Honourable senators, I rise today to speak on Bill C-62, the government’s second bill to extend the sunset clause on the prohibition of assisted suicide for mental illness.

Before I get to my comments, colleagues, I would like to take a moment to recognize the work done by all members of the Special Joint Committee on Medical Assistance in Dying regarding the current bill before us, as well as all of their work since the beginning of the committee. The committee did its work the best it could in the difficult circumstances given by the government, and I want to thank all members of the House of Commons, senators, expert witnesses and the hundreds of Canadians who took the time to appear as witnesses or submitted their opinions to the committee. All were crucial to the important parliamentary work completed by the joint committee.

To begin, I want to point out to my colleagues that I will not be using the term “medical assistance in dying” or referring to it by its acronym, “MAID,” during my speech. I will only use the term and acronym where it is a direct quote. The reason for this, colleagues, is that, in my opinion, referring to assisted suicide as MAID gives it the veneer of a medical procedure. We are no longer referring just to people hastening death but administering death to people who are not dying. Using an abundance of acronyms to describe assisted suicide takes away the humanity from the question. Having said that, I respect the choice of my colleagues to do so, but as a personal belief, I cannot.

Colleagues, almost a year to the day, here we are again, at the eleventh hour, having to save Canadians from the ill-conceived plan by this Liberal government to introduce assisted suicide for mental illness. Just like it did last year with Bill C-39, the government has tied our hands to pass this legislation expeditiously. How did we get here, from respecting a Supreme Court decision to a government stuck on ideology?

Since the introduction of Bill C-14 in 2016, I have actively participated in the debate of every governmental piece of legislation on assisted suicide. Whether it was during committee meetings for Bill C-14 and Bill C-7 or debates in this chamber, I have added my voice with compassion and empathy for all involved. I have respected the convictions of all senators then, as I do those of all senators today.

Life and death is a deeply personal question for all Canadians on all sides of the debate. Canadians have been debating this question for many decades and will continue to do so for many decades to come.

While suicide was decriminalized in 1972, the debate on assisted suicide continued. From 1972 to the legalization of assisted suicide in 2016, Canada has seen the Law Reform Commission of Canada recommending against legalizing or decriminalizing voluntary, active euthanasia in 1983; court cases like the Supreme Court decision in Rodriguez v. British Columbia in 1993; and parliamentarians submitting private members’ bills on euthanasia, the first one in 1991. Our very own chamber has seen various committees studying the question as well over that time.

What has brought us here, more specifically, today is the Carter decision by the Supreme Court in 2015. The decision struck down the ban on assisted death to those near death and who had irremediable medical conditions. It gave Parliament 12 months to come up with new legislation. Therefore, after an extension granted to June 2016, the federal government introduced, in April 2016, Bill C-14, and this bill received Royal Assent on June 17, 2016.

As in 2016, today — eight years later — I remain opposed to any form of assisted suicide, but understand our country was put in this situation by a decision from the Supreme Court of Canada. I accepted that as a fact at the time, and I still do today. During the Bill C-14 debates, my objective then remains the same today: While I oppose assisted suicide in all its forms, I do want to be a voice for improved access to living with dignity, for stronger safeguards in the system and to defend the sanctity of life.

Following the adoption of Bill C-14, the nature of the debates shifted. We went from the Supreme Court imposing a deadline on Parliament to the Liberal government prioritizing medical assistance in dying, or MAID, expansionist ideology over evidence-based medicine and consideration of patient safety as a whole. While the Supreme Court of Canada offered no option other than respecting its decision — in the case of the Truchon ruling by the Superior Court of Quebec in 2019 — the Liberal government still had other legal options. It could have done the sensible thing to defend its own law by appealing the decision of the lower court in Quebec. Instead, the government made the ideological decision to broaden Canada’s assisted suicide regime beyond the Truchon ruling.

As you may know, safeguards were removed with Bill C-7, and introduced Track 2 for assisted suicide to those not dying. Track 1 remains when death is reasonably foreseeable, where people can access assisted suicide the same day as the request, and patients can make themselves sick enough to bypass safeguards.

In its original form, Bill C-7 excluded mental illness. Once the bill arrived in the Senate, our colleague Senator Kutcher introduced the amendment of a sunset clause of 18 months to the prohibition of assisted suicide for mental illness.

Again, the then-Minister of Justice and Attorney General David Lametti and the Liberal government had a choice. They could have easily rejected the amendment proposed by Senator Kutcher, as it often does to Senate amendments, in order to defend its own legislation. Instead, on the advice of David Lametti, the Trudeau government made the choice to push forward the expansion of assisted suicide.

The initial amendment by Senator Kutcher proposed an 18‑month sunset clause, but the government estimated it needed 24 months. The government’s position went from a complete ban on assisted suicide for mental illness to 24 months based on no parliamentary review and no expert panel. It was — and remains today — an arbitrary deadline.

During the following two years, the joint parliamentary committee studied the question and heard compelling testimony while a government-appointed expert panel studied the question. The joint committee heard expert testimony confirming that there remains insufficient data to objectively guide assessing irremediability. We can’t do it, and no medical evidence exists to distinguish between suicidality and an assisted suicide request, if such a distinction exists. For example, the Centre for Addiction and Mental Health concluded:

There is simply not enough evidence available in the mental health field at this time for clinicians to ascertain whether a particular individual has an irremediable mental illness.

Senator Batters spoke briefly about that when she said that she believes mental illness was never irremediable, and I would concur.

Professor Brian Mishara, Director of the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at the Université du Québec in Montreal, stated in his opening remarks:

If it were possible to distinguish the very few people with a mental illness who are destined to suffer interminably from those whose suffering is treatable, it would be inhumane to deny MAID. But any attempt at identifying who should have access to MAID will make large numbers of mistakes, and people who would have experienced improvements in their symptoms and no longer wish to die will die by MAID.

Even the government’s own Expert Panel on MAID and Mental Illness stated in its report that there is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, to predict irremediability.

I could go on from what the committee heard during the 24‑month period but, colleagues, you see the picture: There was no data to support the possibility of safely justifying assisted suicide for mental disorders, and its own expert panel confirmed the near impossibility of predicting irremediability. The assisted suicide regime that the government put into place is based on a patient’s condition being irremediable. Since irremediability is impossible to predict for mental disorders, surely the government should have changed its course.

But David Lametti and the Trudeau government thought otherwise. Another year was added to the sunset clause until March 17, 2024, with the adoption of Bill C-39 last year.

In October 2023, the joint committee was tasked to assess Canada’s readiness to safely administer assisted suicide for people with mental disorders. And, as you all know, colleagues, based on the expert testimony heard at the committee in a race against the clock, the joint committee reported that Canada was not ready.

On irremediability, Dr. Mona Gupta, the chair of the government’s expert panel, agreed that nothing has changed since the May 2022 report concluding that irremediability remains difficult, if not impossible, to predict. Dr. Tarek Rajji, Chair of the Medical Advisory Committee at the Centre for Addiction and Mental Health, agreed by stating:

There’s no scientific evidence on it. We still cannot, at this time, determine at the individual level whether the person has an irremediable illness or not.

And on suicidality, Dr. Jitender Sareen, Head of the Department of Psychiatry at the University of Manitoba and chair of the academic chairs, cautioned that assisted suicide for mental disorders could facilitate unnecessary deaths and undermine suicide prevention.

