“Mental illness is a health issue, just like physical illness. People who have suffered for decades and tried every treatment should have the right to choose medically assisted dying. If this bill bans them from it, the Supreme Court could strike it down.”

“Mr. Speaker, I would like to ask my colleague about people living with mental health issues. It is all well and good if certain psychedelic drugs, taken in low doses, may eventually cure these individuals. Under no circumstances should medical assistance in dying become a way out for those who are unable to access care. When I talk to my colleague from Montcalm, who is an expert on this issue, he tells me that this is not at all intended for such people. They would never be granted access to end-of-life care. Rather, we are talking about people who have been struggling with mental health issues for 20 years, who have tried every available treatment and consulted every possible specialist. What the court has told the government and us, as legislators, is that we must respect the rights and freedoms of people who, after decades of trying everything, have found no relief. We must recognize that mental illness is a health condition, just like physical illness, and respect the rights and freedoms guaranteed to these individuals under the charter. Is there not a risk that the bill, as it stands, could be challenged before the Supreme Court, forcing the government and legislators to go back to the drawing board in a few years’ time?”

“I want the member to explain why this bill bans medically assisted dying for people whose only illness is mental. Doctors disagree on physical illnesses too. Banning this may ignore the terrible suffering that mental illness causes.”

“Mr. Speaker, I want to thank my colleague for his contribution to this debate. I would like him to tell us more about excluding MAID altogether as an option for people whose sole medical condition is a mental illness. Even if we asked 10 different doctors, each of them might well come up with a different diagnosis. I get a sense that this can happen with any diagnosis. By closing the door on medical assistance in dying for people living with a mental illness, are we not moving too quickly and failing to take seriously a health condition that can cause immense suffering?”

“The member says expanding medically assisted dying to people with mental illness is dangerous because our health care system is not ready. Yet he does not support sending more health care money to the provinces to fix the system. It makes no sense to delay this service while refusing to pay for the care people need.”

“Mr. Speaker, I heard my colleague say that, when it comes to mental illness, moving forward while the health care system is not equipped to treat people would be catastrophic. However, I did not hear my colleague call for a 35% increase in health transfers, as the Bloc Québécois has done. Not wanting people to face discrimination indefinitely because they have been resistant to treatment for decades, and wanting to wait until our system is effective, while also not transferring the funds needed to make it so, seems rather illogical to me.”

“This bill lets provinces decide how advance requests are handled, and Quebec has its own law. I want the member to explain why she thinks Quebec's law would have caused what happened to her aunt.”

“Mr. Speaker, I have a question for my colleague. The bill stipulates that the matter of how to administer advance requests falls under provincial legislation. Quebec has its own law. I listened to the example she gave. What makes her think that the Quebec law would have done to her aunt what she claims?”

“This bill should be split into two separate bills and voted on separately. It puts two different issues together: medically assisted dying for mental illness, and advance requests. Completely banning people with mental illness from medically assisted dying is unfair and against our rights. Advance requests are also important, because they let people choose their care before their minds decline.”

