OFFICIAL REPORT (HANSARD)

House of Commons Debates Volume 151 No. 281 1st SESSION 44th PARLIAMENT Tuesday, February 13, 2024 Speaker: The Honourable Greg Fergus HOUSE OF COMMONS CANADA (Table of Contents appears at back of this issue.) COMMONS DEBATES February 13, 2024 DEBATES No. 281 No. 281 N o 281 Volume 151 281 13 02 2024 2024/02/13 10:00:00 Débats de la Chambre des communes House of Commons Debates House Of Commons 1 44

The House met at 10 a.m. Prayer

Routine Proceedings Routine Proceedings

(1000) [ English ] Petitions Taxation

Mr. Mike Morrice (Kitchener Centre, GP) :

Mr. Speaker, it is an honour to rise to present a petition that notes we are in the middle of both a climate crisis and a cost-of-living crisis. Petitioners note that folks across the country are struggling to afford housing and food, while also dealing with unprecedented climate disasters that will only continue to worsen if urgent action is not taken. They note that while this is happening, fossil fuel companies made record profits last year, with the five largest fossil fuel companies operating in Canada alone making annual profits of over $38 billion.

They note that a significant portion of these profits were made as a result of price gouging at the pump, in 2022, costing Canadians an additional 18¢ per litre, more than their previous profit margins on fuel and far more than the 2¢ per litre that carbon pricing went up in the same period last year. They also note the similar taxes on excess profiteering on those oil and gas companies has been instituted in Canada in other sectors already, as well as on oil and gas companies in the U.K. and Europe.

They then call on the Government of Canada to immediately apply a 15% windfall profit tax on the excess profits of oil and gas companies operating over the past three years and to reallocate the revenues that would be generated from that to proven climate solutions as well as to efforts to make life more affordable for Canadians, including investments in public transit, in retrofitting buildings and in greening the grid.

Firearms

Mrs. Rosemarie Falk (Battlefords—Lloydminster, CPC) :

Mr. Speaker, I rise to table a few petitions today. The first one is in regard to the Liberal government's firearms buyback program. The Liberal government's plan to confiscate legally acquired firearms from law-abiding firearm owners and from retailers will do nothing to reduce the crime in Canada. These petitioners are calling on the Liberal government to cancel its plan to enforce a costly and ineffective firearms buyback program, and instead, to set its sights on common-sense polices that will keep guns out of the hands of dangerous criminals.

(1005) Military Chaplaincy

Mrs. Rosemarie Falk (Battlefords—Lloydminster, CPC) :

Mr. Speaker, the next petition I am presenting is on public prayer in the Canadian Armed Forces. The recent directive issued to military chaplains banning religious symbols and public prayer at ceremonies like Remembrance Day actually undermines our religious freedoms, and one of the very values, ironically, that our men and women in uniform have fought to defend. The petitioners are calling on the House of Commons to affirm the right of public prayer in our Canadian Armed Forces.

Children and Families

Mrs. Rosemarie Falk (Battlefords—Lloydminster, CPC) :

Mr. Speaker, I rise to table my last petition regarding Bill C-318 . We know that adoptive and intended parents in our country are at a disadvantage under the current EI system, and all parents deserve equal access to parental leave benefits. Bill C-318 delivers equitable access to parental leave for adoptive and intended parents. The undersigned of this petition, the residents of Canada, call upon the Government of Canada to support adoptive and intended parents by providing a royal recommendation for Bill C-318 .

The Environment

Ms. Elizabeth May (Saanich—Gulf Islands, GP) :

Mr. Speaker, it is an honour to rise and present a petition from constituents in Saanich—Gulf Islands who are concerned about the nexus between the climate crisis and the health of humanity.

The petitioners note that the World Health Organization has determined that, “Climate change is the greatest threat to global health in the 21st century.” The health impacts from climate change include lung disease; heat-related illness and death; the spread of infectious diseases, and we note, in Canada, the spread of Lyme disease related to climate change; displacement; famine; droughts; and mental health impacts, which are already being felt in Canada and abroad, and they are expected to accelerate. Petitioners are, and I want to underline this, a particular class of knowledgeable individuals.

The petitioners are described as physician mothers of Canada. They are people who are mothers and also speak with concern for our children, as many of us do, but with the added lens of the knowledge that they bring as physicians. They call on the government and the House of Commons to act on the Canadian Association of Physicians for the Environment's calls to action on climate change and health, prioritize the reduction of emissions as quickly as possible, implement a national carbon pricing strategy and commit to the rapid elimination of fossil fuels from our economy.

Questions on the Order Paper

Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.) :

Mr. Speaker, I would ask that all questions be allowed to stand at this time.

The Deputy Speaker :

Is that agreed?

Some hon. members: Agreed.

Government Orders S. O. 57

[ Translation ] Government Business No. 34—Proceedings on Bill C-62 Motion That Debate Be Not Further Adjourned

Hon. Steven MacKinnon (Leader of the Government in the House of Commons, Lib.) :

Motion Mr. Speaker, in relation to the consideration of Government Business No. 34, I move:

That debate be not further adjourned.

[ English ]

The Deputy Speaker :

Pursuant to Standing Order 67(1), there will now be a 30-minute question period. I invite hon. members who wish to ask questions to rise or to use the “raise hand” function so the Chair can have some idea of the number of members who wish to participate in this question period. The hon. member for Battlefords—Lloydminster.

Mrs. Rosemarie Falk (Battlefords—Lloydminster, CPC) :

Mr. Speaker, here we are once again, seeing the Liberals enforce time allocation. I wonder, through you, why it is that the Liberals are so terrible at managing legislation to put forward the House calendar. At the end of the day, they are the ones deciding what the calendar is and what their priorities are, and it seems like it is at the eleventh hour, every single time. Here we are, once again, with them trying to invoke closure.

(1010) Hon. Arif Virani (Minister of Justice and Attorney General of Canada, Lib.) :

Mr. Speaker, I thank the member for her contributions, but reject the characterization. We indicated quite openly and publicly that we would not proceed with medical assistance in dying where mental illness is the sole underlying condition until after we had received the study from the joint committee that is made up of members of Parliament and of senators. That joint committee study was tabled in this chamber on January 29. Shortly thereafter, we reviewed that document, prepared legislation and tabled that legislation expeditiously.

That legislation is now before this chamber, and we have a statutory deadline to meet prior to March 17 that relates to the sunset clause, thus necessitating the need to move it expeditiously through both this chamber and the upper chamber.

Mr. Peter Julian (New Westminster—Burnaby, NDP) :

Mr. Speaker, we do have a date that has been fixed, which is March 17. We have, at this point, only 14 sitting days to get this bill not only through the House of Commons but also through the Senate, as the Minister of Justice said. My concern is the confusion. If this bill has not gone through both Houses, what we would end up with is a situation of utter confusion for something as fundamental as medical assistance in dying. To have that confusion is something that I do not think is acceptable to any Canadian. It is important that we get this right. It is important that we meet the deadline.

What I am surprised about is that we do not have a consensus. This is the kind of situation where all parties should get together and facilitate getting this through the House because of the importance of not adding or installing the confusion that would surely result in us not meeting the deadline. My question for my colleague is very simple. Why is there not a consensus around this so that we can move it through the House this week without the use of time allocation?

Hon. Arif Virani :

Mr. Speaker, I would say, quite candidly, that I agree with the member's supposition. When we are dealing with a matter of such compelling interest and such consequential interests that are at stake, with respect to a life-and-death situation involving medical assistance in dying, it is important that parliamentarians work in unison. There have been divisions on this issue in the past, and there remain divisions in this chamber with respect to this issue. What we are saying is that we are dealing distinctly with the issue of mental illness as a sole underlying condition.

On that piece, we believe the prudent course is to have an extension of time for a following three years. We hope that all parliamentarians would support that and the pressing need to get this piece of legislation through both Houses to royal assent prior to March 17 to avoid the very confusion the member identified.

Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.) :

Mr. Speaker, when I reflect on this, the whole discussion and debate that has taken place over the last number of years has been fairly extensive. Going back to the Supreme Court of Canada's Carter decision of 2015 and to the amount of committee and House of Commons' time, there has been a great of deal of discussion, justifiably so. It is important to recognize that medical assistance in dying is not necessarily a new issue. It has been well discussed in many different forms, even the issue of mental health well-being.

I wonder if the minister could provide his thoughts on the journey taken to bring us to this point today and on why it is so critically important that it pass by the end of this week.

Hon. Arif Virani :

Mr. Speaker, I thank the hon. member for his contributions today and every day in this Chamber. The journey has been a detailed one, a responsible one and a prudent one. What we understand, as a government and as parliamentarians, is that mental illness causes suffering, and that suffering is equivalent to physical suffering. We also understand people have decision-making capacity, including those who are mentally ill.

We also understand that, as a federal government in a federation where the health care system and the delivery of health care is primarily the jurisdiction of provinces, proceeding in a situation where the provinces have spoken with one voice, saying that provinces and territories are not ready to deliver medical assistance in dying for people who have mental illness as their sole underlying condition, in that context, we have to listen to those provinces and work with those provinces to help them with their readiness.

The provinces have spoken uniformly to the Minister of Health and to myself about their lack of readiness and about the fact that more time would be beneficial to ensure that there is better take-up of the curriculum and that supports are in place for those who would assess and provide MAID, and that there is more understanding of how those safeguards would be implemented in the context of an individual who has mental illness as their sole underlying condition. Based on that, we are seeking, through this chamber and through the upper chamber, an extension of three years.

That would be a prudent course when the situation is very significant, when the interests are significant and when then consequences are very permanent.

(1015) Mr. Peter Julian :

Mr. Speaker, on a point of order, I apologize. I misspoke. I said 14, but there are actually only nine sitting days, including today, before the deadline.

The Deputy Speaker :

I thank the hon. member for the clarification.

Ms. Elizabeth May (Saanich—Gulf Islands, GP) :

Mr. Speaker, I thank hon. Minister of Justice for sharing these comments with other members of the cabinet, particularly the Minister of Health . This is perhaps the most difficult issue any of us will ever deal with as members of Parliament. Strangely enough, I will just add that, had she been alive when I was a member of Parliament, Sue Rodriguez, who went all the way to the Supreme Court of Canada for the right to die with dignity, would have been my constituent. She lived in North Saanich. There is tremendous public support in my area for medical assistance in dying being available to Canadians.

However, I have to say, when it came to Bill C-14 and extending it to where mental illness was the only underlying cause, I voted for that bill only because there was a time delay, and we should be ready before it comes into effect. I support what the Minister of Justice just said. We know the provinces have spoken with one voice. I am very concerned that access to treatments for mental health are still not available and might push people toward seeking MAID because they cannot get access to something like psilocybin that could deal with their underlying causes. I very much object to using time allocation.

I do not think I have ever voted for time allocation in this place, but now I must because the court deadline is approaching; March 17 is soon. We need to make sure that we do not leave Canadians in this awful gap where we do not have anything in place, as a Parliament, to deal with the current crisis. I offer those comments just to say that I will be voting differently from the way I typically have, but I still vigorously object to time allocation being used routinely.

