“I oppose this bill because it lets people be killed based on past requests without being asked in the moment. People change their minds. In 2024, 692 people asked for medically assisted dying and then decided against it. I want to know if those people would still be alive under this bill.”

“Madam Speaker, the nature of autonomy is that people change their minds. They might think that some future circumstance is intolerable to them. Then, under those circumstances, they have a different experience or an adaptation to those circumstances that they were not expecting. This is why, generally speaking, we do not allow our present selves to bind our future selves. As it relates to MAID specifically, the latest numbers show 692 people in 2024 made requests for MAID and then changed their minds. Obviously, there are going to be a lot of people who are thinking about this, so they make the request and then decide not to do it. However, with the advance directives framework in this bill, a person would be killed based on a previous expression of their desires without even being asked in the moment. This is clear in the legislation. There is no requirement that the person be told what is about to happen to them before it happens. What does the member think this would mean for the 692 people who thought they wanted MAID and decided they did not? Would those people be alive today under this framework?”

“I agree with banning medically assisted dying for mental illness. Doctors cannot reliably tell if a mental illness is untreatable. But I oppose letting people ask for assisted dying years in advance. People change their minds as they age and adapt to illness. The government should split these two issues instead of rushing them together.”

“Madam Speaker, at the outset, I would like to note that I will be sharing my time with my colleague, the member for Elgin—St. Thomas—London South. Tonight, we are debating Bill C-41, the medical assistance in dying safeguard act. This bill would do two substantially different things. First, it would permanently cancel the expansion of MAID for those who are suffering from mental illness. Second, it would introduce a framework for advance medical directives allowing individuals to make decisions in advance about receiving MAID if they later lose the capacity to consent. I support the first measure. I cannot support the second. The permanent exclusion of mental illness as the sole underlying condition for MAID is a necessary and long overdue correction. It reflects what many medical experts have been saying, including mental health professionals and disability advocates, which is that our health care system cannot reliably distinguish between a treatable mental illness and an irremediable one. The risks are simply too great. I am happy that the Liberals have finally come to that conclusion as well. Advance medical directives, on the other hand, raise a very different and a far more complex set of ethical and legal questions. They touch on issues of consent, autonomy and the value of human life at the moment when a person may no longer be capable of expressing their wishes. These two issues should never have been bundled together in one single bill. One requires urgent legislative action before a deadline that is only six months away. The other demands careful study and thoughtful consideration. To understand why the government is finally reversing course on the first issue, medical assistance in dying for those who are suffering from mental illness, it is useful to explore how we arrived at this point. It all started with the Sue Rodriguez case in 1993, where the Supreme Court of Canada upheld the Criminal Code provision that prohibited assisting somebody to die, to commit suicide. Twenty years later, the Carter case came along, and the Supreme Court of Canada changed its mind. It came to quite a different conclusion. Faced with the circumstances of Ms. Kay Carter, who suffered from ALS, a progressive and incurable neurodegenerative disease, the court found that an absolute prohibition of physician-assisted dying was a breach of section 7 of the charter. The court stated that MAID could be available for people in Ms. Carter’s condition as long as that adult was one who clearly consented to the termination of life and it was a grievous and irremediable condition causing enduring and intolerable suffering. It was those two things: clear consent and an irremediable condition. Importantly, the court also emphasized that it really was limited to those specific facts, which is exactly what courts usually do. It was making no pronouncement over any other situation where physician assistance might be sought, for example, for mental illness. Parliament responded to that Carter decision with Bill C-14, establishing a MAID framework that included a further requirement, that natural death had to be reasonably foreseeable. We thought that was going to be our MAID regime going forward into the future. Unfortunately, that proved to not be the end of the story. For the next chapter in how the Liberals have mismanaged this whole MAID file, we turn to the Truchon decision in Quebec, where two individuals successfully challenged the “reasonable foreseeability of natural death” provision. What happened next was remarkable. Rather than appealing a lower court decision that struck down an act of Parliament, the Liberal government, the attorney general, chose not to defend the legislation that had been adopted in the House after one of the most significant ethical debates in modern Canadian history. The result was Bill C-7. The legislation created two tracks, one for those whose death was reasonably foreseeable and the other for those who were not in a situation of dying. Significantly, Bill C-7 expressly stated that mental illness alone would not qualify a person for MAID. After Bill C-7 passed in the House of Commons, the Senate, shockingly in my opinion, proposed amending the bill. It proposed removing the mental illness exclusion after a sunset period of two years. Instead of rejecting the amendment, which the Liberals should have done, the Attorney General, who also should have done it as it is his job to defend the laws of Parliament, accepted it. They caved to the MAID activists. That decision launched Canada down a path that many experts have said is dangerous. For example, in November 2023, the chairs and heads of numerous psychiatric departments across Canada said that there is “no...accepted definition of irremediability” in mental illness and “no reliable way to distinguish a MAID request from suicidal ideation.” That is what the experts were saying. I am happy that the Liberals finally listened to that and are convinced. They cautioned against expanding MAID in these circumstances, saying that it would risk facilitating preventable deaths and undermine suicide prevention efforts. The Liberal government did the right thing, sort of. It postponed the implementation date, at first by one year and then later by three more years. Here we are, after six years of uncertainty. The government has finally arrived at where many experts and Canadians believed it should have been all along: MAID for mental illness alone is not sound public policy. The government made the right decision in the bill that is before us, and we agree with that part of it. However, while retreating from one problematic expansion of MAID, the government would now advance another that is even more problematic. Advance medical directives would allow individuals to specify in advance the circumstances under which they would wish to receive MAID if they later lose the capacity to consent. Now, at first glance, many Canadians might think, well, that makes sense. We write wills. We write powers of attorney. We write health directives. Why should we not write advance medical directives for MAID? MAID is substantially and fundamentally a different matter. Advance directives concerning MAID authorize an irreversible act that results in death, with someone else, a third party, being tasked with making the ultimate decision. The Liberals talk a lot about the importance of the autonomy of the person. Well, someone has lost autonomy when somebody else is making the decision. That is why many experts urge caution. For example, Dr. Pageau of Université Laval told the Special Joint Committee on MAID that it is simply not ethical to permit MAID for persons with dementia through advance requests. He posed this question: As the disease progresses, are we honouring the wishes of the person who exists today, or the wishes of someone who existed years earlier? People change their mind. That question deserves much deeper examination before Parliament accedes. We should not be rushing through this very complex ethical question. The strongest concern with advance medical directives is the issue of consent. The Supreme Court’s decision in Carter began with the simple and essential principle that an individual “clearly consents to the termination of life”. Advance directives risk undermining that basic principle. Dr. Alice Chung appeared before the special joint committee and posed an important question. She asked this: What right does the 60-year-old version of ourselves have to determine the quality of life experienced by the 80- or 90-year-old version of ourselves? She went on to note that medical evidence demonstrates that many individuals adapt to their severe illness, to their disability or to their cognitive decline in ways that they had not anticipated when they might have signed advance directives. What once to them seemed intolerable looking into the future, being uncertain of the future, may later become meaningful and a worthwhile life. These are not abstract scenarios. They are real-world examples that we received from experts, which raised difficult questions about autonomy, dignity and the risk of ending the life of someone who may no longer share the wishes they had expressed years earlier. In conclusion, we applaud the government for proposing to stop the expansion of MAID, but we say that it must not—”

