Mr. Speaker, I appreciate the opportunity to rise today to speak to Bill C-218, which proposes further amendments to Canada's federal legal framework for medical assistance in dying. Specifically, this bill aims to indefinitely exclude those patients whose only health condition is a mental disorder from being eligible for MAID.
This is an issue which is unquestionably complex and can be deeply personal. It continues to challenge parliamentarians, health care providers, experts and people in Canada alike. It is important for us to recognize that medical assistance in dying has been allowed in Canada for close to 10 years now. It is also important to remember that it is the provinces and territories that must put in place the tools and supports that clinicians need to deliver MAID safely and appropriately. Whenever we make changes to the federal legal framework for MAID, we must be cognizant of the impact that those changes have on our partners in the provinces and territories.
As the Supreme Court of Canada recognized in Carter, striking the right balance in this complex area of social policy, where competing social values are at play, is not an easy task. As legislators, we must balance respect for personal autonomy and dignity with our responsibility to those who may be vulnerable.
Today, I will speak to three key elements: first, the objectives of Bill C-218; second, the findings of major expert studies on MAID where mental illness is the sole underlying condition; and third, the federal government's support for provincial and territorial work to improve access to mental health services.
Bill C-218 seeks to make changes restricting eligibility for MAID indefinitely in cases where a mental disorder is the only medical condition involved. There have been concerns expressed by some stakeholders about whether there are sufficient safeguards in place, and whether health care providers have the tools and resources they need to provide MAID safely and appropriately when it comes to mental illness. These concerns are not new, nor are they trivial, and their desire for caution is laudable.
At the same time, we must also recognize that Parliament has debated this question repeatedly over several years. Our legislative framework has evolved in response to court decisions, expert analysis and extensive public engagement. A special joint parliamentary committee has carefully considered the issue at length and provided advice and recommendations on whether to proceed. That committee also reinforced the importance of provincial and territorial health system readiness.
Bill C-218 invites us to consider whether the appropriate balance has been struck with the upcoming lifting of the mental illness exclusion in 2027, or whether another legislative change is necessary at this time. To answer that, it is essential that we understand what the experts have already told us. Significant studies have been completed on the specific question of MAID eligibility where mental illness is the sole underlying condition, including by the Council of Canadian Academies and the expert panel on MAID and mental illness, among others. Taken together, they provide a rich body of evidence.
The Council of Canadian Academies, the CCA, examined Canada's legal and clinical landscape, along with international approaches. The CCA's work highlighted the core clinical challenge: Mental illnesses can be unpredictable in their course and determining irremediability is far more complex than in many physical illnesses. The CCA was not tasked with providing recommendations for or against eligibility, and the members of the working group that dealt with mental illness had a spectrum of views on the matter.
The expert panel on MAID and mental illness, which was mandated by the former Bill C-7, took this analysis further. Its mandate was not to recommend whether eligibility for MAID should be expanded to permit the provision of MAID based on mental illness alone, but rather to recommend protocols, guidance and safeguards for such cases. The panel concluded that the existing Criminal Code safeguards, when supported by the development of MAID practices standards and the implementation of other recommendations, are adequate to allow for safe provision of MAID to people whose sole underlying medical condition is a mental illness.
Both these expert reviews, along with the testimony received through parliamentary committee work, reinforce the same overarching message: MAID in cases involving mental illness requires exceptional caution, but it is not impossible to implement safely. At the same time, clinical readiness, clear standards and comprehensive training are essential.
Following these studies in 2023, a model MAID practice standard was published, and a Canadian-made curriculum was developed. In addition, the federal government is currently supporting the Canadian Psychiatric Association to develop clinical practice guidelines for assessing suicidality and irremediability. Through a federal, provincial and territorial assistant deputy minister-level committee, policy leaders are also considering a range of issues related to MAID, particularly with respect to complex cases, including mental illness.
We have heard from these expert reviews and from a broad range of stakeholders on the importance of provincial and territorial health systems' being ready for the lifting of the exclusion. This includes provincial and territorial efforts to improve access to mental health services and supports across Canada. No one should ever feel that MAID is the only option available to them.
The federal government remains committed to supporting provinces and territories to improve access to health care for Canadians, which includes strengthening mental health services. In 2023 the Government of Canada announced the working together to improve health care in Canada plan, a historic investment of close to $200 billion over 10 years to support provincial and territorial health systems to deliver health care to Canadians. This includes an investment of $25 billion through bilateral health agreements with the provinces and territories to support shared priority areas, including improving access to mental health and substance use services.
The federal government has also expanded support for youth mental health initiatives, recognizing that early access to therapy, counselling and culturally safe care can alter the trajectory of a person's entire life. We have also funded indigenous-led mental wellness programs, which acknowledge the need for approaches that are culturally relevant, trauma-informed and community-based, rather than one-size-fits-all solutions. Provinces and territories have taken significant steps to improve access to mental health services in Canada with federal supports over the past 10 years.
Questions related to MAID in the context of mental illness are among the most sensitive we confront as parliamentarians. Our decisions affect people in Canada at their most vulnerable moment, and our work must reflect both humility and resolve. Bill C-218 asks us to confront difficult but deeply important questions.
Deciding whether medical assistance in dying should be available when a mental illness is the sole underlying condition is not a choice that lends itself to simple answers. Reasonable people may come to different conclusions. The Supreme Court of Canada has recognized this complexity, affirming that Parliament is owed a broad margin of deference when navigating challenging social policy issues such as this.
We will have the opportunity to consider next steps further and to study the state of progress during the parliamentary review that will be held in 2026. I look forward to hearing from colleagues as well as from experts, stakeholders and regular people, including those with lived experience with mental illness, as we continue this important debate.