Hon. Arif Virani :

Mr. Speaker, I thank the hon. member for Saanich—Gulf Islands for her contributions today and every day in the chamber. She outlines exactly the balance that we are trying to craft, and have tried to craft since 2016, in response to the Carter decision. Those are basically two different ideas: promoting the dignity and the autonomy of an individual in this country, and ensuring that we are protecting vulnerable people with adequate safeguards so they are not victimized. In this context, the safeguards and the protection are critical in the context of those who are mentally ill. That has been guiding theme here.

In addition to the provinces and territories that have spoken up about the lack of system readiness, we have also heard from the Canadian Mental Health Association and from the Centre for Addiction and Mental Health that they are also not ready and concur with the provinces' and territories' assessments. With respect to the last point raised by the member for Saanich—Gulf Islands, she talked about mental health supports. This is critical now more than ever, particularly coming out of the COVID pandemic.

What I would say to her is that when we reached a deal about one year ago to provide a record number of dollars in support of the Canadian health care system, we outlined certain parameters for that support. One of the pillars of that support was to support mental health and the mental health needs of Canadians. That is a fundamental priority for us and will remain so.

[ Translation ]

Mr. Rhéal Éloi Fortin (Rivière-du-Nord, BQ) :

Mr. Speaker, I think that the issue before us is an important one, and I recognize the work that my colleague, the Minister of Justice, has done on this file. That being said, with all due respect, I have to say that we already deliberated on this issue several years ago and that we determined that March 17 would be the date on which this would come into force. Quebec has worked on this and it is prepared to administer the medical assistance in dying that we are talking about.

It would be easy for the government to simply adopt the amendment proposed by my colleague from Montcalm , which, we are going to vote on later today, I believe. This amendment would enable the provinces that are ready to administer the treatment to do so. Take

section 720 of the Criminal Code, for example. It provides a similar process for drug treatment. It stipulates that provinces are allowed to administer a provincially approved treatment even if it is not otherwise authorized by the Criminal Code. A similar system could be set up for MAID. It is true that some provinces are not ready yet. That will likely always be the case. I am fairly certain that in three years, five years or ten years, some provinces will still not be ready. However, we cannot allow that to paralyze Parliament.

Some provinces are ready, and we can set up a process that will allow those provinces to administer MAID. I invite my colleague and his entire government to support the amendment proposed by my colleague from Montcalm to allow provinces that are ready, like Quebec, to proceed with the administration of MAID.

(1020) Hon. Arif Virani :

Mr. Speaker, I would like to give a two-part answer to that question. First, the Province of Quebec itself has said that it is not prepared to provide medical assistance in dying to people whose only medical condition is a mental disorder. Second, my colleague mentioned advance requests. That is another issue. I have tremendous respect for the crucial work that has already been done in Quebec on advance requests. However, Canada has only one Criminal Code, and there is a very good reason for that.

Canadians deserve to have consistent standards and clarity about what is criminal and what is not criminal across the country. There is no quick way to safely allow an exception for Quebec on this issue at this time. The conversation does not end here, though. We are committed to working with Quebec to determine the next step. We have taken a cautious approach to medical assistance in dying from day one back in 2016. We will continue to proceed with caution on this issue for the whole country.

[ English ]

Mr. Glen Motz (Medicine Hat—Cardston—Warner, CPC) :

Mr. Speaker, I too am very concerned about closure on such an important matter. My opinion is that by allowing assisted death on the basis of mental illness alone, we might inadvertently close the door on potential recoveries and the possibility of life returning with dignity and purpose. Furthermore, enabling medical assistance in dying for mental health conditions could imply that some lives are less worth living and that some forms of suffering are less deserving of the full measure of our medical and social resources.

This could lead to a slippery slope where the right to die may, under subtle social pressures, become a duty to die, particularly among the marginalized or the less privileged members of our society. For those reasons and many others, we need to be very, very careful. Having closure on such a critically important issue, to me, says to those who might be considering this that they are less worthy. That is the farthest thing from the truth. We should be able to debate this. I do not know what took the government so long to bring the debate, given that, as my friend from the NDP said, there are nine days left.

What took the government so long to bring it forward in the first place for proper debate?

Hon. Arif Virani :

Mr. Speaker, I respect the member opposite, but I am going to take issue with some of the submissions he just made. It is precisely because of the contentious nature of what is at issue that we are ensuring, using every tool that we have, that the bill becomes law prior to March 17 and the expiration. If the bill does not become law by March 17, we would have the confusion that was mentioned by the member for New Westminster—Burnaby , a situation where people may be able to avail themselves of MAID where the context is mental illness as the sole underlying condition.

We do not believe the system is ready, because we have heard that, to a person, from every health minister in every province and territory. We have heard it from the health care practitioners, the nurses, the MAID assessors and the MAID providers. A curriculum has been designed, but take-up of the curriculum is not where it needs to be. The safeguards are not in place. The oversight mechanisms are not in place.

It is precisely because of the unpredictable nature of some people's mental illnesses that we need to ensure that we are working prudently and safely before we propose an expansion of the regime to persons for whom mental illness is the sole underlying condition.

[ Translation ]

Mr. Luc Thériault (Montcalm, BQ) :

Mr. Speaker, the minister's answer to the question posed by my colleague from Rivière-du-Nord is inadequate. Yes, in 2021, Quebec ruled on the issue before the report of the expert panel on mental illness was published. However, the minister had a year to implement the most widely held recommendation of the special joint committee on medical assistance in dying concerning advance requests. Even a Conservative member from Quebec voted for it. Why did he not introduce a bill aimed at enacting this provision, knowing full well, unless he is unaware, that Quebec was going to legislate accordingly?

As for the report, we are talking about a year and he wants three years, but that is another story. He cannot possibly tell us that he did not have the time to implement the special joint committee's main recommendation. Now it is a double standard. He accepted the special joint committee's recommendation about mental illness and made it into a bill, yet he is doing nothing about advance requests, which Canadians from coast to coast agree on. Will the minister commit, if he does not support my amendment, to tabling a bill on advance requests as soon as possible?

(1025) Hon. Arif Virani :

Mr. Speaker, I appreciate my colleague's remarks and his hard work on the special joint committee. I have several points to raise. The first one is that the bill addresses mental illness as the sole condition. The act requires that we deal with the issue before March 17, 2024. I have a lot of respect for my colleague across the aisle. He mentioned that Canadians from coast to coast agree on the issue of advance requests. Although Quebec has expressed its willingness, I do not believe that all Canadians agree; that is the second point.

Obviously, if we want to extend medical assistance in dying to advance requests, we need to do so responsibly and with caution, as we did with all of the other issues, in other words, with all of the health experts, namely health ministers, psychiatrists, doctors and nurses. We need to proceed with caution, making sure to respect individual rights. We also need to strike a balance between individual rights and the protection of vulnerable persons. That is how we have been doing things since 2016, and that is how we will continue in the future.

Once again, it is important to note that the Criminal Code applies to the entire country. It is important to have clear information for all Canadians, so that everyone understands their rights and the criminal rules that apply across Canada. Criminal law must be consistent from one province to another. That said, political discussions with Quebec are ongoing because this conversation needs to be had. However, we need to proceed carefully, cautiously and prudently.

[ English ]

Mr. Randall Garrison (Esquimalt—Saanich—Sooke, NDP) :

Mr. Speaker, in the previous Parliament, I was the NDP's representative on the medical assistance in dying committee. I do support medical assistance in dying, but it was the most difficult issue I have ever dealt with, and I agree with my colleague from Saanich—Gulf Islands that it was probably the most difficult issue most of us have ever dealt with in the House. For that reason, I agree with the minister that we have to proceed very cautiously and very deliberately in any expansion to medical assistance in dying.

Today I would rather be talking about removing mental illness as the sole underlying condition, but Parliament dealt with that question with the private member's bill from the member for Abbotsford , Bill C-314 , so we cannot do that today. We are placed in the awkward position where the Senate added the provision to the original medical assistance in dying legislation, which I think was very ill-advised.

However, we have no choice at this point, I believe, but to support the closure motion to try to get this done so we can prevent the provision from coming into force, when we know clearly we are not ready and when we know some of us have very clear moral reservations about the expansion.

(1030) Hon. Arif Virani :

Mr. Speaker, I want to thank the member for Esquimalt—Saanich—Sooke for his contributions today and every day, particularly on the justice committee and on the joint mixed committee. I agree with him that this is probably the most challenging and personal issue that any of us has touched, particularly for those who were elected in the class of 2015, who have been dealing with this for the last eight years. Because what is at issue is so significant, because the consequences are so permanent by definition, it is critical to get it right and to proceed in a prudent manner.

Some of those things are outlined in the charter statement we have tabled in the House. It talks about the screening for decision-making capacity being particularly difficult in the context because of the symptoms of the person's condition or because their life experiences can impact their ability to understand and appreciate the decision they are about to make.

Further, feelings of hopelessness and wishing to die are common symptoms of some mental illnesses, which can make it difficult for even an experienced practitioner to distinguish between a wish to die that is fully autonomous and considered, and something that is a symptom of one's personal illness. Also, the course of a mental illness over time is very much less predictable than that of a physical illness. Last, and importantly, we do not have a record of evidence that has been built up in this country with respect to how the practice would unfold.

Ensuring that we build up that record of evidence and that we build up the important curriculum and the uptake of that curriculum for the assessors and providers is critical. For these and many other reasons, we are adopting a position that we would proceed responsibility, cautiously and prudently in three years' time with the initiative, but also reconvene the joint committee on which the member has sat so it can assess system readiness about two years from now, prior to the three-year deadline's coming to the fore.

Mr. Richard Bragdon (Tobique—Mactaquac, CPC) :

Mr. Speaker, it has been said that the character of a nation is revealed in how it treats its most vulnerable. I cannot think of a higher obligation for the House that houses the representatives of the people to take up than this very discussion. It is a matter of debate that should not be rushed. It should not be shut down and should not be in any way pushed through in expeditious fashion. We should take all of the time required to make sure we get it right, because we are literally dealing with matters of life and death. The sensitivity surrounding the issue cannot be overstated.

The impact on families that are going to be and are being affected by the issue cannot be overstated. I would ask the minister to reconsider the direction he has taken with this and allow Canadians to have their voices expressed, for their concerns and desires for proper safeguards to be fully expressed in the House during the debate for as long as it takes to get it right. Would the minister care to comment on that?

Hon. Arif Virani :

Mr. Speaker, I thank the member opposite, but I think his comments reflect something that was raised also by the member for Medicine Hat—Cardston—Warner . Just to be clear for Canadians, if we do not proceed expeditiously in this chamber and in the Senate, the law will change on March 17 so as to allow medical assistance in dying for people who have mental illness as the sole underlying condition.

If the member for Tobique—Mactaquac is concerned about supports for those who are mentally ill, and I believe he has that concern, then what he should be doing is working with us collaboratively to ensure passage of the bill to prevent that situation from arising. The logical premise of his question is false. What we are doing is proceeding expeditiously as a responsible government after hearing from the joint mixed committee of MPs and senators about the need to put a pause on this. We would be putting a pause on it.