“I oppose this bill. People must be able to make their own choices about medically assisted dying. Once someone loses the ability to think clearly, they cannot change their mind, and someone else has to decide for them. That takes away their consent.”

“Mr. Speaker, I will go back to the Carter decision, which said that consent is at the centre of MAID, and the autonomy of the human being to make that decision. A person cannot change their mind anymore after they become incapable. Somebody else has to make that decision for them, and that undermines the autonomy of that person and undermines the very central principle of consent to receiving MAID. That is why I object to it.”

“I am worried about letting people ask for medically assisted dying in advance. If people lose the ability to make decisions later, they cannot change their minds. Doctors would not even have to tell them they are about to end their lives.”

“Mr. Speaker, there has been some confusion in the debate tonight around the issue of whether a person could withdraw consent if they make an advance directive. Let us clear it up. If I sign an advance directive today but three weeks later, still having capacity, think I actually do not want to do this anymore, could I withdraw my advance directive? Yes, I could. However, if a person signs an advance directive and then loses capacity, they are not in a position to withdraw it. In addition, if a person does not want MAID at the time they are about to receive it, they could still be given MAID, because there would be no requirement to tell them what is about to happen to them. Yes, if the person resists physically in the moment, the legislation would require that the process of MAID stop, but if a person is simply told— An hon. member: Oh, oh! Garnett Genuis: Mr. Speaker, I hear the member saying, “needle in the skin”. There does not have to be a needle in the skin to administer MAID. Someone could already be on an IV, and the content of the IV could be changed. There would be no requirement to tell someone what is about to happen, which is clearly concerning in terms of the right to withdraw consent, is it not?”

“I oppose letting people get help to end their lives through advance requests. A person must be able to clearly agree and change their mind. If they cannot change their mind, they have lost their choice. This goes against court rulings, ethics, and moral law.”

