Debates of Feb. 7th, 2024

Criminal Code

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I was pleasantly surprised to hear the minister say right off the bat that there was no reason to question whether there is such a thing as an irremediable mental disorder, but the Conservative members do not seem very clear on that. I do not know if she noticed the member for St. Albert—Edmonton's reaction when she said it. I would certainly be worried if I were her, because every time the House has held a debate on medical assistance in dying since 2015, we have been unable to reach a consensus. The Conservatives are always opposed to it.

On this bill, however, the Conservatives are in lockstep with the Liberals and in favour of indefinitely postponing access to MAID for people with mental disorders. Why is that? Is the minister not concerned about that? What evidence does she have to explain why, a year ago, the government said it was going to take a year to sort this out, but now it it is going to take three years? By then, the Conservative Party may have had the opportunity to take power.

I guess she knows very well that this is not going to happen. I am not talking about the Conservatives being elected; I am talking finally legislating on the issue of mental disorders.

[Ya'ara Saks, Liberal, York Centre, ON]

Madam Speaker, this is why we have put a set timeline on this. We took the expert panel recommendations. There were 19 recommendations in that report, which included system readiness and a comprehensive set of modules for MAID assessors across the country to be able to do this work safely and compassionately. That is the work that we have done on implementation. Eleven hundred practitioners, including physicians and nurse practitioners, have participated in these training modules, but we have also been working with regulatory bodies. We want to make sure that there is quality and a standard of care across the country that sees people in their suffering, especially when they are vulnerable, and especially when mental illness as a disorder has caused such suffering and such harm over the years and over a prolonged period of time. We are very sensitive to the concerns of the member, and we are setting clear guardrails on the timelines for this.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, we need to have a reminder of why we are in the situation we are in. I was here in the 43rd Parliament when Bill C-7 was being debated. I remember very clearly the government's original charter statement, which included its rationale for excluding mental disorder as a sole underlying medical condition. I thought the charter statement was quite reasonable. However, we are in this situation because, when Bill C-7 went to the Senate, for some inexplicable reason, at the eleventh hour, the government did a complete 180° and accepted the Senate amendment. It changed the law before the hard work had been done.

I have been a member of the special joint committee from the get-go, and on that committee, we feel like we have been playing a game of catch-up ever since, having to do the work racing against an arbitrary timeline. That is why we have see letters from seven out of the 10 provinces and all three territories asking for an indefinite pause. I hope the minister and the Liberal government can take responsibility for putting Parliament in this position.

I would also like the minister to comment on the fact that there are so many populations, whether they are in rural or remote communities or urban centres, that simply cannot get the mental health care they need. When is her government going to step up to the plate and start servicing communities such as those in Cowichan—Malahat—Langford along with with those from coast to cost to coast? That is a huge problem that really needs to be addressed before we entertain any kind of a change to the law.

[Ya'ara Saks, Liberal, York Centre, ON]

Madam Speaker, my colleague and I are in lockstep in understanding how important a robust and integrated set of mental health services and substance-use services are. They must be available within health jurisdictions throughout the country. That is exactly why last year we committed to $200 billion to improve the health of Canadians. That is exactly why there are bilateral agreements that are tied to our four key principles, which include mental health. Provinces had to ensure that there were plans as part of their agreements and show a clear commitment to providing mental health services and substance-use services for those who are struggling with those disorders.

That being said, we also want to make sure that our health care systems, when it comes to MAID, have the level of system readiness, consistency and quality assurance across the country. We do not want a pick-and-choose system. We want to make sure that our most vulnerable are safe and that those who make this decision are doing it not only to acknowledge the dignity—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

I have to give the opportunity for further questions.

The hon. member for St. Albert—Edmonton.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, at the beginning of her speech, the minister stated that irremediability is not up for debate. Respectfully, it is the core of the debate about whether MAID can be expanded in cases where mental disorders are the sole underlying condition. The overwhelming evidence from leading experts, including psychiatrists, is that it is difficult, if not impossible, to determine irremediability. That was the conclusion of the government's own expert panel, at page 9 of the report. The special joint committee heard evidence that clinicians could get it wrong 50% of the time. In other words, it is like flipping a coin with people's lives. Is the minister comfortable with that risk?