“Mr. Speaker, in this debate, which can get quite emotional, I am going to try to live up to my riding’s name, and I will remain calm. The bill before us today is really two bills in one. The government proposed that the vote at second reading be split. In fact, I expected the Conservatives to support that proposal, but that does not appear to be the case. Later, at third reading, we can discuss whether it is appropriate to split the vote or even split the bill. However, for now, it seems to me that it would have been wise for everyone to agree to hold separate votes at second reading. The reason is that mental illness raises a distinct set of issues, while advance requests raise a different set of issues altogether. In my opinion, there should have been two separate bills. As I have said many times, when it comes to a human being determining the conditions of their end of life and determining what they consider to be the threshold of what is tolerable in this process, the law recognizes the principle of self-determination. The Baudouin ruling, which is an interpretation of the Carter decision, makes it clear that, in matters relating to mental illness, a blanket prohibition is discriminatory. What bothers me a great deal today is that, from the very first Special Joint Committee on Medical Assistance in Dying, the question was not whether we should move forward on the issue of mental illness. On the contrary, we said that we would wait and see whether the network, the providers and the system were capable of proceeding safely. That was the issue. It was not about whether we should move forward with it or not. Why were we so convinced of that as soon as we saw the first report from the late Marc Garneau, who was the chair of the committee? It was precisely because a blanket prohibition is discriminatory in nature. I heard all sorts of things about mental illness: astonishing intellectual shortcuts, horror stories and anecdotes. People are basing their positions on absolutely nothing. If what some are describing is actually happening today in the context of mental illness, that is, if people are being encouraged under the current law to choose medical assistance in dying, or if it is being suggested to people with mental illness, that is a criminal offence. It is that simple. One calls the police and reports it, because the Criminal Code already governs such situations. When witnesses come before committee and tell us anecdotal stories of that nature, I ask them whether they reported the matter to the police, because those cases are already covered by the Criminal Code. However, if we have legislation that sets out all the safeguards needed to ensure that things are done properly, that is quite a different matter. I heard all sorts of claims. The point, here, is not to suddenly allow a suicidal or depressed minor access to MAID. Such a person would not even be assessed for that purpose. Simply making a request does not make someone eligible. Some witnesses came and told us that if the bill had been passed, they would not have been there, in front of us. What basis do these people have for making such claims, given that the assessment process is precise and rigorous? The unfortunate thing about this debate is that very few lawmakers here have carefully read the experts’ report laying out all of the safeguards that would be needed to safely provide medical assistance in dying for people with mental disorders. Some will tell me that psychiatrists cannot assess irremediability. Fine, but they assess people’s decision-making capacity every day. There are people with mental disorders who also have cancer, and their capacity to consent, or not consent, to MAID based on their cancer can be assessed. Everyone is capable of doing that. Psychiatrists do this regularly, but if a mental disorder is the sole condition, suddenly opponents say they cannot do that. They say that psychiatrists cannot accurately determine a prognosis or a diagnosis and that this justifies a blanket prohibition for all individuals who are unresponsive to all the available treatments for their mental disorder. These are individuals who have never refused a treatment that could improve their condition and who, after several decades, sometimes 25 or 30 years, have come to the conclusion that they would like to end their lives with dignity, following a proper assessment, and certainly not when they are in distress or experiencing a suicidal crisis. A suicidal crisis is actually sometimes part of the expression of a mental illness or disorder. The fact remains that irremediability is a chronic condition established over time. That is a far cry from the scenario of a young man suffering from a broken heart who decides to put up his hand and say that he wants MAID. If the law were to pass, what would happen? By raising his hand, he would be raising a red flag, and instead of attempting suicide, thinking he is entitled to access MAID, he could be treated. He could be taken care of. However, right now, with a blanket prohibition, there is no preventive aspect in terms of there being a law to deal with the issue of mental disorders. As I said, this is unconstitutional. Going back to my first point, the government had five years, since the first Special Joint Committee on Medical Assistance in Dying, to ask the Supreme Court for an opinion. The government could have clarified whether the blanket prohibition imposed in the Carter decision unconstitutionally infringes on the rights of patients with a mental disorder and is therefore unconstitutional discrimination. However, it did not do that. It did not summon the courage to do so, and right now, if we decide to uphold the indefinite exclusion, it means there will be no more debate on this matter here. No future government would reopen the debate on this. What is happening? The burden is being placed on vulnerable patients. The government says it wants to protect vulnerable patients, yet there is a contradiction there. The government says that these patients are vulnerable and lack the capacity to make decisions about their own end of life in the circumstances I have described, even after a comprehensive and rigorous assessment. However, the government expects them to navigate the legal system and take their case all the way to the Supreme Court to defend their rights. To me, that shows disregard for human dignity. To me, that shows cowardice, parliamentary cowardice. It is cowardice because Parliament has never been proactive throughout this entire debate on MAID. Now, suddenly, when it comes to mental illness and advance requests, Parliament has decided to be proactive. I will come back to that, but colleagues can surely understand why I find this somewhat surprising. All the regulatory bodies told us that they were ready. The Special Joint Committee on Medical Assistance in Dying refused to hear from the Canadian Psychiatric Association, which had