“Mr. Speaker, my colleague’s question is central to the issue of medical assistance in dying, MAID. The Carter case said that MAID can be applied only when the person clearly consents. Being able to change their mind is part of that autonomy. If a patient cannot withdraw their consent, there is no longer autonomy. I think it goes against the Carter case. It certainly goes against ethics and moral law.”

“I want to split this bill into two parts. People have different views on this, and the evidence shows we need to study it more. We should move forward with one part and send the other part to a committee for a deeper study.”

“Mr. Speaker, I realize there are differences of opinion on this very important ethical and legal question, and I respect that. We are not all going to be of the same mind on these issues, but what I am saying is that the evidence we have so far from the MAID committee suggests very clearly that this requires a much deeper dive. We need to have a study. The bill should be split so we can advance with one issue and put the other to committee for a deep-dive study.”

“I want the government to split this bill into two parts. I agree with stopping medically assisted dying for people with mental illness, but I do not want it expanded to people who ask for it in advance. The current rules already fail to protect vulnerable people. We should pass the ban on assisted dying for mental illness now and study advance requests separately.”

“Mr. Speaker, it is always a great honour to rise in the House, and, I will say, especially so to speak to this legislation. One of the reasons I got into politics, one of the planks of my campaign for the nomination for my party, was to put an end to MAID for mental illness. That is a position that up until a few months ago, the Liberal government was dead set opposed to. For years, the Liberals have argued that MAID must expand to include people with mental illness. Even when concerns were being raised about the lack of readiness and the lack of willingness by provinces and physicians, they would not abandon this. They instead kept kicking the can down the road. It was a great privilege to serve on the Special Joint Committee on Medical Assistance in Dying, a committee that was assembled by Parliament and was tasked very specifically and narrowly to explore the issue of whether MAID could ever be safely or reasonably expanded to people with mental illness. The committee turned back a single recommendation, which Liberal and Conservative members on the committee were united on: that the expansion of MAID to people with only a mental illness not proceed. To have Liberals and Conservatives in alignment on a matter of conscience, on a matter such as that, is so important, especially on something that just a couple of years ago, just in the previous Parliament, the majority of the Liberal caucus voted against doing. When Bill C-314 was put forward, a bill to stop the expansion of MAID to mental illness, only eight Liberal members supported it. That is a huge problem. I am grateful they have now come around to the conclusion that Conservatives were warning about for years: that we must protect the vulnerable. People struggling with mental illness need our support. Yes, we need services and treatment. More importantly, we need to be instilling hope, not sending a message that someone is better off dead than alive. I have said in the House many times, and I will reiterate it so everyone knows, this is an issue that is very personal to me. I nearly lost my life to suicide just under 16 years ago, and I very likely would not be here today if MAID for mental illness had been available in 2010, when I was in my darkest days. I can say that with a level of confidence, seeing how existing safeguards have not worked, how existing safeguards in the MAID regime have not prevented people who do not meet the legal criteria from accessing MAID. Earlier today, the leader of the official opposition mentioned in his speech the case of Kiano Vafaeian, a 26-year-old who dealt with diabetes and partial blindness, and, more importantly, had a range of mental health issues. He was denied MAID in Ontario, but he went doctor shopping. He went to another province, found one of the most prolific purveyors of MAID in Canada and received it. His family got the call that he had died at the hands of a doctor. There have been other cases that we heard about at the special joint committee, and others that we have heard in the media. People have also reached out to me with their stories. There are stories of people who have been offered MAID who do not want it and stories of people who do not meet anything resembling the legal criteria right now but who have nonetheless been found eligible or told they would be. There is a very fundamental question facing parliamentarians right now: If existing safeguards on the current MAID regime right now are not working, how would it be anything other than reckless and irresponsible to expand the system in any way? This brings us to Bill C-41. Despite the singular recommendation that Liberals and Conservatives agreed on to stop the expansion of MAID to people with mental illness, Bill C-41 is not a bill about that. In fact, the 12 pages of Bill C-41 contain three sentences dealing with MAID for mental illness. Two and a half clauses, but three sentences, of the 12-page bill would stop the expansion of MAID that would allow people with depression, schizophrenia or an eating disorder access to this regime, to a medically guided, medically directed death. The rest of the bill, the rest of the 12 pages of Bill C-41, proposes an expansion of MAID called advance requests, MAID for people who would not be able to consent because they will have lost the capacity, but who wish to consent ahead of time. This would be people with very real, very serious degenerative neurological conditions such as Alzheimer’s and other dementias. This is something we find deeply concerning, if we have been following the lack of safeguards already. When I look at this bill, I see a range of issues, some of which we have heard mentioned in debate tonight, such as the fact that one does not need to be told that MAID is about to be administered before it is; that a doctor or nurse practitioner has tremendous latitude to make, in their own opinion, a determination as to whether someone’s suffering is sufficiently intolerable for the request to be actioned, a request that might have been made a decade earlier; and that if the person says no but the practitioner believes there is sufficient doubt as to whether they were really saying no, the practitioner can simply try again in 30 days. That is what the bill says: They can try again in 30 days if there is doubt as to whether the person was refusing it. Some of the MAID practitioners in Canada who have become quite well known talked about this issue before Bill C-41 was tabled. Some of these physicians have said that if someone who has an advance request is screaming “no” and flailing their arms around, doctors would disregard that, as they do not believe that is legitimate because they have made a determination that this person does not know what they are saying or doing. Doctors have already said they intend to ignore what I think are already quite lax guidelines and stipulations set out in Bill C-41. If existing safeguards are not working, how can we ever expect an expansion to not lead to many more problems? At every step of the journey, as we have discussed MAID in Canada, there have been those warning of the slippery slope. If we expand it to this, then there is going to be something else next. At times, many on the Liberal benches have said they are fearmongering. We are barrelling down the slippery slope right now. Every single prediction that has been made about where this is going has come to pass. I would note that the Liberals have done something very cynical. By marrying the provisions stopping the mental health expansion with advance requests, they are holding a gun to the heads of members of Parliament, forcing us to put a complicated and divisive bill forward on a timeline that is not necessary, because we are all committed on the Conservative benches to ensuring that the mental health expansion does not kick in in March of next year. If we do nothing, if no legislation is passed, people with a mental illness as a sole underlying condition will be eligible for MAID. That is why Liberals could have done the right thing two weeks ago and voted for Bill C-218, legislation that I was proud to cosponsor and that was put forward by my colleague from Cloverdale—Langley City, legislation supported by the Green Party leader, New Democrats, a couple on the Liberal benches and huge numbers of Canadians, including disability rights advocates and mental health organizations. If the Liberals had supported that bill, we would have been off to the races. We could have had the time necessary to debate and discuss advance requests, hear witness testimony and ensure that all sides and many Canadians had the opportunity to have a say. Instead, we have comments like those from the member for Etobicoke—Lakeshore, who said that the first part of the bill is not only important but urgent, because if we do not pass this bill immediately, this law will take effect on March 17, 2027. He asked every member of this House to vote in favour of Bill C-41 for that reason. The Liberals are already saying that we are the ones who have to force this bill through to meet a timeline that they are setting by their refusal to separate these two fundamentally distinct provisions. They refuse to allow separate bills or even separate votes on whether to expand MAID to people with mental illness and whether to expand MAID to people who wish to make an advance request. That is a tremendously reasonable response from us to the Liberals, if the Liberals are serious about, as they keep saying, getting this complicated issue right. They should split the bill and dispense with these cynical, divisive politics that are gambling with people’s lives.”

