Debates of Nov. 4th, 2026

Medical Assistance in Dying Safeguards Act

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the main reason is that the bill introduces the concept of “reasonable means” of alleviating suffering when a person no longer has capacity. It is version 2.0 of the phrase “reasonably foreseeable natural death”. In practice, this will create confusion in clinical settings. That is what the practitioners I have consulted are telling me. That is why I believe that, if the government truly intends to model this legislation on Quebec's law, then it should adopt the wording used in Quebec rather than inventing new concepts, especially concepts that could create uncertainty in clinical practice. That is the main reason. That is why I talk about ordinary means.

The lady I was referring to will be given some sort of medication, and she will no longer be a nuisance. Does that constitute conditions considered tolerable in the eyes of someone who made an advance request and who, under this bill, is being told that their wishes will be set aside? This goes to the very principle of advance requests. The Quebec law is subtle. It refers to clinical judgment and does not refer to “reasonable means”.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster—Meadow Lake, SK]

Madam Speaker, we have heard more than once this evening and throughout the day that Conservatives would like to see the bill split in two. We believe there are two separate issues. There is the mental illness component and there is the advance request component.

I am wondering what my colleague thinks about this. Would he agree that there are two separate issues and that both deserve a fulsome debate, specifically the advance requests?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, as I already said at the start of my speech, or during a question a while ago, this bill has two components. I had hoped that we could hold separate votes, I mean, that we could divide the vote at second reading stage.

Following our work in committee, we could have considered whether to request that the bill be divided and that separate votes be held. At this stage, I would like the Conservatives to consider the possibility of holding two votes at second reading stage.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

Madam Speaker, I was in the House five years ago, but I was not involved in the entire process. My father was ill for many years. Experiencing something like that first‑hand makes someone see things differently. I am not telling this story just so I can say that this is what I went through, so here is how it should be.

However, why has there been such a big shift in five years? What does my colleague think happened, and what does he make of the direction that we appear to be taking in the votes ahead?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, as I said, I do not understand why the government is doing a complete about-face when it comes to mental disorders. As for advance requests, it has accepted the Bloc Québécois's position that the provinces are responsible for health care. Since we are talking about end-of-life care, it is reasonable to say that if additional safeguards are warranted, then a province may proceed as long as it has enacted legislation and meets certain conditions.

However, since the only law currently in place is in Quebec, and since the minister claims that it should be modelled on Quebec's experience, I would have preferred to see the same wording, more importantly to avoid introducing a concept that could create confusion in clinical practice. That is what I would say.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, in the “Sixth Annual Report on Medical Assistance in Dying in Canada”, from Health Canada, detailed data was gathered on MAID requests and on the number of requests that were carried out. Strikingly, in one year, 692 people made and then withdrew a request for MAID. This is interesting. These are people who, because of where they were at and because of whatever aspects of their circumstances, made that request and then decided they did not want it. That is 692 people in one year.

Very clearly, if we had a system of advance requests, a person could be killed later based on a document they signed before, without being asked about that contemporaneously at the time they are being killed. That is in this bill. The bill would not require that they be asked anything at the time their life is ended. Someone could carry that out based on what they said before. Where would that leave the 692 people in one year who, using their autonomy, made one decision but later, also using their autonomy, made a different decision to undo their previous decision?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, with all due respect, I think that my colleague is comparing apples and oranges. I also think that he misunderstands the very principle of an advance request. An advance request is made while a person is still of sound mind, after being diagnosed with a degenerative illness that progresses in stages.

At the formal meeting where the patient's criteria for what is tolerable are officially determined, the patient may even receive an explanation of what their will be like and what they will experience up to the end. Out of respect for the patient's dignity and self-determination—in health matters, the law always gives precedence to the individual's personal integrity—a person has a right to say they want to receive MAID when they become incapacitated and their tolerance threshold is met, if this is truly what they wanted and if their decision was based on an informed choice.

I fail to see any moral issue there, unless a person is religious.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I want to pick up on the issue of end-of-life care, because it varies, from what I have found. When I was the health critic in the province of Manitoba, there were individuals in hospitals getting panelled and almost classified as needing end-of-life care, and they went to other institutions. It really varies.

I am hoping that we will see more debate on the type of care in our communities today. It is important that we have a sense of co-operation when dealing with things such as palliative care and hospice care. These are all important elements that should be taken into consideration.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I want to remind my colleague that this was the mandate of the first special joint committee, which submitted a highly detailed report on the matter, along with a host of recommendations confirming the need to strengthen palliative care.