[Ya'ara Saks, Liberal, York Centre, ON]

Madam Speaker, I will remind the member that we cannot speculate on treatment. Treatment is something that a patient decides with their health care provider. There is a lengthy process of assessments that are done for those who struggle with mental illness.

That being said, the criteria of eligibility are crystal clear. It has to be prolonged. It has to be determined irremediable, not only by the patient but also by a group of expert assessors. There needs to be a full assessment of what treatments have been engaged. I know there has been some debate in the House in the past asking about future treatments and all of that.

We are looking at an individual and their prolonged suffering. I would ask the member to really contemplate it. Does an individual's own lived experience with prolonged mental illness, and the suffering that goes with it, not weigh in, beyond that of the experts who have not walked in their shoes?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, here we are again, just as we were last February. We are faced with an arbitrary deadline set by the Liberals for their radical plan to expand MAID for mental illness. The Liberal government is completely unprepared and, therefore, needs to bring in eleventh hour legislation to extend the implementation deadline that it set in the first place.

I cannot think of another time or another issue in which a government has effectively had to bring in emergency legislation twice to extend a deadline for the implementation of its own law. It is truly shambolic. How did we get into this mess, thanks to the Liberals? Very simply, what we have across the way is a radical and reckless government that put blind ideology ahead of evidence-based decision-making. That has been the consistent pattern, in terms of decisions the government has made with respect to this planned expansion. This started with David Lametti, the former justice minister, who accepted a radical Senate amendment back in 2021 to implement MAID for mental illness and then set an arbitrary two-year timeline for implementation.

It should be noted that the charter statement for the bill in which Lametti accepted that radical Senate amendment provided a rationale for excluding MAID in cases of mental illness. The minister said at the time that he and the government were against MAID for mental illness because there were inherent risks and challenges. Indeed, he was right, but then he suddenly flip-flopped and rammed the amendment through with very little debate, one and a half days of debate. There was no parliamentary study, no consultation with experts and affected groups, and no evidence that MAID for mental illness can be implemented safely and appropriately.

The Liberals got it completely backwards. Instead of studying the issue first to determine whether this could be implemented safely, they decided to move full steam ahead and study the issue after the fact. Had they approached this matter responsibly, they would have learned very early on that there are significant clinical, legal and ethical problems with expanding MAID in cases of mental illness.

Among those problems are two fundamental clinical issues. The first is the difficulty of predicting irremediability. In other words, it is difficult to predict whether someone with an underlying mental health condition will get better. That is problematic in two major ways.

One is from the standpoint of the law. Under the Criminal Code, in order to qualify for MAID, a person must have an irremediable condition. More specifically, an irremediable condition is defined as one in which a person has an incurable disease or illness and is in an irreversible state of decline. If it is not possible to accurately determine that someone with a mental illness is in an irreversible state of decline and will not get better, then how can MAID for mental illness be carried out within the law? It cannot.

More significantly, from an ethical standpoint, if it is difficult to predict whether someone will get better, what that means with certainty is that persons who could get better will have their lives prematurely ended. Such persons could go on to lead a healthy and productive life. This was underscored by evidence heard by the special joint committee on MAID, during both its initial study two years ago and its more recent study this past fall. The special joint committee heard evidence that clinicians can get the prediction around irremediability wrong 50% of the time. In other words, it is like flipping a coin with people's lives. Is that a risk that members of the House are prepared to take?

When I posed that question to the minister responsible for mental health, she essentially answered in the affirmative. She doubled down on her support for an expansion of MAID for mental illness in three short years. Flipping a coin, gambling with people's lives, is what MAID for mental illness will result in.