“This bill forces a 30-day wait if a doctor is unsure whether a patient is refusing medically assisted death. The government wrote bad legislation, so we should not rush to pass it.”

“Mr. Speaker, I would ask the member to read the next paragraph: If the medical practitioner or nurse practitioner is in doubt as to whether the person’s words, sounds or gestures constitute a demonstration of refusal or resistance to having the substance administered to them, they must not, at that time or at any time within the following 30 clear days, administer the substance to the person. If the government cannot even get its own legislation right, why is it forcing us to pass it through on an expedited timeline?”

“The government must protect vulnerable people. The current assisted dying system does not have enough safeguards, and it preys on people who cannot stand up for themselves. Allowing people to ask for assisted dying in advance will not fix these problems.”

“Mr. Speaker, I am never going to argue with someone who is advocating for smaller government, but I know there is a very inconsistent way in which the member is pushing for that. The role of the state, at its core, is to protect those who cannot protect themselves, to protect the vulnerable. What we have seen in the current MAID regime, as evidenced by the litany of cases I could and have referenced about the lack of safeguards, is that the system is in many ways preying on people who do not have the capacity or independence to resist it. That is exactly why it is important to get legislation like this right. It is why I believe advance requests can never properly account for all of the issues that have been raised in the course of the debate this evening, which I do not believe can be rectified.”

“Almost 700 people asked for medically assisted dying and then changed their mind. This bill lets people ask for it in advance, before they lose the ability to make choices. It does not require doctors to tell them before taking their life. People will not have the chance to change their mind. How does this bill protect them?”