I urge my colleague to persuade the Minister of Finance to transfer more money to the provinces, which deliver end-of-life care, so they can finally do their work properly. The federal government must co-operate. It cannot introduce exemptions or generalized restrictions without providing the resources to implement them.

[Cheryl Gallant, Conservative, Algonquin—Renfrew—Pembroke, ON]

Madam Speaker, I am sharing my time with the member for Battlefords—Lloydminster—Meadow Lake.

I rise today on behalf of the caring Canadians in the compassionate riding of Algonquin—Renfrew—Pembroke to speak to Bill C-41, the medical assistance in dying safeguards act.

I want to begin by thanking the co-chairs and the elected members of the Special Joint Committee on Medical Assistance in Dying for their work in reviewing calls to expand medical assistance in dying to those who are not dying but instead suffering from mental illness. The committee is bipartisan. It recommended to permanently exclude mental illness as a sole condition for receiving medical assistance in dying, which is welcomed by my constituents and the vast majority of Canadians who have survived mental illness or who are currently living with severe mental illness.

My Conservative colleagues on the special joint committee included a number of supplementary recommendations that I believe should be highlighted before the bill is brought to committee.

The first recommendation was to call on the government to support the member for Cloverdale—Langley City's private member's bill to permanently exclude mental illness as a condition to access medical assistance in dying. Sadly, the government rejected the recommendation and voted down the bill. Instead, the government brought forward a bill expanding medical assistance in dying to allow advance requests, which had not been studied by the special joint committee. While the bill does include the permanent repeal of mental illness as an eligible condition by including it in the legislation to expand access to MAID and voting against a clean bill, the government has politicized this sensitive issue. This was a regrettable decision by the government, but I truly hope we can return to a more collegial approach when it goes to committee.

While the government has given this bill the short title of it being the medical assistance in dying safeguards act, its purpose is not to create safeguards but to allow advance requests. In setting out the criteria for advance requests, the government reveals how difficult any safeguards for advance requests would be.

The bill states:

if, by virtue of subsection (6), medical assistance in dying on the basis of the advance request was previously not provided because there was doubt as to whether the person’s words, sounds or gestures constituted a demonstration of refusal or resistance, ensure that there are at least 30 clear days between the day on which the words, sounds or gestures were observed by a medical practitioner or nurse practitioner and the day on which the medical assistance in dying on the basis of that request is provided;

What the bill is saying is that anyone who has given an advance request on the basis of having an illness where death is reasonably foreseeable can later refuse to go through with it. If there is any subjective doubt felt by the medical practitioner as to whether their patient has refused, the medical practitioner must wait 30 days before trying to administer a substance that would cause death. This alone calls into question any diagnosis that death was reasonably foreseeable. It creates that perverse incentive where a medical practitioner must decide if they doubt the patient's attempt at refusal or they doubt their own medical judgment. No Canadian's life should be lost to confirmation bias.

Even the criteria for administering MAID following an advance request includes a subjective opinion by the medical practitioner that the person who has lost the capacity to consent is experiencing intolerable physical or psychological suffering. If a person has lost the capacity to consent, how can their psychological suffering be assessed? Not only are the limited measures in the bill an insufficient safeguard, the government is downloading the job onto the provinces.

That the government would take this approach so soon after the Ontario government gutted its own MAID review panel is all the more troubling. The fact that Ontario's MAID review panel is run by the coroner's office only highlights the lack of safeguards.

This is why Conservatives made a different recommendation, which states:

The government should work with provinces and territories to establish minimum national standards for MAID oversight to ensure the effectiveness and enforceability of MAID safeguards.

Those standards should include prospective review mechanisms capable of pausing or stopping a provision where serious compliance concerns arise before death, stronger review of prior records and assessments, clear referral pathways for potential Criminal Code violations, and greater independence of oversight bodies from MAID delivery systems.

Given the irreversibility of MAID, genuine safeguards would ensure a case could be stopped before proceeding. Families should not be forced to go to court to protect their loved ones. Doctors should not be assessing patients for MAID in a Tim Hortons parking lot, then driving the patient to the clinic to be killed, as Dr. James MacLean did. Dr. MacLean only received a slap on the wrist from the College of Physicians and Surgeons of Ontario for his drive-through MAID.

The bill provides no safeguards for the kind of doctor shopping that saw an Ontario man denied MAID in this province seek out Ellen Wiebe in B.C., who assisted in his suicide for irritable bowel syndrome. That man's family was not as lucky as the family of an Alberta woman who also was denied MAID in her province but was approved for MAID after a zoom call with Ellen Wiebe. That family secured a court injunction, and the woman stopped seeking MAID.