A second fundamental problem is difficulty on the part of clinicians in distinguishing a rational request for MAID from one motivated by suicidal ideation. That is underscored by the fact that, in 90% of suicide deaths, persons suffer from a diagnosable mental disorder, not to mention that suicidal thoughts are often a symptom of mental disorders. This is why psychiatrists who appeared before the special joint committee said that it is not possible to distinguish MAID for mental illness from suicide. At the very least, MAID for mental illness significantly blurs the line between suicide prevention and suicide facilitation. It fundamentally changes the character of MAID and transforms it into something akin to state-facilitated suicide. This demonstrates just how far down the slippery slope we have gone under the Liberals.

To paraphrase the minister, she said that there are robust safeguards in place in that persons with a mental illness would only be able to qualify after years of receiving treatments and not getting better. However, that is simply not accurate; no such safeguards are found in any legislation put forward by the Liberals. In fact, the expert panel that the Liberals appointed, incredibly, recommended that there be no additional safeguards. Therefore, under the MAID expansion, it is simply not accurate that one must go through treatments or that one must be suffering over an extended period of time in order to qualify. In fact, the Liberals expressly rejected such additional safeguards.

In the face of those political challenges, Conservatives called on the Liberals to put an indefinite pause on this expansion. Likewise, in the lead up to the March 2023 deadline for implementation, the arbitrary deadline set by the Liberals, the chairs of psychiatry at all 17 medical schools called on the Liberals to pause this expansion.

What did the Liberals do? Essentially, they kicked the can down the road. They introduced Bill C-39, which merely extended the deadline for implementation from March 2023 to March 2024. In other words, once again, the Liberals put ideology ahead of evidence-based decision-making, making what amounted to a political decision with a new arbitrary deadline.

Nearly a year has passed, and with respect to resolving the fundamental issues and problems regarding safely implementing MAID for mental illness, where are we today? No progress has been made.

Indeed, when the special joint committee heard from psychiatrists, the message was loud and clear that we should not move ahead with this. It is not safe, and it cannot be implemented appropriately. The responsible course for the government to take is to acknowledge that it simply got it wrong and put an indefinite pause on the expansion.

It is no surprise that, in the face of these challenges, there is a professional consensus against the expansion. We saw that last week, when a survey from the Ontario Psychiatric Association was released. It indicated that a full 80% of Ontario's psychiatrists do not believe the health care system in Canada can safely implement MAID for mental illness. Last week, seven of the 10 provincial health ministers, plus the health ministers from all three territories, called on the Liberals to put an indefinite pause on this expansion.

What did the Liberals do in response? Once again, they kicked the can down the road with Bill C-62, which is before us. They defied experts, the provinces and territories, and common sense. This bill is basically the same bill we were debating a year ago. Instead of a one-year pause, it provides a three-year pause, with absolutely no evidence to indicate that fundamental clinical problems can be resolved. These problems include predicting irremediability and distinguishing between a suicidal request versus a rational request.

We have a government that is telling us to forget the evidence. The minister said it is not even up for debate, that the government does not want to talk about evidence as part of this issue. She basically said to forget about irremediability. The bottom line is that we have a Liberal government that is determined to implement this radical policy against a consensus among psychiatrists and other advocates.

Indeed, to get an insight into the mindset across the way, last week, in a press conference, the Minister of Health said that there is a moral imperative to get ready for MAID for mental illness. What is the moral imperative? Is it to give up on people who are struggling with mental illness? Is it to offer death through the provision of MAID to persons who are struggling with mental health issues?

That is what these Liberals characterize as a moral imperative? I say it speaks to the moral bankruptcy of these Liberals after eight years of the Prime Minister.

When the Liberals talk about MAID and mental illness, they are always very vague about what they mean. They know that if Canadians fully understood what MAID for mental for illness meant, most Canadians would be absolutely appalled. The model practice standard, which I believe the minister alluded to, that was prepared by the government's so-called task group of experts provides that a mental disorder would include anything in the DSM-5. Any condition listed in the DSM-5 is what these Liberals are contemplating as constituting a condition that would qualify someone for MAID in the case of mental illness.