It was, therefore, clear from the joint committee that irremediability and suicidality remains unresolved. With a lack of professional consensus, the joint committee concluded that the medical system in Canada is not prepared for medical assistance in dying where a mental disorder is the sole underlying medical condition.

Unfortunately, certain psychiatrists and doctors in this very chamber — for whom I have all the respect — believe they have the answer. As I said, while I respect them, I cannot understand why they are adamant in not respecting the lack of consensus amongst their professional peers.

We are not talking about reaching unanimity; we are talking about reaching a professional consensus. At this point, it is an undisputable fact: Irremediability, which is at the core of the assisted suicide regime in Canada, cannot be accurately determined for mental disorders.

Colleagues, this will be the second time that the Liberal government is asking us at the eleventh hour to save Canada from sliding further down the slippery slope of medical assistance in dying. At first, many people opposed to assisted suicide warned of a slippery slope only to find out Canada was actually standing on the brink of a cliff. Our concerns have been dismissed since the very beginning, and more forcefully since Bill C-7. While the proponents gave us assurances of assisted suicide being limited to a small number of cases, the truth of the matter is, sadly, the complete opposite.

Since 2019, Canada has seen an average yearly increase of 31.1% in total assisted suicide deaths, resulting in 4.1% of all deaths registered in 2022. Since 2021, with the adoption of Bill C-7, Canada registered 222 assisted suicide whose natural death is not reasonably foreseeable, and 463 in 2022. Colleagues, at the current rate, the report for 2023 could indicate over 16,000 assisted suicide deaths, which would represent the cumulative total of 2020 and 2021 in one year. Canada has quickly become the world leader in assisted suicide, surpassing countries who have had a similar law for decades longer.

According to an analysis by the Investigative Journalism Bureau and the Toronto Star, in the past two years alone, more people have died under Canada’s assisted death regime than in any other nation in the world. Dr. Sonu Gaind, Chief of Psychiatry at Sunnybrook Hospital, said we are on a trajectory that no other country on the planet has gone while not knowing what the full impact is going to be.

At this point in time, colleagues, no one knows what the full impact will be. Projections by the Trudeau government have consistently underestimated the number of assisted suicide deaths. According to projections by Health Canada in 2018, our country would reach a steady rate of 2.05% of total deaths attributed to assisted suicide. It gets worse, colleagues.

In the update on regulations for the monitoring of assisted suicides in dying submitted in May 2022 in the Canada Gazette, Health Canada had projected assisted suicide-related deaths to reach a steady growth of 4% by 2033.

Colleagues, we have surpassed Health Canada’s own projection by a full decade by reaching 4.1% in 2022. How can we trust the Trudeau government and the Minister of Health that assisted suicide for mental disorders will only affect a small number of people? The floodgates are wide open, and instead of doubling the efforts in closing them, the government is stuck in its ideology to further open them.

Under this government, Canada has moved from having to put in place an assisted suicide regime due to a Supreme Court decision to an expansion of the regime for ideological reasons. The majority of provinces and territories requested an indefinite pause. No professional consensus can be found to accurately distinguish suicidality from an assisted suicide request, and the majority of surveys find Canadians not in favour of assisted suicide for mental disorders. The latest survey from Leger was released on February 13 and still showed a majority of Canadians against or unsure about offering assisted suicide with or for solely mental disorders.

Let me be clear, colleagues. The debates we had on Bill C-14 were the most compassionate and respectful debates on a divisive issue that I have seen during my time in the Senate. Although we had different opinions, we all came from a place of compassion, empathy and understanding. And I, too, do have compassion for people suffering just as much from a physical illness than from a mental illness. I really do, colleagues. Too often, people opposed to assisted suicide for mental disorders have been characterized as uncompassionate. That has happened here in the past week again.

My opposition to assisted suicide for mental disorders is not out of believing someone suffering from mental health is less than someone suffering from a physical ailment. It is based on a lack of evidence and the lack of safety of such an expansion, as well as a strong belief that the government should be putting more efforts into offering better quality for mental services.

The federal government should be helping psychiatrists and all mental health practitioners to improve services to help Canadians who are suffering instead of facilitating the path to suicide.

Colleagues, I, like you, have friends and relatives who would not be here today if they had been given a choice on a day of depression under some of the laws that we are proposing, and they are living productive lives.

Canadian Physicians for Life agrees, and stated the following about resource shortages in its submission to the joint committee:

With acute human, financial and material resource shortages in mental health care and services, it seems counterproductive to commit those resources to expanding MAiD to those whose sole condition is mental illness. We have seen a significant number of resources expended on the healthcare system to make MAiD available for those at end of life. More resources have been added to expand MAiD to those who are not dying. It will create cognitive dissonance in the healthcare system to expend more resources to run parallel systems of suicide prevention and suicide assistance.

In 2022, Statistics Canada reported that over 5 million Canadians aged 15 and older met the diagnostic criteria for a mood, anxiety or substance use disorder in the previous 12 months. In the same survey, it showed that more than one in three Canadians who have a mood, anxiety or substance use disorder said their health and mental health care needs were partially or fully unmet. Finally, the survey concluded:

 . . . Increasing the supply of health care providers who focus on mental health and have specific training in this area is one of many possible solutions to improve access to mental health care in Canada. However, disparities in health insurance coverage for medications and counselling services will also need to be addressed.

Furthermore, a poll released in September 2023 by Angus Reid Institute found that a vast majority of Canadians are concerned with the mental health resources available in the country as well as the state of Canadians’ mental health overall. On the following statement, “MAID eligibility should not be expanded without Canada improving access to mental health care first,” 82% feel mental health care should be improved first before MAID eligibility is expanded. Finally, half of Canadians worry that treating mental health won’t be a priority if MAID eligibility is expanded.

Colleagues, during our Committee of the Whole, I was so disappointed when the Minister of Health kept talking about the need to train more nurses and psychiatrists in evaluating if a patient with a mental disorder could qualify for assisted suicide.

Canadians are saying the exact opposite: More training and resources are needed to help patients suffering from mental health illness to recover and live well, not to determine if they qualify for death. They’d rather see the federal government put in more efforts in improving mental health services instead of expanding assisted suicide.

The Canadian public is clear: More needs to be done to improve mental health services in Canada. Until Canadians have equal access to affordable and quality services for mental health and physical health, until we have evidence about how or if we can medically and accurately detect who will not improve from mental illness, we cannot legislate access to dying for mental illness. While I disagree with assisted suicide in general, I cannot change that. But, just like I can’t change assisted suicide in Canada, the Trudeau government cannot continue pushing the expansion of an assisted suicide regime for mental disorders on Canadians, given the lack of general consensus of professionals and Canadians.

For example, during its hearings, the Special Joint Committee on Medical Assistance in Dying received hundreds of submissions. Here are just a few from different associations that I would like to share.

The ARCH Disability Law Centre submitted a brief, and I’ll quote two passages:

Since Bill C-7 became law, persons with disabilities have resorted to MAiD because they do not have other viable options for living with dignity in the community. Some of these stories have been reported in the media.

