moved that Bill , be read the second time and referred to a committee.
He said: Mr. Speaker, I rise today to speak to Bill , an act to amend an act to amend the Criminal Code regarding medical assistance in dying. This bill would extend the exclusion of eligibility for receiving medical assistance in dying, or MAID, in circumstances where the sole underlying medical condition for MAID is a mental illness. The main objective of this bill is to ensure the safe assessment and provision of MAID in all circumstances where a mental illness forms the basis for a request for MAID.
An extension of the exclusion of MAID eligibility in these circumstances would help ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the federal government more time to meaningfully consider the report of the Special Joint Committee on Medical Assistance in Dying, or AMAD, which is expected this week.
My remarks today will focus on the legislative history of MAID in this country. I want to be clear that medical assistance in dying is a right, as affirmed by the Supreme Court.
In its 2015 Carter v. Canada decision, the Supreme Court of Canada ruled that the sections of the Criminal Code prohibiting physicians from assisting in the consensual death of another person were unconstitutional. In response, in 2016, our government tabled former Bill , an act to amend the Criminal Code and to make related amendments to other acts regarding medical assistance in dying.
The basic purpose of the bill was to give Canadians nearing the end of life who are experiencing intolerable and unbearable suffering the option to obtain medical assistance in dying. The bill was passed two months later, when medical assistance in dying, or MAID, became legal in Canada for people whose natural death was reasonably foreseeable. It included procedural safeguards in order to ensure that the person’s request for medical assistance in dying was free and informed, and to protect the most vulnerable.
In 2019, in Truchon v. the Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. One year later, in response, we introduced a second bill on medical assistance in dying, the former Bill .
Former Bill expanded eligibility to receive MAID to persons whose natural death was not reasonably foreseeable. It did so by creating a separate, more stringent set of procedural safeguards that must be satisfied before MAID can be provided. The government proposed, and Parliament supported, these stringent procedural safeguards in recognition of the increased complexities of making MAID available to people who are not otherwise in an end-of-life scenario.
Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person's suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.
Another additional safeguard is the requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering or that they must consult with a practitioner who does. The assessing practitioners must also ensure that the person be informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It is not enough just to discuss treatment alternatives. They must ensure the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.
The former Bill extended eligibility to medical assistance in dying to people whose death is not reasonably foreseeable. However, it temporarily excluded mental illness on its own as a ground for eligibility to MAID. In other words, the bill excluded from eligibility for medical assistance in dying cases where a person's sole underlying medical condition is a mental illness. That temporary exclusion from eligibility stems from the recognition that, in those cases, requests for medical assistance in dying were complex and required further review.
In the meantime, the Expert Panel on MAID and Mental Illness conducted an independent review of the protocols, guidance and safeguards recommended in cases where a mental illness is the ground for a request for medical assistance in dying. The expert panel’s final report was tabled in Parliament on May 13, 2022.
The Special Joint Committee on Medical Assistance in Dying also completed its parliamentary review of the provisions of the Criminal Code relating to medical assistance in dying and their application, as well as other related issues, including mental health. We eagerly look forward to the special joint committee’s final report, expected on Friday, February 17.
I would also like to highlight the excellent work of the expert panel, ably led by Dr. Mona Gupta.
This temporary period of ineligibility was set in law to last two years. It will expire on March 17 unless this legal requirement is amended by law. This bill would do just that, and proposes to extend this period of ineligibility for one year, until March 17, 2024.
As I stated at the outset of my remarks, this extension is needed to ensure the safe assessment and provision of MAID in circumstances where a mental illness forms the sole basis of a request for MAID. It is clear that the assessment and provision of MAID in circumstances where a mental illness is the sole ground for requesting MAID raises particular complexities, including difficulties with assessing whether the mental illness is in fact irremediable and the potential impact of suicidal ideation on such requests.
That is why, when some Canadians, experts and members of the medical community called on the federal government to extend the temporary period of ineligibility to make sure the system was ready, we listened. We listened, we examined the situation carefully and we determined that more time was needed to get this right.
As for the state of readiness of the health care system, I would like to take a moment to highlight the great progress that has been made toward the safe delivery of MAID in those circumstances. For example, standards of practice are being developed for the assessment of complex requests for medical assistance in dying, including requests where mental illness is the sole underlying medical condition. Those standards of practice will be adapted or adopted by clinical regulatory bodies and by clinicians in the provinces and territories. These standards are being developed and will be completed in March 2023.
