Madam Speaker, I will be splitting my time with the Leader of the Opposition.
The Liberals have learned absolutely nothing over the past five years from their disastrous planned expansion of MAID for mental illness. They decided to move ahead with this planned expansion before studying the issue. They did so by accepting an eleventh-hour Senate amendment to Bill C-7, legislation that had nothing to do with MAID and mental illness, until of course they accepted the amendment. They then proceeded to shut down debate and ram through the bill without any meaningful debate, consultation or study, thus setting the train in motion for MAID for mental illness.
Had they studied the issue first, rather than recklessly moving ahead with it, they would have heard what has been now made loud and clear by leading experts, including psychiatrists, namely that MAID for mental illness cannot be implemented appropriately and safely. The Liberals, because they did not do their homework, had to bring in two emergency bills to delay implementation. Here we are, five years and four bills later, and they have finally admitted they got it wrong all along and are now bringing forward legislation to put an indefinite pause on MAID for mental illness.
At the same time, here we are again, with the Liberals' recklessly seeking to ram through a new expansion of MAID, this time advance requests, by shoehorning advance requests into a bill to put an indefinite pause on MAID for mental illness, an expansion that will take place unless a bill is passed by March of next year. What the Liberals are doing is shutting down parliamentary debate and parliamentary scrutiny of the complex issue of advance requests. If there ever was an issue that deserves careful scrutiny, it is advance requests, because there are profound legal, ethical and practical issues at play, and there are significant risks.
The most significant risk identified in its 2018 report by the expert panel the Council of Canadian Academies, which is appointed by the government, by the way, is that in the case of advance requests, MAID could be administered against a patient's wishes. That is not an isolated or remote risk. It is a very real risk underscored by Health Canada's data in its annual reports on MAID, which show that each year, anywhere between 10% and 20% of patients who withdraw their consent withdraw it immediately before the administration of MAID.
The possibility that MAID could be administered against a patient's request really gets to the heart of the central issue around advance requests, and that is the issue of consent. On the question of consent, the Supreme Court of Canada, in the Carter decision, said that in order to qualify for MAID, a patient must clearly consent. The court used those words multiple times in that decision, “clearly consents”, which arguably implies that such consent must be contemporaneous. Hence, advance requests raise serious legal questions about whether they fall outside the parameters for MAID set by the Supreme Court, and whether explicit contemporaneous consent is constitutionally required.
Not only are there issues that are legal in nature, but there are also profound ethical concerns involving consent, because when consent is made in advance, it can never be fully informed consent. That is because it is made based upon future assumptions about one's circumstances, capacities or preference, not upon one's lived experience.
There is abundant research into effective forecasting that demonstrates that when a person is diagnosed with an illness or a condition, they are often poor predictors of what the future will look like. As Dr. Romayne Gallagher, a clinical professor in palliative medicine, told the Special Joint Committee on MAID:
...medical and social science literature reminds us that people are poor at anticipating what life would be like with a life-changing illness or disability. People adapt to illness and disability and adjust their needs for a decent quality of life. Many medical conditions have long and unpredictable courses.
If consent cannot be contemporaneous and therefore cannot be fully informed, it raises the question, can there be true consent? If there cannot be true patient consent, then how can we ethically proceed with an advance request regime?
Now, proponents of advance requests often cite individual autonomy, but I would submit that individual autonomy in the context of advance requests is illusory. That is because advance requests necessarily result in not patient consent but third party consent, based upon observations that are often highly subjective in nature. After all, how does a MAID assessor confidently and accurately determine if a patient is suffering intolerably, which is a prerequisite for MAID to be administered, if the patient cannot communicate the degree to which they are suffering? That is what we invite with advance requests, namely, the administration of death based upon third party, often highly subjective observations of patients who cannot communicate and often have no ability to withdraw their consent.
Then there are other issues that need to be considered, including legitimate concerns that advance requests will lead to abuse and coercion resulting in vulnerable persons having their lives ended. There are concerns from a human rights perspective that advance requests undermine human dignity and will lead to discrimination against persons with cognitive disabilities, that a message is being sent that their lives are not worth living and that they are lesser human beings, completely undermining a fundamental principle of human rights: the universal and equal value of all human beings.
All of this underscores the need for careful study and meaningful consultation, none of which has happened, by the way. The Liberals have not done any meaningful consultation since the 2018 expert review, which recommended against moving ahead with advance requests, but instead the Liberals have learned nothing. Here we are again with the Liberals recklessly trying to ram through a complicated expansion of MAID. Canadians deserve better.