established standards of practice. The government paid a committee to set standards of practice. All the practitioners told us that everyone was ready to move forward. In the end, the answer is no because there are some who oppose all forms of medical assistance in dying and who will seize on any anecdote to say that it will become a horror show, that it will be awful, that it will cause harm, and that the system is unable to deliver proper care. There are indeed mental health challenges. However, when someone has been dealing with a mental disorder for 30 years, in keeping with the definition, I do not want to hear anyone claim that the system is incapable of treating that person and that this is why we have to wait for the system to be able to treat or cure them, especially when some psychiatrists say that no cure is even possible. People are effectively being told to continue suffering within reason. If this constitutes discrimination, does the first clause save the blanket prohibition? Absolutely not. What is really happening is that people are being told to continue suffering until a treatment is found that will finally cure them. These people are being told to be patient, after a lifetime of stigma and discrimination. Only a small minority of people are likely to request MAID, and the assessment would ensure that they meet the criteria. On top of that, there was an additional safeguard in place for people with mental disorders. Prospective monitoring was advised. During the assessment, when it was time to intervene, a panel would be asked to review the process to see whether it had been properly implemented, which is not currently the case for other scenarios involving MAID. The bill has continued to move forward with regard to advance requests. This was a key recommendation of the first special joint committee. We agreed that while we should delay the decision to see whether the necessary provisions for mental disorders could eventually be implemented in practice, there were no reservations about advance requests five years ago. It took the government five years to show some courage and do what had been proposed. If it felt that advance requests were a more delicate process, given that the person is assessed when they are incapacitated, all it had to do was set up an additional safeguard, an additional requirement. It was told that since the provinces are responsible for health care, it should require them to develop a “how to” procedure so that this is done by the book, and, that way, debates will take place in each provincial legislature. This could even become an election issue. If, for example, a province decides not to go ahead at all, someone will surely go to the Supreme Court and have the ban struck down or change the government so that the legislature passes a law. Quebec has implemented a process based on a very interesting approach. First of all, a person is not told that MAID is an option before first undergoing an evaluation. An advance request is made based on a diagnosis, and once care begins following that diagnosis, the patient is given an explanation of the stages of the disease’s progression. At some point during these stages, when the person is of sound mind, they sit down with the care team and establish the criteria that correspond to their personal threshold of what is tolerable. A person might say that they would like to receive MAID when they become doubly incontinent, when they start playing with their own feces, when they resist being fed, when they are no longer able to recognize their own family or even interact with other human beings. There is no automatic threshold. In fact, at a certain point in the progression of the illness, in other words, when the patient has reached a certain level of incapacity, a third person is responsible for informing the care team that they believe the patient should be evaluated. The care team will evaluate the patient and may inform the third party that the patient in question has not yet reached that stage. The process would then continue. This process is based on the clinical judgment of physicians or other professionals. The Quebec law states that, at the time medical assistance in dying is administered, the person must be “incapable of giving consent to care due to their illness”, they must be “exhibiting, on a recurring basis, the clinical manifestations related to their illness” and they must be in a medical state “of advanced, irreversible decline in capability...that gives a competent professional cause to believe, based on the information at their disposal and according to their clinical judgment, that the patient is experiencing enduring and unbearable physical or psychological suffering that cannot be relieved under conditions considered tolerable.” There is no mention of reasonable means. My colleague, who was a social worker, told me about a lady who had what is known as “quiet dementia” or “happy dementia”. Incidentally, this is a transitional phase that leads the person towards the end of their life. It is a transitory state. It is not permanent. People with Alzheimer’s often die from a secondary condition, because they are no longer mobile, because they are bedridden or because they are confined to a wheelchair. That is why the concept of what is considered tolerable is important. However, in the government’s bill, instead of trusting provincial legislatures, it proposes a whole bunch of criteria and the aim is to set aside the criteria that the individual may have put in place, on the pretext that it would lead to MAID being granted in cases of happy dementia. Let us imagine a woman with an illness who reaches a point where she is no longer aware of her actions and is no longer in her right mind. Let us imagine that she repeatedly undresses in public and smiles while throwing herself at men. She appears happy. Who was this woman? It is very important to understand that someone who reaches that stage of the disease and that stage of cognitive decline is not the same person anymore. This woman was a nun who had spent her entire life observing the strictest standards of modesty. Does anyone think that if this woman had set out her wishes in advance, she would have put up with this situation simply because she seems relatively bothered and even seems happy? The Supreme Court has been very clear. The whole question of dementia, whether or not the person appears happy, should be discussed at the formal meeting where the patient establishes their personal criteria. A person could very well say at that meeting that if they reach that stage and wish to continue living in that condition, they should be allowed to do so. I will end here. No one would be forced to make an advance request if they have a degenerative disease such as Alzheimer’s or dementia. The Conservatives always make it seem as though it would be mandatory for everyone. It is not a requirement, but merely an option.”