In addition, since October 2021, the Canadian Association of MAiD Assessors and Providers, or CAMAP, has been developing an accredited study program for health professionals. Once completed, that program will include seven training modules on various topics related to the assessment and delivery of medical assistance in dying, including on how to assess requests for medical assistance in dying, assess capacity and vulnerability, and manage complex and chronic situations. That program should be finalized and ready to be implemented next fall.
This progress was achieved through our government's leadership and collaboration with the health system's partners, such as the provincial and territorial governments, professional health organizations, our government's regulatory agencies, clinicians and organizations such as CAMAP.
The Regulations for the Monitoring of Medical Assistance in Dying, which set out the requirements for the presentation of reports on MAID, came into force in November 2018.
These regulations were recently revised to significantly improve the collection of data and reporting on MAID. More specifically, the regulations now provide for the collection of data on race, indigenous identity and any disability of the person. The revised regulations came into force in January 2023, and the information about activities related to medical assistance in dying in 2023 will be published in 2024 in Health Canada's annual MAID report.
I think we can all agree that substantial progress has been made. However, in my opinion, a little more time is needed to ensure the safe assessment and provision of MAID in all cases where a mental illness is the sole basis for a request for MAID.
I want to be clear that mental illness can cause the same level of suffering that physical illness can cause. We are aware that there are persons who are suffering intolerably as a result of their mental illnesses who were waiting to become eligible to receive MAID in March 2023. We recognize that these persons will be disappointed by an extension of ineligibility, and we sympathize with them. I want to emphasize that I believe this extension is necessary to ensure the safe provision of MAID in all cases where a mental illness forms the basis of the request for MAID. We need this extension to ensure that any changes we make are done in a prudent and measured way.
I want to turn now to the more technical part of Bill and briefly explain how the bill proposes to extend the mental illness exclusion. As I stated earlier in my remarks, former Bill expanded MAID eligibility to persons whose natural death was not reasonably foreseeable. It also included a provision that temporarily excluded eligibility in circumstances where a mental illness formed the basis of the request for MAID. Bill C-39 would delay the repeal of the mental illness exclusion. This would mean that the period of ineligibility for receiving MAID, in circumstances where the only medical condition identified in support of the request for MAID is a mental illness, would remain in place for an extra year, until March 17, 2024.
I want to reiterate that we need more time before eligibility is expanded in this matter. We need more time to ensure the readiness of the health care system, and more time to consider meaningfully and to potentially act on AMAD's recommendations. This is why I urge members to swiftly support the passage of this bill. It is imperative that it be enacted before March 17. If it is not, MAID will become lawful automatically in these circumstances. It is essential that this bill receive royal assent so that this does not happen before we are confident that MAID can be provided safely in these circumstances. I trust that all colleagues in this place will want to make that happen.
The safety of Canadians must come first. That is why we are taking the additional time necessary to get this right. Protecting the safety and security of vulnerable people and supporting individual autonomy and freedom of choice are central to Canada's MAID regime. We all know that MAID is a very complex personal issue, so it is not surprising that there is a lot of debate. It should go without saying that seeking MAID is a decision that one does not make lightly. I know from speaking with members of the medical community that they take both their critical role in the process and their professional duties toward patients extremely seriously. I trust that medical professionals have their patients' interests at heart, and this sometimes involves supporting their patients' wishes for a planned, dignified ending that is free of suffering.
Once again, I strongly believe that an extension of the exclusion of MAID eligibility in this circumstance is necessary to ensure the health care system's readiness and to give the government more time to meaningfully consider and to potentially implement the AMAD recommendations. I remind the House that those recommendations are expected just one month before the current mental illness exclusion is set to expire. Therefore, I implore all members to support this bill.
Mr. Speaker, I rise to speak on Bill , a legislation that imposes a new arbitrary deadline of March 2024 in place of the Liberal government's arbitrary deadline of March 2023 whereby persons with a sole underlying mental health disorder would be eligible for MAID.
I support Bill only because it is better than the alternative, namely that in one short month from now, on March 17, MAID would be available to persons with a sole underlying mental health disorder. This would be an absolute disaster and certainly result in vulnerable persons prematurely ending their lives, when otherwise, they could have gone on to recover and lead healthy and happy lives.
Rather than imposing a new arbitrary deadline that is not grounded on science and evidence, what the Liberal government should be doing is abandoning this radical, reckless and dangerous expansion of MAID altogether. This is why I wholeheartedly support Bill , which was introduced last Friday by my friend and colleague, the member for , and would do exactly that.
