Madam Speaker, at the outset, I would like to note that I will be sharing my time with my colleague, the member for Elgin—St. Thomas—London South.
Tonight, we are debating Bill C-41, the medical assistance in dying safeguard act. This bill would do two substantially different things. First, it would permanently cancel the expansion of MAID for those who are suffering from mental illness. Second, it would introduce a framework for advance medical directives allowing individuals to make decisions in advance about receiving MAID if they later lose the capacity to consent. I support the first measure. I cannot support the second.
The permanent exclusion of mental illness as the sole underlying condition for MAID is a necessary and long overdue correction. It reflects what many medical experts have been saying, including mental health professionals and disability advocates, which is that our health care system cannot reliably distinguish between a treatable mental illness and an irremediable one. The risks are simply too great. I am happy that the Liberals have finally come to that conclusion as well.
Advance medical directives, on the other hand, raise a very different and a far more complex set of ethical and legal questions. They touch on issues of consent, autonomy and the value of human life at the moment when a person may no longer be capable of expressing their wishes. These two issues should never have been bundled together in one single bill. One requires urgent legislative action before a deadline that is only six months away. The other demands careful study and thoughtful consideration.
To understand why the government is finally reversing course on the first issue, medical assistance in dying for those who are suffering from mental illness, it is useful to explore how we arrived at this point. It all started with the Sue Rodriguez case in 1993, where the Supreme Court of Canada upheld the Criminal Code provision that prohibited assisting somebody to die, to commit suicide. Twenty years later, the Carter case came along, and the Supreme Court of Canada changed its mind. It came to quite a different conclusion.
Faced with the circumstances of Ms. Kay Carter, who suffered from ALS, a progressive and incurable neurodegenerative disease, the court found that an absolute prohibition of physician-assisted dying was a breach of section 7 of the charter. The court stated that MAID could be available for people in Ms. Carter's condition as long as that adult was one who clearly consented to the termination of life and it was a grievous and irremediable condition causing enduring and intolerable suffering. It was those two things: clear consent and an irremediable condition. Importantly, the court also emphasized that it really was limited to those specific facts, which is exactly what courts usually do. It was making no pronouncement over any other situation where physician assistance might be sought, for example, for mental illness.
Parliament responded to that Carter decision with Bill C-14, establishing a MAID framework that included a further requirement, that natural death had to be reasonably foreseeable. We thought that was going to be our MAID regime going forward into the future. Unfortunately, that proved to not be the end of the story.
For the next chapter in how the Liberals have mismanaged this whole MAID file, we turn to the Truchon decision in Quebec, where two individuals successfully challenged the “reasonable foreseeability of natural death” provision. What happened next was remarkable. Rather than appealing a lower court decision that struck down an act of Parliament, the Liberal government, the attorney general, chose not to defend the legislation that had been adopted in the House after one of the most significant ethical debates in modern Canadian history. The result was Bill C-7. The legislation created two tracks, one for those whose death was reasonably foreseeable and the other for those who were not in a situation of dying. Significantly, Bill C-7 expressly stated that mental illness alone would not qualify a person for MAID.
After Bill C-7 passed in the House of Commons, the Senate, shockingly in my opinion, proposed amending the bill. It proposed removing the mental illness exclusion after a sunset period of two years. Instead of rejecting the amendment, which the Liberals should have done, the Attorney General, who also should have done it as it is his job to defend the laws of Parliament, accepted it. They caved to the MAID activists. That decision launched Canada down a path that many experts have said is dangerous.
For example, in November 2023, the chairs and heads of numerous psychiatric departments across Canada said that there is “no...accepted definition of irremediability” in mental illness and “no reliable way to distinguish a MAID request from suicidal ideation.” That is what the experts were saying. I am happy that the Liberals finally listened to that and are convinced. They cautioned against expanding MAID in these circumstances, saying that it would risk facilitating preventable deaths and undermine suicide prevention efforts.
The Liberal government did the right thing, sort of. It postponed the implementation date, at first by one year and then later by three more years. Here we are, after six years of uncertainty. The government has finally arrived at where many experts and Canadians believed it should have been all along: MAID for mental illness alone is not sound public policy. The government made the right decision in the bill that is before us, and we agree with that part of it.
However, while retreating from one problematic expansion of MAID, the government would now advance another that is even more problematic. Advance medical directives would allow individuals to specify in advance the circumstances under which they would wish to receive MAID if they later lose the capacity to consent. Now, at first glance, many Canadians might think, well, that makes sense. We write wills. We write powers of attorney. We write health directives. Why should we not write advance medical directives for MAID?
MAID is substantially and fundamentally a different matter. Advance directives concerning MAID authorize an irreversible act that results in death, with someone else, a third party, being tasked with making the ultimate decision. The Liberals talk a lot about the importance of the autonomy of the person. Well, someone has lost autonomy when somebody else is making the decision. That is why many experts urge caution.
For example, Dr. Pageau of Université Laval told the Special Joint Committee on MAID that it is simply not ethical to permit MAID for persons with dementia through advance requests. He posed this question: As the disease progresses, are we honouring the wishes of the person who exists today, or the wishes of someone who existed years earlier? People change their mind. That question deserves much deeper examination before Parliament accedes. We should not be rushing through this very complex ethical question.
The strongest concern with advance medical directives is the issue of consent. The Supreme Court's decision in Carter began with the simple and essential principle that an individual “clearly consents to the termination of life”. Advance directives risk undermining that basic principle.
Dr. Alice Chung appeared before the special joint committee and posed an important question. She asked this: What right does the 60-year-old version of ourselves have to determine the quality of life experienced by the 80- or 90-year-old version of ourselves? She went on to note that medical evidence demonstrates that many individuals adapt to their severe illness, to their disability or to their cognitive decline in ways that they had not anticipated when they might have signed advance directives. What once to them seemed intolerable looking into the future, being uncertain of the future, may later become meaningful and a worthwhile life.
These are not abstract scenarios. They are real-world examples that we received from experts, which raised difficult questions about autonomy, dignity and the risk of ending the life of someone who may no longer share the wishes they had expressed years earlier.
In conclusion, we applaud the government for proposing to stop the expansion of MAID, but we say that it must not—