Their concerns go further:

ARCH is deeply concerned that expanding MAiD to cases where mental disorder is the sole condition will lead to even more cases of people with disabilities, including mental health and psychosocial disabilities, contemplating, applying for and receiving MAiD due to socio-economic suffering.

The Canadian Association for Suicide Prevention submitted the following recommendation:

Increased funding should be available for healthcare to ensure that treatments are available to patients so that lack of access to treatment does not cause the condition to be deemed irremediable. . . .

As well, the Evangelical Fellowship of Canada agreed that assisted suicide must not become an option, especially not the most accessible option, when mental health care may not be accessible or affordable, or when treatment and support are not available. The EFC states:

The EFC is opposed to MAID, believing that it fundamentally devalues human life and normalizes suicide. We are very concerned that MAID for mental illness will disproportionately impact marginalized Canadians. If Parliament is going to go ahead with MAID for mental illness, it is essential that the strongest possible safeguards are in place to protect Canadians in moments of vulnerability before this expansion takes place.

Colleagues, I wholeheartedly agree with that position. Bill C-7 eliminated important safeguards and, even with the existing ones, we’ve all heard various stories of assisted suicide being offered way too soon in the process or to unqualified patients.

For example, last August, an article in The Globe and Mail told the story of a Vancouver woman who went to the hospital seeking help for suicidal thoughts. The person in question lives with chronic depression and suicidality. Feeling particularly vulnerable, she went to the Vancouver General Hospital looking for psychiatric help. Instead, a clinician told her that there would be long waits to see a psychiatrist and that the health care system is broken. She was then asked, “Have you considered MAID?”

It is totally unacceptable for a patient to be asked about assisted suicide while seeking help for suicidal thoughts. Thankfully, the story indicates that the patient was waiting to see a psychiatrist last fall, and I sincerely hope and pray that she was able to receive the help she needed.

Nevertheless, colleagues, stories like these, or like the others we’ve heard about such as an employee at Veterans Affairs suggesting assisted suicide to multiple veterans, or the story of an Ontario woman with severe sensitivities to chemicals choosing assisted suicide after her search for adequate housing failed. Somebody approved that, colleagues. There are too many to ignore. My intent is not to generalize the whole assisted-suicide regime, but it is part of a number of stories we have heard at an alarming rate. These are only the ones we read in the paper. Not everyone would be comfortable publicly sharing a deep, personal story.

I am disappointed that the tone among us has changed since Bill C-7 was introduced. I have said so many times, and I’ve said it already twice today: The debates on Bill C-14 were some of the most respectful debates I have participated in while in this chamber. Senator Harder referred to some of these debates yesterday. Although Senator Joyal and I disagreed on many things, including assisted suicide, I fondly remember how my friend — and now retired colleague — walked across the chamber floor, thanking me for my speech because he knew it came from the heart. He appreciated my participation in the debate, just like I appreciated and highly respected his contributions.

Sadly, that same level of professionalism and respect has sometimes left this debate. More and more, Canadians, experts and politicians who are opposed to assisted suicide for mental illness are unjustly painted as lacking compassion, their work discredited and insulted for holding different beliefs. Instead of having a debate and a conversation on assisted suicide for mental illness, we are constantly confronted with “you’re either with us or you’re against us.” You’re either compassionate or you’re not.

The proponents of assisted suicide for mental illness have taken a confrontational approach by vilifying our beliefs and discrediting our position, even though it is based on facts. Colleagues, this is not a confrontation. The issue of life and death is much too important to be treated as a confrontation, but it should be treated as a moment when we discuss and debate with the highest respect for each other’s positions and beliefs.

During second reading debate on Monday, in my opinion, that line was crossed. Clearly frustrated with how things were not moving according to her preferred timetable, Senator Simons lashed out at every person in Canada whose views were different than hers. She said we are in a “culture war” and that the “pushback against” assisted suicide “is . . . akin to the war on reproductive choice and the war on gender-affirming medical care.” She labelled those who view these issues differently than her as religious fundamentalists and misogynists.

Colleagues, these kinds of accusations and polarized rhetoric are not what we need in this debate. The issue itself is divisive enough without inflaming the discourse further with these extreme characterizations.

Perhaps the good senator has forgotten how much Canada has changed on social issues over the last 50 years. Perhaps she does not understand the angst of those who wrestle deeply with the moral aspects of these questions because of their deeply held religious or other moral convictions. Perhaps she is unaware that these are not mere whimsical preferences on the part of those who are troubled by the free fall we find ourselves in on matters of conscience.

These positions are deeply rooted in our values, our beliefs and our entire world view. These things are not trivial to us; they are the things that keep us up at night — not because we have any interest in telling others how to live their lives, but because we weep for what will become of future generations if we continue to deny the sanctity of life and erode the protections surrounding it.

I will acknowledge that those of us in Canada who continue to hold to the sanctity of life from conception to natural death are the minority in Canada. This is clear. Yet, understand, we are not asking for the power to impose these beliefs or the implications of these beliefs on every Canadian. We are simply asking for the right to be heard. We are simply insisting that our rights be respected as well — the right to hold our beliefs, the right to speak openly about them, the right to engage in debate and be heard, the right to try to influence public policy.

This is not extreme. This is how we got to where we are today. The very existence of these rights allowed Canada to shift away from the societal values that I hold dear, yet I would be the last person to suggest that this means these rights should be curtailed.

Yet, this is exactly what the tone and mischaracterizations brought by Senator Simons on Monday night might suggest — that those who disagree with her should be shamed and silenced. It seeks to suppress their voices and tell them they can have their beliefs but just not speak about them in public.

Colleagues, we need to do better. We must do better. The debate we have in front of us today is too important and deserves better than what we saw and heard on Monday evening. It is hurtful to be unjustifiably characterized in that manner.

I will simply remind colleagues that on the important question of life and death, Canadians deserve better. As much for Canadians who want access to assisted suicide for mental illness as for Canadians who express caution about expanding assisted suicide for mental illness, the debate needs to return to a place of respect, compassion and understanding. It is time to reset the tone of the debate in Parliament and in Canadian society on assisted suicide.

As Dr. Sonu Gaind said in his brief to the joint committee:

This should not be a partisan issue — the cautions about providing MAID for mental illness are not about politics or ideology, but unfortunately in this polarized debate these cautions have been dismissed as “just being the other side”. Nothing could be further from the truth. Such claims wrongly dismiss legitimate concerns in this complex debate.

Dr. Gaind is absolutely right. The debate on assisted suicide for mental disorders should not be limited to hearing only from those in favour but also from people who have concerns. We need to hear the stories from people who continue to live and fight for better care — stories from people like my own mother.

Ruby Plett, who is 96 years old, with crippling arthritis, has a difficult quality of life but wants to live on because she wants to continue to pray for her kids and her grandkids while enjoying their visits.

Thanks to having access to quality physical care, my mother can continue to live and see her children and grandchildren grow. She has that opportunity, and more Canadians deserve the same opportunity she has, whether they are suffering from physical or mental health problems. Sadly, the state of mental health care in Canada dictates that a patient suffering from mental illness does not have the same care and opportunities as someone suffering from physical illness.