Those are just two examples of cases where the current safeguards failed to stop a doctor and MAID activist like Ellen Wiebe. That a court found Dr. Wiebe to be mistaken in granting a track 2 MAID approval called into question the current lack of safeguards. That no criminal charges have followed the court findings proves the safeguards are insufficient. Does anyone believe that doctors such as Ellen Wiebe or James MacLean would have any doubts if a patient who gave an advance request unclearly indicates a refusal?

Conservatives recommended a full review of the effectiveness and enforceability of current MAID safeguards to prevent vulnerable Canadians from being assisted in committing suicide, but instead of listening to our recommendations, the bill would expand MAID to advance requests. Fortunately, it is not too late. We can delete the clauses expanding MAID and turn the bill into a real set of nationally enforceable safeguards. While the government was playing politics and voting down my colleague's clean bill earlier, we can put that aside to transform this bill from one that would expand MAID to one that would provide real safeguards.

Elected parliamentarians from the Liberal Party and the Conservative Party worked together on the special joint committee to find common ground in rejecting the expansion of MAID to people solely suffering from mental illness. While we may disagree on expanding MAID to include advance requests, the majority of people on both sides of this debate are motivated by compassion, yet when it comes to mental illness, or it comes to those who are suffering but whose deaths are not reasonably foreseeable, offering MAID is not compassion, but an admission of our failure to provide the compassion required to live a life of meaning and purpose.

Tomorrow, the government will undoubtedly table a budget filled with more compassion for investors and corporations than for those suffering in silence, and while the government gives hundreds of millions of dollars to fake spaceports and fraudulent electric buses, Canadians linger in hospital hallways. We do not need half measures like five-year funding formulas that add marginal capacity to mental health services. We need bold moves like the Manhattan Project to fight mental illness. If we are not successful in eradicating mental illness, the effort alone could be the hope so many people need.

Killing is not compassion. Fighting for everyone to enjoy a life of meaning and purpose is compassion. If we do not take this opportunity to increase the safeguards and effectively roll back track 2 for all but the most extreme cases, then all we would be doing is greasing the slippery slope. Ever since the Supreme Court overturned precedent and invented a right to death, we have witnessed exactly what so many predicted would happen. Advocates keep on pushing to expand it. First it was those without terminal illness. Then it was those with only mental illness. Now we have doctors asking for the power to decide if an infant's life is worth living. They will not stop pushing it until they find a court to allow it. Nine unelected judges should never decide whose life has value and whose does not. It falls to Parliament to fight for life.

Do not go gentle into that good night.
Rage, rage against the dying of the light.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I posed a question to the member's colleague in regard to the whole issue of advance directives, which has actually been in the public for many years. We can go back to the 1990s, when we had courts dealing with a different form of MAID.

However, the question I have for the member is this: Does she believe that her position on the issue reflects what a majority of her constituents would want her say about MAID? Does she believe that she has provided balance, at the very least, or recognized what her own constituents, and it might even be a majority, have to say about this very sensitive issue?

[Cheryl Gallant, Conservative, Algonquin—Renfrew—Pembroke, ON]

Madam Speaker, the overwhelming majority of people who have contacted me do not want MAID to go forward. Quite frankly, the discussion on advance requests has really not been fully discussed. In fact, it has not been discussed at all. Very few people have raised the issue of advance requests and the whole issue of safeguards has never been put into place. That is what their concern is, that the safeguards will not be there for those who are not ready, do not want it or want to change their mind, are in place.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I am going to quote the Carter decision, and I would like my colleague to tell me whether she agrees with this statement.

This said, we do not agree that the existential formulation of the right to life requires an absolute prohibition on assistance in dying, or that individuals cannot “waive” their right to life. This would create a “duty to live”, rather than a “right to life”, and would call into question the legality of any consent to the withdrawal or refusal of lifesaving or life-sustaining treatment. The sanctity of life is one of our most fundamental societal values. Section 7 is rooted in a profound respect for the value of human life. But s. 7 also encompasses life, liberty and security of the person during the passage to death. It is for this reason that the sanctity of life “is no longer seen to require that all human life be preserved at all costs”.

What does my colleague think about that?

[Cheryl Gallant, Conservative, Algonquin—Renfrew—Pembroke, ON]

Madam Speaker, extreme procedures for extending life do not have to be performed if people do not want them to be performed. It is not a sin to reject special treatment to extend life.