“I want this bill changed. It uses confusing words about relieving suffering instead of copying Quebec's law. Health care workers tell me these new words will cause problems and could go against what a person asked for in advance.”

“Mr. Speaker, the main reason is that the bill introduces the concept of “reasonable means” of alleviating suffering when a person no longer has capacity. It is version 2.0 of the phrase “reasonably foreseeable natural death”. In practice, this will create confusion in clinical settings. That is what the practitioners I have consulted are telling me. That is why I believe that, if the government truly intends to model this legislation on Quebec’s law, then it should adopt the wording used in Quebec rather than inventing new concepts, especially concepts that could create uncertainty in clinical practice. That is the main reason. That is why I talk about ordinary means. The lady I was referring to will be given some sort of medication, and she will no longer be a nuisance. Does that constitute conditions considered tolerable in the eyes of someone who made an advance request and who, under this bill, is being told that their wishes will be set aside? This goes to the very principle of advance requests. The Quebec law is subtle. It refers to clinical judgment and does not refer to “reasonable means”.”

“This bill does two different things. I want the Conservatives to agree to hold two separate votes on it.”

“Madam Speaker, as I already said at the start of my speech, or during a question a while ago, this bill has two components. I had hoped that we could hold separate votes, I mean, that we could divide the vote at second reading stage. Following our work in committee, we could have considered whether to request that the bill be divided and that separate votes be held. At this stage, I would like the Conservatives to consider the possibility of holding two votes at second reading stage.”

“My father was ill for a long time, which changed how I see this issue. Why have views on medical assistance in dying changed so much over the last five years? I want to know what the member thinks caused this change, and what he thinks about the upcoming votes.”

“Madam Speaker, I was in the House five years ago, but I was not involved in the entire process. My father was ill for many years. Experiencing something like that first‑hand makes someone see things differently. I am not telling this story just so I can say that this is what I went through, so here is how it should be. However, why has there been such a big shift in five years? What does my colleague think happened, and what does he make of the direction that we appear to be taking in the votes ahead?”

“I do not understand why the government changed its mind on mental illness. I support letting provinces handle advance requests for medically assisted dying, since health care is their job. But Quebec already has a law for this. This bill should use the exact same words as Quebec's law so doctors are not confused.”

“Madam Speaker, as I said, I do not understand why the government is doing a complete about-face when it comes to mental disorders. As for advance requests, it has accepted the Bloc Québécois’s position that the provinces are responsible for health care. Since we are talking about end-of-life care, it is reasonable to say that if additional safeguards are warranted, then a province may proceed as long as it has enacted legislation and meets certain conditions. However, since the only law currently in place is in Quebec, and since the minister claims that it should be modelled on Quebec’s experience, I would have preferred to see the same wording, more importantly to avoid introducing a concept that could create confusion in clinical practice. That is what I would say.”

“My colleague misunderstands advance requests. People make these requests when they are still clear-minded, after learning they have a progressive disease. They know what to expect and can choose their own limits. People have the right to make their own health choices. They should be able to receive medical assistance in dying later, once they can no longer make choices for themselves. I see no moral problem with this unless someone has religious objections.”

“Madam Speaker, with all due respect, I think that my colleague is comparing apples and oranges. I also think that he misunderstands the very principle of an advance request. An advance request is made while a person is still of sound mind, after being diagnosed with a degenerative illness that progresses in stages. At the formal meeting where the patient’s criteria for what is tolerable are officially determined, the patient may even receive an explanation of what their will be like and what they will experience up to the end. Out of respect for the patient’s dignity and self-determination—in health matters, the law always gives precedence to the individual’s personal integrity—a person has a right to say they want to receive MAID when they become incapacitated and their tolerance threshold is met, if this is truly what they wanted and if their decision was based on an informed choice. I fail to see any moral issue there, unless a person is religious.”