What are the conditions listed in the DSM-5? They include personality disorders, depression, schizophrenia and issues when persons suffer from addictions challenges. That is what we are talking about when it comes to MAID and mental illness. It is truly repulsive, it is morally bankrupt to the core and it says everything Canadians need to know about the values of these Liberals.

There is only one piece of good news in all of this, which is that this legislation provides a three-year pause, and what will happen between now and the expiration of those three years is a federal election. Canadians will have a choice. They can choose between a Liberal government that wants to provide death to persons who are struggling with mental illness or they can choose a common-sense Conservative government that will not give up on anyone, will be committed to offering persons struggling with mental health issues hope and health, and will permanently scrap this radical Liberal experiment that gambles with the lives of vulnerable Canadians.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, there are two points I want to raise quickly and hear his response on. One, he talked about a consensus in the psychiatric community, and I do not know what consensus he is referring to. There are varied views on providing services and cures to people with mental illness. However, my question is in regard to rights of individuals. We have a decision by a Quebec court that required this Parliament to act on the ruling to ensure the rights of individuals guaranteed under the Charter of Rights and Freedoms are protected. I would like to hear his views as to how we will reconcile with those rights and what his plan would be to ensure the rights of Canadians, whether they have mental illness or not, are protected under our charter.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I would submit that 80% of psychiatrists in Ontario saying MAID should not be expanded in the case of mental illness is approaching a professional consensus. The member I would hope would be concerned by a government policy to expand MAID in cases of mental illness significantly impacting vulnerable persons and that he would question the appropriateness of such a policy in the face of opposition from so many experts.

With respect to the Quebec court decision he alluded to, and I believe he is referring to the Truchon decision, there was no pronouncement of the Quebec Superior Court on the question of mental illness. That was not part of the fact pattern in the case. The plaintiffs were not suffering from an underlying mental health disorder. There is no binding precedent forcing the government to enact this legislation. This is a political decision made by these Liberals.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, as my colleague knows, I have been on the Special Joint Committee on Medical Assistance in Dying from the get-go.

If he will recall, in the 43rd Parliament, when this House was dealing with Bill C-7, the government's original charter statement, which provided its rationale for excluding mental disorders as the sole underlying medical condition, was fairly well reasoned, and explained that section 7 and section 15 of the charter can be involved here. However, we have to remember section 1. Sometimes we may need to limit rights.

For me, personally, I am big believer in the charter, but I struggled through this whole process in how to find that balance between an individual's charter-protected rights but also the need of society to sometimes step in and protect the most vulnerable.

Could the member tell us how he personally approached finding that balance, and to also put it in the context that so many people in Canada, whether they are in rural or remote communities or in our urban centres, are marginalized and do not have access to the proper mental health care supports they so desperately need?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I enjoyed working with my colleague, the member for Cowichan—Malahat—Langford, on the special joint committee.

The manner in which I approached this issue was by following the evidence to determine whether this expansion could be implemented safely and appropriately. The overwhelming evidence is that it cannot. It need not have been this way. We need not be here for a second time on the eve of an implementation date that was arbitrarily set by the Liberals.

We could have studied this issue. We could have heard from experts. We could have heard from other groups about this, without moving ahead with legislation before undertaking that important consultation.

Let me simply say that the Liberal government has gotten it backwards. It has gotten it wrong. What the government should be doing is coming back to this House and putting an indefinite pause on this expansion.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I do not think the member is fully online on this. There is a Quebec court decision. That decision does put in a deadline that the government does need to respect and respond to.

At the beginning of his arguments, the member was trying to pass the blame. Let me remind the member that it was Stephen Harper's government, the same government which he worked for, back in 2015, that chose to do nothing, ignoring the issue. That was based on a Supreme Court decision.

Would the member not recognize that the issue cannot just be ignored? That is the track record of the Conservative Party.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, if the member is referring to the Truchon decision, that was not what the Truchon decision provided for.

