Mr. Speaker, medical assistance in dying is a complex and deeply personal issue. It touches patients living with unbearable suffering, their family and friends, and the health care professionals who care for them.
Today, as we begin consideration of Bill C-218, I want to speak to how we got here, what the bill proposes and some of the questions I have concerning this bill.
Let me begin by briefly reviewing the path Parliament has taken over the last decade. Understanding the evolution of the law helps us understand the importance of moving carefully when changes are proposed.
First, in 2015, in the Carter decision, the Supreme Court of Canada struck down the blanket prohibition on physician-assisted dying because it violated section 7 of the charter. The court suspended its ruling so Parliament could craft a new framework, one that balanced individual autonomy and dignity with the sanctity of life and the need to protect vulnerable people. It also recognized that Parliament is owed a high degree of deference given the complexity of the issue and the competing societal values involved.
Second, in December 2015, the Special Joint Committee on Physician-Assisted Dying, which was made up of MPs and senators, was tasked with making recommendations on the legal framework to respond to the Carter decision. That committee heard from 61 witnesses, received 132 briefs and published its recommendations in February 2016.
Third, also in 2016, Parliament passed Bill C-14, which legalized the provision of MAID. It did so by creating a MAID framework in the Criminal Code made up of eligibility criteria to determine who can obtain MAID, procedural safeguards to ensure MAID is provided safely and exemptions to criminal offences such as murder for practitioners who provide MAID in accordance with these requirements. Eligibility for MAID was originally restricted to competent adults whose natural death was reasonably foreseeable.
Fourth, in 2021, Parliament adopted Bill C-7, which expanded eligibility for MAID to those whose natural death is not reasonably foreseeable. It also added additional safeguards to address the increased complexity of providing MAID in those situations. At the same time, Parliament temporarily excluded for two years the eligibility of MAID for individuals whose only health condition was mental illness. Importantly, this was not due to stigma or stereotyping about mental illness, but because experts made it clear that unique considerations, including how to assess whether a mental illness is irremediable, required further study and that further health care system preparation was needed.
Bill C-7 also required Parliament to establish the new Special Joint Committee on Medical Assistance in Dying, which heard from more than 150 witnesses, received hundreds of written briefs and submitted three reports. In addition, the bill called for the ministers of justice and health to initiate an independent expert review to recommend protocols, guidance and safeguards for MAID for mental illness, which they did.
Fifth, in 2023, Parliament adopted Bill C-39, which extended the temporary exclusion of mental illness by one year to allow time for federal, provincial and territorial governments, in collaboration with professional bodies, to prepare standards and training and to consider any recommendations from the special joint committee.
Most recently, in early 2024, the special joint committee and several provincial and territorial ministers of health called for more time for provincial and territorial health systems to prepare for the lifting of the exclusion. Parliament passed Bill C-62, which extended the temporary exclusion to March 2027.
At the same time, Parliament also mandated that further review be undertaken by a special joint committee of Parliament, which is to begin by February 28, 2026. The committee is expected to provide a further assessment by Parliament on the readiness of provincial and territorial health systems for the expansion of MAID eligibility to those whose only underlying condition is mental illness. I look forward to its findings and recommendations.
We must also remember that when we speak of medical assistance in dying, we are speaking of a health service that doctors and nurse practitioners deliver as a part of end-of-life care. Changes to the legal framework for MAID would have significant repercussions for provincial and territorial health systems, and changes should be informed by the experience of the people responsible for health care in Canada.
This brings me to the private member's bill, Bill C-218. At its core, the bill proposes two notable changes: number one, to replace the term “mental illness” with “mental disorder”; and number two, to change the structure of the exclusion provision. At first glance these may seem like technical adjustments, but the first change in particular could have significant consequences for eligibility for MAID and how the law is interpreted.
The term “mental disorder” is used in the clinical world, but it covers a far broader range of conditions than “mental illness” is intended to capture. “Mental illness” refers mainly to conditions that fall within the domain of psychiatry; the term does not include neurocognitive or neurodevelopmental disorders, such as Parkinson's disease, which is typically treated by other medical specialists. Under Bill C-218, however, this condition would now be captured by the exclusion, because it falls under the broader category of mental disorder.
Currently, individuals whose sole underlying medical condition is a neurocognitive disorder are eligible for MAID. This leads me to an important question: Why broaden the exclusion to include conditions like Parkinson's disease that are currently eligible for MAID? If this was not the intent of the bill, then further clarity is needed.
My second concern relates to the proposed change in Bill C-218 of the definition of “grievous and irremediable medical condition”. The Criminal Code's definition of this term includes three components: “a serious and incurable illness, disease or disability”, “an advanced state of irreversible decline in capability”, and “enduring physical or psychological suffering” that is due to the person's medical situation.
Currently a mental illness is not considered to be an illness, disease or disability, for the purpose of MAID eligibility. This means that a mental illness cannot meet the first requirement of a grievous and irremediable condition. Bill C-218 proposes something different; it states, “a mental disorder is not a grievous and irremediable medical condition.” The question is, why? What problem does it aim to solve that the current exclusion does not already address? Could this change be perceived as saying that a mental illness cannot result in enduring suffering?
When it comes to MAID, caution is essential; that is why the government has repeatedly committed to ensuring that provincial and territorial health systems are ready before any expansion would take effect. That includes training assessors and providers, developing and implementing clinical guidelines and supports, and strengthening oversight systems for MAID.
Bill C-218 raises important questions, but before we move forward, we must ensure that its effects are clearly understood and aligned with the careful work Parliament has been doing for nearly a decade. The way Canada approaches MAID speaks to some of our most deeply held values: respect for personal autonomy and dignity, compassion for those who suffer, and a firm commitment to protecting vulnerable people. We owe it to Canadians—