Make no mistake, colleagues. Many times, my mother has had the desire to go home, to be with her husband, with her son who died before her. And if ever there were a list of candidates for assisted suicide, my mother would be at the top of that list. But she would be horrified if somebody suggested that to her. She would be horrified to think that anybody but God had the right to take her life, so she prays that she could go home. Then we come and visit, and she’s just happy to be around again.

Although the state of care in Canada remains a challenge, we have various groups and centres across the country which go above and beyond. HavenGroup in Manitoba is an example of excellence in delivering exceptional care to its residents. It was founded nearly 80 years ago by members of various churches in the area. To this day, it continues to be operated by eight local churches. A brand new home, Rest Haven, with 130-some residents, was built just a few years ago. My mother was the happiest person. She was the most senior person moving in, and she got to pick her room. She was the first one, before construction was even finished, so she definitely thought she was in the waiting room to heaven. She feels a little different now. She thinks she could maybe move out of that room and move on.

Nevertheless, these churches continue to operate HavenGroup and Rest Haven. They are committed to providing long-term care to residents in a Christian environment, with an emphasis on holistic approach to care regardless of age, race or religion, including people with physical illnesses, mental illnesses, dementia and Alzheimer’s.

I do not have enough praise for the exceptional staff at HavenGroup and their tireless dedication to an exemplary level of physical, emotional, social, spiritual and intellectual care. Through loving and caring, the residents are reminded daily that their lives are worth living and how valuable they are.

I have mentioned only a handful of groups and organizations who deserve all the praise, and I’m sure they are not the only ones. Across the country, we have similar stories of individuals who offer premium care service for Canadians to live their lives to the fullest. Their voices and stories also need to be heard in this debate. All Canadians belong in this discussion. Plurality and diversity require it.

Unfortunately, that is not the case for all groups, however, who have these freedoms, who can conscientiously object to assisted suicide. While HavenGroup can provide care to its patients along their values and not provide assisted suicide in their buildings, they are by law mandated that if somebody asks for assisted suicide, they have to direct them to a facility that will offer them that against their beliefs.

A Delta hospice in British Columbia did not even receive that treatment. On February 25, 2020, the B.C. government decided to end the service agreement with Delta Hospice Society due to their refusal to offer assisted suicide to its patients. Despite assisted suicide being offered in a nearby building, the Delta Hospice Society lost its privately funded building, and Canadians who do not want to be offered assisted suicide lost a safe space. For Canadians who do not want anything to do with assisted suicide, there is no escaping.

According to Ramona Coelho, in an article appearing in the Macdonald-Laurier Institute’s magazine, the approach to conscientious objection found in Health Canada’s 2023 Model Practice Standard for Medical Assistance in Dying is troubling. As it states in section 5 of the standard, health care providers who object to providing assisted suicide, even in specific cases, are considered conscientious objectors. And what is a physician to do? Simply refer the patient so they can seek access to assisted suicide.

Colleagues, with effective referrals, as Dr. Coelho demonstrates in her article, instead of the assisted suicide process being stopped, patients are funnelled towards death in the current system. Therefore, a Canadian who wants assisted suicide can effectively shop doctors. It is chilling to know that our health care system has a component to lead and ease Canadians towards death.

How far have we fallen from Bill C-14? The eyes of the world are on Canada, wondering what is happening while various experts are raising the alarm: The regime needs to be fixed, not expanded.

Colleagues, on the question of life and death, every Canadian’s perspective matters and every senator’s opinion in this chamber matters. It is because our hearts beat that we care so deeply about life and death. Whether you are a doctor, a lawyer, a business owner or a tradesperson like myself, we all have different views because the question of life and death is the most personal of questions. It is based on our life experiences — on our walk of life. I see the compassion of and difficulty for Senator Ravalia with respect to this question, and it is clear he comes from a place of compassion because of what he has seen and experienced. I have empathy and understanding for him and all the Canadians he is representing on this issue. I know I have it from him, but I only hope others can offer the same empathy and understanding for those like me who want to do more to improve access to better options for living a life of dignity instead of further opening access to assisted suicide.

I’ve always said that the issue of assisted dying is a very personal and emotional one on which reasonable people can disagree. The question of life and death is the most common one that unites us all; whatever your career or background, you are born into this world with your heart beating, and you leave this world when your heart stops beating.

While I am opposed to assisted suicide and euthanasia in all forms, that is not to suggest in any way that I do not have profound sympathy for those who are suffering intolerable pain, whether that stems from physical or mental illness. I am not saying someone who suffers should be forced to live through anguish. I do not want mental health patients to have more or prolonged suffering, nor do I believe they suffer less or differently than those with physical illnesses.

My goal is for everyone who suffers to have better access to living instead of easier access to dying. In a country as wealthy as Canada, I cannot help but feel we are giving up on life just a little by continuously pursuing this avenue instead of improving access to living. The long-term effects are unknown, and in a question of life and death, unknowns could have dire consequences, and I do not wish that for our country.

My objective here today is not to change your position on assisted suicide. We will either agree or disagree on assisted suicide based on our beliefs and own life experiences, and that’s okay. I respect each and every person’s position and beliefs on this matter. What I hope to do is bring to your attention the other side of the debate that keeps being dismissed. Colleagues, I am just a few minutes from being done.

Based on expert testimony, your joint committee clearly stated that experts cannot agree on irremediability or suicidality and suggested that Canada is not ready.

The numbers are alarmingly high in the Canadian context, and in the world by comparison. Projections by Health Canada have underestimated the results, and the death rate by assisted suicide in Canada is the fastest in the world. These numbers clearly confirm the slippery slope of assisted suicide in Canada. It pains me that this is the case because we are talking about Canadian lives in the balance.

Most provinces requested an indefinite pause. Most importantly, Canadians do not want assisted suicide for mental illness. They’d rather see an improvement in mental health services.

In a time when mental health awareness is improving; when we are encouraging Canadians to seek help, that it is okay to speak up when times are dark and that no one needs to suffer alone; and when stigmas and barriers are being removed, let’s build on that momentum. It will take time and effort to improve access to quality mental health services to the same level as physical health services. It won’t be easy, but I remain confident that, with all the compassion found in this debate and with strong political and medical leadership, we can overcome the mental health care challenges in this country and improve the mental health of all Canadians. I remain steadfast in the belief that we can and must do better.

Colleagues, while various experts took part in the joint committee’s study, hundreds of Canadians also took the time to share their stories with the joint committee, and out of respect for the time they have taken, I will share just a few:

Christine Aalbers from Lloydminster, Alberta, submitted this to the joint committee:

Thank you for taking the time to read my submission. For this past year, I am grateful that you have saved my family members, friends, and countless Canadians struggling with depression and other mental conditions. However, we are again at a moment where if action is not taken, death will be presented as a solution rather than support and life. Death is something that is final and offering it as a treatment option normalizes ending someone’s life. I am very concerned that we are not prepared or ready for these changes to take place as MAID is set to be expanded to those where mental health is the sole underlying medical condition. The experts said we weren’t ready a year ago for these changes. Nothing has changed and lives are again at stake.

Further, a group of 30 Canadians jointly submitted a brief. They are a group of people with disabilities and/or family members and friends with disabilities and mental disorders who are directly menaced by the imminent passage of assisted suicide for mental illness. They are not opposed to assisted suicide for those who are suffering extreme pain as their lives approach a natural death, but they are opposed to it for people who are not close to dying.

