“I want the House to pass this bill. It permanently bans medically assisted dying for people whose only condition is a mental illness, because doctors cannot agree when a mental illness cannot be cured and people need better care instead. It also lets people with diseases like Alzheimer's ask for assisted dying ahead of time, before they lose the ability to make choices.”

“Mr. Speaker, I will be sharing my time with the member for Etobicoke—Lakeshore. Today, I rise to speak in support of Bill C‑41, the medical assistance in dying safeguards act. This is a bill that is particularly close to my heart and to which I am deeply committed. This bill would prevent the planned expansion of MAID for mental illness and would allow for advance requests, subject to strict conditions and safeguards. I believe it takes a careful, compassionate and balanced approach that respects the will of individuals while recognizing our responsibility to protect those who are most vulnerable. This is a deeply personal issue for me, as it is for many Canadians in this country. This is an issue that asks us to consider some very difficult questions about suffering, dignity and protecting people when they are at their most vulnerable. I approach the subject knowing very well that we all have different experiences and beliefs when it comes to such a sensitive subject, and I respect that. Whatever our views, as politicians we have a responsibility to listen carefully and remember that every decision we make here affects real people and their families. Today, I want to explain why this bill matters to me and why I advocated for caution in expanding MAID to people whose sole underlying condition is mental illness. I commend the Minister of Justice and Minister of Health for proposing reforms that would maintain this exclusion, would allow people diagnosed with conditions such as Alzheimer’s to make advance requests, where permitted by provinces and territories, and would strengthen the national oversight of MAID. Let us begin with the first pillar: preventing the scheduled expansion of MAID on the basis of a mental illness. March 17, 2024, was the original date that MAID was to extend to people suffering from mental illness alone. This followed a Senate amendment to the original bill, an amendment that introduced a provision that would expand MAID to mental illness. This would have given people suffering from a mental illness, including depression, the right to apply for assisted death. Having a background in psychology, I was particularly concerned about what this expansion could mean. Mental illness can cause profound suffering. It can affect so many aspects of our lives, such as our relationships, work or physical health, and our ability to get through the day. For some, this suffering can go on for years. Symptoms can change over time, and recovery can be difficult to predict. People can respond differently to treatments, and finding the right balance of care and treatment can take time. This left me with some serious questions about how we could determine that a person’s condition would not improve and about how to ensure that people had meaningful access to treatment and support before they ever reached the point of applying for MAID. These apprehensions did not sit well with me at all. They led me to speak up and express my concern with my caucus colleagues in order to ensure that these difficult questions received the attention they deserved. I felt compelled to contribute to this discussion and explain why I believed more time was needed and why we needed a more cautious approach. As the date approached, I felt a responsibility to my constituents in Saint-Laurent and to all Canadians to raise my concerns and sound the alarm. I kept thinking about the people and families who could be affected by this decision, people experiencing profound suffering, some of whom might still be struggling to find the right treatment or supports. I wanted us to take the time to work through these difficult questions and be confident that we could protect those at risk. Ahead of the vote on a private member’s bill addressing this issue, two of my colleagues and I voiced our concerns and worked within our caucus to advocate for the expansion to be postponed. These were constructive discussions about a deeply sensitive issue, and although these conversations were very difficult, I honestly did not believe that going ahead with the legislation as it was proposed with the extension was the right move. My concern was whether we could move forward safely, whether our health care system was prepared and whether people living with mental illness had access to the treatment and support they needed. Most of all, if it is possible for people to recover from their mental illness and live functional and peaceful lives, would this legislation take this possibility away prematurely? As those important discussions continued, other colleagues shared their perspectives and concerns, contributing to a growing recognition that more time was needed before this legislation could be adopted. The government decided to create the Special Joint Committee on Medical Assistance in Dying specifically to study whether it should be expanded to individuals suffering solely from a mental illness. That committee found that Canada was not ready to offer MAID for mental illness, and the government subsequently introduced Bill C-62, which received royal assent on February 29, 2024. The legislation postponed the expansion of MAID to people whose sole underlying medical condition is a mental illness until March 17, 2027. It also required a parliamentary committee review of the health care system’s readiness. Bill C-41 would prevent this expansion from happening. Today, I will share some of the main concerns that I raised with my caucus and that have shaped my position on this piece of legislation. Originally, medical assistance in dying was allowable only in cases where a patient had an irremediable health condition. To have an irremediable condition means that the condition has become permanent and cannot be reversed. According to witnesses at the MAID committee, there is a lack of established criteria to determine if a mental illness is irremediable, as well as a lack of consensus among psychiatrists for if and when a mental illness should be considered irremediable. Furthermore, we are still learning about the brain and continue to do so every day. The brain is neuroplastic, meaning it continuously changes and grows in response to a person’s environment and experiences. This does not mean it always changes for the better or that it improves, but it does mean that it can be difficult to predict if a mental illness will be irremediable or if it can be healed. According to Sharon Reynolds in an article published in the National Institutes of Health journal, there are some properties in some types of psychedelic drugs that have shown promise as therapies for treatment-resistant depression and PTSD. They encourage growth of new neural connections in the brain, so it might be possible to develop related drugs that can promote brain plasticity without causing harmful and hallucinogenic effects. This would be a very promising development. Another concern that I had with expanding MAID to individuals suffering solely from mental illness is the fact that we do not have adequate mental health care services in Canada. Therefore, people would be applying for MAID without trying other treatments for a lack of accessibility to them. According to the Canadian Institute for Health Information, there are several factors that contribute to unmet mental health needs across the country, and these include cost, as many services are not fully covered by public health insurance; caregiving or work responsibilities; a lack of support in navigating existing services; a lack of trust in the health care system; and the fear of what others may think for needing help in the first place, due to the stigma associated with mental health issues. The second pillar speaks to another group of Canadians, those living with Alzheimer’s or another form of dementia and the families who walk beside them. For these Canadians, there may come a day when they can no longer tell the people they love what they want at the end of their life. Today, under the Criminal Code, they cannot say it in advance. Advance requests are prohibited. An advance request allows a person who has been diagnosed with a capacity-limiting disease like Alzheimer’s to set out the circumstances under which they would want to receive MAID in the future after they have lost the capacity to consent. Canadians living with dementia have told us clearly that they want their wishes respected. Bill C-41 would permit advance requests so that a person diagnosed with a capacity-limiting disease can set one out while they still can. It does so with care, by setting minimum national safeguards in the Criminal Code for the lawful provision of MAID based on advance requests. Over the past few weeks, people in my riding have put it better than I ever could: People struggling with mental illness deserve care that is compassionate, hopeful, and focused on suicide prevention, not medical assistance in dying. They told me that many people living with mental illness will reach such a low point that they will come to see MAID as the only way to escape their suffering. Furthermore, they asked me a question that has stayed with me: When that person is at their lowest point, what do we, as a society, say to them? Do we reinforce their sense of despair, or do we protect, support and care for them? If we do not take action, the current exclusion will end on March 17, 2027. Bill C-41 addresses this. It takes a cautious approach, as there is still no clinical consensus and too many Canadians still cannot access the mental health care they need. A parliamentary committee composed of senators and members of Parliament from various parties heard from experts and stakeholders and recommended not moving forward. The bill follows through on that recommendation. The bill is the result of listening. We heard from parliamentary committees, clinicians, the provinces and territories, disability groups and academics, and this decision follows the evidence so that people get the support they need. To those who are struggling, the bill offers hope and is a promise—”