That was outside the scope of the Truchon decision. Evidenced by that is the fact that when the Liberals responded to Truchon by introducing Bill C-7, mental illness as the sole underlying condition was expressly excluded from the legislation.

This is a political decision brought on by the Liberals.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my colleague is always very eloquent when it comes to defending the “no” camp and the pro-life camp. Does his position represent the position of the Conservative party? Is that the official position of the Conservative Party?

I just want us to be able to understand what is at stake in this debate today. Essentially, to him, irremediability is something that can never be proven. That means that, under a Conservative government, people who are suffering intolerably, who are dealing with intolerable suffering because they are victims of a mental disorder, could never be relieved of their suffering.

What I am also hearing is that he claims that he can solve the problem of suffering and irremediable mental disorders by injecting a lot of money into the health care system to make access to health care something that can help these people put all their suffering behind them.

Is that what he is telling us?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, the member for Montcalm is a thoughtful member on this issue.

With respect to irremediability, I am absolutely not comfortable with moving ahead with this expansion if it cannot be accurately determined. We have psychiatrists come before committee and say it is like flipping a coin, that clinicians get it wrong 50% of the time. That is not an appropriate risk. That is evidence of a policy that has not been well thought out, and that is dangerous and will negatively impact vulnerable persons on a matter of life and death.

With respect to the position of the Conservative Party, yes, the position is that a common-sense Conservative government would permanently scrap this radical and dangerous expansion.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, the arrogance and incompetence of the members opposite on this issue is truly alarming and frightening. Are they not aware that 30 legal experts wrote a letter to the former justice minister and cabinet saying, “Parliament is not forced by the courts to legalize MAID”.

What does the hon. member make of this argument, from the minister who spoke earlier, that somehow, in her words, the debate is over?

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, it is arrogance, it is recklessness and it is incredible. It is incredible in the sense that they hide behind a Quebec court decision. It is a decision, frankly, they should have appealed but did not. It did not pronounce on the question of MAID and mental illness, and they are now using that as the basis to say we need to move forward with this legislation, even though, when they initially responded, they said they were going to exclude mental illness from the legislation. They are trying to have it both ways.

They got into this mess because David Lametti accepted a radical Senate amendment and it has been a three-year mess ever since.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I rise on a point of order. I made a technical error in my vote on PMB Motion No. 86 on the seventh vote today, and I would very much appreciate the House's unanimous consent to allow me to change my vote to no.

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Is that agreed?

[Some hon. members]

Agreed.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I never thought I would end up debating medical assistance in dying in the House again, or reliving what we went through when we passed Bill C‑14, a bad law. I never expected that the Liberals would again be in the same position, or show the same lack of courage they did with Bill C‑14, which was prescribed by the Carter-Taylor decision.

Quebec passed its legislation on end-of-life care before the Carter decision. In the Carter decision, the court ruled that Quebec had to revise its legislation to include more than end-of-life issues only. The Parliament of Canada, which had never considered this before, was also told that it had to address not only end-of-life issues, but also degenerative diseases like those afflicting Ms. Carter and Ms. Taylor. Ms. Carter had spinal stenosis and Ms. Taylor had amyotrophic lateral sclerosis. In its decision, the court ruled that Parliament had to legislate because both women's right to life was being infringed.

Why was their right to life being infringed? The right to life is not a minor right. This should be of interest to the Conservatives, who are pro-life. I am too, in that sense. The right to life was being infringed because these people had to shorten their lives when they would have liked to live until their suffering became intolerable.

As members of Parliament, as representatives of the state and the people, our duty is not to decide what the patient needs when it comes to an issue as personal as their death. The role of the state is to ensure the conditions needed for them to exercise free will, so that they can make a free and informed decision. That is the role of the state. Otherwise, we get into government paternalism.

I invite my Conservative colleague to do some reading in clinical ethics and not to limit himself to what psychiatrists in Ontario are saying. We know that psychiatrists are divided on the issue. In fact, if there is one discipline in which medical paternalism continues to reign, it is psychiatry. We would never have seen the progress that we have seen in clinical ethics if medical paternalism in general still ruled supreme.