One would expect that before deciding to expand MAID in cases of mental illness, a responsible government would take the time to study the issue thoroughly and consult widely with experts. After all, we are talking about life and death. We are talking about a significant expansion that would impact a vulnerable group of Canadians.
However, the Liberal government is not responsible, and that is not what happened. This is why the government finds itself in the mess it is in today with this rushed, 11th-hour legislation to delay the expansion.
Instead, the accepted a radical Senate amendment to Bill , which established an arbitrary sunset clause. That set in motion this expansion of MAID in cases of mental illness, effective in March of 2023. To provide some context, Bill C-7 was a response to the Truchon decision; its purpose was to remove a critical safeguard, namely that death be reasonably foreseeable before someone is eligible for MAID. It was a terrible piece of legislation that the government should have appealed but did not.
As bad as the bill was, when it was studied at the justice committee, of which I was a member at the time, nowhere in the bill was there any mention of expanding MAID in cases of mental illness. The justice committee did not hear evidence on that point. Indeed, when the minister came to committee, he said that there were inherent risks and complexities with expanding MAID in cases of mental illness, and therefore, it would be inappropriate to do so.
The bill went over to the Senate, and all of a sudden, the unilaterally accepted the amendment. Then what did the Liberals do? After little more than a day of debate, they shut down debate on a bill that had drastically changed in scope and rammed through the legislation for this expansion of MAID in cases of mental illness.
There was no meaningful study and absolutely no consultation with experts, including psychiatrists; persons struggling with mental illness; or these person's advocates. There was nothing. In short, the made the decision to go ahead with this significant expansion and then said the issue would be studied later. Hence, there was the establishment of an expert panel that was appointed after the government had already made the decision to go ahead. One would think that if an expert panel were going to be appointed, it would be appointed before deciding. However, that is not what happened with the justice minister and Liberal government.
We saw a special joint committee established after the fact. Talk about getting it backward, putting blind ideology and hubris ahead of science and evidence, and showing a total disregard for the concerns and lives of Canadians struggling with mental illness. Had the and the Liberal government done their homework at the outset, they would have learned very quickly that this expansion of MAID cannot be implemented safely.
I serve as a co-vice-chair on the Special Joint Committee on Medical Assistance in Dying. As early as the spring, the committee heard from multiple witnesses, including representatives of the mental health community, and most importantly with respect to some of the clinical issues, leading psychiatrists. The body of evidence showing that this cannot proceed safely was overwhelming. One of the key reasons cited for this was that in the case of mental illness, it is difficult, if not impossible, to predict irremediability. In other words, in the case of mental illness, it is difficult or impossible to determine whether someone can recover and become healthy. This is a serious problem.
Let us look at some of the evidence that was available to the in the spring. Dr. John Maher, a clinical psychiatrist and medical ethicist who appeared before the committee, said, “Psychiatrists don't know and can't know who will get better and live decades of good life. Brain diseases are not liver diseases.”
Dr. Brian Mishara, a clinical psychiatrist and professor at the Université du Québec à Montréal, told the committee, “I'm a scientist. The latest Cochrane Review of research on the ability to find some indicator of the future course of a mental illness, either treated or untreated, concluded that we have no specific scientific ways of doing this.”
Even the government's expert panel conceded the difficulty in predicting irremediability. At page 9 of the expert panel report, the panel observed, “The evolution of many mental disorders, like some other chronic conditions, is difficult to predict for a given individual. There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.” The government's own expert panel said that it is difficult, if not impossible, to predict irremediability.
If one cannot predict irremediability, persons who could go on to lead healthy and happy lives may have their lives prematurely ended. This is a problem that the government cannot avoid and that has not been resolved. Let me remind this House that, under the law, one must have an irremediable condition in order to be eligible for MAID. However, here we have leading experts and psychiatrists, including the government's expert panel, saying that it is difficult, if not impossible, to predict irremediability.
According to the psychiatrists who appeared before the special joint committee, what that means is that medical assessments in cases of mental illness for MAID are going to be decided on the basis of “hunches and guesswork that could be wildly inaccurate.” Those are the words of Dr. Mark Sinyor, a professor of psychiatry at the University of Toronto, who appeared before the special joint committee. These words were echoed by other psychiatrists who appeared before our committee.