“Mr. Speaker, I want to thank my friend and colleague for his excellent work on this important issue. He has spoken a lot in the context of this issue about hope, about people finding hope, about people recovering and about people being able to continue their lives under new circumstances. I think that relates to the point about advance requests. In the last report on MAID in Canada, 692 people made a request for MAID and then changed their mind. That can happen in the absence of advance directives, but under an advance directives framework, if someone signs an advance directive and then loses capacity or is simply not told before a health care practitioner takes their life, then there is no opportunity for them to change their mind. It is clear in the legislation that if a person actively resists, the process is supposed to stop, but a health care practitioner is not required to inform them of what they are about to do. There is no such requirement. How does that take into consideration the almost 700 people who changed their mind?”

“I oppose this bill because it leaves out important details about how safety rules will work. Advance requests for assisted dying will not expire. A person could make a request and live for 10 or 15 years, even though people often change their minds over time. These problems must be fixed.”

“Mr. Speaker, that is exactly the problem here. Because so much is being left to how this system would be implemented, we do not actually know what safeguards in practice, if any, would exist. I will note as well that the lack of an expiration for advance requests is a key problem. Conceivably, someone could live with a diagnosis for 10 to 15 years, which means an advance request could collect dust on a shelf for that long as well. I know there have been cases where people had signed up at one point to be organ donors and later regretted it. There is a litany of problems with this that need to be dealt with.”

“Other countries criticize Canada for how our assisted dying laws treat people with disabilities. People with disabilities are offered assisted dying even when they did not ask for it. This sends the message that they would be better off dead. The government should listen to these concerns and stop expanding assisted dying.”

“Mr. Speaker, it has become evident to me, spending some time in other parts of the world talking to legislators elsewhere, how much Canada has become an international pariah. A source of its international shame relates to the protection of the rights of people with disabilities. There has been high-level criticism of Canada, and in particular, the MAID regime, in terms of how it treats people living with disabilities. I have spoken to disability rights organizations that are deeply concerned about how, on a regular basis, people with disabilities live with unprompted proposals for MAID from people who are supposed to be supporting them, essentially sending them the message that people in authority think they would be better off dead. This is a source of shame for our country and something we need to take seriously and change. Meanwhile, the government wants to further push MAID in spite of all of these concerns. Why do we not take this criticism seriously and listen to people with disabilities who are raising these concerns?”

“I want the government to split this bill into two parts. We should pass the ban on medically assisted dying for mental illness right now. The plan to allow advance requests is complicated and risky, so we should study it separately.”