What happened for patients to be given back control over their end of life? We find the answer to that question in the bioethics literature. In the past, some doctors who had cancer said they did not want treatment. Now, we have good medical practices, whereas in the past, aggressive treatment was the standard. The doctors said that they wanted to live the two years they had left without undergoing treatment that would leave them bedridden. They claimed that they wanted to spend quality time with their loved ones. It took doctors with cancer demanding that option for patients to be able to discuss these sorts of things with their own doctor. In the 1960s, there were patients who only found out that they were dying of an incurable disease and were in fact at the end of their life when the priest came to their room to administer the last rites. They were not even told that they were terminally ill. That was medical paternalism.

Over time, the right to die was granted. Patients were granted the right to die and the opportunity to refuse aggressive treatment. That is when we began providing the palliative care that is so important to my Conservative friends. Before that, palliative care was called passive euthanasia, and it was not allowed.

Medical paternalism has been gradually set aside. What has this led to?

It has led to the right to refuse life-saving treatment, to stop treatment. These are all rights we have today.

We have before us a bill that perpetuates suffering indefinitely for people with a severe mental disorder who have been unable to relieve their suffering through treatment. That is no mean feat. They have spent 10, 20, 30 years suffering, trying multiple treatments and being stigmatized by the society in which they live.

We are able to establish the decision-making capacity of people living with a severe mental disorder. For those capable of making decisions, the court told us that it would be discriminatory and stigmatizing if, just because they have a severe mental disorder causing suffering that psychiatry is unable to properly change or relieve, they were told what was best for them and that they should continue to suffer forever, while psychiatry need only provide a palliative care option until the end. That is what we are discussing today.

I will calm down. It is just that I heard some nonsense earlier.

Then what happens? There was Bill C‑7, which was rather cautious. It set a two-year deadline for creating an expert panel. Who read the report of the expert panel in the House? Who read it before voting? This is the second vote we are having on this subject. We have to read the report of the expert panel. Indeed, the irremediable aspect is something that is hard to implement. Admittedly, there is an additional difficulty, but the expert report does set out guidelines. That is what this is about.

Then the Liberals show up today with a clause they added that says we are going to work with an expert panel for two years and create a joint committee. The problem is that the joint committees have always been set up at the last minute, too close to the deadline.

When we submitted our report the last time, we were forced to admit that, before moving forward with the issue of mental disorders, we needed to assess the situation in the field. Even though I think the group that was supposed to work on it had developed important guidelines and standards of practice, it was obvious to me that there was still not quite enough time. Everyone told us so, including the Collège des médecins du Québec—I will have more to say later about its criteria and guidelines for proceeding that I find useful.

How is it that, a year ago, the government gave itself a one-year deadline and thought that would be enough time? A lot of work has been done in that year, yet the government is saying we should put it off until 2027.

We heard what the Conservatives just said. We can forget about MAID if they form government; they will put it off indefinitely. That means that people will continue to suffer indefinitely, and that suffering will be intolerable because psychiatry is unable to provide relief other than by rendering them virtually incapacitated. Somehow, people find that morally acceptable. I honestly do not know where the morality lies in that. Some people have very flexible morals. In any case, it has nothing to do with suffering.

When people claim that someone living with depression could have access to medical assistance in dying, it is simply not true. Just because someone applies for MAID does not mean they will be able to access it. The assessors will do their job. Stefanie Green was saying that a person in a suicidal crisis is not eligible for medical assistance in dying. Someone who raises their hand and says that they want MAID simply because we allow mental disorders to be eligible grounds for MAID would not have access to it because they have not received proper care.

However, there would be an opportunity for prevention, because we could provide treatment at that time. It is wrong to say that 90% of people who have suicidal ideation and commit suicide received proper care. No, they did not receive proper care. Very often, when people commit suicide, no one saw it coming at all.