“The minister did consult Canadians about this bill. People with Alzheimer's suffer a lot near the end of their lives, and they lose control of their bodies. They should have the right to decide in advance to die with dignity.”

“Mr. Speaker, of course, the minister consulted with Canadians. Someone who suffers from Alzheimer’s disease suffers tremendously, especially toward the end of their life. They lose capacity in many functions in their body, and it is only fair that they get the right to decide to die with dignity if they so choose.”

“I have concerns about this bill. Our health care system is stretched thin, and doctors need to be able to verify how long someone has been sick. Without the right supports in place to carry out this law, some people will die before their chosen time.”

“Mr. Speaker, based on our discussions in caucus, the proposed bill was not necessarily intended only for people who have been living with a mental illness for 20 years. We also know that our health care system is stretched to the limit. I think that doctors need to make informed decisions and verify whether a condition has truly persisted for 20 years. I think that some people are going to die before their chosen time simply because we lack the supports needed to implement this kind of legislation.”

“We need to talk more about home care, hospice care, and end-of-life care. These are essential services that we need to expand and support. Provinces run most of this, but this law affects different levels of government, so we must work together. What are the member's thoughts on hospice care?”

“Mr. Speaker, I am hoping that throughout the debate this evening, we will hear more discussion on home care services, hospice care and palliative care. These are all essential services, and we need to look at ways to continue to expand and support them. Much of this is provincial responsibility, but it is important to recognize that the legislation would have an impact on different levels of government in terms of their responsibility. That is one of the reasons it is critical that we work collaboratively with other jurisdictions. I wonder if the member could provide her thoughts in regard to the issue of hospice care in particular.”

“People who are suffering should get to choose how they end their lives, especially with illnesses like Alzheimer's. Good end-of-life care is important, but the dying person should make this choice.”

