more work to be done to support patients and clinicians involved in MAID.

The Liberal government is committed to supporting and protecting Canadians with a mental illness who may be vulnerable, while respecting personal autonomy and choice. The provinces and territories are ultimately responsible for the organization and delivery of MAID and supporting health services. Given their responsibility for how MAID is delivered, moving forward before provinces and territories are ready would not be the responsible course of action.

We believe that the extension of three years proposed in Bill C-62 would provide the time necessary to work on these important elements for the safe and consistent application of MAID for persons suffering solely from a mental illness.