“Mr. Speaker, it is always an honour to stand in this House and speak for the constituents of Bow River. This is a deeply held and personal issue for so many people across the country. I am often skeptical of government intervention in the economy, on the farm and in the private lives of Canadians. I believe the government should respect the freedom of people in their own decisions. I also believe Parliament has the duty to protect life, especially when the law puts vulnerable people at risk of irreversible harm. That duty brings us to Bill C-41 with respect to medical assistance in dying, and to a straightforward request to split the bill, pass the permanent exclusion where mental illness is the sole underlying medical condition and give the issue of advance requests the separate scrutiny that it deserves. On October 7, the Liberals voted against Bill C-218. Introduced by my colleague, the member for Cloverdale—Langley City, that bill would have permanently prevented MAID eligibility where a person’s sole underlying medical condition was a mental illness. Twenty days later, the government has now introduced Bill C-41 with provisions to maintain that exclusion, but attached them to a separate proposal on advance requests. They have deliberately turned this into a moral paradox. The Liberals rejected the Conservative solution, then returned with the protection we had sought tied to a much broader change in the law, a change that would expand the availability of MAID. The first part of this bill is necessary because we cannot ensure that someone suffering from a mental illness is competent to make a final and binding decision to engage in MAID. This bill then goes on in the second part to do just that and enable MAID when a person is unable to give competent consent or competent refusal by design. The Liberals owe Canadians an explanation. If we agree that people whose sole underlying condition is mental illness must be protected, why make that protection dependent on settling a separate debate? Conservatives are united on the way forward. Let us split the legislation. We are prepared to work with the government to pass the mental illness provisions through all stages of this House without delay and send them to the upper house. The current exclusion expires on March 17, 2027. Unless Parliament acts, the scheduled expansion will take effect. The Liberals have already delayed the expansion of MAID for mental illness more than once, which is exactly why they should not rush a separate and complex change through Parliament at the same time. They are going to make the same mistakes. There is no corresponding federal deadline requiring Parliament to authorize advance requests. The government should not use the deadline on the issue of mental illness to rush a different and complex change through this House. The Special Joint Committee on Medical Assistance in Dying recommended that people whose sole underlying medical condition is a mental illness be excluded indefinitely. Our proposal would have provided a lasting protection without another expiry date. The committee heard warnings about two fundamental problems that remain unresolved. First, doctors and nurse practitioners warned that they cannot reliably determine when there is no possible recovery from a mental illness. Put plainly, they cannot reliably predict that a person will never improve. Severe, prolonged suffering does not itself settle that question. Second, witnesses warned that clinicians cannot reliably distinguish a request for MAID from a desire for suicide in this context. There are different clinical views on these questions. When the consequence of an error is death, Parliament must take those warnings seriously. A person whose condition could have improved with treatment must never lose that chance because the law moved ahead of the evidence. The committee also heard serious concerns about whether existing safeguards and oversight are working in practice. Before Parliament extends the law further, Canadians deserve answers about how those protections are enforced and what happens when they fail. Bill C-41 acknowledges significant unresolved concerns about the safe provision of MAID on the basis of mental illness. Ministers should act on that acknowledgement and work with us to put this protection into law, now. People living with mental illness deserve to have their suffering taken seriously. They deserve care that is available when they need it and a country that remains committed to their recovery. I recognize that this debate raises questions about autonomy and equality. The Canadian Civil Liberties Association has raised those concerns about the exclusion. Those arguments deserve a serious response. Section 7 of the charter protects life, liberty and security of the person. Section 15 guarantees legal equality, including protection against discrimination. Parliament must consider all of those rights. Protecting people from the irreversible consequences of a mistaken assessment is a legitimate and necessary responsibility of government. We can respect the dignity of people living with mental illness while insisting that the law protect their chance to recover. The second part of Bill C-41 raises a very different question. Herein is the paradox. It would permit an adult to make an advance request after a diagnosis of a serious incurable illness expected to permanently take away their capacity to consent. This is important on the “expected” part, which I will get to in a moment. By the time MAID was administered, that person would no longer be able to give informed consent to the procedure. Families facing dementia and other devastating conditions deserve a careful hearing, and so do people who fear that a past request could be acted on in circumstances that they never understood or anticipated. The bill contains safeguards, including two independent assessments and rules about refusal and resistance. Parliament must examine whether those rules can reliably protect someone who is no longer lucid. A clear refusal would prevent MAID under that request. Where a practitioner is unsure whether a reaction means refusal or resistance, the bill would require a pause of at least 30 clear days. The legislation proposed already anticipates uncertainty in the practitioner. How would that uncertainty be resolved after the waiting period? Who would review the decision? How would the conditions distinguish an involuntary reaction from a person trying to resist? More importantly, the real question here is can the practitioner understand what a person is trying to communicate at the last moment? I submit this is the crux of the problem. It is not so much whether the patient is able to communicate. Is the practitioner equipped to understand what they are communicating? We have all heard examples of locked-in syndrome, where there is complete consciousness and lucidity, but the inability to move or communicate. How would suffering be assessed when a person cannot really describe it? What would happen when a request is many years old and the treatment circumstances or preferences have changed? These questions concern the moment when someone is least able to speak for themselves. They require evidence, clear legal rules and enforceable accountability. When ambiguity exists, we must err on the side of caution and prevent advance requests. The advance request provisions would also depend on provincial legislation. Alberta and other provinces must be heard on their responsibilities, on the safeguards they would administer and on how the federal framework would operate in practice. Doctors, legal experts, families, veterans and people living with disabilities must have a meaningful opportunity to testify. Members of Parliament should be able to assess the proposal to allow MAID by advance request on its own merits, separately from the urgent mental illness protection. As Remembrance Day approaches, we should reflect on our particular responsibility to veterans. Veterans Affairs’ own investigation confirmed four incidents in which a single employee inappropriately raised MAID with veterans. That was shameful. It was a shameful failure toward people who served our country. The government must ensure it never happens again. Veterans living with trauma, chronic pain or physical injuries deserve timely treatment and comprehensive support. When a veteran needs help, Canada’s response must demonstrate that their life and service matter. That responsibility extends to every vulnerable Canadian. People must have meaningful access to health care, mental health support services, disability supports and palliative care. If someone feels MAID is their only realistic option because adequate care is unavailable, Parliament has a duty to confront that failure. A list of services on paper means little to a person who cannot actually get them. We have common ground before us. The government now proposes to prevent the expansion of MAID for mental illness. Conservatives are ready to pass that protection immediately. Members of the House may reach different conclusions about advance requests after hearing the evidence. The government should give them the opportunity to consider that question separately with the care it demands. The Liberals keep asking for co-operation. The Minister of Justice can put aside petty politics and work with us today. Separate the two measures. Let us pass the protection on which we agree. Parliament can examine the rest. Canadians living with mental illness should not have to watch their protection evaporate. Conservatives will continue to fight to ensure vulnerable Canadians are met with help to live, not a pathway to state-facilitated death. Split the bill, pass the exclusion and give advance requests to the study they need.”

