They're very happy, yes. At least they can all watch you live. They can know that you're not with anyone else and that you're doing productive work, so it's good. Anyway, I thought I'd make a little light of that.
Welcome to meeting number 50 of the House of Commons Standing Committee on Justice and Human Rights. Pursuant to the House order of February 13, 2023, the committee is beginning its study on the subject matter of Bill , an act to amend the Criminal Code, medical assistance in dying.
Today's meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022. Members are attending in person in the room and remotely using the Zoom application.
I'd like to make a few comments for the benefit of the witnesses and members. Please wait until I recognize you by name before speaking. For those participating via video conference, click on the microphone icon to activate your mike, and please mute yourself when you are not speaking.
For interpretation for those on Zoom, you have the choice at the bottom of your screen of floor, English or French audio. For those in the room, you can use the earpiece to select the desired channel. I remind you that all comments should be directed through the chair. For members in the room, if you wish to speak, please raise your hand, and for those on Zoom, if you wish to speak, please use the “raise hand” function.
I use little cue cards, so when you're down to 30 seconds, whether that's your statement or your questioning, I put this up so I don't have to interrupt you. When you're out of time, I raise the red card and ask you to wrap up. If you don't, then, unfortunately, I will have to interrupt you.
Let's now begin our study of the subject matter of Bill —
Absolutely, and thank you for asking. I confirmed with the clerk that the sound tests were all positive.
Let's begin our study on the subject matter of , an act to amend the Criminal Code, medical assistance in dying.
Please welcome with me the Honourable David Lametti, Minister of Justice and Attorney General of Canada. Along with him are the following officials: Matthew Taylor, general counsel and director, criminal law policy section; Joanne Klineberg—she's online—acting general counsel; and Myriam Wills, counsel.
From the Department of Health, we have Sharon Harper, director general, health care programs and policy directorate; Venetia Lawless, manager, end-of-life care unit, via video conference; and Jacquie Lemaire, senior policy analyst, also by video conference.
Mr. Lametti, I'll give you 10 minutes, if that will suffice.
Thank you, Mr. Chair, for the opportunity to speak to the committee on Bill .
I thank all of you for the urgency you have shown in considering this important legislation.
I would also like to thank officials from both Health Canada and the Department of Justice who are here with me this evening. As you all are fully aware, this bill transcends different departments and, therefore, it is critical that I have Health Canada support here this evening in addition to the usual DOJ support.
In March 2021, the previous Bill , provided greater eligibility to medical assistance in dying for people whose natural death was not reasonably foreseeable. It also provided for a temporary exclusion to the provision that mental illness could be the sole basis of a request for medical assistance in dying. If no legislative amendments are made, this exclusion will automatically be repealed on March 17, 2023. On that day, medical assistance in dying will become legal in such cases.
Bill proposes to temporarily extend the exclusion relating to mental illness for one year up until March 17, 2024.
The main objective of this bill is to facilitate the safe assessment and provision of MAID in all circumstances where a mental illness forms the only basis of a request for MAID. An extension of the exclusion of MAID eligibility in these circumstances would ensure health care system readiness by, among other things, allowing more time for the dissemination and uptake of key resources by the medical and nursing communities, including MAID assessors and providers. It would also give the government more time to meaningfully consider the report of the Special Joint Committee on MAID, or AMAD, which is expected to be tabled by Friday, February 17.
I am confident that a temporary one-year extension will allow us to proceed in a measured and prudent way and will ensure that we get this right. As always, our government remains committed to ensuring that our law reflects Canadians' evolving needs, protects those who may be vulnerable and supports autonomy and freedom of choice.
As I have just explained, the previous Bill temporarily excluded access to medical assistance in dying in cases where mental illness was the sole factor. This temporary exclusion is based on the fact that these cases are often complex and that it would be better to have more time to reflect on them.
Over the past two years, much work has been accomplished. The Expert Panel on Medical Assistance in Dying and Mental Illness has conducted an independent review of the protocols, directives and safeguarding measures to be recommended in those cases where mental illness is the basis of a request for medical assistance in dying. The expert panel's report was tabled in Parliament on May 13, 2022.
