Élisabeth Brière

“Mr. Speaker, tonight, we have gathered to discuss a particularly sensitive issue that raises legal, ethical and social questions affecting patients suffering from an incurable disease, their families and health care professionals. I believe this is a topic we all take very seriously. Let us take a step back. The law on medical assistance in dying came into effect in Canada in 2016. That marked a significant change in Canadian society’s approach to end-of-life care. MAID provides eligible individuals with an additional choice regarding their care by allowing them to end their suffering with dignity. There are certainly strict guidelines in place. Medical assistance in dying is reserved for adults who meet strict eligibility criteria. We are talking, for example, about people living with an incurable illness who are approaching the end of life, such as cancer patients, or individuals with an incurable condition that causes irreversible physical decline and significant suffering, such as certain neurodegenerative disorders. There are guidelines that must be followed. The consent must be informed. The person has the right to withdraw consent at any point in the process. The passage of the bill in 2016 was not the end of the debate. I would say that it was the beginning and the continuation of an ongoing societal discussion on the subject of MAID. Over the past decade alone, we have pondered substantive questions about MAID, such as whether a person has a right to set the conditions for their end of life. This led to questions about dignity and suffering. As we know, the law was expanded in 2021. Initially, it was for naturally foreseeable death. The law was amended in 2021 to include people suffering from an irreversible illness that causes significant suffering. At the time, as a citizen, I heard very touching testimony from people who asked that their situation be taken into consideration so that they could have the right to make this choice for themselves. This also raises questions about the protection of vulnerable individuals, consent, and the ability to make a free and informed decision, as well as what to do when an illness deprives a person of that ability. With Bill C-41, we aim to update Canada’s legislative framework on medical assistance in dying, particularly with regard to people with mental illness and advance requests. We are therefore clarifying matters with respect to these two elements. I would say that this is another step in a collective reflection that began more than a decade ago. One key component of Bill C-41 seeks to allow for advance MAID requests. Under the current legislation, a person must be able to give informed consent to receive this care. They must understand their medical condition, their options, and the consequences of their decision. As a general rule, they must also confirm their consent immediately before MAID is administered. Very strict guidelines are in place. However, some diseases, such as Alzheimer’s disease and other forms of dementia, can lead to a gradual loss of decision-making capacity. As the disease progresses, a person may lose the ability to make an informed choice at the time they wish to receive MAID. Under the current rules, they cannot access this option, even if they had clearly expressed their wishes earlier in life when they were still capable of making that decision. Our government believes that Canadians with terminal illnesses should be able to make informed decisions about their future care while they still have the capacity to do so. That is why, with this bill, we intend to allow eligible adults who receive an early diagnosis of a terminal illness that is likely to cause them to lose their decision-making capacity to make an advance request for MAID. For example, an adult diagnosed with early-stage Alzheimer’s disease could specify in advance the conditions and circumstances under which they would want to receive MAID at a more advanced stage of their illness, when they would no longer be able to make that decision for themselves. The underlying objective is to respect the person’s wishes and their individual end-of-life choices, which I believe are based on deep and careful reflection. We heard some very moving testimony. Loved ones of people with Alzheimer’s said that MAID should be expanded to allow people in these situations to make informed choices while they still can. An advance request does not necessarily mean that MAID will automatically be administered at a later time. The eligibility criteria must be met and the strict guidelines must be followed. For example, two independent assessments will always be required for advance requests to ensure that the conditions described in the request are met. There must be confirmation that the person is in an advanced and irreversible state of decline and experiencing profound suffering, so the independent assessments still need to be carried out. The person may also signify, through sounds or gestures, that they withdraw their consent when MAID is about to be administered. If the person does not appear to consent to MAID, the procedure will be stopped. Obviously, a family member cannot submit an advance request on behalf of someone else. The aim is really to respect the choice of the person who made the request while they still had the capacity to do so. In our discussions tonight, it is important to understand the key role that the provinces and territories will play in this matter. At the federal level, we can amend the criminal framework, including the Criminal Code, since this falls under our jurisdiction. However, the delivery of health care services is a provincial responsibility. The federal government alone cannot oversee the implementation of advance requests for MAID. Even if Parliament were to amend the Criminal Code for this, the provinces would also have to take steps to ensure that advance requests would be available in their health care systems. As I mentioned, the provinces are responsible for the organization and delivery of health care in their jurisdictions, and it will be up to them to decide whether they want to implement this option and how it will be carried out. What I mean is that, even if the federal law changes, it does not become automatic across Canada. The provinces will have to decide whether to implement the framework within their borders. Co‑operation with the provinces and territories will therefore be critical so that everyone who is eligible can have access. As the federal government, we will continue to work with the provinces as we make progress on this matter. I will now discuss the second part. Through Bill C-41, we will maintain the exclusion for cases when mental illness is the sole underlying health condition. After careful consideration, following committee deliberations, and after hearing from numerous experts, we came to an agreement that MAID should not be expanded to cover individuals for whom mental illness is the sole underlying health condition. That said, we recognize that mental illness can cause profound suffering, even when it is not necessarily as visible as in the case of other physical health conditions. Canadians living with mental health issues deserve to have their suffering taken seriously. In the context of MAID, however, serious concerns remain regarding the ability to assess these situations safely and consistently. For these reasons, we decided not to expand MAID eligibility to individuals whose sole underlying medical condition is a mental illness. As I mentioned, this decision was not taken lightly. A parliamentary committee made up of senators and MPs from the various political parties examined the issue. Health experts and stakeholders also gave evidence. Finally, following all these consultations, the Special Joint Committee on Medical Assistance in Dying recommended against expanding medical assistance in dying. At the same time, other consultations took place. The conclusion was that uncertainty remains as to whether these situations can be assessed reliably and consistently. In light of that, our government believes that the current exclusion is the most appropriate approach. In closing, we are debating substantive issues tonight, issues that affect the choices people make when they are considering their end of life. I think it is important that legislators put a framework in place, particularly for people suffering from conditions such as dementia or Alzheimer’s. It is important to give these individuals the opportunity to make a free and informed choice about their end-of-life care.”