Here are just a few passages from their brief:

We know that a 90-day waiting period for MAID — MDSUC is not a serious safeguard. Some of our loved ones have “pretended” to be treatment compliant for much longer periods. People with mental disorders are quite capable of forming and holding self-destructive plans for years.

The brief continues:

Canada should not implement this dangerous law unless and until social support systems are fully and generously operational and the social determinants of health are adequately and demonstrably addressed in every province and territory.

It continues, stating:

We are specifically talking here about safe affordable housing and adequate financial support. Not everyone with a disability or a mental disorder can work for wages. Our loved ones who cannot work in the system should not be penalized for their disabilities.

Colleagues, while I support Bill C-62, it is not to be seen as my endorsement of assisted suicide in any form. I would prefer that the idea be put aside indefinitely. But in the meantime, colleagues, I will accept this three-year delay in the hopes that the federal government will eventually listen to Canadians and experts and do the right thing. Thank you for your time, colleagues.

Honourable colleagues, since I arrived in the Senate in 2016, I’ve supported the right to die with dignity and the importance of the right to self-determination.

In fact, my maiden speech in this chamber was in support of Bill C-14. I later had the responsibility of sponsoring Bill C-7. Colleagues, I said it then and I say it again: This conversation on medical assistance in dying is not easy and never will be.

We are currently studying Bill C-62. We are being asked to endorse a further three-year delay before allowing people whose sole medical condition is mental illness to be eligible for medical assistance in dying. Senator Kutcher moved to expand eligibility during our consideration of Bill C-7 through an amendment that received strong majority support.

It was clear to me then — as it still is today — that the suffering of people living with mental illness is real, it is documented, it is measurable and it can become unbearable. Let’s be clear, too — whether it’s through Carter, Canada (Attorney General) v E.F., Truchon or Gladue — the courts are clear: No one can be discriminated against because of the nature of their suffering. I support this principle of social justice.

Under MAID, striking a balance between the right to self-determination and adequate protective safeguards for vulnerable individuals is essential. That’s why I abstained from taking a position on Senator Kutcher’s amendment in 2021. I had some reservations at the time about whether the Track 2 safeguards were robust enough to include mental illness as a sole cause of suffering, risk-free. Time has passed and progress has been made on both sides.

However, taking a stand on expanding eligibility for MAID is still a complicated undertaking. It puts us in a situation that forces us to act under circumstances that are far from ideal. For me, various aspects of the issue remain problematic.

First of all, as to the recent work of the Special Joint Committee on Medical Assistance in Dying, or AMAD, when I read this third report, I am left with more questions than answers both in terms of substance and form.

Although the committee focused — as its mandate required — on the degree of preparedness of the health care system, we quickly realize that the committee also chose to revisit access to medical assistance in dying and its already recognized principles, which was not part of its mandate. Furthermore, we cannot make abstraction of the fact that of the five senators on the committee, four felt it was necessary to express their concerns in dissenting reports. What’s more, these dissenting opinions come from some of our colleagues who have done a huge amount of specific work on this issue over the years and for whom I have enormous respect. It’s impossible for me to ignore this dissent and what it implies.

I would also have liked to have had more assurances about the soundness of the safeguards for Track 2. I consider these measures to be perfectly adequate when it comes to people whose death is not reasonably foreseeable, but are they adequate in the case of individuals whose suffering stems solely from mental illness?

The final report of the 2022 Expert Panel on MAID and Mental Illness seems to answer that in the affirmative, although it recognizes certain peculiarities. I asked the Minister of Health a question on this subject during the Committee of the Whole, but didn’t get a specific answer.

In my opinion, it would have been reasonable, in order to avoid any potential abuse — as I mentioned before my vote on Senator Kutcher’s amendment — for the Special Joint Committee on Medical Assistance in Dying to have dug deeper into this subject, to ensure that the current Track 2 measures are adequate, or just as solid and safe for this specific group of people suffering from mental illness. This is especially important in the current context, when we know that our health care system has many flaws and weaknesses.

Which brings me, incidentally, to a challenge that I believe many of us are facing, which is that it is difficult to separate the level of readiness of assessors and providers on the one hand and health care services on the other hand, which, in my opinion, are not optimal for these specific cases.

It’s true that most experts tell us that the evaluation protocols are ready, but this state of readiness can’t exist just on paper. It will have to be applied in the field and on the ground all across Canada.

We know that our health care system is overwhelmed. Granted, it is the case already that an individual has safe access to MAID. But there are singularities with mental illness, and it has not been demonstrated clearly, in my opinion, if these health care system gaps will have a greater impact on safe access to MAID for individuals living with mental illness. To me, that is key.

You might say that those are two different things, and that’s true at a conceptual level because everything is interconnected. It’s one thing to have appropriate training and systems for assessors, but what happens when there are endless waiting lists and overburdened specialists, when services and treatments that aren’t available everywhere for everyone? I see a disconnect between what the experts tell us and the reality on the ground, and that could create vulnerabilities.

I want to emphasize that because, according to the Criminal Code, for people whose natural death is not reasonably foreseeable, practitioners must ensure that they are informed of, and I quote:

 . . . available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and must be offered consultations with professionals who provide those services.

Assessors must also have discussed reasonable and available means to relieve the person’s suffering, and agree that the person has seriously considered those means.

It would be ironic if we were to respect an individual’s right to medical assistance in dying but, in practice, we did not have the capacity to adequately provide them with such services. That would make conducting proper assessments a major challenge. What would be even worse would be to ask an individual to seriously consider all the possible treatments when those treatments are not available to them within a reasonable time frame. What about health care professionals who could find themselves in very difficult situations? We need to be aware that, in every case, it is the individuals involved who would be losing out.

How can we ensure that we put into practice the right to choose one’s end of life for individuals with a mental illness whose suffering is intolerable, while also ensuring that such individuals are supported in a respectful, effective and caring way?

My concern is that everyone will end up in a quandary if March 17 marks the beginning of this new phase of medical assistance in dying.

This brings me to my last point, which will be brief. During consideration of Bill C-7, I abstained from voting on Senator Kutcher’s amendment as a precaution, but I was sure it would only be temporary. Today, here we are once again asking the small number of affected individuals to wait. I know that this work is complicated and that nothing should be taken lightly. However, it still baffles me. I am sad to see that, despite Carter and Truchon, Senator Kutcher’s amendment, and the studies and reports, we’ve reached a point where the government hasn’t been able to resolve the matter after three years, and now we have to add on another three years. Why three years, by the way? I’m still skeptical, despite the answers provided by the Ministers of Health and Justice to the Committee of the Whole or by Senator Gold in this chamber.

In a recent article of The Hill Times, Daphne Gilbert, a professor of criminal law at the University of Ottawa, provides an interesting reminder of the time limit granted to Parliament by the courts in judgment of unconstitutionality.

She writes:

When the Supreme Court declares a law to be unconstitutional, it wrestles with the length of time it should give governments to fix the impugned state of affairs. After all, any suspension in remedy means an unconstitutional violation of rights continues.

The Court typically offers 12 to 18 months. Would it offer six years to come up with protocols for one small category of MAID recipients? It is unfathomable that it would.