We presented the legislation expeditiously and are seeking passage of the legislation expeditiously. As we have heard from the member for Saanich—Gulf Islands , in this context even she is making an exception to her principled approach towards closure in order to invoke closure so we can get the bill done and protect Canadians. Fundamentally, my job as Minister of Justice is to do just that, and I will not be deterred in that task.

(1035) [ Translation ]

Mr. Luc Thériault :

Mr. Speaker, the minister did not answer one aspect of my question. Why the double standard? The minister had a full year to implement the recommendation of the Special Joint Committee on Medical Assistance in Dying concerning advance requests. An Ipsos poll of 3,500 people showed 85% support across Canada. If the minister does not know that, he is not staying on top of his file. As far as postponement is concerned, the minister has implemented the recommendation to the letter. Three years is too long. He knows that. However, he could have added another dimension to Bill C‑62 . He had a year to do it.

Will he introduce legislation on advance requests, yes or no? Bill C‑14 is bad legislation. The minister says that he worked carefully. People have been forced to go on hunger strikes to meet the reasonably foreseeable natural death criterion. Is that what he means by protecting vulnerable people?

Hon. Arif Virani :

Mr. Speaker, what I can add to the conversation I just had with my colleague across the way is that we created expert panels to study several aspects of expanding medical assistance in dying. Experts conducted a study on advance requests. They found that it is extremely complex when we talk in the present about articulating a desire to seek medical assistance in dying, added to the fact that a person might submit a request 30 or 40 years ahead of time. Given the context, their situation, condition and wishes could change.

This said, Quebec has already addressed the issue, and a bill has been introduced in the province. We are well aware of this, and we are starting a discussion with Quebec. Discussions will be held. We have a Criminal Code that applies across the country. Consequently, the question has to be approached the same way we dealt with the other aspects, meaning nationally. This is what we did when we prudently undertook consultations while taking the necessary precautions.

[ English ]

Mr. Peter Julian :

Mr. Speaker, I am very concerned about the comments that I have just heard from the Conservatives saying that the debate should just go on for as long as Conservatives would like. That could take months. Our deadline is March 17. We have nine sitting days, including today, before the deadline. I wanted to make sure, because some of my Conservative colleagues were saying that they are concerned about having, as a condition, the sole underlying medical condition being a mental disorder. They did not want to see that. The provinces and territories certainly agree.

Ten of the provinces and territories have written to say that their health care system is simply not ready to put that into place. What would happen, would the minister say, if we end up missing that deadline, going on for months afterward? What type of confusion? What situation would we find ourselves in, in Canada, if we follow the desire of the Conservatives to simply talk this out for months?

Hon. Arif Virani :

Mr. Speaker, I thank the member opposite for his second contribution this morning, because it is very salient and very pointed. I would urge my Conservative colleagues to actually reconsider their presumed position with respect to this legislation and the need for passing it efficaciously, as soon as possible. As a candid response to his question, so that we are crystal clear, if we do not pass this legislation by March 17, it would be possible in this country for someone whose sole underlying condition is mental illness to avail themselves of MAID.

That would occur in the riding of Medicine Hat—Cardston—Warner, in the province of Alberta, as well as in the province of New Brunswick, which the member for Tobique—Mactaquac represents. The ministers of health for New Brunswick and Alberta have both said to us unequivocally that their health care systems, their MAID assessors and providers, are not ready. I do not want a situation where we have that kind of lay of the land in terms of the criminal law in Canada. We have the power to prevent that from happening by voting in favour of this bill.

(1040) [ Translation ]

Mr. Gérard Deltell (Louis-Saint-Laurent, CPC) :

Mr. Speaker, first, I would like to thank the minister and congratulate him on the quality of his French. I knew him when he arrived in 2015, and I have seen his progress, step by step. I would like to sincerely congratulate him on his French. That is where my congratulations end. It is never a victory when a time allocation motion is introduced in a debate on an issue as sensitive as medical assistance in dying. This topic should be free from partisanship, because there is no right or wrong position. There are only the positions with which we are at ease as legislators.

Opposing opinions should always be respected. Some of our friends, family members and loved ones may take the exact opposite view, and they are right. That is what a non-partisan debate is. That is what a debate about personal quality of life is. As my colleague from Montcalm illustrated so well, the minister had a year to take action, but he did nothing. We realize that the Prime Minister decided to change justice ministers, as is his right and privilege, and we also realize that the predecessor to this Minister of Justice had a different approach.

However, in the face of such a delicate issue, why act so quickly when we need to make room for every possible opinion? This is not a partisan issue, let us not make it one.

Hon. Arif Virani :

Mr. Speaker, I appreciate the comments of the member for Louis‑Saint‑Laurent. I want to note two things. First, my colleague is absolutely right when he says that we must avoid partisanship when we are dealing with such a sensitive subject and where the consequences are so serious for Canadians. I might add that he and his colleagues sat on the special joint committee both the first and second time. So we have already had the opportunity to hear the Conservatives' views on the matter. We have reflected on those comments and indeed we introduced a bill that reflects the will of their caucus.

I believe that we need to move forward with that expressed will and promote the adoption of this bill today in the House.

[ English ]

The Deputy Speaker :

It is my duty to interrupt the proceedings at this time and put forthwith the question on the motion now before the House. [ Translation ] The question is on the motion. [ English ] If a member participating in person wishes that the motion be carried or carried on division, or if a member of a recognized party participating in person wishes to request a recorded division, I would invite them to rise and indicate it to the Chair.

Mr. Kevin Lamoureux :

Mr. Speaker, I request a recorded vote.

The Deputy Speaker :

Call in the members.

(1125) (The House divided on the motion, which was agreed to on the following division:)

(Division No. 637)

YEAS Members Aldag Ali Anand Anandasangaree Angus Arseneault Arya Ashton Atwin Bachrach Badawey Bains Baker Barron Beech Bibeau Bittle Blaikie Blaney Blois Boissonnault Boulerice Bradford Brière Cannings Carr Casey Chagger Chahal Champagne Chatel Chen Chiang Collins (Victoria) Cormier Coteau Dabrusin Damoff Davies Desjarlais Dhaliwal Dhillon Diab Drouin Dubourg Duclos Duguid Dzerowicz Ehsassi El-Khoury Erskine-Smith Fillmore Fisher Fonseca Fortier Fragiskatos Fraser Freeland Fry Gaheer Gainey Garrison Gazan Gerretsen Gould Green Guilbeault Hajdu Hanley Hardie Hepfner Holland Housefather Hughes Hussen Hutchings Iacono Idlout Ien Jaczek Johns Jowhari Julian Kayabaga Kelloway Khalid Khera Koutrakis Kusmierczyk Kwan Lalonde Lambropoulos Lamoureux Lapointe Lattanzio Lauzon LeBlanc Lebouthillier Long Longfield Louis (Kitchener—Conestoga) MacAulay (Cardigan) MacDonald (Malpeque) MacGregor MacKinnon (Gatineau) Maloney Martinez Ferrada Masse Mathyssen May (Cambridge) May (Saanich—Gulf Islands) McDonald (Avalon) McGuinty McKay McKinnon (Coquitlam—Port Coquitlam) McPherson Mendès Miao Miller Morrice Morrissey Murray Naqvi Ng Noormohamed O'Connell Oliphant O'Regan Petitpas Taylor Powlowski Qualtrough Robillard Rodriguez Rogers Romanado Rota Sahota Sajjan Saks Samson Sarai Scarpaleggia Schiefke Serré Sgro Shanahan Sheehan Sidhu (Brampton East) Sidhu (Brampton South) Singh Sorbara Sousa St-Onge Sudds Tassi Taylor Roy Thompson Trudeau Turnbull Valdez Van Bynen van Koeverden Vandal Vandenbeld Virani Weiler Yip Zahid Zarrillo Zuberi -- 170

NAYS Members Aboultaif Aitchison Albas Allison Arnold Baldinelli Barlow Barrett Barsalou-Duval Beaulieu Bergeron Berthold Bérubé Bezan Blanchette-Joncas Block Bragdon Brassard Brock Brunelle-Duceppe Calkins Caputo Carrie Chabot Chambers Champoux Chong Cooper Dalton Dancho Davidson DeBellefeuille Deltell Desbiens Desilets Doherty Dowdall Dreeshen Duncan (Stormont—Dundas—South Glengarry) Ellis Epp Falk (Battlefords—Lloydminster) Falk (Provencher) Fast Ferreri Findlay Fortin Gallant Garon Gaudreau Généreux Genuis Gill Gladu Goodridge Gourde Gray Hallan Hoback Jeneroux Kelly Khanna Kitchen Kmiec Kram Kramp-Neuman Kurek Kusie Lantsman Larouche Lawrence Lehoux Lemire Leslie Lewis (Essex) Lewis (Haldimand—Norfolk) Lloyd Lobb Maguire Majumdar Martel Mazier McCauley (Edmonton West) McLean Melillo Michaud Moore Morantz Morrison Motz Muys Nater Normandin Patzer Paul-Hus Pauzé Perkins Perron Plamondon Poilievre Rayes Redekopp Reid Rempel Garner Richards Roberts Rood Ruff Savard-Tremblay Scheer Schmale Seeback Shields Shipley Simard Sinclair-Desgagné Small Soroka Steinley Ste-Marie Stewart Strahl Stubbs Thériault Therrien Thomas Tochor Tolmie Trudel Uppal Van Popta Vecchio Vidal Vien Viersen Vignola Villemure Vis Vuong Wagantall Warkentin Waugh Webber Williams Williamson Zimmer -- 146

PAIRED Nil

The Deputy Speaker :

Motion agreed to I declare the motion carried.

Proceedings on Bill C-62 Government Orders Motion

The House resumed from February 12 consideration of the motion, and of the amendment.

Mr. Gord Johns (Courtenay—Alberni, NDP) :

Mr. Speaker, it is an honour to rise today on the unceded lands of Tseshaht and Hupacasath on Vancouver Island in Nuu-chah-nulth territory to speak to Bill C-62 , which is calling for the extension of the temporary exclusion of eligibility for medical assistance in dying for persons suffering solely from a mental illness by three years, until March 17, 2027. Clearly, without an intervention by Parliament, this expansion would come into effect on March 17, 2024, in just one month.

New Democrats agree with the majority decision made by the Special Joint Committee on Medical Assistance in Dying, also known as the AMAD committee, which I will refer to it as in my speech. It reported that Canada is not adequately prepared to deliver medical assistance in dying to individuals whose sole underlying medical condition is a mental disorder. The bill would allow more time to implement the necessary safeguards and address the capacity concerns that are expected to be the result of the expansion of medical assistance in dying for those with the sole underlying medical condition of a mental disorder.

It would give medical practitioners more time to become familiar with available training and supports, while providing time for the public to become more aware of the robust safeguards and processes in place. I know this is a very sensitive and very personal matter to so many people around this country. Especially in my riding of Courtenay—Alberni, I have heard from many people about this. We also need to ensure that we have the understanding and compassion to respect the right of an individual's choice of dignity when they have deep, prolonged and ongoing suffering. I will speak to that.