What are we going to do? What are the Conservatives going to to with people who are desperate and suffering and who currently still have hope that we are going to consider their suffering and find a solution so that things are done properly and by the law? What do they think those individuals are going to do in their despair? Is suicide morally acceptable? Suicide attests to the failure of our system and our society. I will never, ever accept suicide. That is why, when we talk about medical assistance in dying, we are not in the same page at all.

A person who is feeling suicidal is not eligible. Someone who has just been taken into care and diagnosed is not eligible. Applications take structural vulnerabilities into account. Just because someone is poor and does not have access to care does not mean that they will be eligible for medical assistance in dying. They would not be eligible, because they would have to have tried every possible treatment. Someone who unjustifiably refuses treatment that could improve their condition will not be eligible. If accessible and effective treatments are available and the person refuses them, they are ineligible. If the assessors cannot agree that the criteria have been met, the person is not eligible either.

The Collège des médecins du Québec told us that it remains at the discussion stage, that it has established its guidelines and it still needs time in order to eventually get there. Personally, I think one year would have been enough, otherwise we might give up. We could end up being hypocritical and leave it to chance. We might as well flip a coin.

The Liberals need to work hard if they want to win the election. If not, they are going to be leaving the fate of those who are suffering in the hands of people who just told us today that this will not happen on their watch, that they support suffering for life everlasting, and that they know what is moral and right for these people.

The Quebec college of physicians said, and I quote, “the decision to grant MAID to someone with a mental disorder should not be viewed solely as an episode of care. Rather, the decision should be made following a fair and comprehensive assessment of the patient's situation.” We are talking about taking the time to establish the chronicity of the condition.

The college of physicians also set out a second condition. It said, and I quote, “the patient must not exhibit suicidal ideation, as with major depressive disorders”. It might be a good idea for the members of the Special Joint Committee on Medical Assistance in Dying to hear that, although they are on the same committee as I am and that was said in committee.

That is a far cry from the grandstanding Leader of the Opposition who stands up in the House and asks the Prime Minister, in prime time, whether medical assistance in dying is the only thing he has to offer those who are depressed and having a hard time making ends meet. That is a bit much.

The third criterion laid out by the college of physicians states that the patient must “experience intense and prolonged psychological suffering, as confirmed by severe symptoms and overall functional impairment, over a long period of time, leaving them with no hope that the weight of their situation will ease. This prevents them from being fulfilled and causes them to see their existence as devoid of meaning.”

The experts tell us that they cannot apply irremediability and suffering metrics to mental health, and that prevents them from creating a category as a grounds for MAID. It has to be done on a case-by-case basis. All questions of clinical ethics, in terms of clinical assessment, are examined on a case-by-case basis. Some seem to think that going on a case-by-case basis is hell and that it is not a rigorous process. It is very rigorous.

The fourth condition states, “the patient must have been receiving care and appropriate follow-up over an extensive period of time.” Access to care must have been available. Otherwise, no access to medical assistance in dying will be provided for mental disorders. It seems to me that we heard the same thing in committee. We heard the same criteria.

At some point, we have to have the courage of our convictions. I believe that we have to offer relief to people experiencing intolerable suffering, who have reached their limit. I also believe that we must not make decisions about their life or quality of life for them. They alone can decide what is tolerable or intolerable.

When people talk to me about a slippery slope, they seem to be working on the assumption that all health care workers are evil. However, people who work in health care need to be kind. As far as I know, gaining admission to medical school is not easy. I imagine that the selection criteria are quite strict and challenging. The same goes for nursing.

The fifth condition states, “requests [from social workers] must undergo a multidisciplinary assessment, including by the physician or specialized nurse practitioner in the field of mental health who has treated the individual”. This is in the case of a follow-up assessment, not in the midst an episode. A person cannot get medical assistance in dying simply by saying that their life no longer has any meaning. Making a request does not mean one is eligible.

