“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.”