Now, in terms of the other topic, I would say the vast majority of people in my riding value life and compassion to the point of, instead of even thinking about MAID, they would rather put their money, their time and their volunteer hours into hospices to make sure that, when somebody passes, they do so in comfort rather than having the process sped up. That is because people from where I come from, including myself, believe in miracles.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, we have heard the Liberals argue that anyone who does not support this bill is putting vulnerable Canadians at risk, but Conservatives have already put forward legislation to permanently exclude mental illness, and the Liberals voted against it.

Could my colleague explain why the government is now insisting that protecting Canadians struggling with mental illness must come at the price of expanding assisted dying, when Parliament could deal with these two issues separately?

[Cheryl Gallant, Conservative, Algonquin—Renfrew—Pembroke, ON]

Madam Speaker, I cannot get my head into the brain of a Liberal. It is quite diabolical what they are doing. It sounds like they would rather save money and deal with mental illness by having MAID.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster—Meadow Lake, SK]

Madam Speaker, when considering legislation, we have a responsibility as parliamentarians to think carefully about the decisions we make in this place and the real-life impacts they have on Canadians. That responsibility is even greater when we are dealing with matters of life and death.

Medical assistance in dying is not an ordinary policy issue. The decisions made under this legislation have final and irreversible consequences. There is no opportunity to change course or undo what has been done.

I approach this legislation with a deep respect for the inherent value of human life and with the conviction that our laws must offer protection to those who are most vulnerable. That responsibility is particularly important when we consider the changes to Canada's MAID framework before us today.

One area where these concerns have been particularly evident is the question of MAID for individuals whose sole underlying medical condition is mental illness. Previous Liberal legislation amended the Criminal Code to include a two-year prohibition on the availability of MAID for mental illness. The legislation included a sunset clause that would allow the exclusion to expire, opening the door to this expansion of MAID eligibility.

Including a sunset clause on such a significant change was reckless. Mental health experts and advocates have continuously raised serious concerns about expanding MAID eligibility to include mental illness, and a mental illness should not be treated as irremediable. Recovery is possible even for those experiencing severe and prolonged suffering. A person's circumstances and response to treatment can change over time. Someone experiencing severe suffering today may find relief through treatment and support tomorrow.

The most important message we can send to those struggling with their mental health is that there is always hope for recovery. Offering someone MAID when they are experiencing hopelessness risks taking away the opportunity for that recovery. That is why the Special Joint Committee on MAID recommended making the exclusion for mental illness permanent in the Criminal Code. This recommendation followed testimony from medical experts, researchers, advocates and Canadians with lived experience.

The chief medical officer at the Centre for Addiction and Mental Health told the committee that there is currently no established criteria or consensus among psychiatrists about whether or when a mental illness should be considered irremediable. He also pointed to the difficulty of distinguishing a request for MAID from a suicidal intent, explaining that researchers found no reliable way to make that distinction.

Professor Brian Mishara, an expert in suicide prevention, also spoke to the uncertainty of predicting whether someone will recover. His testimony reinforced the importance of recognizing that even when someone is experiencing severe and prolonged suffering, their circumstances and outlook can change. We cannot lose sight of that possibility when considering legislation with such irreversible consequences.

Another important concern raised before the committee was the lack of access to mental health treatment and support. The chief medical officer also acknowledged there may be individuals who have not had the opportunity to access treatments that could help them. There is something deeply troubling about offering someone an irreversible end to their life when they may not have had a real opportunity to access the treatment and care they need.

We cannot say someone has truly exhausted all their options when all options have not been made available to them. For someone struggling with mental illness, access to treatment should not be out of reach. They deserve the opportunity to receive care, explore treatment options and find a path forward. We cannot allow gaps in our health care system to become a reason why somebody is offered MAID.

A system that offers MAID without ensuring access to appropriate care is failing the very Canadians it should be protecting. Permanently excluding MAID for people whose sole underlying condition is a mental illness is the right decision. This is a recognition of the serious concerns Conservatives have been raising all along. Expanding MAID to include mental illness would undoubtedly lead to the death of someone who still has a chance to recover. With the right treatment, care and support, their future would be very different. We should never rob someone of the opportunity to get better, or, in fact, rob their families and friends of the opportunity to see them recover.

This makes the Liberal government's handling of MAID all the more troubling. The government had an opportunity to take a clear and direct step to protect Canadians with mental illness. If the Liberals were serious about protecting those affected, they would have supported Bill C-218. That Conservative private member's bill would have addressed the issue directly and provided an opportunity to work together on a measure that has broader support.