When it was conducting its parliamentary study, the Special Joint Committee on Medical Assistance in Dying also looked at the provisions of the Criminal Code concerning medical assistance in dying and their application in various contexts, such as that of mental illness. In June 2022, the committee published an interim report containing a summary of the testimony that it had heard or received. Witnesses included psychiatrists and other physicians, as well as people living with a mental illness and representatives of various stakeholder groups. We are looking forward to the special joint committee's final report which will be presented before February 17, which is this Friday.
I commend the expert panel and the special joint committee for their hard and important work. MAID is a very personal and challenging subject, and we are better for their careful study and advice.
In addition to the work of the expert group and the special joint committee over the past two years, the provinces, territories and health care community have been working with Health Canada to ensure system readiness. They have developed resources to support MAID assessors and providers, including clinician education and training. They have developed the necessary policies and practice standards. The work is well under way.
Some provinces likely would have been ready to begin offering MAID for mental illness to eligible and properly assessed patients on schedule in March 2023, but we heard from many that they were not quite ready. An extra year will make sure that everyone is ready and well equipped to make MAID for mental illness available in a way that is prudent and safe.
I'm here to talk to you today about the urgent need to extend the exclusion of MAID for mental illness by one year, but I would be remiss if I did not also take this opportunity to address some misinformation about MAID that I've heard over the past few months. I want to reassure all Canadians and all of you around this table that Canada's MAID regime is safe. The system has extensive checks and balances to make sure that only eligible people who clearly and freely choose MAID can access it.
In 2021, in response to the Superior Court decision in Truchon, former Bill expanded eligibility to receive MAID to people whose natural death was not reasonably foreseeable. To address the additional complexities of these kinds of cases, we created a separate and even more stringent set of procedural safeguards that must be satisfied before MAID can be provided.
Some of these additional safeguards include a minimum 90-day period for assessing eligibility, during which careful consideration is given to the nature of the person suffering and whether there is treatment or alternative means available to relieve that suffering. This safeguard effectively prohibits a practitioner from determining that a person is eligible to receive MAID in fewer than 90 days.
Another additional safeguard is a requirement that one of the practitioners assessing eligibility for MAID has expertise in the underlying condition causing the person's suffering, or that they must consult with a practitioner who does have that requisite expertise. The assessing practitioners must also ensure that the person is informed of the alternative means available to address their suffering, such as counselling services, mental health and disability support services, community services and palliative care. It's not enough to merely discuss treatment alternatives. They must ensure that the person has been offered consultations with relevant professionals who provide those services or care. In addition, both practitioners must agree that the person gave serious consideration to treatment options and alternatives.
MAID for mental illness poses even more complex challenges. That is why we need to take the time necessary to ensure that the health care system is completely ready before we expand eligibility for MAID to those whose sole underlying condition is a mental illness. We recognize that mental illness can cause the same level of suffering that physical illness does.
We are aware that there are people who were waiting to become eligible to receive MAID in March 2023. We recognize that these people are suffering and will be disappointed by an extension of the ineligibility period. We empathize with these individuals.
Nevertheless, I believe this extension is necessary to ensure the safe provision of MAID in all cases where mental illness forms the basis for a request for MAID. We need this extension to ensure that we do not rush the expansion of eligibility and to ensure that we make any changes in a prudent and measured way. Our main priority is to ensure the safe provision of MAID. I'm confident that courts would find this short extension to be constitutional.
Canada has implemented legislation on medical assistance in dying that supports autonomy and freedom of choice while offering protection to the most vulnerable. We believe that the timeframe provided for in Bill C‑39 will be sufficient so that this continues to be the case.
We need to take the time to get this right. The one-year extension will give more time to ensure that the health care system is ready, and more time to meaningfully consider and act on the special joint committee's recommendations.
Merci. I look forward to your questions.
Minister, we're here today because two years ago, you made a mistake that was offside with your caucus. We know that you voted against the first MAID bill because you didn't think it went far enough. That made you an outlier in your caucus. You came to this committee and said that Bill , an act to amend the Criminal Code for MAID, was constitutional.