“I oppose this bill. This is a final decision, and we cannot risk making a mistake if someone changes their mind at the last moment and cannot tell us.”

“Mr. Speaker, it is quite simple. I would like to thank the member across the way for the question, because it is important. This issue is a matter of conscience, and we all have different perspectives on it, which is quite evident, but it comes down to the point that I made earlier that this is a final decision. If we get it wrong and we cannot communicate properly and evidence the refusal at the last moment, we cannot risk making a mistake in this case.”

“We must be careful and not pass this bill right now. Our understanding of science changes over time, and a mistake on this issue can cause someone to die.”

“Mr. Speaker, it is important. This is extraordinarily contentious. It is absolutely a matter of conscience. We have different perspectives, but this transcends that. The role of the House of Commons transcends the individual opinion, in that we have to err on the side of caution until we collectively understand the impact. We cannot take the risk of making a mistake. We cannot take the risk of not understanding the context. Science and the perception and reality of all of the things we study change over time. They are always a moving target. In this instance with this legislation, the consequences are literally fatal, and we cannot take the risk of making a mistake.”

“I respect health care workers, but a lot can change between when a person asks for assisted dying and when it happens. The patient's wishes could change, and doctors might not understand what they want. We cannot afford to make a mistake.”

“Mr. Speaker, I am thankful for the genuine question from the member opposite. I have been through the palliative care process with my father and other members of my family, and I understand completely the compassion of health care providers and their desire to provide the standard of care that we have come to expect. However, that does not take away from the circumstance that we find ourselves contemplating, where long periods of time can transpire between the order and the action, with a changing in circumstances and a changing in the understanding of the patient and how well the practitioner can understand what the patient wants. We cannot make a mistake.”

“I have a question about this bill. If someone asked for medically assisted death in advance, should someone have to tell them what is about to happen right before their life is ended?”

“Mr. Speaker, I want to ask my colleague just a simple question about the process around an advance directive. Does he think that a person who has signed an advance directive and then would be about to be killed on the basis of that advance directive should have it explained to them before they are killed what is about to happen? In the moment when their life would be ended, should the person be told what is about to happen to them?”

“I want the government to split this bill into two separate votes. It puts two different issues together: stopping medically assisted dying for people with mental illness, and expanding it to let people ask for it in advance. These are serious moral questions, and we should vote on them one at a time. I am worried that very sick people will choose to die early out of fear, depression, or not wanting to burden their families.”