“Mr. Speaker, it should always depend on what the person who is suffering wants, especially with a disorder like Alzheimer’s. Of course, hospice care and end-of-life care are extremely important, and a person dying should always die with dignity, but at the end of the day, it is ultimately up to them how they choose to end their days of suffering.”

“I want everyone to vote for this bill right away. It stops medically assisted dying from being expanded to people with only a mental illness. Doctors do not agree on how to diagnose these cases, so we are not ready for that. This bill also lets adults choose assisted dying in advance, while they can still think clearly, if they are diagnosed with a disease that will take that ability away later.”

“Mr. Speaker, it is an honour to stand up and speak to Bill C-41 for reasons that will become apparent as I move forward. MAID is, frankly, one of the more difficult issues that I have had to deal with in my 11 years here as an MP. It is an issue that deals with people at the most vulnerable time in their life, making one of the most difficult decisions they will ever make. We have a great responsibility in getting this right. It is a discussion, of course, that people wish they never had to have, but it is a conversation that is necessary, and that is why this piece of legislation is so important. MAID provides Canadians with the ability to make a choice about how they wish to live out their last days and to exercise some control over the most inevitable parts of human existence, and it brings comfort to their family members. It is also something that generates a lot of questions and concerns from Canadians, and rightly so. People across the country are struggling with these personal issues. When family members are ill, sick and dying, they are dealing with medical professionals, and they need to know that this is a top priority for us. I know this because I, like every other member of Parliament in this chamber, have received phone calls and emails from constituents and people sharing these deeply personal stories. The most recent iteration of the special MAID committee, which I had the honour of sitting on, completed its work in June. I see one of my colleagues across the way. She was on the committee with me, so she understands the great angst that we all experienced in dealing with these deeply personal issues. We heard from witnesses. We listened to testimony. We heard from professionals. We heard from families with lived experience. I think we got it right. It was a tough decision to make, and anybody who thinks that committee did not take its job seriously was not paying attention. Bill C-41 would get us to where we need to be, in my opinion, and I am honoured to stand up here and speak to it. Firstly, the bill would conclusively halt the scheduled expansion of MAID on the basis of mental illness. Secondly, it would legalize the provision of MAID on the basis of an advance request. An adult diagnosed with a capacity-limiting illness could make a request while they still have the capacity to do so, in anticipation of a future loss of capacity. I want to speak first about the mental illness decision. As I said, I was on this committee most recently. I was on the committee immediately prior to that, when we reviewed the issue. I was on the committee the first time there was a joint committee. I was also on the justice committee when the legislation was first considered and, ultimately, was introduced. I have heard from all of the witnesses time and time again. I know how troubling this issue is. I struggled with it myself. Mental illness is a real issue. It is a real medical condition. However, we have to get this right. Until we have concurrence among the medical community, we as legislators would be irresponsible to do anything but introduce this bill and stop the law from coming into effect on March 17 of next year. All three times, we heard from experts from across the country, people who practise in this area, people who are specialized and have particular knowledge. We heard from family members. The overwhelming majority view was that the system is not ready, the country is not ready, and we cannot responsibly and safely introduce MAID for people whose sole underlying condition is mental illness. There is no consensus among the doctors. If we cannot get consensus among the doctors on a diagnosis, how can we possibly get consensus among the doctors on whether we should proceed? That is a very important distinction. This is not a value judgment. We have to listen to these experts, but if 10 doctors examine the same patient and cannot agree on the diagnosis, how can we possibly responsibly proceed and allow this to take effect? We cannot. That is where we are today. An irremediable mental health condition is something the medical community can simply not agree on, full stop. That is why we are here talking about this today. This is not to say that mental illness is not a serious or grievous condition. We all know it is. We have talked about it many times. We all have people in our families who experience these challenges. Nobody makes light of this, I can assure members. It does not matter. It does not mean people cannot be helped. It does not mean there is not help out there for these people in their darkest moment to have something to look forward to. That is why this is so important. The committee heard from experts about the insufficient mental health services available in this country. Let us call it what it is. We know that. That is something we have to address here. It is something the provinces have to address. It is something that I am proud to say this government, and in fact all parliamentarians as it is not a partisan issue, can agree on and something we have made great strides on. This first part of the bill is not only important but urgent. If we do not pass it immediately, the law takes effect on March 17, 2027, so I am asking every member of this House to vote in favour of Bill C-41 for that reason and the reasons I have outlined. The second part of the bill deals with creating a framework for baseline safeguards for the provinces and territories to be able to introduce their own legislation to allow MAID to be provided on the basis of an advance request. An advance request lets a person decide now, after diagnosis of a disease that in the future would strip them of the ability to consent to MAID, to make decisions about their end-of-life care while they still can. This generates great debate too. The crux of the concern that I have heard is that people lose their ability to make the decision, which means we do not know if they have possibly changed their mind. Here is the thing about that. We know when we are making that decision that that is part of the equation. If I am presented with that scenario, and I know the action is going to be carried out after I have lost my ability to make that decision, I make that decision myself, and I know that going in. That is consent. I think people need to give that serious consideration. I know my friend across the way is going to raise the issue of a perceived lack of study. It has been studied. I have been on all three iterations of this committee. Members can look at the report from the first one. The matter of advance requests was part of our discussion. We reviewed it thoroughly. We heard from experts. We gave it detailed consideration. This is not something the government just decided to do. This debate has been going on for several years. Not only that, but when this bill gets through the House, it will go to committee and we will have the opportunity to scrutinize it again. Members can rest assured that this will be done responsibly. I have great confidence that that is a fact. Under Bill C-41, in order to qualify or make the decision for an advance request, the requester must be an adult, 18 years old or older; live in Canada and be eligible for publicly funded health care; have a diagnosis of an incurable, capacity-limiting disease; and have the capacity to make the decision about their own health care. I emphasize that again. The advance request must be drafted with the assistance of a physician or a nurse practitioner and in consultation with an expert in this disease. The request reflects the person’s voluntary and informed decision. I cannot put enough emphasis on this. It is an informed decision, when one has the ability and the capacity to make that decision. Is that not what we want? I say the answer to that is yes. I know I am running out of time. I think this legislation would put our country where it needs to be. I feel very strongly about it. It is an issue I have been committed to for many years now, and I am very proud to be standing here in support of this bill.”