Suffering from mental illness is extremely serious, and it is just as real as suffering from a physical illness. In our health care system, we clearly do not have parity when it comes to mental and physical health, and I will speak to that as well. We must also affirm and protect the most vulnerable when we do any sort of decision-making on such a serious piece of legislation as expanding medical assistance in dying.

This additional delay is necessary and needed right now to ensure that we have a health care system in place that can safely provide medical assistance in dying for those whose sole underlying medical condition is a mental disorder. We know how we got here. The Liberal government made an ill-advised decision and did a complete 180° by accepting the Senate's amendment to Bill C-7 in the 43rd Parliament. That is what got us here. The government changed the law before any kind of comprehensive review had been conducted, and we have been trying to play catch-up ever since.

I am going to speak about the important work that needs to be done, and I want us to be thoughtful in our approach to expanding medical assistance in dying. As New Democrats, we take people's concerns and feedback very seriously. We are committed to helping find the best possible solution for Canadians in the policy of medical assistance in dying to ensure that it does what it was always intended to do. One of the biggest concerns New Democrats have with the expansion of medical assistance in dying is with the barriers that many Canadians face when they reach out for mental health treatment.

Because of the Liberals, and the Conservatives before them, the chronic underfunding of our health care system has become even more apparent. It is now more than ever, as we see the disparity between mental and physical health and how people are taken care of. We heard the Prime Minister promise to implement a new mental health transfer of $4.5 billion over five years, but he has still not done that. Even with the bilateral agreements, the Liberals are falling far short, and that would not even be enough.

Everyone should be able to access mental health supports when they need it, but under the Liberal government, and that of the Conservatives before it, this has not been the reality. It is the same with all provinces and territories.

(1130) New Democrats wholeheartedly support the delay in expanding medical assistance in dying for those who have a mental disorder as the sole underlying condition, but the Liberal government needs to ensure that proper consultation happens between now and the expansion date, or it would need to be extended again. It needs to ensure that people will be protected while respecting their individual choice. The Liberals cannot just delay the expansion either. They need to fund adequate supports and treatment options for people dealing with mental illness.

Members have heard me say this repeatedly, but we need a pathway, a road map, to how we are going to achieve parity for mental and physical health and ensure people get the timely help they need when they need it. Seven of the provinces and all three territories have said that they are not ready and have signed a joint letter to that effect, including my home province of British Columbia. That was signed by the ministers of health in those provinces and territories. They are calling for an indefinite pause on the expansion for individuals whose sole underlying medical condition is a mental disorder.

That is what those ministers identified. As New Democrats, we want to see a MAID regime where guardrails are in place to protect vulnerable populations while still allowing for personal bodily autonomy and end-of-life choices. We must make sure that people do not request medical assistance in dying because they do not have access to treatments, supports and services. This has to be absolute. The Liberals need to make sure everybody can access mental health supports. However, after nine years of carrying forward with the Conservative cuts to health care, this is where we are at right now right across the country.

Help is out of reach for many people. This needs to change before medical assistance in dying can be expanded. We know that the housing, toxic drug and mental health crises that are happening are not being addressed. I see that I do not have a lot of time left, but I want to ensure I outline that the AMAD committee heard from plenty of witnesses who cautioned the committee on expanding MAID in cases of persons suffering solely from a mental illness. I want to share what a couple of those experts had to say.

Professor Brian Mishara, who is with the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at Université du Québec à Montréal, said, “The expert panel report on MAID and mental illness states that there are no specific criteria for knowing that a mental illness is irremediable”, and that there is absolutely no “evidence that anyone can reliably determine if an individual suffering from a mental illness will not improve.” He warned us that “any attempt at identifying who should have access to MAID will make large numbers of mistakes, and people who would have experienced improvements in their symptoms and no longer wish to die will die by [medical assistance in dying].” We heard from many experts.

The CAMH raised similar concerns. Because I see that I only have a couple of minutes left here, I want to talk a bit about the system and the lack of access. We are talking about a crisis going on from coast to coast to coast, according to a poll done just a year ago. The Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction released a report talking about postpandemic findings. It cited that 35% of respondents reported moderate to severe mental health concerns. This is alarming.

It should also be alarming to all parliamentarians that it found that fewer than one in three people with current mental health concerns accessed services. The report identified key barriers to accessing services as financial constraints and help not being readily available. We know that right now we are in a financial crisis, and I am sure those numbers have only gone up. It identified that one of the top stressors was between income and unemployment with mental health concerns. We need to create a system of parity with mental and physical health.

The government has not delivered when it comes to a plan, a road map, on how we achieve parity with physical and mental health. I hope in this budget, it is going to release funding on top of the bilateral agreements directly to community-based organizations as a COVID emergency recovery response because, post-COVID, we know some people are struggling financially, but the biggest concern right now and the biggest epidemic post-COVID is in mental health. I hope the government is hearing that. I see that I have run out of time. I have a lot to say on this matter.

I look forward to taking questions from my colleagues.

(1135) Mr. Ken Hardie (Fleetwood—Port Kells, Lib.) :

Mr. Speaker, in the process of debating this, I would draw attention to the case back in 2016 of E.F., a woman in Alberta. There is media coverage on it and it is worth a good read. The reason I bring it up is because E.F. did get access to medical assistance in dying. She had nothing but a mental condition but it was horrific. If this next step in medical assistance in dying is put on hold, would the member want to consider some mechanism by which a person like E.F. could get the relief from a life that simply was agonizing and not worth living?

Mr. Gord Johns :

Mr. Speaker, first and foremost, we want to ensure that we have a system of care in place to ensure that E.F. can actually get access to supports if she is suffering. However, that is not in place anywhere in the country, not in all 10 provinces and three territories. We know that. We are falling far below our OECD partners. Provinces and territories spend between 5% and 7% of their health care budgets on mental health compared to France and Britain that are at 12% and 14% respectively.

As New Democrats, we want to see a medical assistance in dying response where guardrails are in place to protect the most vulnerable. We want to ensure that safe and adequate delivery of medical assistance in dying is in place, but that there still is bodily autonomy and end-of-life choice. We need to have a system in place that the experts support, one that actually responds to medical assistance in dying, that ensures we have the training and that we have addressed all the recommendations of AMAD committee. We have not done that. I know the government is working toward that, but we are very far away from it.

Mr. Garnett Genuis (Sherwood Park—Fort Saskatchewan, CPC) :

Mr. Speaker, the position of the government when it comes euthanasia is so disconnected from the reality and the concerns many Canadians have. The Liberals constantly want to have a conversation about further expansion. However, I hear concerns from constituents and from people across the country about the abuses under the existing system; about how people with disabilities have been pressured and told that they are selfish for not wanting to go down this road; about how, in the absence of proper support, life and dignity affirming support, we have individuals who are at risk of giving up.

Instead of being affirmed in their pursuit of meaning and purpose, they are being told “Sure, go ahead and give up.” This is the reality in Canada. When I talk to legislators in other parts of the world, including legislators from the so-called progressive left, they are horrified by what is happening in Canada. Canada is presented as a counter-example of what can go wrong when we go down this road. Why are we not having more conversations about addressing the existing abuses in the system instead of this fanatical push by the government to always look for the next expansion.

Why not stop and look at how we got here and how we can address these significant problems that have emerged in the current system?

(1140) Mr. Gord Johns :

Mr. Speaker, a lot of discussions needs to take place at the AMAD committee, to look at the existing legislation. However, right now, we are dealing with a timely situation, and I am going to speak to that. This is around the Liberal government's ill-advised decision to accept the Senate amendment to Bill C-7 in the 43rd Parliament. That is what has gotten us here today. This is why we are having to rush legislation, because there is not adequate support for people with the sole underlying medical condition of a mental disorder.

The Liberals changed the law before any kind of comprehensive review had been conducted, and we have been trying to play catch-up ever since. The Liberals decided to support an amendment from the Senate, the unelected Senate, that was brought back to the House. We voted against it because of that. We did not believe that the supports were in place for people to make those decisions. We are working toward ensuring that we have parity between our mental and physical health care system, that we listen to the experts and that we do a full evaluation. This needs to take place.

However, I appreciate the comments from my colleague in that there needs to be broader conversations about the existing legislation.

[ Translation ]

Mr. Luc Thériault (Montcalm, BQ) :

Mr. Speaker, I would like to know whether my colleague thinks that, one day, it will be possible to alleviate the suffering of people struggling with an irremediable mental disorder. I would also like to know whether he agrees that it would have been wiser for the government to implement the joint committee's leading recommendation regarding advance requests and to take advantage of the introduction of Bill C-62 to add that component.

[ English ]

Mr. Gord Johns :

Mr. Speaker, my colleague has done incredible work at the health committee and the AMAD committee. I really appreciate him for that. I hope that some day we will have an opportunity so that those with the sole underlying medical condition of mental disorder will have the ability to make that decision. However, we are so far away from parity, given that consecutive Liberal and Conservative federal governments have not prioritized mental health.

We are also far behind other countries, including U.K. and France, when it comes to delivering parity with our mental and physical health care systems, and that needs to be addressed. With respect to the member's other question, absolutely I support that. The AMAD committee needs to put its next focus and amount of work around advance directives.

Mr. Francis Scarpaleggia (Lac-Saint-Louis, Lib.) :

Mr. Speaker, I joined the latest edition of the Special Joint Committee on Medical Assistance in Dying, which was mandated to deal specifically with the question of the health system's readiness for an extension of MAID to cases of severe mental illness, out of a sense of duty as this is a deeply serious matter for Canadian society, one on which I received correspondence from a great many concerned constituents. At first, I humbly questioned my qualifications to sit on the committee. I am not a psychiatrist. I am not a medical doctor. I do not have expertise or experience in this area.

However, in a democracy, not all is left to the experts. The people, through their elected representatives, set legal parameters in areas of public interest by way of legislation and regulations. In fact, that is what has been happening since 2016 on the issue of MAID. That said, it is important to carefully listen to and consult the experts out of respect for the authority of knowledge and experience. This is the opposite, I might add, of the new populism.

I agree with the committee's recommendation that we should indefinitely postpone MAID where the sole underlying condition is mental illness, also known as MD-SUMC. The central issue in MD-SUMC is irremediability; that is the question of whether there is the possibility that a person with severe mental illness can be cured of their terrible suffering, a suffering not different from physical suffering. Under the law, for a person to be deemed eligible for MAID, the illness must be irremediable; grievous and irremediable.

The problem when we move from somatic, that is physical, illness to psychiatric illness is that irremediability becomes more difficult to establish. In the case of psychiatric illness, an accurate prognosis is infinitely more difficult to produce. Because of the difficulty, in cases of mental illness, of offering a reasonably certain prognosis, the determination of irremediability will necessarily have to be based on a retrospective view; that is on an assessment of the extent of a patient's past treatments and whether the patient exhausted all treatment possibilities in a quest to be relieved of their suffering.

The problem is that the MAID assessors will most likely not have been involved in past treatments, which makes it difficult to ascertain the quality of those treatments. When it comes to establishing irremediability in cases of mental illness, evidence has shown accuracy is poor. It is less than 50%, a coin toss. To quote Dr.

