“We should not just look at polls on deep, ethical issues like this. We need to debate advance requests for medically assisted dying thoroughly, just like we did with mental illness.”

“Madam Speaker, my colleague from Winnipeg North is suggesting that Conservatives should look at polls more, and I am suggesting that we should be debating these very deep, ethical, complex issues a whole lot more. Would he agree that we cannot just escape our duty as parliamentarians by looking at the polls, but that we need to do a deep dive and study this, like we did with MAID for mental illness? I would remind the member that, after six years, all the people on that side of the House changed their mind on that issue because of the deep debate that we had on that. Would my colleague agree with me that we need to have a similar debate on this very complex issue of advance medical directives?”

“The member for Winnipeg North now says he wants to stop expanding medically assisted dying to people with mental illness. But he has voted three times to allow it. Why did he change his mind?”

“Madam Speaker, I am glad to see my colleague from Winnipeg North supporting, in principle, anyway, a halt to the forthcoming expansion of MAID for people with mental illness. However, the member has voted three times against stopping that expansion. He voted for adding mental illness to the MAID regime in Bill C-7. He voted against Bill C-314 in the previous Parliament, and a couple of weeks ago, he voted against Bill C-218. To what do we attribute the change of heart?”

“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.”