The Collège des médecins du Québec concluded by saying, “Under these conditions, it would be possible, in the CMQ's view, to provide individuals suffering from a grievous and irreversible mental disorder with access to MAID. It is important to prevent situations where individuals opt for MAID out of desperation, because they do not have access to proper care or do not consider the care available to be acceptable, such as an extended stay in a facility without the prospect of gaining more autonomy.”

That is the exact opposite of the nonsense we heard earlier. We were told that this was like a house of horrors, that we were dealing with experts and doctors who simply wanted to harm people's physical integrity. We have to be careful.

To access MAID, the individual must first make a request, which is then followed by informed consent. When it comes to mental disorders, doctors currently perform a daily assessment of a person's decision-making capacity if they have a mental disorder and a comorbidity, an additional illness that is hastening their death. Everyone agrees that these people are capable of choosing and consenting to medical assistance in dying. MAID practitioners have long been determining the decision-making capacity of people with a mental disorder. Just because someone has a mental disorder does not mean that their right to self-determination and to make decisions should be violated. That is discrimination and stigmatization.

When people tell me they want to protect the vulnerable, I wonder who could be more vulnerable than someone who has suffered for decades with a mental disorder and has tried every treatment. Who could be more vulnerable than someone grappling with a paternalistic psychiatrist—I am choosing my words carefully—who thinks he knows better than his patient what treatment they need, then chains them to a palliative care pathway and throws away the key because he cannot bring himself to admit that he is unable to provide relief to his patient?

At committee, I put the question to some psychiatrists who told us we were on the wrong track. They admitted that, in 25 or 30 years of practice, they had seen some patients fall through the cracks. Indeed, it is for this small group of people who fall through the cracks in psychiatry that this expansion is necessary. We need to show a little humanity here in the House.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I extend my sincere thanks to the member across the way for the details and the compassion with which he made his comments about patient-centred decisions and things around the Charter of Rights and Freedoms that we protect in the House. Right now, I understand the Quebec legislature is debating the Superior Court decision. I was hoping we would have a more fulsome debate tonight, and I was surprised the Bloc did not support having that debate.

I spoke with a nurse practitioner in my area who comes from Ottawa to Guelph to provide service, and she can only do it as a volunteer because she is not paid by the province to work outside of Ottawa. On the ground, we really have problems building capacity. Something that this bill tries to address is building the capacity of our health care system within the provinces to be able to provide MAID effectively in our communities.

Could the member maybe reflect on the need for us to work with provinces and their health care systems to build our capacity and, at the same time, to work with legislatures, both provincially and federally, so that we can get this across the line together, and comment on the amount of time that could take?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is an interesting question.

I would like to point out to my colleague that the committee had very little time to assess whether the system was ready. We had two or three meetings to determine that and the deadline was ridiculous. However, many people came and told us that the system was ready.

The Quebec National Assembly took a stand in 2021. Bill C‑7 was passed after that, after a lot of work had been done and brought to a halt in Quebec. The Quebec college of physicians said that it still needed a little more time. However, there is a big difference between needing a little more time to ensure that everything is done safely and properly and putting off indefinitely the need to deal with the suffering of people with serious mental disorders.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, it was a pleasure to work the member for Montcalm on the Special Joint Committee on Medical Assistance in Dying. We have both been on that committee from the get-go, and we have both been exposed to a wide range of witness testimony and the briefs.

Following up slightly on the earlier question, our responsibility here in the federal scene, of course, deals primarily with just the Criminal Code. Once we complete our task with the Criminal Code, the oversight and accountability of the system falls largely on the provinces.

It is not insignificant that seven out of 10 provinces and all three territories had their health ministers and ministers responsible for mental health and addictions sign a letter, in which they referenced the fact that back in November, they were already raising concerns, and they have clearly called for an indefinite pause. I understand Quebec was not a signatory to this, but the very fact that seven provinces and three territories are, and those ministers are responsible for the oversight of those medical systems, I do not think that is insignificant.

I am wondering if the member for Montcalm can reflect on that. When we have clear direction from ministers responsible for the system saying that they are not ready, how does he respond to those concerns?