“This bill delays medically assisted dying for mental illness indefinitely. That cancels it and abandons people who are suffering. The government should not rush this bill. It should also change the rules for advance requests so federal law does not override Quebec's laws.”

“Mr. Speaker, I will come back to what I was saying earlier, when things were a bit chaotic in the House. Bill C-41, on medical assistance in dying, is extremely important. This is a subject that must be handled with care and seriousness. It must be addressed conscientiously. The bill addresses two aspects: mental illness and advance requests. I will begin by talking about mental illness. To postpone implementation indefinitely is, in effect, to cancel it altogether. There are people who are suffering immensely. There may not be many people who are eligible, but they do exist. In effect, we are telling those people that they are being abandoned. Why are they being abandoned? It is because the federal government is always playing catch-up with the courts on these sensitive issues and lacks the political courage to act. This is a complex and sensitive issue. That is why we must be careful. I will give an example. Why has the government not already asked the Supreme Court for an opinion on whether the bill we are about to vote on is constitutional? All the government has to do is ask. If that is not done and this bill is passed as is, it means that these people are considered too vulnerable to exercise informed judgment, but not so vulnerable that they should not be forced to hire a lawyer and sue to do what the government itself refuses to do. The government has a duty to protect its citizens in different types of circumstances, including these circumstances. Of course, this needs to be regulated carefully, but the rights of every individual must also be respected. That is the issue that concerns us the most. I would remind members that the Special Joint Committee on Medical Assistance in Dying, established by the House of Commons and the Senate, recommended that medical assistance in dying and advance requests be authorized under the Criminal Code so as not to encroach upon the jurisdictions of the provinces and Quebec. The committee further recommended that all aspects relating to care be defined and developed by the Government of Quebec and the provincial governments. We are well aware that not every province is at the same stage and that, once again, Quebec is ahead in this area because it is fundamentally a social issue. That is an observation of a general trend, not a judgment. Nevertheless, we must respect these areas of jurisdiction. We must ensure that the wording of the Criminal Code does not unduly restrict the application of Quebec’s laws. That is our main request. I was pleased to hear the minister, in response to the question I asked earlier this morning, extend an invitation and open the door to a meeting with our critic, who I believe is one of the country’s leading experts on these issues. We hope that this meeting will take place in a conscientious spirit and with a genuine willingness to engage. Concerning advance requests, it is important to keep in mind that the Criminal Code takes precedence over Quebec legislation. We exist in a federation—for now, in any event—so the conditions should not be too restrictive. I will repeat the question I raised this morning. Quebec’s legislation uses the criterion of conditions considered intolerable, while the federal legislation says that advance requests do not apply if the suffering can be relieved through reasonable means. What does “reasonable means” mean? Who gets to decide whether the means are reasonable, if the patient is incapacitated? That is the crux of the issue. The patient is the one who should make that decision, not caregivers, who might be tempted to interpret the legislation according to their own personal values. I know it is not an easy task. Making such decisions must weigh heavily on the assessment panel. Their task is extremely serious and grave, but it is important not to lose sight of the person’s wishes. That is why it is important to sit down and get this right. We are again disappointed by the bulldozer approach the Liberals are taking. We are being asked to rush this bill through. We got the report back in April, but this bill is only being introduced now, in late October. We are told that this is urgent. Can we carry out our work conscientiously and in a non-partisan manner for once? Fundamental issues like this one must be dealt with conscientiously.”

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“We should not rush this bill. We must take the time to study it properly. Health care belongs to the provinces, and Quebec already has its own rules for medical assistance in dying. I do not want this federal law to override Quebec's law or put stricter limits on it.”