Instead, the Liberals voted down Bill C-218 and then brought forward their own legislation. Bill C-41 would go beyond permanently excluding MAID for mental illness. It would also include further expansion to Canada's MAID regime. These are separate issues. Each deserves its own debate and careful consideration. The recent committee study focused on MAID for mental illness. It did not examine these further expansions to the regime. This is why these issues should not have been combined in one bill. The recent committee study focused on MAID for mental illness. It did not focus on or scrutinize further expansions of the regime, but the committee did hear testimony from witnesses who raised serious concerns about vulnerabilities within the existing MAID framework. Those included gaps in access to care, social and economic pressures and questions about whether the current safeguards are working as intended.

Beyond these broader concerns, there have also been several public accounts of Canadians being offered MAID when they had not asked for it. Miriam Lancaster, an 83-year-old woman in British Columbia, has spoken about being offered MAID when she went to the hospital with severe pain. She had not yet even been diagnosed. Ultimately, doctors later found a fracture and she went on to recover. The death of Brigitte Stegemann, an 83-year-old grandmother who died by MAID in July, is now under investigation. Her family says she had made it clear that she did not want MAID and that she did not give final consent before the procedure.

These are just a few recent cases that have received media attention, and they raise serious concerns about consent, pressure and the protection of vulnerable people. These cases have occurred under the current MAID framework. These concerns become even more serious when we consider the Liberal government's proposal to expand MAID. If we are still struggling to ensure consent and to protect vulnerable people under the current framework, there are serious questions about whether the proposed safeguards will be enough. This is particularly concerning when someone can no longer speak for themselves.

Bill C-41 raises serious questions about the direction of Canada's MAID framework and the protections in place for vulnerable Canadians. The exclusion for MAID where mental illness is the sole underlying condition must be made permanent. Expanding eligibility to those with mental illness should never have been a consideration to begin with. The Liberals had an opportunity to work with Conservatives on targeted legislation to permanently address this issue. Instead, they put forward this bill that combines this important measure with further expansions to the MAID framework. These are separate issues, and they should have been dealt with separately. It is reckless to further expand MAID when serious issues remain around consent, pressure and coercion under the current system.

We have a responsibility to ensure that the law protects those who are most vulnerable. When it comes to the decision about someone's life, getting it wrong even once is one time too many.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my colleague spoke about suicidal crises. A suicidal crisis is reversible and does not make someone eligible for MAID. She talked about the gaps in the health care system, but that has nothing to do with eligibility for MAID.

If she has read the expert panel's report, she must know that for someone to be assessed—without necessarily getting a positive decision at the end of the process—the guidelines state that all available treatments must have been tried. The available treatments will span a number of years, if not decades. This is not a matter of whether or not health care is accessible. People cannot apply for MAID if they have not received care. If a person has not tried every possible treatment over a number of years and has refused one that could have improved their condition, they are no longer eligible for MAID.

There are guidelines in the expert report. I suggest that my colleague read it.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster—Meadow Lake, SK]

Madam Speaker, I humbly disagree. There are Canadians who have been suggested and coerced. I spoke of Miriam Lancaster, who went to the hospital with pain. It was suggested that she should have MAID. It happened that she had a fracture, and she ended up getting treatment and going home. The problem is that the current framework is not working. Canadians are still being coerced and pressured into ending their life without asking for it and, in some cases, without consent.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I think that the minister has been fairly clear in terms of working with provinces and territories to ensure that we have a rigorous process that has safeguards to protect people. I think that is an important thing to say. In my canvassing, I have had people talk to me about this issue. Where I disagree is that it seems to me that a majority do seem to want to see the legislation. I am not talking about knocking on doors and things of that nature.

I am wondering if the member could provide her thoughts on whether she believes that the Conservative Party's positioning on this issue, because that is what it seems to be, is reflective of what a majority of Canadians would want to see.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster—Meadow Lake, SK]

Madam Speaker, I will just say, to the first part of my colleague's remarks, that the current framework is not working. I referred to the death of Brigitte Stegemann, here in Ontario, who did not want and did not consent to MAID. Her death is under investigation because the current framework's safeguards are not working. If we add the mishmash of different provinces and territories, we then could end up with MAID tourism, where people are shopping around to get what they want if one doctor says no, that they do not think that the situation fits into that framework. This is a problem.

I will say, regarding hearing from constituents, I have received many petitions, specifically on Bill C-218. Many of my constituents wanted to see that passed. I have received many letters and phone calls regarding the importance of this and not wanting to see MAID expanded at all in any area.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Madam Speaker, why? This place has arrived at a consensus, albeit it took some time, on the first part of the bill. All the disabled groups, mental illness groups and everyone else recognized that the path the government was going down was the wrong one, in allowing mental illness to be the sole driver for MAID.