“A parliamentary committee already showed that we must improve end-of-life care. The provinces provide this care. The federal government must give them more money to do it instead of adding rules without the resources to follow them.”

“Madam Speaker, I want to remind my colleague that this was the mandate of the first special joint committee, which submitted a highly detailed report on the matter, along with a host of recommendations confirming the need to strengthen palliative care. I urge my colleague to persuade the Minister of Finance to transfer more money to the provinces, which deliver end-of-life care, so they can finally do their work properly. The federal government must co-operate. It cannot introduce exemptions or generalized restrictions without providing the resources to implement them.”

“The Supreme Court ruled that the right to life does not force people to stay alive at all costs, and it does not ban assisted dying. I want the member to tell me if she agrees with that.”

“Madam Speaker, I am going to quote the Carter decision, and I would like my colleague to tell me whether she agrees with this statement. This said, we do not agree that the existential formulation of the right to life requires an absolute prohibition on assistance in dying, or that individuals cannot “waive” their right to life. This would create a “duty to live”, rather than a “right to life”, and would call into question the legality of any consent to the withdrawal or refusal of lifesaving or life-sustaining treatment. The sanctity of life is one of our most fundamental societal values. Section 7 is rooted in a profound respect for the value of human life. But s. 7 also encompasses life, liberty and security of the person during the passage to death. It is for this reason that the sanctity of life “is no longer seen to require that all human life be preserved at all costs”. What does my colleague think about that?”

“People in a suicidal crisis cannot get medically assisted dying, and issues with health care access do not make someone eligible. Patients must try every available treatment over years before they can even be assessed. If someone refuses a treatment that could help, they cannot get assisted dying. I want my colleague to read the expert panel's report.”

“Madam Speaker, my colleague spoke about suicidal crises. A suicidal crisis is reversible and does not make someone eligible for MAID. She talked about the gaps in the health care system, but that has nothing to do with eligibility for MAID. If she has read the expert panel’s report, she must know that for someone to be assessed—without necessarily getting a positive decision at the end of the process—the guidelines state that all available treatments must have been tried. The available treatments will span a number of years, if not decades. This is not a matter of whether or not health care is accessible. People cannot apply for MAID if they have not received care. If a person has not tried every possible treatment over a number of years and has refused one that could have improved their condition, they are no longer eligible for MAID. There are guidelines in the expert report. I suggest that my colleague read it.”

“Completely banning medical assistance in dying for people with mental illnesses is discriminatory. If we delay this debate, we are forcing suffering people to fight the government in court to protect their constitutional rights.”

“Madam Speaker, my colleague talked about the history of MAID in Canada. I hope my colleague knows that Bill C-14 did not respond to the Carter decision, because Ms. Carter and Ms. Taylor were not terminally ill, and Bill C‑14 enshrined a flawed Quebec law. Essentially, that legislation should have addressed the cases of Mr. Truchon and Ms. Gladu. However, the onus once again fell on Ms. Gladu and Mr. Truchon to assert their constitutional rights and to invoke the Carter decision in the Baudouin case. Neither of them was terminally ill, and natural death was not reasonably foreseeable. With respect to mental disorders, is my colleague aware that all the experts said that this blanket exclusion is discriminatory and that, if we postpone the debate indefinitely, we will never again be able to have this debate here? This means that vulnerable people with mental disorders who have been suffering for decades will still have the burden of taking their cases all the way to the Supreme Court to assert their constitutional rights.”

“Advance requests were the main recommendation of the special committee, and only the Conservatives opposed them. Advance requests let people work with doctors to decide ahead of time what level of suffering they do not want to endure. The member's objections are based on religion and legal technicalities, not ethics.”

“Madam Speaker, I would like to point out to my colleague that advance requests were the flagship recommendation of the first joint special committee. No one opposed them except, of course, my colleague and the Conservatives. I would like to point out to him that the very principle of an advance request is to be able to work with a health care team to establish the threshold of what is tolerable, in other words, the criteria beyond which a person does not wish to continue their end-of-life in a state of deterioration that can ultimately lead to a level of stiffness akin to rigor mortis. Often, people do not die from Alzheimer’s. They die from a host of concomitant illnesses. The bill states that all of this must be assessed in accordance with best practices. Does my colleague fully understand that, in a sense, his reasoning is not ethical and his objections are not ethical, but rather purely legalistic, based on a theological foundation?”