“Mr. Speaker, I would like to begin my comments today by reiterating a request that has been made by many of my colleagues here in the House of Commons, which is to split the bill. Bill C-41 is a real moral dilemma. The way it has been politically manipulated is of great concern. It is only by splitting the bill into two separate decisions, two separate votes by members of the House, that I think it could be fairly presented to the public as an appropriate examination of the very serious medical and moral issues that are embedded within it. I was trying to explain to one of my constituents earlier what the moral dilemma is exactly. What I found to be helpful was a reference to the movie The Dark Knight. There is a scene in which the Joker calls Batman and tells him that his girlfriend, Rachel Dawes, has been left in one room. On the other side of Gotham, the DA, Harvey Dent, has been left in the other room. The Joker tells Batman that he has to make a choice and that it is going to suck regardless. It is going to be a really hard, horrible decision. He only gets to make one decision on who he gets to save. That is what has been presented to us with Bill C-41. Every member of the House, from all parties, is being put in this situation by the Prime Minister and whomever in the government is making the decision to combine these two elements of a very complicated and dense issue into one bill. Whoever is making that decision is putting every single one of us in the exact same situation that the Joker put Batman in. We are not going to feel good about the decision we make at the end of the day. Either we are going to vote against the bill, which has a very important and needed element in it, to further protect people with mental illness from euthanasia, or we are going to vote against the bill, because it also expands euthanasia to include people with dementia and other illnesses. These are really two things that should not be combined. I feel obligated to point out the cynical, cold and callous nature in which these two things have been combined into one bill. Every member of the House had an opportunity to vote on a Conservative private member’s bill that would have only addressed the expansion of MAID to those facing mental illness. All members of the Conservative Party voted for that bill. All members of the NDP voted for that bill. In fact, we even had one bold, brave soul on the other side of the aisle, in the Liberal ranks, vote for that bill. The remainder of that party voted against it. Why? What would possibly be the reason, other than the cold and cynical ploy to wedge those of us, with a heavy heart and a heavy conscience on this issue, into combining our very well-intentioned opposition to the expansion of euthanasia to those with mental illness and forcing us to also reconcile that with the expansion to more Canadians? That is not the way this place should work. I will be honest. I appreciate that politics is an ugly and dirty game. I can appreciate that a lot of this is about wedging people constantly. On something so heavy, on something that is such a matter of conscience, I really do hope that the government will reconsider and split the bill when it comes time to vote. How I would like to use the remainder of my time is to address why this is such a concern for people. I think a good place to start is to capture the fact that since 2016, MAID, or as I call it, euthanasia, has become a very common form of death for people in this country. In 2016, it was slightly over 1,000 people that were killed by euthanasia. In 2024, it was 16,499, which is the most recent statistic, in one year. In total, over an eight-year period, over 76,000 Canadians have had their lives ended through the practice of euthanasia. I raise this because I think that there are two ways that people look at that information. Some people might look at that and think that this is a sign of progress. I shudder at that thought, as do many Canadians. I look at that number and my heart breaks. I know many people who have been in very serious situations, facing very serious illnesses. I am a stage 4 cancer survivor. There was a time in my life when my mother and I sat in a room and a doctor said to me that I might not live. I know what that is like. I know what it is like to sit in a cancer ward and see people who are on their third, fourth or fifth year of chemotherapy. I know what it is like to sit in a hospital waiting room and see people lined up waiting to go through radiation, hoping that maybe this time it is going to work. I have seen people face death. I have faced death, so when I see numbers like this, my heart breaks, because I wonder how many of those people made the decision to end their life based on fear and because they were scared. I have been there, and I have seen people there. When we talk about advance directives and a medical professional approaching a sick person saying that they should make a decision now about how their life is going to end, it is very concerning. The emotional roller coaster of a serious illness is very real. There are times when a person may be depressed. There are times when their spirit may be broken, and they might consider it a good decision to end their life at some point on their own terms. However, we never know what life is going to throw at us, and we never know how our life is going to change. We do not know how it is going to feel in the moment. Opposing advance directives is about saying that at minimum, people deserve the dignity to make such a choice of great finality in the moment, and that we should not have a system designed such that potential coercion or the exploitation of a very emotional and difficult situation leads to a decision that a person may pay the ultimate price for. We have heard from families on the other side of this debate. We have heard from people with loved ones in very extreme situations on the other side of this debate. I do not want to pretend that this is simple. I am not trying to diminish another point of view. I get that this is complicated. I am not trying to point a finger at anyone and say there is a bad guy in this story. What I am trying to do is point out that these are very serious things we are debating in the House of Commons, both from a moral perspective and from a health care perspective. I am trying to point out that people come to their conclusions on these issues for very good reasons, whether that is their personal life, family life or religious or philosophical convictions, whatever they may be. Wherever we wind up on this debate, I believe, humbly, that it is a cheapening of the issue to combine both of these very complicated questions into one bill. If I could leave anyone listening to my words with one message, it would be to please consider the weight of this. If we are taking this as seriously as we should, then it should not be something that gets lumped into some kind of omnibus euthanasia discussion. Every single way we decide which Canadians become vulnerable to the practice of euthanasia and which ones do not should be treated with the weight of significant individual policies and legislative decisions in mind, as it should be. I would also like to elaborate on why I think it is very important that we consider the difficulty of asking an ill person to make this decision in an advance request context. I remember when I was first told that I might pass away from stage 4 cancer. The hardest part of the entire ordeal for the year and a half that I was a hospital patient, in the hospital every day, was seeing my mom go through it. I can absolutely understand why a sick person might say, “I do not want to put the responsibility on my family to have to make a difficult decision about my life one day.” I can absolutely understand why someone would say, “The moral thing to do is to take that responsibility onto myself.” To anyone who feels that way, my word of encouragement would be that if they talk to the relatives of people who have been in those situations, they will find that many of them were very happy to have taken care of their ill loved ones and were very happy to have been by their side even when it was difficult.”

“I do not want this bill to lock people into choosing medically assisted death years ahead of time. People should only make that choice in the moment, when they can fully understand it.”

“Mr. Speaker, with all due respect, the member opposite has asked a very silly question. We have been very clear in saying people should make the choice in the moment that death is being presented to them as an option by their government through the health care system. We are not taking the choice away. We are saying do not hold them to a decision they may have made years prior under different circumstances. Make sure that they can make the decision in an informed capacity in the moment.”

“I want this bill split into separate bills. If we cannot do that, we should vote on its parts separately. Every part of this bill has serious moral and medical importance.”

“Mr. Speaker, I do think, ideally, the legislation would be split. If not, a vote split would be a great idea. Anything that we can do to highlight the weight of every part of this legislation, the moral and medical significance of it, would be welcomed.”