The unelected Senate amended it dramatically and created a brand new bill, I would argue, saying that those who are suffering from mental illness would be eligible for MAID. This extension is evidence that you got it wrong two years ago.
I know you're a professor, but you're not the only professor. I have a letter here, signed by 32 law professors, which says:
We disagree as law professors that providing access to MAiD for persons whose sole underlying medical condition is mental illness is constitutionally required, and that Carter v Canada AG created or confirmed a constitutional right to suicide, as Minister Lametti has repeatedly stated. Our Supreme Court has never confirmed that there is a broad constitutional right to obtain help with suicide via health-care provider ending-of-life.
Minister, quickly, who is right? Is it you or these 32 law professors?
Minister, I have only six minutes. I gave you time to answer it.
I wish I could say it surprises me that you think you are right, when these 32 law professors say you're wrong. They say in this letter that you're wrong.
You just indicated, Minister, that there's some kind of constitutional requirement that we do this, but two years ago, you came to this committee with what's called a charter statement. You, as the Minister of Justice and Attorney General, have to certify that all government legislation is charter compliant. Your own charter analysis, speaking about mental illness, says:
...it is based on the inherent risks and complexity that the availability of MAID would present for individuals who suffer solely from mental illness. First, evidence suggests that screening for decision-making capacity is particularly difficult, and subject to a high degree of error, in relation to persons who suffer from a mental illness serious enough to ground a request for MAID. Second, mental illness is generally less predictable than physical illness in terms of the course the illness will take over time. Finally, recent experience in the few countries that permit MAID for people whose sole medical condition is a mental illness (Belgium, Netherlands and Luxembourg) has raised concerns. The concerns relate to both the increasing numbers of these cases and the wide range of mental illnesses in respect of which MAID has been provided.
This isn't the 32 professors talking. This is you. This is your charter statement.
Who are we to believe? Is it the Minister Lametti who sat in that exact chair two years ago with this charter statement or the minister who is here before us today, saying that somehow this is constitutionally required?
Have you updated your charter statement, now that we have an entirely new bill that expands MAID in Canada for those suffering with mental illness?
Thank you for your question, Ms. Brière.
As I have just said, we have accomplished a lot. That includes the work of the Expert Panel on Medical Assistance in Dying and Medical Illness, the Special Joint Committee on Medical Assistance in Dying, the federal government and Health Canada, as well as the provinces and territories, experts, doctors and nurses.
We are nearly there. We just need to make sure that everyone is on the same wavelength. In order to do so, we need another year to take into account the work that has been done so that the assessors and healthcare providers that are working in the field are ready to assess requests for medical assistance in dying in a safe and consistent manner. We are here to take the time that we need to ensure that the guidelines and the framework are understood by everyone.
We are on the right track. As I said, many experts believe that we are already there and that we should go forward right now, but we want to make sure that we are proceeding in a safe and prudent manner. That's the reason we're asking for another year, to make sure that we are all on the same wavelength.
Six minutes is not much time for an issue that is so sensitive.
Minister, you have given me an opportunity and I am taking it. Unlike you, I do not believe that what you have tabled will allow us to do more in the field of mental health; nor do I not believe that this will help us to take care of our fellow citizens over the next 10 years.
We have to take note of the meaning of mental health in this debate. Experts have told us that we should stop talking about mental illness because this is not a clinical term. We should refer to mental disorders. If we are going to agree on this issue, we should adopt the terms used by the experts.
Experts have indicated in their final report that practice standards need to be established in the case of mental disorders.
In a letter sent to committee members, the deputy minister of Health stated that a working group had been created to work on practice standards for medical assistance in dying. This group is made up of people with clinical expertise. Who are they?
Thank you very much, Mr. Chair.
It's good to be back on the justice committee. I don't think I've been since the 42nd Parliament.
Thank you, Minister Lametti, for being here today.