“We voted against the earlier bill because its wording did not match the Criminal Code. By law, mental disease and mental illness mean different things. This new bill uses the correct words to fix the problem, and I want us to pass it so we do not have to do this again.”

“Mr. Speaker, that is a great question. The simple answer is that the language used in that bill did not accurately reflect the language used in the Criminal Code, and we have to get this right. The member is right; I feel strongly about this. Mental disease and mental illness are two different things from a legal perspective, and this piece of legislation addresses that with the language that is appropriate and would get us the result we need. Not voting for that bill was not a reflection of my attitude or anybody else’s attitude, but as I said during my remarks, I want to get this right. I do not want to have to do this again.”

“I do not support medically assisted dying for mental illness alone. Doctors can easily agree on a physical illness like cancer, but they often disagree on whether a mental illness can get better. Until we can protect vulnerable people, I cannot support this.”

“Mr. Speaker, I alluded to that as well. Let me give an example. If an individual is diagnosed with terminal cancer and that person goes to see 10 physicians, all 10 of them are going to agree on that diagnosis. Some of them may disagree on life expectancy, some might disagree on the type of treatment, but they would agree on the core issue, which qualifies the individual to apply for MAID. A mental illness is entirely different. In my previous life, I dealt with this quite a bit. If somebody with a mental illness goes to 10 doctors, six of them might say yes, there is a serious mental illness; two of them might say no, there is no mental illness; and the other two might just say yes, there is, but it is going to get better. How in that scenario can a person possibly be granted access to MAID? Four of those doctors are saying they do not know whether the illness is irremediable. That is the difference. Until we can get that right, until we can design a system that those people do not slip through, I will never be comfortable supporting it.”

“I want to thank my colleague for his years of hard work on this issue. He studied it on difficult committees, and it took a lot out of him.”

“Mr. Speaker, I just have a comment. I want to thank my colleague for all the years of work he has put into this issue. As we heard in his speech, he has put everything he has into this issue. He studied it for years on end, and those were difficult conversations. Those were difficult committees to sit on. I have heard stories from my friend over the years. I know he has put a lot into it and it has taken a lot out of him. I want to thank him for his service.”

“Any member here would have done this work. Studying medically assisted dying was the most serious issue I have ever worked on, and I am proud I was part of it.”

“Mr. Speaker, that was very kind. I do not need thanks. I am just grateful to be in a position to do this, as any one of us would be. I mean, we all sit on committees. We all participate in different activities here every day. I can say without hesitation that this was the most weighty issue and process I have ever been through, but I am proud I was there to participate in all of it.”

“Canadians have been debating medically assisted dying since the early 1990s. People should have the right to make decisions about their own bodies and their own lives.”

“Mr. Speaker, I want to quote Stefanie Green, who is a practitioner, on the issue of MAID. This goes back to the case of Ms. Rodriguez, which dates back to 1991, when the debate was ongoing in Canada. “After learning what lay ahead for her, she wanted a doctor to be able to give her medication to end her life when she felt the time was right, so that her death could be quick and certain.” She then goes on to quote Ms. Rodriguez: “If I cannot give consent to my own death, whose body is this? Who owns my life?” I note that because it is important that we recognize that the debate on this in Canada has been going on since the early 1990s.”