Sonu Gaind, one of the experts who appeared before the committee, “Worldwide evidence shows we cannot predict irremediability in cases of mental illness, meaning that the primary safeguard underpinning MAID is already being bypassed, with evidence showing such predictions are wrong over half the time.” It should be pointed out that under our MAID law, clinical certainty about irremediability is not actually required. Here it is important to highlight the distinction between legal irremediability and irremediability in clinical medicine.

In the MAID law, “grievous and irremediable” has a different meaning than in medicine. It is defined as incurability, “be in an advanced state of irreversible decline” and “enduring...physical or psychological suffering” that is intolerable to the person and cannot be relieved “under conditions the person considers acceptable.” In law, therefore, it is not necessary to establish irremediability with a degree of clinical certainty. Rather, both patient and assessor must come to the shared understanding based, among other things, on the assessor's analysis of the history of past treatments.

There is an element of subjectivity on the part of both patient and assessor. Naturally, the assessor will bring their own philosophical biases, values and ethics to this subjective equation. As Dr. Gaind suggested to committee members, “Try those mental gymnastics on your constituents.

Convince them it was okay that their loved ones with mental illness got MAID, not because of a clinical assessment based in medicine or science, but because of the ethics of the particular assessor.” An important issue in determining eligibility for MD-SUMC is being able to separate suicidal ideation from a considered request for MAID. It bears keeping in mind that suicide attempts are not always rash and impulsive, the product of a panicked state. This, in some ways, is a stereotype. Psychiatrists will say that some suicides are not frenetic but carefully planned in advance. Dr.

Tarek Rajji, chair of the medical advisory committee at the Centre for Addiction and Mental Health, told the committee, “There is no clear way to separate suicidal ideation or a suicide plan from requests for MAID.”

(1145) To again quote, Dr. Gaind:

We cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests, with overlapping characteristics suggesting there may be no distinction to make.

In the Netherlands, an assessment by an independent physician is required for MAID, and in the case of psychiatric suffering, a third assessment by an independent psychiatrist, preferably one with specific expertise regarding the patient's disorder. The problem with Canada's law, as it stands, is that there is no requirement for one of the assessors of MAID eligibility to be a psychiatrist, yet psychiatric issues are exceedingly complex. Often a patient has more than one illness. It is said that 71% to 79% of psychiatric patients who died through MAID in the Netherlands had more than one psychiatric disorder.

We humans are not self-directed, rational atoms exercising unencumbered clear-eyed autonomy. We are not as free as we think. We are born into families and communities, and influenced by the opportunities they offer, and alternatively, by the constraints they impose on us. I sometimes wonder if we are not in the process of turning personal autonomy into ideology. I say “wonder” because as a liberal, I have not been bestowed the gift of absolutism that has blessed ideologues. Requests for MAID can be influenced by, even driven by, extraneous factors like poverty and isolation, that is by psychosocial factors.

According to Dr. Gaind, “those with mental illness...have higher rates of psychosocial suffering.” This all means that MAID assessors will be wrong over half the time when predicting irremediability, will wrongly believe they are filtering out suicidality and still, instead, provide death to marginalized suicidal Canadians who could have improved.

Archibald Kaiser, Professor at the Schulich School of Law and Department of Psychiatry, Faculty of Medicine at Dalhousie University added that “The Supreme Court concluded in 1991 that people with mental illness have historically been the subjects of abuse, neglect and discrimination.” Dr. Gaind further underscored that “Suffering is cumulative, and life suffering unfortunately fuels much of the suffering of those with mental illness, even more so for marginalized populations.” There is, in fact, the possibility that gender-based marginalization can influence requests for MD-SUMC.

We know that in countries that allow MAID for severe mental illness, the ratio of women to men who seek MD-SUMC is two to one. For their part, indigenous representatives have expressed serious reservations about expanding MAID to include mental illness. According to Professor Kaiser:

In February 2021...many distinguished indigenous signatories wrote to Parliament that the consultation ... has not been adequate and “has not taken into account the existing health disparities...we face compared to non-Indigenous people.” They said, “our population is vulnerable to discrimination and coercion...and should be protected against unsolicited counsel.”

We know there is systemic racism in the health care system. Ask the family of Joyce Echaquan. How would systemic racism influence the rate of acceptance of MAID requests of indigenous and other racialized peoples? That is a pertinent question. As Dr. Lisa Richardson, Strategic Lead, Centre for Wise Practices in Indigenous Health, Women's College Hospital, told a Senate committee on February 3, 2021:

In an environment where both systemic and interpersonal racism exists, I don’t trust that Indigenous people will be safe. I don’t trust that anti-Indigenous prejudice and bias will not affect the decision making and counselling about MAID for Indigenous people, no matter how much education is given.

Indigenous communities, many of which have felt the scourge of high suicide rates, especially among youth, may have concerns about possible contagion effects of MD-SUMC on suicidality. Then, there is the basic question of the ability of the health care system in Canada, already stretched to the limit, to handle an expansion of MAID. According to Dr. Eleanor Gittens of the Canadian Psychological Association, as a country we have not yet established parity between available physical and mental care.

To quote her, “Care and treatment of mental illness are not covered by medicare, nor is it readily accessible.” We do not really know how many people would request MD-SUMC, and thus whether we have enough qualified assessors. By some estimates, we would have well over 2,000 patients a year getting MD-SUMC with countless more requesting eligibility assessments. I know there is dispute around that number.

(1150) Just because there is a published Health Canada standard for MD-SUMC and a training module does not mean the system is ready. A building built on a soft foundation is not ready for occupancy, no matter the level of completion of its structure. There are today no safeguards preventing poverty, housing insecurity, loneliness, etc., that is psychosocial factors, from significantly fuelling MAID requests of those suffering from mental illness. I will quote Dr.

Rajji: “The standards document itself, the one developed by the expert panel, states that these are not clinical guidelines, and this is what is missing to ensure quality.” According, again, to Dr. Gaind, “it is a legal fiction that determinations of the eligibility of MAID are based on objective clinical judgment. In fact, I regularly witness practitioners' values influencing the

interpretation of the current MAID eligibility criteria and safeguards.” As per an

article in the review Impact Ethics, “The few jurisdictions allowing MAiD for [sole] mental illness have safeguards Canada lacks, notably (unlike Canada) requirement of due care and no reasonable alternative, or treatment futility, prior to MAiD eligibility.” In Canada, a patient would be able to qualify for MD-SUMC even if they refuse treatment. Often a psychiatric patient will refuse additional treatment owing to treatment fatigue.

While treatment fatigue has been studied in the context of HIV and type 1 diabetes, with the goal of developing strategies to help overcome it, treatment fatigue has not yet received attention in psychiatry. A better understanding of treatment fatigue could lead to alternatives to MAID, such as palliative or recovery-oriented treatments. I respect the Senate. I value the Senate. Senators bring more than just sober second thought; they bring expertise in fields crucial to good public policy making, but senators are not elected. They are not the voice of the people.

It was never the government's intention to extend MAID to those suffering from mental illness. The government was running out of runway to meet the court-imposed deadline in the Truchon decision for amending the law to remove the requirement that death be foreseeable to qualify for MAID. It could not afford a back-and-forth game of procedural ping-pong with the Senate over its last-minute amendment to remove the mental illness exclusion from Bill C-7 . It had to accept the Senate's amendment to get the bill across the finish line. In my view, we are not ready for MD-SUMC.

We cannot ascertain irremediability with any acceptable degree of certainty and objectivity. We cannot sufficiently distinguish an unfettered request for MAID on the grounds of mental illness from suicidal ideation. We are not able to separate out psychosocial factors that might drive MD-SUMC. We have not properly consulted racialized communities to take account of their views, concerns and fears, notably those of indigenous communities, and we have not built proper safeguards into the law.

We do not require the involvement of a psychiatrist in assessment nor require that a person have reasonably exhausted available treatments before making a request for MD-SUMC. The few other jurisdictions that allow MD-SUMC have this requirement. We have not studied and understood treatment fatigue such that we can develop strategies that can possibly lead a patient to other non-lethal treatment options, and finally, we have allowed an unelected body, the Senate, to drive this agenda.

(1155) Mr. Garnett Genuis (Sherwood Park—Fort Saskatchewan, CPC) :

Mr. Speaker, I listened with interest to my colleague's speech, but there is this framing of not being ready. We support further delay so that a Conservative government can forever protect Canadians by ensuring this expansion never happens, but it does not make sense to me that the member would identify obvious problems with this, and not just present problems or short-term problems, but structural problems, with allowing the medically facilitated killing of those with mental health challenges, and say that just means we are not ready.

I think it is quite obvious that, after years of the government trying to fit a square peg into a round hole and trying to say that somehow we can have medically facilitated killing for those with mental health challenges while at the same time not increasing other kinds of risks and problems, the government has tried to figure out how to do this for years and has clearly concluded that it is not something that is desirable. Why not just admit that this was a terrible idea from the beginning rather than couch it in this framing of not being ready, but that maybe we will be soon?

Mr. Francis Scarpaleggia :

Mr. Speaker, I do not have a crystal ball. I do not have a monopoly on the truth. As I said in my speech, I am not blessed by absolutism. I am torn by this issue as much as I think anyone in this House is. Even if we hide behind the certainties we put up as political parties, we still question ourselves and we are still torn by this issue. I do not know if we will ever be ready. What I was trying to do in my speech was to point out some of the things we have not done to be ready. Maybe we will never be ready. I am not a psychiatrist.

I do understand psychiatric suffering can be as severe as physical suffering, and I do feel for the people, especially John Scully, who I have heard from in testimony in a small working group. I feel for him and what he is living through. To be honest, I do not have the answer.

[ Translation ]

Mr. Luc Thériault (Montcalm, BQ) :

Mr. Speaker, my colleague participated in all three sessions on the issue. When Quebec tabled its report and when we voted on Bill C-7 in 2021, I was very reluctant to consider opening up MAID to mental disorders. However, I worked my way through the experts' report and I invite my colleague to read it again. My colleague says there is nothing in the legislation. However, it does not have to be in the legislation. The regulations can set out the “how to”. Recommendations 10 and 16 are important safeguards.

Let us assume I am not questioning anything in my colleague's speech; the fact remains that, today, as I speak, there are people who are suffering irreversibly and intolerably. What solution does my colleague have for those people?

(1200) Mr. Francis Scarpaleggia :

Mr. Speaker, first, I want to congratulate my colleague on the thoughtfulness of his remarks. His speeches, his interventions, offer fresh perspectives. I learned a lot just from listening to him at meetings of the Special Joint Committee on Medical Assistance in Dying or even in the House. It is complex. As I was saying earlier, I am torn. The problem is that this becomes very subjective at some point. We are giving a lot of power to a doctor or a nurse practitioner who may not have the necessary background in psychiatric illnesses.

As I said in my speech, a person might present with one psychiatric illness, but roughly 80% have more than one. It is complicated enough to deal with psychiatric illness; when we add two or three more, it becomes even more complicated. I very much appreciate the interventions of my colleague. Like everyone else, we are doing everything we can on this file.