Three years is a long time. Let’s be honest. There’s nothing to say that the same arguments won’t be used again in 2027. There’s no guarantee that the necessary efforts will be made. It also seems reasonable to expect the shortcomings of the health care system across Canada to persist.

How is it that we’re still here, not having found a proper solution? Have we done everything that needed to be done? Has it become political? Who hasn’t taken their responsibilities? And what do we do now?

One thing is certain. While political decision makers say that they aren’t ready, many people with mental disorders continue to suffer intolerably, and their rights continue to be violated.

There is a flagrant injustice in this situation, so let’s be clear. No one here would be surprised to learn that the issue is still before the courts. This debate will come back to us sooner rather than later.

In conclusion, as I’ve already said, three years is too long. A Charter right is too precious to be suspended for so long. We could have been spared the current turmoil. Despite all these shortcomings, we have a decision to make. The stakes are so high that we can’t afford to take risks. I am mindful of my responsibility to fully assume my role in protecting the vulnerable. This is what I will do by adopting the precautionary principle and voting, with little enthusiasm, for the passage of this bill. Thank you.

Honourable senators, I rise to speak to Bill C-62. I will offer a couple of contextual observations at the start of my remarks, followed by five or six lenses through which one might view the bill. This approach has helped me in my consideration of Bill C-62.

I will try my best not to make this sound like a lecture, but I do have a small weakness in that regard. Apologies at the outset.

The contextual observations are these: First, a reminder that we are amending the Criminal Code, the criminal law, through Bill C-7 and now Bill C-62. More specifically, Bill C-7, which set the foundation for this, removed the criminal law prohibition disallowing access to medical assistance in dying. Once such criminal law prohibitions are removed, the matter falls almost entirely into the category of health. Health is almost entirely a matter of provincial jurisdiction. This gives greater legitimacy to the perspectives of the provinces than might normally be the case with federal legislation.

The second contextual observation is a reminder that we need to deal with this bill now. The problem of going past March 17 was highlighted eloquently by Senator Dalphond when he spoke earlier. The issue of a potential vesting of rights that would then be clawed back would be foundationally disturbing, especially with respect to the criminal law, and we cannot go there.

I will move now to the criteria or lenses through which to consider the bill.

Personal perspectives: Here, this might include your own religious or spiritual or moral viewpoint or your concern for the suffering of people who are presently without access to MAID or your concern for those who could be made more vulnerable if MAID access is provided or your own views on the relationship of autonomy of citizens and the appropriate limits of government intervention to restrain that autonomy.

Each of us will have our own framework, but on this topic, my personal inclination is to favour the autonomy arguments, although, having said that, I am continually distressed, as I was in the consideration of Bill C-7 — and here I echo Senator Petitclerc’s observations — that our governments were and are not doing enough to support vulnerable populations so as to ensure that an exercise of autonomy in seeking MAID is genuine and not forced upon people by circumstance.

Readiness: This is a more contestable issue. Others more knowledgeable than I have debated this at length, including in the chamber this afternoon. I’ll offer my own conclusions, having read a fair amount of the material and followed the debate, on the two aspects of readiness.

On balance, on the question of professionals’ readiness, I’m inclined to the view of the experts tasked with building the standards and training criteria, the most credible of whom, in my opinion, say we are at a state of suitable readiness. I’m sympathetic to that point of view.

With respect to health system readiness broadly, in terms of availability of adequate numbers of trained professionals, et cetera, subject to what I will say about provincial perspectives, there are legitimate concerns, as we have heard and has been noted by provinces and territories, about the lack of widespread availability of these services. But I do note, as did Senator Kutcher — and as Senator McBean presciently asked of officials at our technical briefing — that we did not ask this question of the health care system when we adopted Bill C-7 for access to MAID for so-called Track 2 candidates.

Now I’ll move on to minority rights and constitutional considerations — here I’ll speak at more length.

Bill C-62 deals with the rights of minorities in a constitutional context. These are very important questions, and it’s deeply problematic if we as a Parliament, whether the Senate or the other place, pass legislation that is highly likely to be unconstitutional. So, the consideration and protection of rights at this level is a fundamental consideration for all of us. It certainly is for me. And it’s not just an issue for lawyers. Since each of us as parliamentarians has to make a decision on this question, we all have to reflect to the best of our ability on the question of whether passing this bill or opposing it would lead us to be doing something that is unconstitutional.

I want to take you through my perspective on the dimensions of constitutionality that are at play with respect to MAID for people whose sole underlying condition is a mental disorder. I will do this by talking about the two provisions of the Charter of Rights and Freedoms that are implicated, the moderation of those rights that the government articulates and its position in relation to these rights, and I will talk in slightly more detail than Senator Gold, but from a slightly different angle.

The concerns that revolve around sections 15 and 7 of the Charter of Rights and Freedoms are fundamental law. Starting with section 15, the equality provision, the focus of this concern has primarily been equality before and under the law. The question is whether a further three-year delay in providing access to MAID for a mental disorder constitutes a violation of that equality provision because MAID is denied to a community of interests that is specifically identified in section 15 as deserving protection. I say “denied,” certainly delayed. This is people with a physical or mental disability, a category specifically outlined in section 15.

My understanding is that the government accepts that complete denial of access for such a category of people would be an unconstitutional violation of section 15. Indeed, it was the foundational basis for the acceptance in the other place of the Senate amendment to Bill C-7 in 2021.

The other provision in the Charter is section 7, which protects the right to life, liberty and security of person. Once again, the government accepted with respect to the amended Bill C-7 that a complete denial of access would constitute a violation of section 7, but you should remember the two parts. As Senator Gold noted, it’s important, in constitutional terms, to note that section 7 is violated only if the law we adopt deprives people of life, liberty or security of person in ways that do not accord with principles of fundamental justice.

Let me give you one small and largely irrelevant example, but you get the point. If you’re convicted of a serious crime and sentenced to incarceration, obviously, your liberty is denied, but it is done in accordance with principles of fundamental justice — criminal trial, proof of guilt beyond a reasonable doubt, rules of evidence — you get the idea.

The courts have developed criteria for examining what the phrase “principles of fundamental justice” means. Essentially, embedded in it is the following: Infringements cannot be arbitrary, they cannot be overbroad, and they cannot be grossly disproportionate. So the question here is whether the delay in making MAID available for mental disorders is arbitrary, overly broad or grossly disproportionate. If it is, if the law is, it’s a violation of section 7.

The next point, though, is even if there are infringements to section 15, the equality provision, or section 7, life, liberty and security of person, the government is entitled to justify infringements of constitutional rights if it can satisfy the criteria that are set out in section 1 of the Charter, which is commonly known as the “reasonable limits” clause. Limits can be placed on certain constitutional rights if they are reasonable limits prescribed by law and demonstrably justified in a free and democratic society. That’s the language of section 1.

As far as back as 1986 — and still adhered to — the Supreme Court of Canada identified the essential elements of these reasonable limits in language that’s a bit more understandable. The criteria are that the law-limiting rights must present a pressing and substantial objective, the law-limiting rights must be proportionate — and that means that the limitation must be rationally connected to the objective — it must impair the rights as minimally as possible and there must be proportionality between the positive and negative features of the law.

Essentially, the government is seeking to justify the limitation on access on the basis that there is a justifiable delay in terms of readiness. It needs to achieve rational connection, as I said; it has to minimally impair rights; and there must be a reasonable balance in the choice.