I just want to go back to the Bill conversation you had with Mr. Moore. I was in the House serving with you at that time. We had the third reading of Bill on December 10, 2020, so the version we sent to the Senate was in line with your charter statement. Mental disorder still would not have qualified for medical assistance in dying.
The Senate went through the bill fairly quickly. They were able to get to their third reading vote by February 17, 2021, so in a little over two months. They reported it back to us with that amendment.
I just want to narrow it down. You're telling us that in that two-month period, that's when you converted your thoughts on this. I just want to know your thought process. You were fine with the version we sent to the Senate, but then when they sent it back, just in that space of two months, you had a conversion and accepted what they had done to the bill.
I believe they inserted that amendment not at the committee stage but at the report stage of the bill. It was done from the floor of the Senate.
If I can just interject, I think there's been a pattern here, and that's why it's caused so much consternation among different members of Parliament. You introduced Bill before the statutory requirement of Bill had been met. There was a requirement in that bill for a statutory review of the legislation, but Bill C-7 came in.
I was a member of our Special Joint Committee on Medical Assistance in Dying in the 43rd Parliament and in this Parliament. It didn't get its work under way. It was interrupted by the election in 2021, so I can tell you, Minister, that in working on that committee we always felt under the gun having that sunset clause hanging over us. It was always hanging over us. That was a real issue.
However, I want to change to the expert panel that was convened by your government. The panel, in its report, said:
the existing MAiD eligibility criteria and safeguards buttressed by existing laws, standards, and practices in related areas of healthcare can provide an adequate structure for MAiD MD-SUMC so long as those are interpreted appropriately to take into consideration the specificity of mental disorders.
I want to know about that, because of course, in our existing Criminal Code, in order to meet all the eligibility requirements in section (e), they have to give “informed consent” and only after they have been informed of the means that are available.
I just want to get your interpretation of that, because being informed of something is one thing, but we know from many people who have testified that in many areas of Canada, some of these services just are not available or not available in a sufficient quantity.
Do you think your government might approach a change in the Criminal Code to change that term “informed”, or are you quite satisfied with what the expert panel has provided you?
Welcome, Minister and department officials. Thank you for your attendance.
Minister, I want to go back to my colleague's question regarding the charter statement. I'm just taking a look at the requirements.
On December 13, 2019, amendments to the Department of Justice Act came into force, creating a new duty on [you] to ensure a Charter Statement is tabled in Parliament for every Government bill.
Charter Statements are a transparency measure intended to inform parliamentary and public debate on a bill and help increase awareness and understanding of the Charter.
I listened to your evidence. You said it will be “deposited”— I think that was the word—or tabled.
You also noted, Minister, that yesterday was set aside for all parliamentarians to debate this issue, and largely we heard from Conservative MPs, with not much from the Liberal bench. Between yesterday and tomorrow, approximately 15 hours have been set aside for parliamentary debate, with no charter statement for any parliamentarian to review in advance in order to factor that type of analysis into their speech. You've denied parliamentarians the ability to really reflect on the legality of this bill.
My question to you is very specific. What does “depositing” mean and when can Canadians, but more importantly parliamentarians, expect to receive this and review it fully?
I'm mindful of the cause of that.
First of all, we are moving ahead because we feel that we will be compelled by the courts to move ahead, so we're going to do this prudently.
I'm also mindful of the misinformation that is out there, which, frankly—I'll be honest—a number of people on your political side are peddling. They're saying that somebody, a young person, will—and I heard this in the House of Commons yesterday—be able to go to their doctor and say, “I'm having suicidal thoughts. I would like MAID.” That is clearly not the case.
What we are talking about here, Mr. Brock, is a fraction of a fraction. Already the number of people on track two for MAID, from the numbers we've seen, is 500 out of 10,000—that's half of 1% on track two. This will be a fraction of that.
This is a tiny fraction of people.
Thank you very much, Chair.
Thank you, Minister and officials, for being here.