[ English ]

Ms. Lisa Marie Barron (Nanaimo—Ladysmith, NDP) :

Madam Speaker, it sounds like we are in agreement around the importance of us not moving forward MAID legislation that includes those living with mental illnesses as the sole underlying condition. I worked in mental health and addictions prior to becoming a member of Parliament.

As somebody who is in the governing party, what can the member share with those living day to day who are not getting access to the mental health supports they need when there was a promise of $4.5 billion in the last election to be transferred to those who need it most, those who do not have access to the housing they need and those who are not getting the money from a disability benefit actually in their bank accounts at a time when they need it most? I am wondering if the member can share what he would say to those who need the supports today around mental illness.

Mr. Francis Scarpaleggia :

Madam Speaker, I would tell them I would always vote for those kinds of supports, and I am very pleased we have passed Bill C-22 on creating a framework for an eventual disability benefit. It is excellent public policy and I am, quite frankly, hoping the next budget includes something more concrete on that around a figure of the kind of financial support people with disabilities can expect. Yes, there are many social problems, and this is one of the reasons I do not think we are really ready. We do not know how to extract those influences such as the inability to find housing, loneliness, drug addictions, etc.

We do not have the ability to extract those motivators from what we could call, I suppose, for lack of better words, a more considered request for MAID. It is a big problem. As a society, we have many problems to deal with, and that is why I am here. I am trying to do my best, as the member is, to solve those problems.

Ms. Elizabeth May (Saanich—Gulf Islands, GP) :

Madam Speaker, this has become an issue, because it was inserted in the legislation at Bill C-14 by the Senate. Does the hon. member have any knowledge of what attitude the Senate is going to take? We are operating under the gun here. We have to do something before March 17. Do we have any indication of whether the Senate will, once the House dispatches this matter, take it up quickly?

Mr. Francis Scarpaleggia :

Madam Speaker, I do not, because I am not in the Senate. Now that the Senate is on the other side of the street, it is a little harder to confer with the senators. I understand their position. They are generally for this extension. I would like to believe that they are also responsible, and they would not want to see a void open up after March 2024. Therefore, I expect and hope that they will do the responsible thing.

(1205) Mr. Marcus Powlowski (Thunder Bay—Rainy River, Lib.) :

Madam Speaker, I would like to thank the member for his excellent speech and hard work on the MAID committee. He talked about the problem of irremediability. I think it would be an absolute tragedy if legislation we pass led to a situation where a MAID practitioner took the life of someone who would have actually gotten better had we given them some more time. How are we going to know? The person will be dead. I was troubled to hear the testimony of some people on the committee, some psychiatrists, who did not seem very worried about the problem of determining irremediability.

They would still be willing to allow MAID even though they were not totally sure if the situation was irremediable. Could the member comment on the issue of what he heard at the committee and what he thought about it?

Mr. Francis Scarpaleggia :

Madam Speaker, in fact, I do not know how to answer that question. We have seen that there is a subjective element. There are some who believe they would make the right call. I guess that confidence is at the root of the perspective they bring to the issue. I am not a medical doctor, much less a psychiatrist, so again, I do not have a definitive answer for the member.

[ Translation ]

Mr. Gérard Deltell (Louis-Saint-Laurent, CPC) :

Madam Speaker, I will be sharing my time with my colleague from Kelowna—Lake Country . Once again, I rise in the House to speak about a sensitive topic, one that is fundamental in our lives, and that is medical assistance in dying. Personally, I am in favour of medical assistance in dying. I am not here to defend my personal opinions. I am here as a legislator who has to consider all the data that support giving the green light, under certain conditions, to medical assistance in dying or, conversely, the red light urging us to not go forward. I believe this is in no way a partisan issue.

People can be on the left, they can be on the right, they can be sovereignists, or they can be federalists; that is not the point. It is a matter of how we, as human beings, feel about this issue. Regardless of where we come from or where we are on the political spectrum, we are first and foremost human beings. On that basis, we must make a choice for people who need medical assistance in dying, and we must make sure this is done right, within the proper rules. We are dealing with this situation because the debate began here, at the federal level, in 2015. However, in Quebec, the debate began long before that.

It just so happens that I have participated, both at the provincial and federal levels, in the early stages of this legislation that we are discussing today. I would remind hon. members that the first province to have legislated on this issue did not do so overnight, quite the opposite. Only after six years of serious, thorough, scientific and medical debates and hearings did the Quebec government and the National Assembly vote for a law that would be the first step in medically assisted dying. I would like to emphasize the importance of that process.

It was done over six years, under three different governments, under three different premiers. That proves this is not a partisan issue. As much as possible, we should always take this approach. I will always remember, during the final debate on the adoption of the first steps toward medical assistance in dying in Quebec, how one of the members was very much against the bill. I can see him now, rising in the National Assembly and telling members not to vote for it. He felt so strongly on the issue and was so against the bill that he was red in the face. Once he sat down and the speech was over, I applauded him.

I did not applaud him because I agreed with him. I applauded him because we live in a democracy that allows him to express an opinion that differs from my own. That is the beauty of democracy. Despite the fact that the majority of his party and his government were about to vote in favour of the bill, he was against it, and he had the opportunity to say so with all of the passion that drove him. That is how we should debate medical assistance in dying. Let us not forget that this debate started at the federal level because of the Carter decision.

Without going into detail, I will remind members that happened in 2015, which was an election year. Using his good judgment, the head of the Canadian government at the time did not move forward immediately because we were on the verge of an election campaign. At the risk of repeating myself for the umpteenth time today, this is not a partisan issue, while an election campaign by definition is the epitome of political partisanship. That is fine, that is what an election campaign is. That is why the prime minister and head of the Government of Canada at the time, the Right Hon.

Stephen Harper, showed good judgment and decided to hold the debate after the election campaign. Canadians made their voice heard. They elected a new government. There was then a debate on the subject. That is when the first steps toward this bill on medical assistance in dying were taken. Some may have noticed that the bill, like all other bills, was not perfect. Nevertheless, it did lead to certain specific situations. Personally, I was for medical assistance in dying, but I did not vote in favour of the bill because I found it was poorly drafted. I remember the Hon.

David Lametti who, at the time, was not the minister of justice. As we know, he became minister of justice later on. The Prime Minister removed him from that office, and he decided to serve elsewhere. I remember that Mr. Lametti said that he would vote against the bill because he found that it did not go far enough. The bill was passed, but other things happened, and today we find ourselves having a debate on mental health.

(1210) I would remind members that I am in favour of medical assistance in dying as long as the rules are well defined. I will give the example of Quebec. Actually, I am going to talk about Quebec's experience, because an example is something that should be followed. Instead, let us take inspiration from the experience of Quebec, which held a political debate on the issue of medical assistance in dying for six years before passing its first bill on the subject.

With regard to MAID for people with mental illness, after holding hearings and consultations and thoroughly analyzing the issue, the Quebec National Assembly and the Government of Quebec decided not to move forward with MAID for people whose only underlying medical condition is a mental disorder. They felt that there was no consensus on this issue and that there was no scientific consensus. Some people were in favour of it, while others were against it. That is where we are at right now. That is why I think that we need to be careful as long as there is no strong scientific consensus.

Personally, I am in favour of medical assistance in dying, but I think that it must be administered to those who want it within a very clear legal framework. In this case, the framework does not go far enough. I have a colleague from Nova Scotia, the member for Cumberland—Colchester , who is a physician. I listened carefully to what he had to say yesterday because he knows what he is talking about when it comes to his profession. He practised medicine for over a quarter of a century and continues to practise to this day. He cared for thousands of people in his community.

He talked about the hardest parts of his practice. One example he shared involved a person showing up in the middle of a suicide crisis on a Saturday night and needing treatment. That is not a broken arm, it is not a growing cancer, it is not trying to get a pebble out of someone's eye. It is much more complicated than that, and it cannot be resolved immediately.

That is why his perspective was so valuable. (1215) [ English ] He said he is ready to challenge anybody who is not in that kind of a situation and whether they would be comfortable with that. [ Translation ] He said that, in his practice, he had always found these situations very difficult, and that he needed time to recover from that kind of meeting. Anyone who has spoken to doctors dealing with patients who have suicidal feelings will confirm it. Mental health problems are difficult to identify and to treat. I would again remind members of Quebec's experience.

After thoroughly examining this issue, Quebec decided not to go forward with medical assistance in dying for people struggling with psychiatric illnesses. The issue of medical assistance in dying can never be separated from the issue of palliative care. Palliative care is an essential part of our health care system; we should always be thinking of doing more, because, unfortunately, we will never do enough in that area. Without going into my life story, I can say that, two years ago, I had a particularly challenging year, given that both my parents died.

I remember May 2022, when my mother spent the last days of her life in the hospital. She was in a wing where people were receiving palliative care, one after another. Then there were rooms with people who had requested medical assistance in dying. For the last 15 days of my mother’s rich life, I was with her in the hospital and met people who had requested MAID. They all did so in full knowledge of the facts and with the support, assistance, guidance, and, above all, the presence of their families, in the same way that we were with my mother in the last days of her life. That is how we must look at the issue.

Respecting the choices of individuals, insofar as the guidelines have been well established. That is true both for people who wish to receive medical assistance in dying and for those who wish to receive palliative care.

[ English ]

Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.) :

Madam Speaker, I appreciate many of the member's comments. One thing that stuck in my mind was when he made reference to the fact that the Province of Quebec took a number of years to design its legislation. It is important to demonstrate the contrast with the federal government back in 2015; the member made reference to the Supreme Court decision. We had a very short window to get the legislation passed. I personally do not believe, and I suspect that no one really believed, that the legislation at the time was absolute, in terms of being perfect. However, we needed to get it through.

Could he reflect on the many discussions and debates inside and outside the chamber with Canadians as a whole, with respect to how important it was that, at least, we bring forward and get the legislation in, in order to meet court requirements?

Mr. Gérard Deltell :

Madam Speaker, that is an interesting question. I was there in 2015, when I got elected for the first time. As I said earlier, the prime minister at that time made the right decision not to put the bill on the table just before the election because this is everything but a political issue; it is a personal issue. An election campaign is anything but straight. [ Translation ] An election campaign is the epitome of political partisanship. [ English ] It was good that we did not have the debate during the campaign; after that, yes, for sure.

We had a time frame established by the Supreme Court and we had to act as fast as possible, and that was not exactly the picture-perfect time to do it. Based on the Quebec experience, we have to take our time to study an issue. The bill that has been adopted was not perfect. I voted against it because I saw many loopholes in the bill. I remember David Lametti; we voted against because it had not, in his mind, gone far enough to support. This is part of the debate, and there is no political-partisan agenda behind the debate. It is only a human agenda that we shall have.

[ Translation ]

Mr. Luc Thériault (Montcalm, BQ) :

Madam Speaker, my colleague gave us a history lesson. He said that his party was not able to move forward because there was an election. I would point out to him that Quebec has had two elections in those six years of work on MAID. That did indeed delay the work, as he will agree. However, I do agree with him that Quebec's approach crosses party lines and is far more thorough. Some people complain about the delay associated with the Carter decision, but that is because this Parliament never took the opportunity to try to change the Criminal Code before there was a court order.