I draw your attention to Senator Dalphond’s minority opinion in the joint committee, which regarded the majority’s recommendation of a delay of indefinite length as being unconstitutional. I think he was right in that assessment. It appears now to be the case that the government heard his opinion and modified the delay to three years, and that he will now support the amended or adopted version. How could he not if it was his idea?

The government has also offered up a balancing-policy-choices option; that is, there is a range of policy choices that are possible here. I think this is a weak argument, and I don’t care much for it in this policy-choices justification. I think the better argument is the issue of whether section 1 limitations have been established as justifiable limitations on the constitutional rights under consideration.

My own big concerns are, one, whether there is a less intrusive option available, as some of the opponents of Bill C-62 have suggested, and two, whether the three-year delay is a constitutionally acceptable limit. A long-term prohibition on access to MAID for mental disorders would be unconstitutional, but the long term itself is composed of a series of short terms. So does the series of short terms, adding up to six years, constitute an unjustified abridgment of constitutional rights?

My own view is that, if adopted, Bill C-62 is sure to be litigated and that there is a reasonable — but not by any means guaranteed — prospect that it could be found to be unconstitutional. For me, that level of risk of unconstitutionality would have to be higher before I would be willing to play the Senate unconstitutionality card and withhold assent.

I mentioned two other themes. One is provincial positions. As you know, at least seven provinces and three territories have written to express the view that they’re not yet ready. Senators, I believe, have a duty to be attentive to the provincial interests as part of their service in the Senate. This does not mean adherence or deference to the views of provincial governments, but it’s fair to say that the governments themselves have a special status in expressing views. The status is probably enriched when those views are related to inheriting responsibilities that fall directly within provincial jurisdiction, as is the case here.

Admittedly, some of this opposition is motivated by opposition to medical assistance in dying, generally — that is true in my own province — but that doesn’t detract from their entitlement to an expression of their concerns and the obligation on our part to give this position a meaningful degree of consideration. In my deliberations, I have tried to do that.

Finally, on our role as senators, it is a truism that when it comes to exercising legislative authority, within some limits, we have coordinate authority with the other place. It’s meaningful authority.

Here’s a metaphor. There’s an old story about three baseball umpires talking together about balls and strikes. The junior umpire says, “When a pitch comes in and I think it’s a strike, I call it a strike.” The second umpire, with a bit more experience, says more definitively, “If I call it a strike, it’s a strike.” The third umpire, older, wiser and grumpier, says, “A pitch comes in. It ain’t nothing till I call it.” The same is true, at least in principle, with respect to legislation: It “ain’t nothing till” the Senate calls it.

That said, none of us are elected. We exercise our authority independently within a political and constitutional reality. We have, if I might say it in this way, limited democratic legitimacy compared to the elected members of the other place. Sometimes, we might be justified in asserting that coordinate authority to the limit, and there are circumstances or criteria — for me at least — where that could be the case. Whether those circumstances arise in this case in opposition to Bill C-62 is a question for each of us to decide, I will mention, in the face of near-unanimous support in the other place and near-unanimous messages from governments that will inherit the health responsibility.

So the bottom line for me — almost identically to the conclusions of Senator Petitclerc — is that I don’t like the policy choice to delay access for three years, but the constitutionality threshold is met, provincial voices are meaningful here and the overwhelming support for the bill in the other place deserves to be respected. I will vote for Bill C-62, though without enthusiasm. Thank you.

Honourable senators, we’re on the cusp of yet another monumental vote on medical assistance in dying. I had not intended to intervene, but I will make brief comments for the record.

What we can be certain of, regardless of how the vote goes, is that it will be challenged in the courts. We can also be certain of the fact that this same debate will come back — not even in three years but before — since there will likely be a special joint committee set up to look at the readiness question.

Insofar as there will be a court challenge, I think the consensus is that the ruling is uncertain, though I hear from some people with legal training that they feel the outcome will go in a particular direction. For my part, I think a better course of action for someone who is not trained in the law is to be agnostic about how the court will rule. I would much rather spend my time focusing on the policy option that we’re debating and perhaps, with humility, offering some input to the justices when they eventually hear this case on what we as legislators are thinking as we debate the policy. Again, I am saying that we should not play a Supreme Court judge, but rather play the role that we are, in fact, supposed to play.

If and when the courts are called to rule upon the constitutionality of MAID where a mental disorder is the sole underlying medical condition, or MAID MD-SUMC, or its prohibition, one of the central questions they will be thinking about is whether this ad hoc fix that we are looking at today, if the bill passes, is appropriate and proportionate. For many of us — and perhaps for the justices as well — the central question at that time, and even before when it comes to us for our own consideration, is whether readiness has been met.

We have heard in this chamber two definitions of readiness. One is based on the views of the assessors and the regulators. They believe readiness has been met. The other is based on what might be termed a health system view, which, on the one hand, has been expressed by a number of provinces and territories but which is also expressed more generally among the supporting infrastructure or ecosystem of people who work with disabilities and mental health, as well as people who are addicted and so on.

Three years from now — or sooner because of the joint committee that will be struck — that will be the same debate: whether readiness has been met. Again, we will be looking at a distinction between the views of assessors and regulators versus the health system in general. I am sympathetic to Senator Kutcher’s complaint that no appropriate goalposts have been set as to how to define readiness, and the quandary that will put us in when we have to revisit this question. However, insofar as the Supreme Court may well — and likely will — consider this question even before the three-year period is up, I would like to offer some thoughts on how we think about the readiness question.

I do not believe we can properly answer the question of readiness without addressing the fundamental driver — the trigger for our medical assistance in dying, or MAID, regime — which is irremediability. Absent a much stronger consensus on irremediability in the case of mental disease where it is the sole underlying medical condition, it strikes me that the question of readiness cannot be properly answered. I’ll explain why: In a world where there is deep, deep disagreement around whether or not a particular mental disease — or a particular case — is irremediable, a patient seeking MAID for that condition would presumably be able to find a set of assessors who would assess that person to be irremediable.

Now, I want to be careful. That does not mean that person would get MAID, because the guidelines, I hope, will be robust enough that crossing that one threshold will be insufficient to reach the end stage. Nevertheless, that is, to me, a very likely outcome because, by definition, assessors of MAID will have accepted the premise — the proposition — that certain mental diseases are irremediable.

Therefore, I think it’s conceivable that someone who is under the care of a set of highly trained doctors who believe that there are more options and that there is remediability for this particular patient — doctors who might not agree with giving the green light, if you will, for the next step in MAID — will be overridden. This patient will be able to find support for their request from another set of assessors and physicians.

That is why, colleagues, my own hope is that at the end of three years — assuming the court doesn’t short-circuit this delay period — we will, in fact, be ready in the fullest sense of the term. I hope that our medical profession and the health system as a whole can come to a clear idea of readiness, and the guardrails will be firm and agreed upon and will protect people who are vulnerable. However, I don’t know if we can reach that place. And if we cannot reach that place, if we are back in this chamber debating readiness, and if the Supreme Court is looking at whether this is constitutional and is thinking about how readiness connects with irremediability, I would strongly suggest that these two concepts cannot be divorced.