I want to start off by saying a couple of things. I wasn't here two years ago, nor am I on the committee that was struck. I will say that MAID is a deeply personal and complex choice that really does touch every person and every family. These are usually very difficult, painful situations in a person's life as well as in the lives of their loved ones. I can appreciate that the Government of Canada needs to get this right as best it can. I don't believe there's any such thing as perfect. We all know that laws change. That's why we're here. That's why we have parliamentarians and courts.
Having said all that, I'm wondering if you could clear up a couple of things. I want to give you enough time on the record.
What are the current eligibility criteria for MAID? What happens if we don't pass and give this extension? Can you tell me what the law of the land is and where we are today?
After that, where are the provinces in this?
It's precisely the track two that did that. We did that after careful consultation with a number of different communities, including representatives of people living with disabilities.
The 90-day assessment period was meant to be a sufficiently long period, so that in the case of a catastrophic accident someone would have time, after that initial period, to reflect on what happened and what might be possible.
As I've mentioned, there is a criterion that the person must be made aware of what the possible supports are, have meaningfully thought about that, and have discussed those thoughts and alternatives for support with a practitioner.
Again, there is the criterion that there must be assessments from two people. One of those people has to have an expertise in the field. On Mr. Thériault's previous question, we kept that flexible. In some places—such as the north—they felt that having two experts in a particular medical field, for example, might be an impediment. We made that flexible. Obviously, it can be up to provinces to make that more stringent if they have the resources to do so.
Bill was a terrible bill, a bad copy of the Quebec bill and because of it, people like Ms. Gladu and Mr. Truchon were forced for a time to plead their case before the courts. These are people who had lived full lives, even if they were in a wheelchair, and who refused to be infantilized and considered as vulnerable people. They had put up with enough discrimination during the lives. They went all the way to the Supreme Court, whereas other people were obliged to stop eating and drinking in order to meet the criteria of a predictable natural death. That is horrible. A state cannot allow that.
That said, Bill did rectify the problem and in order to get that bill passed, a compromise was made to include mental disorders. Senators said that the bill, which didn't include people suffering from mental disorders, contravened the Canadian Charter of Rights and Freedoms.
The prudent approach consisted of asking people who know what they are talking about, that is to say professionals and experts in the field of mental health and mental illness. Actually, the experts asked us to stop talking about “mental illness” and use the term “mental disorders”. Moreover, they presented us with 19 recommendations for providing access. I encourage you to read them.
Two years ago, I was one of those people who were sceptical about the inclusion. I read the report 20 times. I asked questions and I think that indeed, the prudent approach would be to pass Bill . That way, for example, a person who has been suffering from schizophrenia for 30 years and who, at certain times, has become a shell of a human being due to his or her medication, could have access to MAID upon request. However, we're not saying that this would apply to a young person, a minor even, who had tried to commit suicide. The report indicates that it would take decades before such a person would have access to MAID. The person's condition would have to be irreversible and all therapies would have to have been tried.
At some point, we will have to put things into perspective. I will be watching you, Minister, and I will be watching people who are telling us that we are ready. We are not ready right now. You stated that we will be ready to go forward in March. I don't think that will be the case. I don't know who was saying that it will be possible, but it was certainly not the members of the Canadian Association of MAiD, Assessors and Providers, CAMAP, who are putting together seven training modules.
That requires trainers, not assessors. People have to be ready on the ground so as not to make any mistakes. To avoid mistakes, we will have to implement two key recommendations of the report, recommendations 10 and 16. They will become safeguarding measures that go beyond what is being done currently in terms of MAID.
I do not have any more questions, but I am sick of hearing nonsense.
Minister, when I was on the special joint committee, we heard from a lot of witnesses on far-ranging topics. I remember, when it came to the specific subject matter we're dealing with here, with Bill , that some of our witnesses said that there aren't really any specific criteria for knowing that a mental illness is irremediable, and that there is not a lot of evidence out there that anyone can reliably determine if an individual suffering from a mental illness will not improve. That's how it's different from a physical illness. That's what's given us a lot of pause. We just want to make sure we are, in fact, getting this right. I think that's why you're seeing a lot of this trepidation.