“We have debated this issue for decades, and personal opinions matter. I want to know if the member's constituents agree with her view on this bill.”

“Mr. Speaker, as I tried to allude to earlier, the discussions and debates on this issue have been around for decades, starting in the early nineties. It is good that we have personal opinions and we want to share those personal opinions. Does the member have any sense of whether the constituents she represents reflect her opinion? Does she have any indication of what her constituents would have to say on this legislation?”

“I want the House to pass this bill. People who are suffering and seniors have asked for advance requests for medical assistance in dying for years. I want to know why the Bloc Québécois opposes this step forward.”

“Madam Speaker, I really want to thank our colleague from Montcalm, who has championed this issue and advanced it with great rigour. He has done a lot of work. I had the great pleasure of serving on the special committee, and I really want to point out how passionate the member is about this subject. We heard it in his speech. Advance requests are already a big step forward. We hear about the need for advance requests in our communities, although our Conservative colleague was unable to tell us what she was hearing from her constituents on the matter. I can speak to this from my own experience. I worked as a notary for nearly 30 years at a time when MAID did not exist, and people would ask me to include something about it in their living will. They said that, if MAID ever became legal, then they wanted to have something in writing. Since this bill directly addresses a need that has been expressed by our loved ones, our seniors and people who are suffering, as our colleague so rightly pointed out, why is the Bloc Québécois opposed to Bill C-41 as it now stands? Does the Bloc not believe that it would be a good idea to pass this step forward and continue the debate on certain aspects of the bill?”

“End-of-life care is not the same everywhere. We need to talk more about how we care for dying people in our communities, and we need to work together on palliative and hospice care.”

“Madam Speaker, I want to pick up on the issue of end-of-life care, because it varies, from what I have found. When I was the health critic in the province of Manitoba, there were individuals in hospitals getting panelled and almost classified as needing end-of-life care, and they went to other institutions. It really varies. I am hoping that we will see more debate on the type of care in our communities today. It is important that we have a sense of co-operation when dealing with things such as palliative care and hospice care. These are all important elements that should be taken into consideration.”

“I want the member to tell us if her position on medically assisted dying reflects what most people in her riding actually want.”

“Madam Speaker, I posed a question to the member’s colleague in regard to the whole issue of advance directives, which has actually been in the public for many years. We can go back to the 1990s, when we had courts dealing with a different form of MAID. However, the question I have for the member is this: Does she believe that her position on the issue reflects what a majority of her constituents would want her say about MAID? Does she believe that she has provided balance, at the very least, or recognized what her own constituents, and it might even be a majority, have to say about this very sensitive issue?”

“The government is working with the provinces to protect vulnerable people. Most Canadians seem to want this bill. Does the member think the Conservatives' position reflects what most Canadians want?”

“Madam Speaker, I think that the minister has been fairly clear in terms of working with provinces and territories to ensure that we have a rigorous process that has safeguards to protect people. I think that is an important thing to say. In my canvassing, I have had people talk to me about this issue. Where I disagree is that it seems to me that a majority do seem to want to see the legislation. I am not talking about knocking on doors and things of that nature. I am wondering if the member could provide her thoughts on whether she believes that the Conservative Party’s positioning on this issue, because that is what it seems to be, is reflective of what a majority of Canadians would want to see.”

“I want the House to pass this bill. It stops assisted dying for people whose only condition is a mental illness, because the provinces are not ready to do that safely. It also lets people make advance requests for assisted dying if they get a disease like Alzheimer's, before they lose the ability to decide for themselves.”