The expert panel did not use such language, but it essentially conceded the point in its report because it was unable to come up with any objective standard by which to measure whether a patient's condition in the case of mental illness is irremediable. Instead, the expert panel ridiculously and recklessly said that it was going to wash its hands clean of this and that it was going to give a big green light and say it can all be done on a case-by-case basis. There would be no objective standard whatsoever; all would be guesswork and subjective assessment.
At the special joint committee on the issue of predicting irremediability in the context of mental illness, Dr. Mark Sinyor said that physicians undertaking a patient assessment “could be making an error 2% of the time or 95% of the time.” A 95% error rate is the risk on a matter of life and death, on a procedure that is irreversible and results in the termination of someone's life. For persons who are struggling with mental illness, this is the government's solution. The just stood in this place and said, “Damn the evidence. Damn the facts. We are going full steam ahead”.
I cannot think of a more reckless approach than the one the Liberal government has taken on an issue of profound importance to so many Canadians. It is not just the issue of irremediability, although given that this cannot be resolved, it should be the end of the matter. In addition, psychiatrists and other experts at the special joint committee emphasized that in the case of mental illness, it is very difficult to distinguish between a request motivated by suicidality versus one made rationally. In fact, suicidality is a symptom of mental illness, and indeed, 90% of persons who end their lives by suicide have a diagnosable mental disorder.
To illustrate how radical the government is, I note that when the Ontario Medical Association surveyed Ontario psychiatrists in 2021, 91% said they opposed the expansion of MAID for mental illness under Bill . About 2% expressed support. Some 91% were against, 2% were in support and the reset were undecided. This speaks to how reckless, how radical, how extreme and how out of touch the government is on the question of expanding MAID in the case of mental illness.
In the face of the overwhelming evidence that we heard at committee, we issued an interim dissenting report calling on the Liberals to put a halt to this radical and reckless expansion. The ignored our interim dissenting report. He ignored the experts. He ignored the evidence. It appears he is so blinded by ideology that it is impossible for him to see what is in plain sight: This cannot be done safely.
In December, when it was evident that the was not listening, the Association of Chairs of Psychiatry in Canada, which includes the heads of psychiatry at all 17 medical schools, said to put a halt to this expansion. However, the minister still was not prepared to act. Indeed, it was not until the day after Parliament rose for Christmas that he had a late afternoon press conference where he made some vague commitment to introducing legislation in which there would be some type of extension. Then, with only 17 sitting days left before the expiration of the sunset clause, the minister finally saw fit to introduce this bill. I think this very clearly illustrates the shambolic approach with which the government has handled this issue.
We now have legislation, but what does this legislation do? As I noted at the outset of my speech, it provides for a new arbitrary deadline, even though issues of irremediability, suicidality and capacity to consent have remained unresolved for the past two years. There is absolutely no evidence that those issues are going to be resolved a year from now.
What we have is nothing more than an arbitrary deadline, and a year from now, we are going to find ourselves in exactly the same place. Let us be clear. When we speak about suicidality, irremediability and capacity to consent, these are not issues to be brushed under the rug. These are serious legal and political issues that are fundamental to determining whether this can go forward.
In closing, whether this expansion takes place a month from now or a year from now, it will be an absolute disaster and will result in persons struggling with mental illness having their lives wrongfully terminated. It is time for the government to get its head out of the sand, stop being blinded by extreme ideology, follow the science, follow the evidence and scrap this ill-conceived expansion.
Mr. Speaker, I would like to begin by providing some background on Bill , which is not rocket science, when it comes down to it. Then I would like to talk about the philosophical foundation for dying with dignity, as well as the context and whether or not medical assistance in dying should be extended to patients whose sole underlying medical condition is a mental disorder. I would also like to talk about mental illness generally in our societies and the experts' report before finally concluding my speech.
The context is rather simple. This is not about rehashing the entire debate. We are studying Bill C-39, which simply defers the provision in Bill that would have ended the two-year exclusion for mental disorders on March 17, 2023.
Following consultations, the government has decided to extend this exclusion clause for one year, which means that on March 17, 2024, mental disorders, or rather individuals whose sole underlying medical condition is a mental disorder, would be eligible for MAID, subject to the conditions, limits, guidelines, standards of practice, safeguards and precautionary principles outlined in the expert report.
Before voting, I invite all parliamentarians in the House to read the report of the expert panel. It contains precautionary principles that do not lend credence to last week's comments by, for example, the leader of the official opposition. It really puts into perspective the ideology underlying the comments by my colleague from . Let me dive right into this matter.