Why combine it with an expansion process that needs far more study, irrespective of where one is on the spectrum? Why combine it, with the deadline that the House is facing? What is the logical path for combining those two issues?

[Rosemarie Falk, Conservative, Battlefords—Lloydminster—Meadow Lake, SK]

Madam Speaker, I believe it is just for political gain. I believe the Liberals wanted to wedge and thought they could wedge us on this. At the end of the day, less than a month ago, that party voted against Bill C-218. It could have already been in committee. I heard a Liberal member say they had an issue with some of the verbiage. That could have been amended in committee. This could have been moved along, and we—

[The Assistant Deputy Speaker (Alexandra Mendès), Alexandra Mendes]

We have to move to another speech.

The hon. member for Milton East—Halton Hills South.

[Kristina Tesser Derksen, Liberal, Milton East—Halton Hills South, ON]

Madam Speaker, my remarks today seek to contribute to the discussion we have had in this House since 2016 regarding medical assistance in dying, commonly referred to as MAID, and particularly with respect to Bill C-41, the MAID safeguards act, which proposes to amend the Criminal Code and make two important updates. The first one is to end the expansion of MAID for mental illness as a sole condition, and the second is to allow Canadians to request MAID in advance for a time later in an illness.

MAID is a controversial topic, and it has generated much constitutional debate. For all the nuances, though, the main arguments are divided into two general opinions. From one perspective, providing legal access to MAID enhances the personal autonomy and dignity of people with serious illnesses, giving them control over the manner of their death. From another perspective, it could be a precarious medical advancement that could impact the lives of people who may already be vulnerable. This legislation would provide safeguards so that all Canadians can be assured of their rights and protections, specifically with respect to MAID for mental illness and MAID for advance requests.

Regarding the first change in Bill C-41, MAID for mental illness, MAID will not be available for those suffering with mental illness as a sole condition. The planned expansion for MAID to those with mental illness as a sole condition has been delayed twice to allow more time to consider questions around readiness and safeguards from the provinces and territories.

Most recently, a parliamentary committee made up of senators and MPs from different parties studied the issue, heard from experts and stakeholders and recommended that the expansion for mental illness not move ahead. I was a member of that committee, and the result of extensive discussions found that we cannot be assured that the provinces and territories are ready to safely and consistently assess and provide MAID for Canadians with mental illness as their sole condition. I will say that there was not necessarily consensus around the committee on all underlying issues and definitions, and that just indicates the variety of perspectives that were considered.

Without legislative action, the current exclusion for mental illness would expire on March 17, 2027, and this would have allowed MAID to be provided to eligible individuals on the basis of mental illness only. Given the lack of clinical consensus, Bill C-41 takes a precautionary approach and would maintain the exclusion.

I will make an important point here. Several people have contacted my office about this. The eligibility for people with other eligible conditions is unchanged. A person who has a mental illness may still be eligible if they meet all other legislative criteria. For example, someone with an advanced stage of terminal cancer who also has, for example, diagnosed clinical depression as a mental illness may still be eligible to access MAID on the basis of their cancer, so long as they meet all the other eligibility criteria. I will also note here that Bill C-41 uses the term “mental illness”, not “mental disorder”, so people with serious degenerative neurological disorders who are eligible today keep their access. We are talking about conditions like Parkinson's disease.

Mental illness can cause suffering just like the suffering experienced by a physical illness. Canadians living with mental illness deserve to have their suffering taken seriously, and our government takes it very seriously. We are working with provinces and territories to determine how we can best support Canadians living with mental illness in strengthening our public health care system. That is why we announced a $1.2-billion investment to extend the mental health and substance use agreements and home and community care agreements as we work with provinces and territories toward long-term solutions to prevent and treat mental illness. In addition, in 2023, we announced the working together to improve health care in Canada plan, which provides $200 billion over 10 years to provinces and territories, including $25 billion for shared priorities such as mental health.

Regarding MAID for advance requests, Bill C-41 would allow adults to make an advance request for MAID following an early-stage diagnosis of an incurable illness that is expected to take away their ability to make decisions. This would allow an individual to make an informed decision about their care while they still have capacity and would set out the circumstances in which they would want to receive MAID later in their illness. For example, someone diagnosed with early-stage Alzheimer's could make an advance request so that their wishes could be respected if they later lost the ability to make the decision for themselves. An advance request would not mean MAID is provided automatically. Eligibility requirements and safeguards would still need to be satisfied.