“Madam Speaker, my remarks today seek to contribute to the discussion we have had in this House since 2016 regarding medical assistance in dying, commonly referred to as MAID, and particularly with respect to Bill C-41, the MAID safeguards act, which proposes to amend the Criminal Code and make two important updates. The first one is to end the expansion of MAID for mental illness as a sole condition, and the second is to allow Canadians to request MAID in advance for a time later in an illness. MAID is a controversial topic, and it has generated much constitutional debate. For all the nuances, though, the main arguments are divided into two general opinions. From one perspective, providing legal access to MAID enhances the personal autonomy and dignity of people with serious illnesses, giving them control over the manner of their death. From another perspective, it could be a precarious medical advancement that could impact the lives of people who may already be vulnerable. This legislation would provide safeguards so that all Canadians can be assured of their rights and protections, specifically with respect to MAID for mental illness and MAID for advance requests. Regarding the first change in Bill C-41, MAID for mental illness, MAID will not be available for those suffering with mental illness as a sole condition. The planned expansion for MAID to those with mental illness as a sole condition has been delayed twice to allow more time to consider questions around readiness and safeguards from the provinces and territories. Most recently, a parliamentary committee made up of senators and MPs from different parties studied the issue, heard from experts and stakeholders and recommended that the expansion for mental illness not move ahead. I was a member of that committee, and the result of extensive discussions found that we cannot be assured that the provinces and territories are ready to safely and consistently assess and provide MAID for Canadians with mental illness as their sole condition. I will say that there was not necessarily consensus around the committee on all underlying issues and definitions, and that just indicates the variety of perspectives that were considered. Without legislative action, the current exclusion for mental illness would expire on March 17, 2027, and this would have allowed MAID to be provided to eligible individuals on the basis of mental illness only. Given the lack of clinical consensus, Bill C-41 takes a precautionary approach and would maintain the exclusion. I will make an important point here. Several people have contacted my office about this. The eligibility for people with other eligible conditions is unchanged. A person who has a mental illness may still be eligible if they meet all other legislative criteria. For example, someone with an advanced stage of terminal cancer who also has, for example, diagnosed clinical depression as a mental illness may still be eligible to access MAID on the basis of their cancer, so long as they meet all the other eligibility criteria. I will also note here that Bill C-41 uses the term “mental illness”, not “mental disorder”, so people with serious degenerative neurological disorders who are eligible today keep their access. We are talking about conditions like Parkinson’s disease. Mental illness can cause suffering just like the suffering experienced by a physical illness. Canadians living with mental illness deserve to have their suffering taken seriously, and our government takes it very seriously. We are working with provinces and territories to determine how we can best support Canadians living with mental illness in strengthening our public health care system. That is why we announced a $1.2-billion investment to extend the mental health and substance use agreements and home and community care agreements as we work with provinces and territories toward long-term solutions to prevent and treat mental illness. In addition, in 2023, we announced the working together to improve health care in Canada plan, which provides $200 billion over 10 years to provinces and territories, including $25 billion for shared priorities such as mental health. Regarding MAID for advance requests, Bill C-41 would allow adults to make an advance request for MAID following an early-stage diagnosis of an incurable illness that is expected to take away their ability to make decisions. This would allow an individual to make an informed decision about their care while they still have capacity and would set out the circumstances in which they would want to receive MAID later in their illness. For example, someone diagnosed with early-stage Alzheimer’s could make an advance request so that their wishes could be respected if they later lost the ability to make the decision for themselves. An advance request would not mean MAID is provided automatically. Eligibility requirements and safeguards would still need to be satisfied. The role for the federal government relates to the Criminal Code. To implement this change, provinces and territories would still have to make advance requests available in their respective jurisdictions. Under the current law, a person must be able to give informed consent to receive MAID. They must understand their condition, their options and the consequences of their decision, and they must generally confirm their consent immediately made before MAID is provided. Some illnesses, such as Alzheimer’s disease and dementia, gradually take away a person’s ability to make these decisions. As the illness advances, a person may no longer be capable of giving informed consent by the time they would want MAID. Under the existing law, this means they cannot receive MAID, even if they were clear about their wishes while they were still capable. Many Canadians feel this is inherently unfair. Importantly, this is about respecting the wishes expressed by an individual while they are capable of making decisions about their own care. Importantly, a family member would not be able to make an advance request for MAID on someone else’s behalf. Provinces and territories would decide whether to make advance requests available in their jurisdictions, and our government will continue working closely with them as we move forward. This is because MAID eligibility is a shared federal-provincial matter. The provincial role in the MAID framework is crucial to the fair and consistent delivery of care to Canadians. Individual provinces and territories have their own customized approaches to MAID to best serve their populations. Provinces and territories provide services, coordinate care and regulate providers so that Canadians in their respective provinces and territories have consistency and certainty. This must be done in deference to the autonomous choice of an individual as they approach the end of their life with a grievous and irremediable medical condition. In short, Canadians rely on their provincial and territorial governments to provide access to their charter right of security of the person in the context of MAID. If the House will indulge me, I will provide a short legal and historical context for this discussion. I will take members way back. A discussion about MAID became necessary in 2015 after the Supreme Court decision in the Carter case. Carter decriminalized medically assisted death. In that decision, our Supreme Court held that the criminal laws prohibiting assistance in dying limited the rights to life, liberty and security of the person under section 7 of the charter in a manner that was not demonstrably justified under section 1. As a result of the Supreme Court’s decision, the Criminal Code provisions prohibiting assisted suicide and providing that no person may consent to death being inflicted on them were deemed to be in violation of Canadians’ rights under the charter. Responding to the Carter decision via Bill C-14 in 2015, MAID was legalized for competent adults whose natural death was reasonably foreseeable. The Criminal Code established eligibility criteria and safeguards for MAID, as well as made exemptions to criminal offences, including murder and aiding someone to die by suicide. A subsequent case, Truchon, was heard at the Quebec Superior Court in March 2021, and the court’s decision in Truchon expanded eligibility for MAID to adults whose natural death was not reasonably foreseeable. This created two tracks in the Criminal Code: one where natural death is reasonably foreseeable, track 1, and one where it is not, track 2. In addition to eligibility criteria for those receiving MAID, notably that an individual must have a grievous and irremediable medical condition, the Criminal Code set out additional procedural safeguards that health care providers must follow before