Why is there such a delay? The reason is that we believe things should be done properly by the medical world. When a mental disorder is the sole basis for a request for MAID, how prepared are those working in this field across the country to ensure that MAID is adequately and safely delivered in light of the safeguards?
More providers and seasoned assessors will be needed. I should note that the experts did say that assessing whether a person with a mental disorder has the capacity to choose MAID is something they are already doing. Often a person may have cancer and also suffer from a mental disorder. It is not the sole underlying medical condition, and they still need to establish the person's capacity to decide for themselves. Again, in response to the oversimplification by my colleague from St. Albert—Edmonton, first a person needs to want MAID, and then they need to meet the criteria.
As far as mental disorders are concerned, to meet the criteria, this is not going to happen overnight or anytime soon. It is going to take decades before anyone can have access. It is going to take time for the whole range of necessary treatments and possible therapies to be tested without the condition that the person demonstrate that they cannot bear any more and that their pain cannot be relieved. That is a long way from people living in poverty, who are depressed and who might have access to medical assistance in dying. We are far from it.
That being said, what are we talking about? When we talk about medical assistance in dying, I know that everyone in the House wants to do the right thing. Everyone has the best of intentions and wants to look after the best interests of patients and people who are suffering. However, being compassionate does not square with undermining human dignity. Human dignity is grounded in the capacity for self-determination.
Those are the philosophical premises. The law grants any individual with a biomedical condition the right to self-determination. Nothing can be done without the patient's free and informed consent. To that end, the role of the state is not to decide what that patient, who is the one suffering, needs. Rather, the state must ensure the conditions needed for them to exercise free will, so that patients can make a free and informed decision.
Historically, it was difficult to fight medical paternalism. At one time, people who had reached the terminal phase of an incurable disease did not have the right to die. The right to die was acquired, and it was called palliative care. Life was artificially prolonged, and people died from clinical trials or new therapies rather than dying a peaceful death in palliative care. However, palliative care is not a substitute for medical assistance in dying.
I find it strange that my colleague thinks it is unacceptable to grant access to medical assistance in dying to someone whose soul is suffering, and that he even opposes any form of medical assistance in dying, even when people are at the end of their life. He is opposed. At some point, if people are opposed, they need to explain why.
Why does the law recognize people's right to bodily autonomy throughout their lifetime but take it away from them at the most intimate moment of their lives? The government or our neighbour is not the one dying, so on what basis is the government giving itself the authority to decide for us at the most intimate moment of our lives?
These are the ethical and philosophical grounds and principles behind our position. Just because someone has a mental disorder does not mean that they should also be subject to social discrimination and stigma. Even though mental illness is now considered to be an actual illness, mental health is still not on the same footing as physical health. Mental illness results in discrimination and stigma.
Should we be telling people who have to deal with such discrimination and stigma that they will also never be given the right to MAID, even if they have been suffering from a mental illness and have had schizophrenia, for example, for 25 or 30 years? On what grounds are we refusing them that right? That is the basis of the expert panel's report. Do we give that right to someone with a mental disorder who is suffering, who has tried everything, whose problems are far from over and who says that they cannot go on?
There are people out there who have an ache in their soul, and unfortunately, we lose them when they attempt suicide. It is really no better. We absolutely must fight against suicide because it is one decision that cannot be undone.
In the report, the experts set out several precautionary measures. They talk about structural vulnerabilities like poverty. On page 11 of the report, the experts state the following: “In the course of assessing a request for MAiD—regardless of the requester's diagnoses—a clinician must carefully consider whether the person's circumstances are a function of systemic inequality”, and, if so, this should be addressed.
With respect to suicidal ideation, experts offer us another precautionary measure. It is not enough for a person to request MAID to have access to it.
The report states: “In any situation where suicidality is a concern, the clinician must adopt three complementary perspectives: consider a person's capacity to give informed consent or refusal of care, determine whether suicide prevention interventions—including involuntary ones—should be activated, and offer other types of interventions which may be helpful to the person”.
What is this claim about people who are depressed being able to request MAID? Members need to stop talking nonsense. That is not what the expert panel's report says. It says that incurability can be established over the course of several years. The patient must have exhausted all available therapies and treatments. However, that does not include overly aggressive therapy.
What does the member for think should happen? When a person with a psychiatric disorder says that they reached their breaking point years ago, should psychiatric science insist that there is a treatment out there and that it is going to find it? That is what I mean by overly aggressive therapy.