The role for the federal government relates to the Criminal Code. To implement this change, provinces and territories would still have to make advance requests available in their respective jurisdictions. Under the current law, a person must be able to give informed consent to receive MAID. They must understand their condition, their options and the consequences of their decision, and they must generally confirm their consent immediately made before MAID is provided.

Some illnesses, such as Alzheimer's disease and dementia, gradually take away a person's ability to make these decisions. As the illness advances, a person may no longer be capable of giving informed consent by the time they would want MAID. Under the existing law, this means they cannot receive MAID, even if they were clear about their wishes while they were still capable. Many Canadians feel this is inherently unfair.

Importantly, this is about respecting the wishes expressed by an individual while they are capable of making decisions about their own care. Importantly, a family member would not be able to make an advance request for MAID on someone else's behalf.

Provinces and territories would decide whether to make advance requests available in their jurisdictions, and our government will continue working closely with them as we move forward. This is because MAID eligibility is a shared federal-provincial matter. The provincial role in the MAID framework is crucial to the fair and consistent delivery of care to Canadians.

Individual provinces and territories have their own customized approaches to MAID to best serve their populations. Provinces and territories provide services, coordinate care and regulate providers so that Canadians in their respective provinces and territories have consistency and certainty. This must be done in deference to the autonomous choice of an individual as they approach the end of their life with a grievous and irremediable medical condition. In short, Canadians rely on their provincial and territorial governments to provide access to their charter right of security of the person in the context of MAID.

If the House will indulge me, I will provide a short legal and historical context for this discussion. I will take members way back.

A discussion about MAID became necessary in 2015 after the Supreme Court decision in the Carter case. Carter decriminalized medically assisted death. In that decision, our Supreme Court held that the criminal laws prohibiting assistance in dying limited the rights to life, liberty and security of the person under section 7 of the charter in a manner that was not demonstrably justified under section 1. As a result of the Supreme Court's decision, the Criminal Code provisions prohibiting assisted suicide and providing that no person may consent to death being inflicted on them were deemed to be in violation of Canadians' rights under the charter.

Responding to the Carter decision via Bill C-14 in 2015, MAID was legalized for competent adults whose natural death was reasonably foreseeable. The Criminal Code established eligibility criteria and safeguards for MAID, as well as made exemptions to criminal offences, including murder and aiding someone to die by suicide.

A subsequent case, Truchon, was heard at the Quebec Superior Court in March 2021, and the court's decision in Truchon expanded eligibility for MAID to adults whose natural death was not reasonably foreseeable. This created two tracks in the Criminal Code: one where natural death is reasonably foreseeable, track 1, and one where it is not, track 2.

In addition to eligibility criteria for those receiving MAID, notably that an individual must have a grievous and irremediable medical condition, the Criminal Code set out additional procedural safeguards that health care providers must follow before providing MAID where death is not reasonably foreseeable. The same legislation temporarily excluded persons from eligibility if their sole underlying medical condition was a mental illness. That exclusion for mental illness was originally set to end on March 17, 2027. Bill C-41 would permanently end the extensions.

I would hazard that this issue of expansion for mental illness has perhaps been one of the most contentious and complex issues we have grappled with in the development of MAID legislation. In the joint committee's third report, it was noted that although MAID is governed by federal law, health care regulations and medical standards fall within provincial jurisdiction. The division of authority introduces some added legal and administrative complexity in aligning federal policy with provincial implementation. With the benefit of the special joint committee's findings, we have determined that the provinces and territories simply are not ready to administer an expansion of MAID for mental illness.

I speak with some experience on end-of-life issues. Prior to entering politics, I worked in long-term care, I worked as a licensed funeral director and I worked as an estate planning lawyer. I have also sat as a board director of our local North Halton Hospice foundation. This is an organization seeking to build a palliative care hospice residence in my riding of Milton East—Halton Hills South.

In these professional activities, discussing death became a fairly innocuous exercise. Death is, most simply, a fact of life that when possible, is best planned for and discussed with loved ones and trusted professionals. It is my opinion that those discussions are best had without the pressure of prying eyes or proselytization from the outside world, and free from those who contend they know better about how an individual should move through this life and how they should move on to the next. Choosing a medically assisted death is a fundamentally personal decision and a very fundamentally personal right.

How MAID is delivered has become a main focus of the debate since 2015. Some of the concerns I have heard from people in my riding include the fear that vulnerable people will turn to MAID as a first option because they feel that other care or health services are too difficult to access or simply do not exist. Also, there is a concern that people could be coerced or influenced to opt for MAID, and this may be more likely for people who could already be vulnerable due to other socio-economic factors. It is important that Canadians are properly informed on the process to access MAID and the safeguards that exist to ensure that vulnerable persons do not improperly access MAID.