I agree that Bill needs to be passed. We do need this extension, but, given the testimony that we received in terms of the irremediability of mental disorders and the unknowns that still exist, when we are approaching March 2024, how are you going to ensure that everything is, in fact, in place? Are you going to put in place plans for Parliament to have another say or another review of this before that deadline comes into effect in 2024?
We are talking about an increased risk. The expert panel didn't rule that out.
The experts made it clear that general rules should not be applied across the board. Cases should be reviewed individually, on a case-by-case basis, as the experts referred to it. The history and progression of the disease need to be considered, as does the number of treatment attempts. The assessor should not be the treating provider or a member of the care team; the assessor should be independent from the treating team. Lastly, the case should also be examined by a psychiatrist, who would also assess the situation. All that to say, the risk is high.
All of those elements are implemented with precautionary principles in mind, as well as measures that require stakeholders to follow a different process.
Medically speaking, Ms. Gladu's condition was easy to assess. No one is saying that a mental disorder is easier to assess. That's why the issue was entrusted to a panel of experts. That's why we created a joint committee, which reviewed the expert panel's report, heard from witnesses and asked questions. There seems to be an appreciation of the increased risk.
What do you think?
Mr. Taylor, I'll start with you, if I can.
I asked the in the first round about the section where someone has to be informed of the means available to relieve their suffering, including the appropriate counselling services, mental health and disability support services, and community services. This is all under paragraph 241.2(3.1)(g) for track two. I think we can rightly determine that for those who are suffering with a mental disorder and who are going through that profound, internal psychological suffering, their death is not going to be reasonably foreseeable. They have to come under the safeguards specified under track two.
My question to you is this. The Criminal Code uses verbs like “has been informed” and “has been offered”. Is that the limit of what criminal law in Canada can do?
What is the federal government's expectation on the provincial side of things for how their medical systems will step up to ensure...?
I can tell you, from my own personal experience as a member of Parliament, in my community—I represent a riding on Vancouver Island—we have a lot of people who are going through extreme mental health issues. There's a lot of underlying trauma. It is feeding a lot of the opioid crisis.
I understand there are additional safeguards. Someone's not going to be able to walk off the street and access MAID. I understand that very clearly, but I'm trying to figure out where the language of the Criminal Code—the necessity of being informed and offered—meets the provincial side of things.
I'd like it if you could walk us through that.
Thank you. I'm sorry; I just want to make sure I have time for questions.
You mentioned treatments and therapies. I think those were the two terms. I met with some patients today, and we've heard testimony from the special joint committee about alternative therapies, such as guided psilocybin therapy, that are being used. There's some promise. I will acknowledge that with research, there's a lot more that's needed, so that's the caveat I'll put out there.
That being said, though, it has shown some promise in helping people in palliative care relieve the existential dread they feel, knowing their end of life is coming. There's also, perhaps, some promise in maybe effectively treating mental disorders.
I know from conversations with them that either through the section 56 exemption or the special access program, there's still a lot of trouble they have to go through to get approved. What is Health Canada doing with respect to these types of alternative therapies? You must be aware of them. Is there additional funding and research coming our way to fully explore this?
We're dealing with a pretty monumental shift to our Criminal Code here, and we just want to make sure all the alternative therapies, if they show promise, are available and being explored to their full potential.
I think that is a good question.
I think we will have a very good sense when the clinicians feel that they are well supported, that they have the resources they need to make the assessments, and that they understand what they need to do in order to make the assessments for people with mental illness as a sole underlying condition.
I think that's a really crucial step.
It will take time, because they will need to be able to take up the clinical practice standards. The provinces, territories and regulators will be able to adopt and adapt those, and then the providers will be able to take them on and try them in various situations.
The interesting thing is that because the expert panel said that the cases of mental illness were not, in some ways, that different from other track two cases, they will also be able to bring these clinical practice standards to questions of cases that they're working with right now.
I think it's going to be a really instructive year. They will be able to take those clinical practice standards and understand how to bring them to life.
We agree that there needs to be.... That is a very difficult question.
We recognize that suicidality is a concern, and we agree that it's important to distinguish between suicidal intent and a rational, well-considered request for MAID from someone with a long-standing mental disorder.