“Mr. Speaker, I would like to thank my colleague for his question and for listening. He clearly paid close attention to both parts of my speech. I am pleased that he agrees with me that we should not rush this bill through. I trust that he will work within his party to ensure that we take the time necessary to do this properly. That is my understanding. What I was emphasizing in my remarks is that it is important to make sure that the federal law does not interfere with the application of Quebec’s law. That is important. Provincial and Quebec legislation must have the flexibility to reflect their own societal choices, and the health care aspect is part of that. Health care falls within the jurisdiction of the provinces and Quebec. That was what I was getting at. My colleague mentioned trusted third persons. All of that is already covered by Quebec law. There is a risk that the federal Parliament will step in and override this. We know that the federal law will take precedence. There is a danger that it could be more restrictive.”

“I disagree with this bill. We need to change the law to allow advance requests for medical assistance in dying. This bill might violate the Constitution, and sick people should not have to go to court to get their rights. The government should ask the Supreme Court if this bill is constitutional before passing it.”

“Mr. Speaker, I could not disagree more. It would be reckless to not take care of these vulnerable people. We do agree on one thing, and that is on this very point. I will quote a paragraph from one of the reports of the Special Joint Committee on Medical Assistance in Dying: While most of the details relating to advance requests fall to the provinces and territories since they are primarily responsible for healthcare, the Criminal Code would still need to be amended to allow advance requests, and the committee supports amending the Criminal Code in that manner. The committee seemed to agree. I do not think that is what my colleague meant earlier. I know these are sensitive issues. I would like to go back to my previous comments about political courage. What I mean by that is that we need to be proactive so that people are not forced to sue. Why should we not collectively decide that the government should seek an opinion from the Supreme Court? If the bill passes in its current form, will it be constitutional? We in the Bloc do not think so.”

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“We should not rush to vote on this bill. We must make sure it respects provincial laws, especially in Quebec. We should ask the Supreme Court to clear up these big questions, including whether it is right to ban all people with mental illness from medical help to die.”

“Mr. Speaker, yes, obviously, we need to be very careful. That is why I am saying that we need to take our time and not rush to vote on this bill. We need to make sure that it does not infringe on the provincial and Quebec laws. That is important. I think it is a matter of fundamental respect. Perhaps we need the courts to clarify some of the substantive issues. Is it right to exclude everyone who has a mental illness right off the bat? I am not a psychiatrist. Perhaps someone in the House is, but I do not know because I do not know all of my colleagues’ professions. Let us ask the Supreme Court to rule on this so that we know what direction to take.”

“We should slow down and not rush this bill. Completely banning people with mental illness from medical assistance in dying may be unconstitutional, and the government should ask the Supreme Court about that. We could split the bill so we can approve advance requests now. Also, this federal law must not limit or override the advance requests that Quebec already allows.”