providing MAID where death is not reasonably foreseeable. The same legislation temporarily excluded persons from eligibility if their sole underlying medical condition was a mental illness. That exclusion for mental illness was originally set to end on March 17, 2027. Bill C-41 would permanently end the extensions. I would hazard that this issue of expansion for mental illness has perhaps been one of the most contentious and complex issues we have grappled with in the development of MAID legislation. In the joint committee’s third report, it was noted that although MAID is governed by federal law, health care regulations and medical standards fall within provincial jurisdiction. The division of authority introduces some added legal and administrative complexity in aligning federal policy with provincial implementation. With the benefit of the special joint committee’s findings, we have determined that the provinces and territories simply are not ready to administer an expansion of MAID for mental illness. I speak with some experience on end-of-life issues. Prior to entering politics, I worked in long-term care, I worked as a licensed funeral director and I worked as an estate planning lawyer. I have also sat as a board director of our local North Halton Hospice foundation. This is an organization seeking to build a palliative care hospice residence in my riding of Milton East—Halton Hills South. In these professional activities, discussing death became a fairly innocuous exercise. Death is, most simply, a fact of life that when possible, is best planned for and discussed with loved ones and trusted professionals. It is my opinion that those discussions are best had without the pressure of prying eyes or proselytization from the outside world, and free from those who contend they know better about how an individual should move through this life and how they should move on to the next. Choosing a medically assisted death is a fundamentally personal decision and a very fundamentally personal right. How MAID is delivered has become a main focus of the debate since 2015. Some of the concerns I have heard from people in my riding include the fear that vulnerable people will turn to MAID as a first option because they feel that other care or health services are too difficult to access or simply do not exist. Also, there is a concern that people could be coerced or influenced to opt for MAID, and this may be more likely for people who could already be vulnerable due to other socio-economic factors. It is important that Canadians are properly informed on the process to access MAID and the safeguards that exist to ensure that vulnerable persons do not improperly access MAID. First, at least 90 days must pass between the day the MAID eligibility assessment begins and the day the person receives MAID. Second, two health care practitioners, independent of one another, must conduct assessments and confirm that the person is actually eligible for MAID. Third, these assessors must inform the person of all reasonable and available options for relieving their suffering and offer the person consultations with people who provide those services. Fourth, the person and the assessors must have discussed all of the options for relieving the person’s suffering and agree that the person has seriously considered those options. Last, immediately before the person is to receive MAID, the MAID provider must give them the opportunity to withdraw the request for the procedure. If the person wants to proceed, the MAID provider must ensure that the person gives final consent. In Bill C-41, which we are discussing here today, there would be additional requirements in the case of an advance request. First, generally, we would implement minimal national safeguards that would set out Criminal Code requirements for the lawful provision of MAID based on advance requests. Second, the implementation of provincial and territorial frameworks would have to be developed and would have to state that any province or territory wishing to permit advance requests must first enact its own legislative framework. Advance requests would remain prohibited in jurisdictions that do not have this framework. Third, operational rules and participating jurisdictions would be responsible for rules on making, validating, amending, storing and withdrawing requests, including a reliable storage mechanism to verify that a request remains valid. Fourth, the requirement for two independent assessments would be enhanced so that the two physicians or nurse practitioners must confirm that the circumstances in the request have occurred, that the person is in an advanced and irreversible decline, and that they are experiencing intolerable suffering. Fifth, as in any MAID case, refusal would end the process. MAID could not be provided to a person who refuses, and their advance request would then be invalidated. When it comes to Quebec, Quebec’s existing framework would be incorporated into the federal criminal law regime without the need to amend Quebec’s legislation. I want to note here the tremendous responsibility that frontline care providers would shoulder in fulfilling these criteria. Their expertise, training, compassion and courage in providing this service really cannot be understated. These safeguards show that the analysis in providing MAID in each unique case would be a process of some burden, and it should be. I note the historical position of our Conservative opposition colleagues. They have been vocal on this, urging the government to scrap the expansion of MAID for what they call a mental disorder, most recently in a private member’s bill, Bill C-218. Bill C-218 was premature at the time of its tabling, as the special joint committee had not yet had time to consider evidence or hear from witnesses, and the bill ultimately failed in this House. In any event, our government’s Bill C-41, currently before this House, aligns with the request in the Conservatives’ private member’s bill, Bill C-218, to end the expansion of MAID for someone with a mental illness as a sole condition. On that, we have agreement, although perhaps for different reasons. I am not sure of my Conservative colleagues’ position on Bill C-41, but I cannot imagine on what grounds they would oppose it, since in one instance, it would provide what Bill C-218 asked for in ending the expansion for mental illness, and in the second, it would provide greater freedom and autonomy for Canadians in determining their own treatment and end of life through advance requests, a principle that is very popular, especially among older Canadians. It is hard to deny that MAID can be a contentious topic, because for all the legalities, science, regulations and debate, we are essentially discussing an issue that is the most profound experience of being human. We are all going to die. Dying is still a great mystery, one that we must continue to navigate and explore together with conversations like this one that embrace mutual respect, empathy and understanding for the emotion and fundamental humanity of contemplating how we leave this world. During my time working as a funeral director, I had the privilege of hearing the unfiltered experiences and stories of families as they found themselves as observers and helpers during the death journey of their loved ones. This is where the importance of individual autonomy and choosing the care and form of dying really became real for me. In the years that I have been serving on the hospice foundation board, a discussion has proceeded about how health care should address the experience, needs, beliefs and requests of each unique individual as they move through their own unique, individual death. Not all of us will be able to plan for our death or have control over the circumstances and timing of our transition from this world, but many of us will. When that time comes, I want to have the autonomy to make the choice that is best for me, in consultation with my family, my health care provider and my own conscience. We all deserve that. I would argue that it is the role of legislators to work with experts to achieve this for Canadians, not only because of the moral imperative to do so but because security of the person is enshrined in our charter, which contains protections for individuals, allowing them to maintain control of their bodily integrity, personal integrity and basic freedom of choice. Conversations such as the one we are having here in the House work to expand minds, address misinformation, open the dialogue and provide space for each of us to learn and share. These debates are absolutely imperative in bringing the best care to our citizens and helping government move toward legislation that will serve all Canadians.”