We've heard from practitioners that psychiatrists are well trained to do this. They have indicated that suicide assessments are already part of the current MAID assessment practices, as are suicide prevention efforts when these are warranted.
The expert panel has made recommendations to assist practitioners in discerning a rational request for MAID, including doing many assessments over a period of time, “including when possible, during periods of remission or reduced symptoms, and not during periods of acute emotional distress or crisis.” The panel advises that “suicidal ideation must be considered and evaluated to best determine whether the requester's wish to end their life by MAiD represents a capable appraisal of their situation rather than a potentially treatable symptom of their mental disorder.”
The MAID practice standards, which will be available in March 2023, will assist in this regard.
We talked about vulnerability. Is there anyone more vulnerable than someone who has an incurable illness causing them so much suffering that they have reached their breaking point? That is why I think the government wisely decided not to take the issue to the Supreme Court. People were going on hunger strikes in an attempt to satisfy the reasonably foreseeable natural death criterion because they could no longer take their suffering and desperately wanted access to MAID. That's horrendous.
My fellow members over here are critical of the judge's decision, but it established that the government's position infringed on the individual's right to life because, instead of providing assistance when the person could no longer tolerate their suffering, the system waited for them to commit suicide. The message that sends people is that suicide is their only option. It amounts to telling them to commit suicide because it's not our problem. On top of it all, those individuals had to take their fight all the way to the Supreme Court despite the intolerable suffering they were experiencing because of their illness. I don't think that is a government's role. A government's role is to make sure the conditions are in place so that people can exercise their freedom of choice.
That said, how many MAID bills, other than Bill , were private members' bills? None. Bills and came about in response to court decisions, because citizens were forced to defend their rights in court.
My Conservative colleagues say that, had they been in power, Ms. Gladu and Mr. Truchon would have never had access to MAID, nor would all the others who suffered and were granted access to MAID precisely thanks to Bill . It's probably worth asking who the most vulnerable members of society are. In my view, the vulnerable ones are those suffering from incurable illnesses who are denied MAID because the right-thinking government knows better than they do what's good for them. For what reason should they be denied that?
Throughout their lives, their right to self-determination is recognized. In biomedical contexts, they are told that no intervention can be provided without their free and informed consent. Then, at the most intimate moment of their lives, meaning death, the Conservatives would have the government make the decision for them because it knows best. It is not the government or their neighbour dying, it is the person themselves. I'm sorry, but I do not agree. I think the passage of Bill was a good thing.
However, we need to make sure we are truly ready, because people have mental disorders and are suffering. Implementing this across the country isn't easy. There will be pushback, as there has been in Quebec. Some institutions don't want to provide MAID to people who are terminally ill, even though that criterion is the subject of a countrywide consensus. Patients are prevented from accessing MAID by those institutions. It's scandalous. It's shameful. We have to avoid that.
Our special joint committee did release an interim report specifically on this subject. It was tabled last year. I'll just quote from our conclusions:
We must have standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight in place for the case of [medical assistance in dying where a mental disorder is the sole underlying medical condition]. This task will require the efforts and collaboration of regulators, professional associations, institutional committees and all levels of government and these actors need to be engaged and supported in this important work.
Although some work is already underway to implement the recommendations of the Expert panel, there is concern that more remains to be done to ensure that all necessary steps have been taken to be ready by the March 2023 deadline....
Now, you've expressed confidence—I was writing notes—that by next March the standards will be in place. I know that provincial governments and the regulatory bodies are already talking about this. I guess one question I have is this: In Health Canada's conversations with your provincial counterparts, do you expect that the provincial governments and the regulatory bodies, the professional associations, will 100% accept these, or do you expect that in some provinces there might be some variances here and there?
That's what I'm curious about. I mean, I expect that they all have very much a vested interest in the work that's been done so far. I know that a lot of very committed people are working on this. Do you get a sense that there might be the odd bit of variance, depending upon what province you're in?
And now they have an extra year to think about it.
Voices: Oh, oh!