Overly aggressive treatment may exist for all types of illness. Who gets to decide when it is too much? The Supreme Court and the Superior Court of Quebec have told us that it is up to the patient to decide. That is important, because the member for St. Albert—Edmonton keeps saying that we are cutting lives short, ending lives prematurely.
In reality, the opposite is true. Everyone wants to live as long as possible. People who are on what we call the second track, whose natural death is not reasonably foreseeable, want to live as long as possible. What they do not want is to be denied help when they reach their breaking point. If we do not give them access to MAID, they will find their own way to avoid ending up in that situation, because it is currently illegal for them, and they will end their lives prematurely. They will commit suicide.
The ruling that some contend should have been appealed to the Supreme Court states that there is an infringement on the right to life. The Conservatives' position infringes on the right to life because it forces people to end their lives prematurely rather than waiting for the moment of death, which sometimes is in one or two years. As proof, there is the case of Ms. Gladu. She did not go ahead with MAID, but she was relieved to know that she had that option. She did not commit suicide; she died naturally.
However, if her suffering became intolerable, she knew that she could access MAID because our compassionate and empathetic society would take care of her and ensure that she had a peaceful and dignified death. This meant that she could have the death that she did. Many people say that they choose to end their lives because they are not certain that they will be taken care of.
Is there anything more devastating than a suicide? That is a societal failure. We cannot be complacent about suicide attempts, about people feeling suicidal. In the health care system, mental illness, which is an illness like any other, absolutely must have all the necessary resources.
I just want to say a few words about the governments' ability to pay for the health care needs of the patients I am talking about, given the feds' post-pandemic offer. Governments have to deliver care to these people with irreversible illnesses, but they will not be getting money to do so. Over the next 10 years, they will barely be able to cover indexing on chronically insufficient funding. The federal government's share will go up from 22% to 24%. I hope government members are not too proud of that, especially considering that, during the third wave, people told us the system was in critical condition. The pandemic had destabilized it to the point that it would take 10 years to recover from the pandemic's side effects on patients without COVID. Right in the middle of the third wave, the said it would all be dealt with after the pandemic. We were told an agreement was imminent. I figured that they would come close to the $28 billion everyone expected, that they would give the governments of Quebec and the provinces the predictable funding they needed to rebuild their systems, take care of people over the next 10 years and finally recover from the pandemic.
I have heard the Conservatives say they will honour that small percentage. Of all the G7 countries, Canada still has the best borrowing capacity. If debt is unavoidable, what better justification for it than taking care of our people and restoring and rebuilding our health care systems?
I hear people say that individuals who have had an incurable mental disorder for years should not be given access to MAID on account of structural vulnerabilities. According to the expert report, however, two independent psychiatrists would have to be consulted. Not only would two independent psychiatrists be required, but we also have to consider recommendation 16. So far, I have been talking about recommendation 10, but my colleagues should hold on to their hats, because recommendation 16 states that, unlike for other kinds of MAID, when mental disorders are involved, there would be something called “prospective” oversight. This is different from retrospective oversight, as required by Quebec's commission on end-of-life care, which requires a justification every time MAID takes place. No, this does not happen after, but rather before, in real time.
This prospective oversight needs to be established in each jurisdiction, which is precisely what the delay will be used for. This additional safeguard needs to be established in controversial cases. According to the expert report, when an individual's capacity cannot be properly assessed, MAID is not provided, period. It is not complicated. There will be no slippery slope.
If there is a slippery slope, there is the Criminal Code, the courts, the police. Evil people do not belong in the health care system. They would be fired. If they do harm, they can be taken to court. To my knowledge, the provisions allow action to be taken.
My esteemed colleague seems to assume that everyone in health care is necessarily evil, which is absurd. The slippery slope is based solely on health care workers having evil intentions. However, to work in that field, people have to demonstrate skills proving the opposite. Consequently, all the precautionary measures and principles in this report are sufficient, in my opinion.
What needs to be done now is to ensure that people get training. Not all Quebec psychiatrists have read the report. If they listen to interviews given by the member for , they will wonder what is happening with their profession.
We must be able to see things realistically and proportionately, provide training, and ensure that we implement a law that will be both accessible and equitable throughout the country. We must avoid situations where an institution that does not want to provide MAID prevents someone from accessing it, if it is their choice and they meet all the criteria.
This is still a dangerous situation. It is happening in Quebec, and the college of physicians warned last week that, in a simple case of MAID for a terminal patient, some doctors did not want to refer the patient to another doctor who was willing to provide it.