“I want this bill to pass. It protects people from being forced to ask for medical assistance in dying. Patients must choose to ask for it themselves after talking with their doctor. They can also change their mind at any time, even with just a sound or a gesture.”

“Madam Speaker, this is a perfect example of how complex the issue really is. First of all, no one would be offered a document to sign. People would take the initiative, once they have received a diagnosis, in consultation with their medical provider, and they would decide. They would have to do the research. In fact, the legislation would protect people from having this offered to them or forced upon them. I know that is a concern of our Conservative colleagues, and it is one that is addressed in this legislation. Again, we are getting back to how much faith we put in individual Canadians to make autonomous decisions for their own care. For something in the future that they would have to deliberate, it would be a discussion they would have with their doctor, with their family and, if they are a person of faith, with their creator, and they would ultimately make the decision for themselves. At any point in time in the process after someone decides to sign an advance directive, they could withdraw it. In fact, they would not have to formally withdraw it. They could just say to the provider of MAID in the moment, or prior, that they are not willing to move forward. In fact the legislation even says if they make sounds or gestures that indicate they may not want it administered, then the provider could not administer it.”

“I want the member to support this bill. We cannot allow medically assisted dying for mental illness yet because the provinces and territories are not ready to do it safely.”

“Madam Speaker, I thank my colleague for that good question. In my remarks, I mentioned that I was on the joint committee with the hon. member, and there was vigorous debate and certainly difference of opinion on a number of factors. I take his point with respect to what he is saying for folks who are experiencing mental illness as the sole underlying condition. I had an experience of talking to someone in my riding who was very disappointed that as someone with mental illness, they would not be able to access MAID, given the recommendations of the committee. As I mentioned, it was primarily because the provinces and territories had shown they were not ready to assess and consistently and safely administer MAID in those situations. My colleague also referenced the extensive case law and the legal history. I am sure the law will continue to develop, as it has over the past 10 years, but right now we find ourselves here with this very important comprehensive piece of legislation that I hope we can have his support on.”

“We left the wording in this bill broad on purpose. It lets provinces make their own rules. People experience suffering in very different ways, so it cannot be strictly defined. These choices should be made between patients and their doctors.”

“Madam Speaker, sometimes in law, definitions are left broad on purpose. We want to ensure that the provinces that would choose to come on board with this would have their own requirements, their own regulations. Again, we want to ensure that medical providers and the people who go to them seeking care and perhaps choosing MAID have a discussion about what that means. It is impossible to define it in black and white in any sensible way, because there are so many vastly different ways that people can experience intolerable suffering.”