First, at least 90 days must pass between the day the MAID eligibility assessment begins and the day the person receives MAID. Second, two health care practitioners, independent of one another, must conduct assessments and confirm that the person is actually eligible for MAID. Third, these assessors must inform the person of all reasonable and available options for relieving their suffering and offer the person consultations with people who provide those services. Fourth, the person and the assessors must have discussed all of the options for relieving the person's suffering and agree that the person has seriously considered those options. Last, immediately before the person is to receive MAID, the MAID provider must give them the opportunity to withdraw the request for the procedure. If the person wants to proceed, the MAID provider must ensure that the person gives final consent.

In Bill C-41, which we are discussing here today, there would be additional requirements in the case of an advance request. First, generally, we would implement minimal national safeguards that would set out Criminal Code requirements for the lawful provision of MAID based on advance requests. Second, the implementation of provincial and territorial frameworks would have to be developed and would have to state that any province or territory wishing to permit advance requests must first enact its own legislative framework. Advance requests would remain prohibited in jurisdictions that do not have this framework. Third, operational rules and participating jurisdictions would be responsible for rules on making, validating, amending, storing and withdrawing requests, including a reliable storage mechanism to verify that a request remains valid. Fourth, the requirement for two independent assessments would be enhanced so that the two physicians or nurse practitioners must confirm that the circumstances in the request have occurred, that the person is in an advanced and irreversible decline, and that they are experiencing intolerable suffering. Fifth, as in any MAID case, refusal would end the process. MAID could not be provided to a person who refuses, and their advance request would then be invalidated.

When it comes to Quebec, Quebec's existing framework would be incorporated into the federal criminal law regime without the need to amend Quebec's legislation.

I want to note here the tremendous responsibility that frontline care providers would shoulder in fulfilling these criteria. Their expertise, training, compassion and courage in providing this service really cannot be understated. These safeguards show that the analysis in providing MAID in each unique case would be a process of some burden, and it should be.

I note the historical position of our Conservative opposition colleagues. They have been vocal on this, urging the government to scrap the expansion of MAID for what they call a mental disorder, most recently in a private member's bill, Bill C-218. Bill C-218 was premature at the time of its tabling, as the special joint committee had not yet had time to consider evidence or hear from witnesses, and the bill ultimately failed in this House.

In any event, our government's Bill C-41, currently before this House, aligns with the request in the Conservatives' private member's bill, Bill C-218, to end the expansion of MAID for someone with a mental illness as a sole condition. On that, we have agreement, although perhaps for different reasons. I am not sure of my Conservative colleagues' position on Bill C-41, but I cannot imagine on what grounds they would oppose it, since in one instance, it would provide what Bill C-218 asked for in ending the expansion for mental illness, and in the second, it would provide greater freedom and autonomy for Canadians in determining their own treatment and end of life through advance requests, a principle that is very popular, especially among older Canadians.

It is hard to deny that MAID can be a contentious topic, because for all the legalities, science, regulations and debate, we are essentially discussing an issue that is the most profound experience of being human. We are all going to die. Dying is still a great mystery, one that we must continue to navigate and explore together with conversations like this one that embrace mutual respect, empathy and understanding for the emotion and fundamental humanity of contemplating how we leave this world.

During my time working as a funeral director, I had the privilege of hearing the unfiltered experiences and stories of families as they found themselves as observers and helpers during the death journey of their loved ones. This is where the importance of individual autonomy and choosing the care and form of dying really became real for me. In the years that I have been serving on the hospice foundation board, a discussion has proceeded about how health care should address the experience, needs, beliefs and requests of each unique individual as they move through their own unique, individual death.

Not all of us will be able to plan for our death or have control over the circumstances and timing of our transition from this world, but many of us will. When that time comes, I want to have the autonomy to make the choice that is best for me, in consultation with my family, my health care provider and my own conscience. We all deserve that. I would argue that it is the role of legislators to work with experts to achieve this for Canadians, not only because of the moral imperative to do so but because security of the person is enshrined in our charter, which contains protections for individuals, allowing them to maintain control of their bodily integrity, personal integrity and basic freedom of choice.

Conversations such as the one we are having here in the House work to expand minds, address misinformation, open the dialogue and provide space for each of us to learn and share. These debates are absolutely imperative in bringing the best care to our citizens and helping government move toward legislation that will serve all Canadians.