“Mr. Speaker, I thank my colleague for his speech. I will of course continue in a similar vein. I also want to thank my colleague, the member for Montcalm, for all the thoughtful and empathetic work he has put into this, because that is what is needed on this kind of bill. We are talking about human suffering. He has done comprehensive and rigorous work on MAID over the past seven years. I know for a fact that he made a significant contribution to all the legislation that we have discussed and passed since then. I say “since then” because, obviously, this is an ongoing discussion. There is one criticism I have for the government, and I am sure many will agree with me. The report was tabled in the spring, the government introduced the bill, and now it is urging the House to pass the bill fast, even though we have been talking about this issue for years. This may be a new way of doing things, now that the government has a majority. The government may not be as interested in hearing what the opposition on the other side of the House thinks. However, majority government or not, I think we should take the time to study bills like this one, which, as I said, deals with human suffering. This issue is a very human issue. We should take the time to go further, instead of imposing something and saying that it is this or nothing. That is more or less what is happening. One of the first things I would like to discuss about the bill is its constitutionality. We are being asked to take a position on a bill that is basically twofold: the issue of permanently excluding mental disorders from the legislation and the whole issue of advance requests for MAID. When we know that this is discriminatory or, to keep things hypothetical—despite knowing for a fact that it is discriminatory—when we suspect that discrimination is involved, we have to determine whether the bill is constitutional. Voting for something unconstitutional would not advance the cause of people who are suffering. The government has had years to seek an opinion on the matter from the Supreme Court, but it has not done so. To me, that is irresponsible. It should seek the court’s opinion so we do not end up needing to repeat the same work again or forcing people in pain to prove that they deserve access to certain end-of-life services. That is one of the first points I want to make. I am not saying that it outweighs the others on substance, but on form, at least. We are already up against a problem here, and the government is trying to impose a solution without even knowing whether it is constitutional. Furthermore, no proposal is being made to divide the bill and, for instance, introduce one bill that we could vote on and seek an opinion for the other. We will now move on to the bill’s two purposes. The first is the matter of shelving the bill indefinitely or perhaps even permanently. I heard a member opposite say that the bill was not necessarily being shelved permanently and that we could maybe come back to it one day. Unlike him, I would say that we should strike while the iron is hot, because there are people who are still suffering right now. There are people who are suffering who are being excluded from the legislation. I spoke about discrimination earlier. They are being excluded, and we need to discuss that now. Just because a discussion is difficult and just because there are differences of opinion does not mean that we should put off having these difficult and demanding debates. It is difficult because it is a matter of beliefs. It is an emotional issue. There are, of course, various schools of thought on the matter, but the fact remains that these decisions must be reasonable, rigorous and science-based. As my colleague said several times, no one here is a psychiatrist. We need to hear from everyone. Even during the committee study, I do not think that we heard from everyone. We did not hear from people who are struggling with mental health issues and who are currently excluded from the bill. We heard from other witnesses. If we want our work to be completely objective and we really want to deliberate responsibly, then we need to hear from everyone. Perhaps, first and foremost, we should be listening to those who may wish to request MAID at some point, regardless of whether that request is ultimately granted. In Quebec, we believe that every individual has the right to choose for themselves what constitutes a healthy and dignified life. That is one thing. I get the impression that the reluctance to ask difficult questions stems from preconceived notions. That is why it is important to conduct an objective study and to engage directly with those affected in order to better understand the issue. What I heard earlier astonishes me. It shows me exactly where we have landed in certain aspects of the debate. We are talking about access to mental health care. That needs to be improved. However, I see that a sort of calculation is being made, and the assumption is that greater access to mental health care will mean less need for MAID. That alone tells me that the very premise of what MAID is has not been understood. That is a huge issue. I believe we need to talk about that, particularly given that we are dealing with stereotypes and preconceived notions here. People think that someone is going to walk into a doctor’s office and say that they are depressed, that they are having dark thoughts and suicidal ideations, so they want MAID. I have heard that before in the House. I am paraphrasing, those are not the exact words, but we can certainly find that in the Hansard. That is where things stand, to a certain extent, so we must not stop discussing this. At worst, let us split the bill, because there are people who are suffering. We want the advance requests to move forward, but we also need to resolve this issue. We cannot hide behind the excuse that it is too difficult and that we cannot address it. The second point is in fact the issue of advance requests. My colleague from Berthier—Maskinongé talked about it already. Advance requests are available only in Quebec. What we in the Bloc Québécois fear is that the federal law, which takes precedence, will be more restrictive than what already exists in Quebec. We want the laws to be harmonized. My concern is that the government may not agree with what Quebec is doing now. Why would the government not use terms that have already proven effective in Quebec and with which the members of the Bloc Québécois and Quebeckers in general agree? In any case, 80% of Quebec’s population agrees with MAID and advance requests. We have a strong consensus. Let us just say that the percentage of people who support this is higher than the percentage of voters who supported the government in the last election. In short, people agree and they are open to the idea, but we do not want to lose out. We do not want the federal government to set us back or cause more people to suffer. I am also thinking about doctors. What will they do? Through the Criminal Code, the federal government will have the power to dictate what Quebec does. It would restrict what is permitted to less than what we currently have. This is truly a huge concern for us. The minister said earlier, in response to my colleague from Berthier—Maskinongé, that he was ready to talk. Well, my colleague from Montcalm has raised this matter several times. He has already brought it up. I think we need to take the time to discuss this. We cannot be steamrolled into rushing this discussion. We need to see what will be done so we can ensure that we are properly defending our constituents. As I said, we do not want to go backwards. I would like to make one final point. This addresses a concern that one of my opposition colleagues raised earlier. He said that doctors did not agree and that there was a medical consensus. However, the Collège des médecins du Québec agrees that a blanket ban should not be considered. Everyone in Quebec is ready to have this discussion. We in the Bloc Québécois are ready to have this discussion so that certain individuals with mental health disorders can benefit from this measure. Again, this does not apply to everybody. There needs to be a discussion. I urge all members of the House to show the utmost compassion, to strive to set aside their biases and to get informed. We are talking about science here. The people on whom our health care system depends are fully capable of telling us what could be done in this case. I hope that the bill will respect Quebec and, of course, respect those who are suffering.”

