Mr. Speaker, I will be sharing my time with the member for Etobicoke—Lakeshore.
Today, I rise to speak in support of Bill C‑41, the medical assistance in dying safeguards act. This is a bill that is particularly close to my heart and to which I am deeply committed.
This bill would prevent the planned expansion of MAID for mental illness and would allow for advance requests, subject to strict conditions and safeguards. I believe it takes a careful, compassionate and balanced approach that respects the will of individuals while recognizing our responsibility to protect those who are most vulnerable.
This is a deeply personal issue for me, as it is for many Canadians in this country. This is an issue that asks us to consider some very difficult questions about suffering, dignity and protecting people when they are at their most vulnerable.
I approach the subject knowing very well that we all have different experiences and beliefs when it comes to such a sensitive subject, and I respect that. Whatever our views, as politicians we have a responsibility to listen carefully and remember that every decision we make here affects real people and their families.
Today, I want to explain why this bill matters to me and why I advocated for caution in expanding MAID to people whose sole underlying condition is mental illness. I commend the Minister of Justice and Minister of Health for proposing reforms that would maintain this exclusion, would allow people diagnosed with conditions such as Alzheimer's to make advance requests, where permitted by provinces and territories, and would strengthen the national oversight of MAID.
Let us begin with the first pillar: preventing the scheduled expansion of MAID on the basis of a mental illness. March 17, 2024, was the original date that MAID was to extend to people suffering from mental illness alone. This followed a Senate amendment to the original bill, an amendment that introduced a provision that would expand MAID to mental illness. This would have given people suffering from a mental illness, including depression, the right to apply for assisted death.
Having a background in psychology, I was particularly concerned about what this expansion could mean. Mental illness can cause profound suffering. It can affect so many aspects of our lives, such as our relationships, work or physical health, and our ability to get through the day. For some, this suffering can go on for years. Symptoms can change over time, and recovery can be difficult to predict. People can respond differently to treatments, and finding the right balance of care and treatment can take time.
This left me with some serious questions about how we could determine that a person's condition would not improve and about how to ensure that people had meaningful access to treatment and support before they ever reached the point of applying for MAID. These apprehensions did not sit well with me at all. They led me to speak up and express my concern with my caucus colleagues in order to ensure that these difficult questions received the attention they deserved. I felt compelled to contribute to this discussion and explain why I believed more time was needed and why we needed a more cautious approach.
As the date approached, I felt a responsibility to my constituents in Saint-Laurent and to all Canadians to raise my concerns and sound the alarm. I kept thinking about the people and families who could be affected by this decision, people experiencing profound suffering, some of whom might still be struggling to find the right treatment or supports. I wanted us to take the time to work through these difficult questions and be confident that we could protect those at risk.
Ahead of the vote on a private member's bill addressing this issue, two of my colleagues and I voiced our concerns and worked within our caucus to advocate for the expansion to be postponed. These were constructive discussions about a deeply sensitive issue, and although these conversations were very difficult, I honestly did not believe that going ahead with the legislation as it was proposed with the extension was the right move.
My concern was whether we could move forward safely, whether our health care system was prepared and whether people living with mental illness had access to the treatment and support they needed. Most of all, if it is possible for people to recover from their mental illness and live functional and peaceful lives, would this legislation take this possibility away prematurely? As those important discussions continued, other colleagues shared their perspectives and concerns, contributing to a growing recognition that more time was needed before this legislation could be adopted.
The government decided to create the Special Joint Committee on Medical Assistance in Dying specifically to study whether it should be expanded to individuals suffering solely from a mental illness. That committee found that Canada was not ready to offer MAID for mental illness, and the government subsequently introduced Bill C-62, which received royal assent on February 29, 2024. The legislation postponed the expansion of MAID to people whose sole underlying medical condition is a mental illness until March 17, 2027. It also required a parliamentary committee review of the health care system's readiness.
Bill C-41 would prevent this expansion from happening. Today, I will share some of the main concerns that I raised with my caucus and that have shaped my position on this piece of legislation.
Originally, medical assistance in dying was allowable only in cases where a patient had an irremediable health condition. To have an irremediable condition means that the condition has become permanent and cannot be reversed. According to witnesses at the MAID committee, there is a lack of established criteria to determine if a mental illness is irremediable, as well as a lack of consensus among psychiatrists for if and when a mental illness should be considered irremediable. Furthermore, we are still learning about the brain and continue to do so every day. The brain is neuroplastic, meaning it continuously changes and grows in response to a person's environment and experiences. This does not mean it always changes for the better or that it improves, but it does mean that it can be difficult to predict if a mental illness will be irremediable or if it can be healed.
According to Sharon Reynolds in an article published in the National Institutes of Health journal, there are some properties in some types of psychedelic drugs that have shown promise as therapies for treatment-resistant depression and PTSD. They encourage growth of new neural connections in the brain, so it might be possible to develop related drugs that can promote brain plasticity without causing harmful and hallucinogenic effects. This would be a very promising development.
Another concern that I had with expanding MAID to individuals suffering solely from mental illness is the fact that we do not have adequate mental health care services in Canada. Therefore, people would be applying for MAID without trying other treatments for a lack of accessibility to them. According to the Canadian Institute for Health Information, there are several factors that contribute to unmet mental health needs across the country, and these include cost, as many services are not fully covered by public health insurance; caregiving or work responsibilities; a lack of support in navigating existing services; a lack of trust in the health care system; and the fear of what others may think for needing help in the first place, due to the stigma associated with mental health issues.
The second pillar speaks to another group of Canadians, those living with Alzheimer's or another form of dementia and the families who walk beside them. For these Canadians, there may come a day when they can no longer tell the people they love what they want at the end of their life. Today, under the Criminal Code, they cannot say it in advance. Advance requests are prohibited.
An advance request allows a person who has been diagnosed with a capacity-limiting disease like Alzheimer's to set out the circumstances under which they would want to receive MAID in the future after they have lost the capacity to consent. Canadians living with dementia have told us clearly that they want their wishes respected. Bill C-41 would permit advance requests so that a person diagnosed with a capacity-limiting disease can set one out while they still can. It does so with care, by setting minimum national safeguards in the Criminal Code for the lawful provision of MAID based on advance requests.
Over the past few weeks, people in my riding have put it better than I ever could: People struggling with mental illness deserve care that is compassionate, hopeful, and focused on suicide prevention, not medical assistance in dying. They told me that many people living with mental illness will reach such a low point that they will come to see MAID as the only way to escape their suffering. Furthermore, they asked me a question that has stayed with me: When that person is at their lowest point, what do we, as a society, say to them? Do we reinforce their sense of despair, or do we protect, support and care for them?
If we do not take action, the current exclusion will end on March 17, 2027. Bill C-41 addresses this. It takes a cautious approach, as there is still no clinical consensus and too many Canadians still cannot access the mental health care they need. A parliamentary committee composed of senators and members of Parliament from various parties heard from experts and stakeholders and recommended not moving forward. The bill follows through on that recommendation.
The bill is the result of listening. We heard from parliamentary committees, clinicians, the provinces and territories, disability groups and academics, and this decision follows the evidence so that people get the support they need. To those who are struggling, the bill offers hope and is a promise—