It never had the courage to do that, and so we were then stuck with a court order. Mr. Lametti did not stand up solely because the bill did not go far enough. He stood up because it violated patients' constitutional rights. Bill C-7 corrected that. I would like my colleague to explain what he is advocating when it comes to advance requests for MAID. Does he think that the government, which had a year to introduce legislation, could have included that component in this bill?

(1220) Mr. Gérard Deltell :

Madam Speaker, for starters, yes, the work took place over a period of six years under three different governments. There were two elections during that time. That is exactly what I said earlier. This is not meant to be a partisan issue. It took years for the debate to come before the House. We know that, but we also know that it would not have been a good idea to start a debate on this issue, which is supposed to be non-partisan, on the eve of an election campaign.

I think my colleague would agree, especially since, as we know, there was a lot of opposition on all sides regarding many issues at the time, and the people spoke. On the issue of prior consent, personally, I agree, as my colleague said.

Ms. Niki Ashton (Churchill—Keewatinook Aski, NDP) :

Madam Speaker, in terms of accessing MAID, we know that many people have shared their thoughts publicly, particularly through the media, about how desperate they feel and how they are not getting help from the social safety net. They need help with health care, housing and mental health therapies. Everyone knows we need to acknowledge that reality. Does my colleague think our country is making progress if it recognizes the need to shore up our social safety net and provide the right supports to people who need them? That way, they will not ask for MAID if they do not really need it.

Mr. Gérard Deltell :

Madam Speaker, I thank my colleague for her question and the quality of her French. That is similar to what I was saying at the end of my answer. Palliative care must go hand in hand with the issue of MAID. They are not mutually exclusive. We must think about palliative care before we think about medical assistance in dying.

[ English ]

Mrs. Tracy Gray (Kelowna—Lake Country, CPC) :

Madam Speaker, it is always a privilege to rise on behalf of the residents of Kelowna—Lake Country. We are confronted with a decision of profound significance: the proposed delayed expansion of medical assistance in dying to include individuals suffering solely from mental illness. The delay should be supported, and I will note at the same time that as the shadow minister for employment, future workforce development and disability inclusion, I am compelled to express my opposition to the expansion altogether.

I want to draw attention to the recent findings of the report of the committee on MAID presented on January 30, 2024. The committee's report aligns with the long-standing concerns Conservatives have been voicing. It advocates pausing the expansion of assisted suicide to include those afflicted with mental illness. MAID is an irreversible outcome. The expansion, if unchecked, could tragically lead to the loss of lives that might have been saved through treatment and support. This is why we should not even be debating a delay but looking to abandon this piece of legislation.

The Liberals continue to ignore mental health experts, advocates and opposition parties, and have not completely abandoned the concept of MAID for those with the sole underlying condition of mental illness. In 2023, the government introduced eleventh-hour legislation to put a temporary pause on expanding assisted suicide to those suffering with mental illness. This came only after significant backlash from experts across Canada who called on the government to delay the expansion of MAID. The government is not listening to people speaking out and saying they want it abandoned altogether.

If the Liberal government moves ahead with the radical expansion of MAID to include those whose sole underlying condition is mental illness, it could lead to irreversible results. In 2023, the heads of psychiatry at all of Canada’s 17 medical schools called for a delay to the federal government’s MAID legislation that would have expanded eligibility to persons suffering solely from a mental illness. Many stated that it is impossible to determine that an individual’s mental illness will never respond to treatment.

As the shadow minister responsible for persons with disabilities, I have also found widespread opposition to the expansion of MAID to persons with mental illness among advocates for persons with disabilities. More than 50 disability and human rights organizations, including several from my home province of British Columbia, wrote a joint letter to then minister of justice and to federal party leaders in December 2022, to express their total opposition to the MAID expansion. They cited discrimination, lack of supports and concerns for protecting vulnerable people.

Many people have come out again, still opposing the Liberal government's legislation and lack of empathy, adding weight to the argument against the expansion and making it permanent for anyone suffering from mental illness. Disability and human rights organizations are clear that delaying the legislation is simply not good enough; we must completely halt the expansion of MAID for mental illness. My argument against expansion for MAID for those whose sole underlying condition is mental illness is rooted not only in expert opinion, as I have outlined.

As I address the chamber today, I carry with me the voices of residents from Kelowna—Lake Country living with disabilities and mental illness who have reached out to me, having serious concerns about this. A striking example is a letter I received from a young woman in my community who fears the human impacts of this type of legislation. Her journey through the darkness of suicidal thoughts and battle with mental illness is an important reminder of what is at stake. She fears that availability of MAID might have led her down an irreversible path.

This is a sobering testament to the potential dangers of this type of law. Her personal story is not just one of struggle but is also a clarion call for our society to be a source of support and hope. Just recently, a resident of Kelowna shared a distressing experience that deeply resonates with the gravity of our current dilemma. He told me that he sat with a friend who opted for MAID recently.

He expressed that if we allow the expansion to persons with the sole underlying condition of mental illness, those people might not always be capable of making such grave decisions, and we risk opening a door to irreversible consequences. This story is a stark reminder of the weighty responsibility we bear. This is a call to action, urging us to rethink and reassess, and to prioritize the well-being and dignity of Canadians in our health care and mental health policies.

(1225) When battling mental health issues for years, many people often feel on the brink of giving up. The cost of living is so bad that people cannot even afford to live, but what they need is support and understanding, not an easy exit offered by the government. A policy to expand MAID to those whose sole underlying condition is mental illness is a betrayal.

The commitment to help people was evident in Conservative private member’s bill, Bill C-314 , which sought to amend the Criminal Code to provide that a mental illness is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying. The bill was voted down, unfortunately, in October 2023, with 150 MPs voting in favour and 167 against. This shows that the Liberal government just wants to delay the issue until after the next election. After eight years of the Liberal government, many people are increasingly struggling with a rapidly deteriorating quality of life.

Many local residents in Kelowna—Lake Country and Canadians across the country have to deal with the immense stress of not knowing how they will pay to house themselves or put food on the table every month. This is heightened by economic stresses and escalating mental health challenges. At such a time, expanding MAID to include mental illness as the sole condition is not only ill-advised but also literally life-ending.

We have already seen concerning examples of not helping people with mental anguish who reach out, such as Veterans Affairs Canada's confirming that unprompted suggestions of MAID were offered by a Veterans Affairs caseworker to several veterans as a resolution for concerns such as PTSD. In addition, there has been testimony at the human resources committee by disabled persons considering MAID due to lack of living affordability, and reports of food banks being asked by clients for details on applying for MAID.

These examples highlight the risk of MAID becoming a misguided solution for individuals in desperate need of compassion and support. With such a climate of anxiety, mental health challenges and increasing rates of addiction across the country, expanding MAID to include mental illness as the sole underlying condition could be a tragic course. I believe we should be focusing our efforts on improving affordability and quality of life, and on compassionately helping people. It should not be easier to get MAID than to access mental health and addiction supports.

I, alongside my Conservative colleagues, will continue to stand with the many experts, doctors and persons with disabilities who oppose MAID expansion where mental illness is the sole underlying condition. They are expressing inherent risks and concerns related to protecting those who may be struggling and to protecting the most vulnerable. The proposed policy expansion of MAID for those with mental illness as the sole condition sends a troubling message that the government is willing to give up on some of the most vulnerable citizens.

It is an admission of defeat, suggesting that we as a society are retreating from our moral obligation to provide comprehensive and compassionate care to those battling mental health challenges. Instead of passing legislation like my common-sense private member’s bill, Bill C-283 , the end the revolving door act, which aims to provide mental health assessments and addiction treatment and recovery in federal penitentiaries, policies like the expansion of MAID to those with mental illness are really an irreversible path. We need to ensure that we support mental health systems and long-term solutions.

As members of Parliament, we should not choose the easy path over the right one. This is not the Canada we aspire to be: a nation that prides itself on compassion and support. Our duty is not just to legislate but also to protect, support and give hope to Canadians, particularly the most vulnerable among us. It is a duty we must uphold with the utmost seriousness and commitment.

(1230) Mr. Marcus Powlowski (Thunder Bay—Rainy River, Lib.) :

Madam Speaker, the member mentioned people in the disabilities community. I too have heard from the disabilities community about its opposition to MAID within that community. I wonder whether she could comment on what she has heard from people with disabilities regarding MAID and whether she thinks perhaps we need to have more safeguards for MAID for people with other forms of physical disabilities.

Mrs. Tracy Gray :

Madam Speaker, persons with disabilities have been very vocal about the part of the legislation that we are talking about here today, specifically the expansion for persons with the sole underlying condition of mental illness. They also have concerns in general about other safeguards in order to protect the most vulnerable, people who cannot necessarily speak for themselves. It is a general concern that I hear from persons with disabilities.

Mr. Randall Garrison (Esquimalt—Saanich—Sooke, NDP) :

Madam Speaker, while the member and I do not agree on a lot of things, this is a case in which we do stand together in our concerns about proceeding with allowing those with mental disorders as a sole underlying condition access to medical assistance in dying. My question is this. Given that this is true for, I think, most of the Conservative members, why are the Conservatives not helping to advance this bill as quickly as possible? We are facing this deadline, and this will come into force if we do not take action. Why are Conservatives holding up this bill today?

Mrs. Tracy Gray :

Madam Speaker, it is the government that sets the agenda and what is on the docket for the day. It is actually the government that decides what we are discussing every day. It is an honour for me to be here to speak on behalf of my community on a very important piece of legislation.

Ms. Elizabeth May (Saanich—Gulf Islands, GP) :

Madam Speaker, my friend, the member for Kelowna—Lake Country , and I share many of the concerns expressed today. This is one of those issues on which I would beg everyone in this place not to seek partisan advantage. The divide we have here is really the most non-partisan thing of all: the structure of our Parliament, the Westminster system, whereby we still have the equivalent of the House of Lords; that is, the Senate. The Senate put in Bill C-14 that medical assistance in dying be available to those whose underlying medical condition is a mental health condition only.

Everyone here, regardless of partisanship, is struggling to make sure Canadians do not seek access to medical assistance in dying if there is another option that allows them to continue to live. It is not partisan. I would like comments from my hon. friend.

(1235) Mrs. Tracy Gray :

Madam Speaker, for those who might be following this, when legislation comes back from the Senate to the House, if there are amendments, the government of the day can choose what it agrees with and wants to bring forward. The government chose to allow this, and that has created further deadlines. The government could have taken a stand against this at many stages along the way, but here we are, discussing simply a delay. The government has delayed it once already and is now looking at delaying it again, until after the next election. The government could have decided to not support this early on.

Mr. Ted Falk (Provencher, CPC) :

Madam Speaker, I wonder about something that the member articulated a little in her previous answer. What would be the solution to this, moving forward? I think Parliament has heard the concerns of many Canadians. We have heard it at committee. It has been verbalized here. In her opinion, how could we solve this?

Mrs. Tracy Gray :

Madam Speaker, we should not be talking about a delay. We should be talking about not expanding MAID at all to those suffering from mental illness as the sole underlying condition.