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“We want to debate including people with mental illness in medical assistance in dying, not ban them. We also want to make sure federal rules are not stricter than Quebec's rules.”

“Mr. Speaker, since we are talking about things that the members opposite consider to be vague and uncertain, I will let the Quebec National Assembly have that discussion. I think the Bloc Québécois has been quite clear. The first thing that we are calling for is not to exclude people with mental health issues. We are asking to debate that issue. We are also asking that the federal framework not be more restrictive than Quebec’s framework. That is what we are calling for right now.”

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“Mental pain is just as real as physical pain, even if we cannot see it. People in a sudden crisis cannot ask for medically assisted dying anyway. We should not ban people with mental illness from accessing it without having this discussion.”

“Mr. Speaker, I was just talking about empathy. Some issues are painful and resonate differently with each and every one of us. We need to be open to others and to the many different stories we encounter. I have often heard the issue framed in terms of access to health care. I would not want that expression to be reduced to a caricature. We see it in our society: There is a hierarchy of suffering. Physical suffering is recognized, but when it comes to psychological suffering, people question whether it is real, even if they may have legitimate reasons for doing so. We do not have access to another person’s thoughts. In fact, I certainly hope no one has access to mine. We cannot see inside a person’s mind, and that can indeed make things difficult. It is not something tangible. We are dealing with something intangible. Sometimes, we find it hard to understand. Nevertheless, these debates need to happen. We are not talking here about someone in crisis. The health care system takes charge of people in crisis. A person cannot request medical assistance in dying while in crisis or while in need of services. However, I agree with my colleague that we need to have this discussion in order to help the people who can be helped.”

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“We must not deny medical assistance in dying to people who are suffering from mental illness. I want my colleague to explain how this bill might go against the Constitution.”

“Mr. Speaker, I thank my colleague for her speech, which was, frankly, highly eloquent and exceptionally clear on the importance of addressing this issue and not shying away from difficult questions. Of course, we need to improve access to mental health care. I think we all agree on that. Beyond that, however, can we stop avoiding the issue and denying access to this group of people who are suffering? I would like my colleague to elaborate on the potentially highly unconstitutional nature of the bill currently before us.”

“The government should ask the Supreme Court if this bill is constitutional before we keep debating it. That way we can settle the issue and move forward quickly.”

“Mr. Speaker, the government said earlier, through some of its members, that it would be willing to resume the discussion at some point. If we are to resume the discussion, it should immediately ask the Supreme Court for an opinion on whether this is constitutional or not. That will ensure that we can continue the discussion very quickly.”

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“Quebec already has its own laws on advance requests for medically assisted dying. Health care is Quebec's jurisdiction. I want reassurance that the federal government will not step in and take over our power.”

“Mr. Speaker, I want to thank my colleague for his informed contribution to the debate. He raised the idea of proposing a national framework to guide how advance requests are submitted. As my other colleague in the official opposition said, Quebec already has legislation on advance requests. My concern, and I would appreciate some reassurance in this regard, is that the federal government is going to encroach once again on a jurisdiction that truly belongs to Quebec, and that jurisdiction is health care.”