“We are not rushing this bill. We have talked about it for five years, and Quebec already has good models for it. People should be allowed to ask for medical assistance in dying in advance, before a disease like Alzheimer's takes away their dignity.”

“Madam Speaker, the first thing I want to say is that there is no rush. We have been talking about this for five years, and Quebec has spent years working on it. Let us look at the models in place. They should not be dismissed just because they come from Quebec. I want to make an analogy. I know someone who has been in politics his entire life. Image matters. Let us imagine that he unfortunately develops Alzheimer’s. He makes a request to his loved ones in case there comes a day when he starts to behave completely differently, when they no longer recognize him, when he stops being able to feed himself and when he no longer behaves the way he did when he was in politics. I am not making a link here. When he arrives arrive at a long-term care facility, he keeps wanting to take his clothes off and starts flirting with all the women. An advance request gives a person a way to say that, if they get dementia or any other disease, they never want their loved ones to let them go through this. Is that not legitimate in terms of human dignity?”

“This bill should use Quebec's rules for medically assisted dying. Quebec lets patients decide if their suffering can be tolerated, while this bill could allow heavy drugs to keep patients quiet against their wishes. This bill also discriminates against people with mental illness and breaks the Constitution.”

“Madam Speaker, my colleague from Winnipeg North spoke about Quebec’s approach to advance requests. It was a long and rigorous process, but we came up with legislation. He says that process should be respected, but when it comes to administering medical assistance in dying, rather than introducing the notion of reasonable means to relieve intolerable suffering, as his bill does, why not use the wording in the Quebec legislation, which refers to determining whether an individual is experiencing suffering that cannot be relieved under conditions the patient considers tolerable? A person’s conditions could be completely intolerable and yet, through what might be considered reasonable means, such as chemical restraint, it could become impossible to respect that individual’s criteria. That is my first point. Second, how can an experienced legislator vote in favour of the principle of a bill that is unconstitutional and discriminates against people with mental illness?”

“In Quebec, medically assisted dying has strict medical rules. Doctors check at every step that the patient still wants it. It is not open to just anyone. I want to know if other members of Parliament understand how these medical procedures actually work.”

“Mr. Speaker, this evening, I cannot help but feel that there is a great deal of hypocrisy in this House. On the one hand, we know exactly where the Conservatives stand. On the other, the Liberals’ position is far less clear. In Quebec, however, things are clear. In fact, this morning I heard on the news that Quebec reached an objective decision through a non-partisan commission that examined the issue of the right to die with dignity. Do my colleagues understand what it means, from a clinical perspective, to administer MAID? This morning, I saw a video produced by Santé Québec Montérégie-Est, which explained that, at every stage, the doctor asks the patient whether this is still what they want. My point is simple. In Quebec, it has been clearly established that MAID is not available to just anyone and that there is a specific procedure to follow. Are my colleagues familiar with the clinical procedures that govern MAID?”

“The government should not decide what is best for a person who is suffering. Its job is to make sure people can make a free, informed choice. If someone has a mental illness that treatments cannot fix, but they can still make their own choices, the government should not stop them from choosing medical assistance in dying. Banning them is unfair and discriminates against people with unbearable suffering.”

“Mr. Speaker, my colleague knows full well that the role of the state is not to presume it knows better than the person who is suffering what is best for that individual in a matter as intimate as their own death. The role of the state is to ensure the conditions necessary for a free and informed choice. This is what I would ask my colleague: On what basis should the state infringe upon or restrict the right to self-determination of a person whose mental illness is resistant to treatment, as long as their decision-making capacity remains intact? On what grounds should chronic suffering that has become intolerable be considered reasonable? On what grounds would discrimination be reasonable?”

“The member should not disrespect my place in this House. People in Quebec pay federal taxes, and they elected me to represent them. I want the member to apologize for disrespecting me.”

“Mr. Speaker, I rise on a point of order. My colleague need not show any contempt for my position here in the House. I was democratically elected. We pay taxes to the Canadian government, and as long as we pay taxes to the Canadian government, we will be represented in this Parliament. I would therefore ask the member to apologize for his contempt for me.”