Mr. James Maloney (Parliamentary Secretary to the Minister of Justice and Attorney General of Canada, Lib.) :

Madam Speaker, I will be sharing my time with the member for Saanich—Gulf Islands . It is a pleasure to speak today to Bill C-62 . The bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID—

The Assistant Deputy Speaker (Mrs. Carol Hughes) :

There seems to be a telephone ringing. I am not sure if it is the member's telephone that may be ringing, but I would ask members, when they are taking the opportunity to speak, to ensure their telephones and earpieces are not on their desks, as they can cause problems for the interpreters. The hon. parliamentary secretary.

Mr. James Maloney :

Madam Speaker, I think it is my assistant calling me, telling me it is time to speak. She is very efficient. As I was saying, the bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID, on the basis of mental illness alone would remain prohibited until March 17, 2027. In my remarks today, I will be addressing some of the concerns that have been expressed about allowing MAID for mental illness and the importance of ensuring that our health care system is ready before legalizing this practice.

As members know, Bill C-7 temporarily excluded MAID for mental illness until March 2023. Parliament extended the exclusion for an additional year after organizations such as the Association of Chairs of Psychiatry in Canada and the Centre for Addiction and Mental Health expressed a need for additional time. The Special Joint Committee on Medical Assistance in Dying, or AMAD, also supported the extension. At the outset of my remarks, I want to emphasize that the government recognizes that mental suffering may be as severe as physical suffering.

We know that not all individuals with a mental illness lack decision-making capacity. The extension of the temporary exclusion of eligibility for MAID is not based on these stigmatizing stereotypes. I also want to announce my profound sympathy for anyone in Canada who is intolerably suffering because of a health disorder. My thoughts are with them. While the federal government believes that MAID eligibility should be expanded to those whose sole condition is a mental illness, this process cannot be rushed.

Over the past year, important progress has been made to prepare for the expansion, but provinces and territories are at varying stages of readiness. The federal government has listened to its partners and introduced this bill as a direct response to their concerns. A cautious, deliberate and rigorous framework is essential to ensure the safe provision of MAID where a mental illness grounds a request for MAID.

Debate about the parameters of the MAID regime has been taking place since before the Supreme Court of Canada's 2015 decision in Carter, in which it held that the absolute prohibition on physician-assisted dying was unconstitutional. This is a sign of a healthy democracy. Most recently, the Special Joint Committee on MAID witnessed the diversity of views and expertise first-hand. Some witnesses who testified, such as Dr. Trudo Lemmens, chair in health law and policy at the University of Toronto, expressed concerns about permitting MAID where the sole underlying condition is a mental illness.

Others, including the members of the Canadian Association of MAID Assessors and Providers, thought the country was ready for the current March 17, 2024 deadline. Still others supported expanding MAID for mental illness, or accepted that it would become legal but recommended a delay. This recommendation came from Dr. Jitender Sareen of the University of Manitoba on behalf of eight chairs of psychiatry departments in Canada. The chairs of psychiatry outlined several reasons, including concerns about a need for further safeguards and accepted

definitions of irremediability in mental disorders, before moving forward. I would like to acknowledge the important contributions that have been made on this topic. While not everyone agrees, it is clear that we all care deeply about the well-being of those seeking MAID and the protection of the vulnerable. Let me now get into some of the specific concerns that have been raised. Members will recall that certain eligibility criteria need to be met to qualify for MAID. This includes having a grievous and irremediable medical condition, which requires that a person be in an advanced state of irreversible decline.

Some doctors, such as Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre, have said it is impossible to predict which patients with a mental illness will get better; in other words, we cannot determine whether their illness is irremediable. However, other experts, including members of the expert panel on MAID and mental illness, suggest that the evolution of the illness and the response to past interventions can be used to assess irremediability, as is done with some physical conditions such as chronic pain. Concerns have also been raised, by Dr.

Sareen and others, that it is too difficult to distinguish between suicidality and a rational request for MAID when the request is based on a mental illness alone, because suicidality may be a symptom of the mental illness itself. Dr. Stefanie Green acknowledged that this can be complicated, but testified before the MAID committee that clinicians have a duty to assess every patient for suicidality. It is something that doctors do regularly in clinical practice. In addition, MAID assessments may involve suicide prevention efforts where warranted.

(1240) Another concern expressed by Dr. Tarek Rajji, the chair of the medical advisory committee at the Centre for Addiction and Mental Health, is that there was no consensus within the medical community about whether MAID should be available for persons whose sole underlying medical condition is a mental illness. However, others, including Dr. Green, note that the lack of consensus in the medical community is not unique to MAID. A last concern that I want to address is that individuals are requesting MAID due to a structural and systemic vulnerability, such as lack of income and social supports.

I want to be clear that the law requires that the suffering be due to illness, disease or disability, not poverty or unmet needs. Our government is confident that the existing safeguards will ensure that only those who meet the eligibility criteria receive MAID. We are also determined to invest in social programs that can alleviate non-medical suffering and bolster social supports. Our MAID framework contains two sets of safeguards, one for requests where natural death is reasonably foreseeable and the other, more robust set for requests where natural death is not reasonably foreseeable.

The second set of safeguards would apply to cases where a mental illness is the basis of a MAID request. These include a requirement for a doctor or nurse practitioner with expertise in the condition to be involved in the assessment, a longer assessment period of 90 days, a requirement that the patient has been informed of the means available to relieve their suffering and has been offered consultations with relevant professionals, and a requirement that both assessors and patient agree that the patient has given serious consideration to the reasonable and available means of relieving their suffering.

In addition to these stringent safeguards, there is other guidance for doctors, nurse practitioners and regulators, including a model practice standard. Implementation of robust regulatory guidance and additional resources is ongoing, as is uptake of the nationally accredited bilingual MAID curriculum. We are confident that, with more time, we can achieve readiness to ensure the safe provision of MAID in circumstances in which a mental illness grounds the request for MAID.

We have made important strides, but work remains to be done to prepare health care systems and for more doctors and nurse practitioners to benefit from the available training and supports. Our government thinks that three years is enough time to complete this work, so that our health care system is prepared when MAID for mental illness is permitted. In addition, we are proposing to add a requirement for a parliamentary review by a joint committee of both Houses of Parliament, to start within two years of this bill's receiving royal assent.

The committee will have six months to submit a report, including a statement of any recommended Criminal Code changes. This review will inform government action and ensure that they move forward only once the Canadian health care systems are ready. With the March 17, 2024 deadline fast approaching, I urge everyone to work together to see that this bill is adopted before that date.

(1245) [ Translation ]

Mr. Luc Thériault (Montcalm, BQ) :

Madam Speaker, that is a rather accurate

summary of what happened in committee. The government decided to include in legislation the committee's main recommendation on mental disorders. My colleague sat on the committee that produced the report tabled in February 2023, which recommended allowing advance requests. Why has his government not introduced a

section on advance requests after a year of waiting? I think that would have been good for people who are currently suffering and who cannot make an advance request. Why is this not included in Bill C‑62 ?

[ English ]

Mr. James Maloney :

Madam Speaker, I will start by saying how much I enjoyed working with the hon. member on the special joint committee, not just on this occasion but last year as well. He is well aware of this looming deadline. We need to focus on the issue at hand and get this bill passed. Any additional layers of discussion that we add to that could potentially impact our ability to get this bill through the House and through the Senate. It is important that we get this done before the March deadline, and I think we agree on that. I think he will agree with me, and in fact I know he agrees with me, that the process at the committee has been very positive and constructive.

Ms. Lori Idlout (Nunavut, NDP) :

Uqaqtittiji , I wonder if the member could share with us what would happen if we missed the deadline. What kinds of challenges will be experienced by Canadians and the system if we do not get this passed before March 17?

Mr. James Maloney :

Madam Speaker, I really appreciate that question because it goes to the core of the reason we are moving this bill forward. If we do not get this bill through the House and if we do not get this bill through the other place, this law will take effect on March 17. That, then, triggers a situation where we have multiple jurisdictions that have made it very clear that they are not ready to proceed, but it will be the law of the land. A scenario could be created in which there is, I will not use the word “chaos”, but a situation which would be unsettled and inconsistent across the country. We cannot have that happen.

When we are dealing with an issue that is so significant and so serious and that has permanent implications, we have to make sure that we are ready and that we have it right. That is why we have to get this bill passed.

[ Translation ]

Ms. Louise Chabot (Thérèse-De Blainville, BQ) :

Madam Speaker, there is wisdom in life, in our decisions, but fear should never dictate our actions. I do not want to use the word “chaos”, but I think we need to recognize all the work that has been done on this file. Today's bill adds a three-year delay to the inevitable question that arises when mental health comes into play. It seems to me that re-establishing the Special Joint Committee on Medical Assistance in Dying and giving it an extra year to do a more in-depth study might have been a better solution. This is just going to postpone suffering. Psychological suffering exists.

Some people who have it talk about cancer of the mind. That is also a reality. That said, it is 2024. Much progress has been made, such as being able to make an advance request for MAID for certain illnesses. Why has the progress made at the special joint committee not been moving forward? Can my colleague tell us why—

(1250) The Assistant Deputy Speaker (Mrs. Carol Hughes) :

The hon. parliamentary secretary.

[ English ]

Mr. James Maloney :

Madam Speaker, on the member's first point, she is right. Fear should never dictate and reason should, particularly when we are dealing with issues of such importance. This bill is not about delay; it is about getting it right. This issue is so important. If we do not have the system in place and the structural integrity to make sure that it is ready to go, we are not doing our jobs as parliamentarians. It is as simple as that. I sat on the special committee on both occasions. The work it has done has put us in a position where we can deal with this in a reasonable, rational and timely way.

It was the committee that recommended, last year, that the special committee be put together again this year, which is again recommended. We do not want to be put in a position 12 months from now of having the same discussion and again being rushed. Postponing this for three years is rational and reasonable, but it does not mean the discussion does not continue in the interim.

Ms. Elizabeth May (Saanich—Gulf Islands, GP) :

Madam Speaker, I appreciate the opportunity to speak to this. Having been in this place for all the debates we have had, I have been trying to figure out the best way to explain to Canadians, if there is an argument here, why it is not between Liberals and Conservatives, or between Greens and NDP and Conservatives and the Bloc. It has actually been, from the very beginning, a struggle for Parliament to actually deal with an issue we have been kicking down the road for too long.

I mentioned earlier in debate, as the member for Saanich—Gulf Islands, the quiet and extraordinary courage of a single woman, Sue Rodriguez, who took her irremediable medical condition of suffering all the way to the Supreme Court of Canada and was denied the opportunity for what is generally called death with dignity. She had the procedure illegally. Those who were with her at the time would have been subject to criminal penalty as well, including my friend Svend Robinson, who at the time was member of Parliament in a different party from a different place.

It was a very fraught time, and the issue of medical assistance in dying kept coming back to me from constituents who were heartbroken that their parents or loved ones had to go through suffering. Quite often people would say to me they would not let a family pet go through this kind of suffering so why do we allow our moms and our dads to go through this when there is no prospect they are going to recover