I encourage all of us to think more deeply about this issue. We have up to three years to reflect on it and to see if there is a way we can ensure that patients who may yet be remediable are not given the option of going down the path of MAID where a mental disorder is the sole underlying medical condition, or MAID MD-SUMC, simply because there is a portion of medical professionals who are willing to give them that option.

Thank you very much.

Senator Kutcher, your time for debate has expired.

Is leave granted?

Honourable senators, I rise once again to speak to Bill C-62, An Act to amend the Criminal Code (medical assistance in dying), No. 2, as the opposition critic in the Senate.

As I have stated several times, medical assistance in dying remains one of the most complex and deeply personal issues for individuals and families, especially when it comes to mental illness. The issue of expanding MAID, or medical assistance in dying, eligibility to those suffering from mental illnesses is deeply personal for me as well, as I know it is for many of our colleagues.

We began with Bill C-14, then Bill C-7 with an amendment and sunset clause of 18 months to the prohibition of assisted suicide for mental illness. This began the journey for mental illness and MAID that has led to where we are today. Two additional bills have been put forward by the government, Bill C-39 and Bill C-62, to attempt to temporarily delay the issue posed by the sunset clause rather than to examine what is really needed.

As a country, we should be focusing on improving our mental health care first and foremost. It is indisputable that mental health services in Canada are insufficient and inconsistent. According to the Centre for Addiction and Mental Health, or CAMH, only half of Canadians experiencing a major depressive episode receive “potentially adequate care.” One third of Canadians aged 15 or older who report having a need for mental health care say those needs have not been met. Specialized treatment services are not accessible for 75% of children with mental disorders. Aboriginal youth are about five to six times more likely to die by suicide than non-Aboriginal youth. Suicide rates for Inuit youth are among the highest in the world, at 11 times the national average.

New data from the non-profit Angus Reid Institute supports the major concern of mental illness and mental health care in Canada; 80% of Canadians are concerned with the mental health care resources available in Canada, and 81% of Canadians are concerned with the state of Canadians’ mental health overall. The data further stated that:

This concern is more elevated among those who sought care from the country’s mental health-care system in the past year. Overall, one-in-five (19%) Canadians say they’ve looked for treatment for a mental health issue from a professional in the last 12 months. In that group, two-in-five say they’ve faced barriers to receive the treatment they wanted. . . .

MAID for mental illness as a sole underlying condition is moving forward with a policy that will offer these individuals assisted death. The focus should be in providing them with the resources, information and care they need, not MAID. How can we be certain we are providing mental health patients with a fair and honest choice and not further blurring the lines between suicide and MAID? How can we be certain feelings of suicidality associated with a mental illness are not a factor in the request for MAID?

Another common theme in debates for Bill C-39 and Bill C-62 in this chamber, and during proceedings of the special joint committee, is that it remains impossible to predict irremediability with any certainty. To be eligible for MAID under the Criminal Code, a person must have “A grievous and irremediable medical condition . . .” which is defined as “A serious and incurable illness, disease or disability . . .” that has led to “. . . an advanced state of irreversible decline . . . .” and intolerable suffering.

The government established an expert panel to study MAID and mental illness as a sole underlying medical condition. However, this panel was created after the passage of the sunset clause, and the members were not asked to consider whether Canada was ready, whether it is possible to do this safely or whether there was scientific consensus to justify this expansion. The expert panel was tasked with presenting recommendations on implementation only. The work of the expert panel should not be misconstrued as expert consensus. In fact, even the panel’s final report indicated that it would be difficult, if not impossible, to predict irremediability with mental disorders.

The Model Practice Standard for MAID provides the following definitions of “incurable” and “irreversible.” Section 9.5.2 defines “incurable” as:

. . . there are no reasonable treatments remaining where reasonable is determined by the clinician and person together exploring the recognized, available, and potentially effective treatments in light of the person’s overall state of health, beliefs, values, and goals of care.

In section 9.6.4 “irreversible” means that:

. . . there are no reasonable interventions remaining where reasonable is determined by the clinician and person together exploring the recognized, available, and potentially effective interventions in light of the person’s overall state of health, beliefs, values, and goals of care.

“Irremediability” is defined in section 241.2(1) of the Criminal Code as a medical condition that is “. . . incurable . . .” and in “. . . an advanced state of irreversible decline . . .” In other words, for a person to qualify, a MAID assessor must be satisfied that their condition will not get better.

The May 2022 report of the government’s Expert Panel on MAID and Mental Illness acknowledged the difficulty in determining the irremediability of a mental disorder:

The evolution of many mental disorders, like some other chronic conditions, is difficult to predict for a given individual. There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient. . . .

The special joint committee also heard that it is difficult, if not impossible, to accurately predict the long-term prognosis of a person with a mental disorder. Dr. Gaind told the committee that the training medical practitioners receive to assess suicidality does not equip them to distinguish requests for MAID from suicidality. He said:

MAID is for irremediable medical conditions. These are ones we can predict won’t improve. Worldwide evidence shows we cannot predict irremediability in cases of mental illness, meaning that the primary safeguard underpinning MAID is already being bypassed, with evidence showing such predictions are wrong over half the time.

Scientific evidence shows we cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests, with overlapping characteristics suggesting there may be no distinction to make.

Dr. Sareen, speaking on behalf of eight chairs of psychiatry at medical schools across Canada, said:

We strongly recommend an extended pause on expanding MAID to include mental disorders as the sole underlying medical condition in Canada . . . .

Dr. Sareen, responding to questions about how psychiatrists are trained to separate suicidal ideation from psychiatric MAID requests, said:

. . . there is no clear operational definition differentiating between when someone is asking for MAID and when someone is asking for suicide when they’re not dying. Internationally, this is the differentiation. If somebody is dying, then it can be considered MAID. When they’re not dying, it is considered suicide. It’s very difficult, and there’s no operational definition on it.

Dr. Rajji stated:

There is no clear way to separate suicidal ideation or a suicide plan from requests for MAID. Therefore, there needs to be some discussion to see a consensus and agreement, as professionals, on what part of an individual’s history with a particular illness would constitute that separation.

It’s not simple.

The Special Joint Committee on Medical Assistance in Dying stated in its final report that many psychiatrists do not support the practice of MAID MD-SUMC.

Dr. Alison Freeland, representing the Canadian Psychiatric Association, could not confirm that a consensus exists when asked whether psychiatrists share a consensus on the issue of MAID MD-SUMC. Dr. Sareen noted that the majority of surveys have shown that the majority of psychiatrists are against MAID for mental illness.

The committee also heard differing views as to whether there is an adequate number of trained practitioners, psychiatrists in particular, to safely and adequately provide MAID MD-SUMC.

Another concern that was raised at the joint committee and part of the final report is the issue of distinguishing MAID requests from suicidality. Some witnesses told the committee that there is no way to distinguish requests for MAID MD-SUMC from suicidality.

The Canadian Association for Suicide Prevention addressed these concerns relating to suicide in the context of MAID expansion to those not at the end of life:

While our core mission will always focus on preventing suicide, we believe that it is not enough for a suicide prevention organization to merely stop people from dying — it is imperative that Canadians invest in finding other ways to alleviate suffering and support people in connecting to a life worth living. MAiD, as it currently exists in Canada, is in no conflict with this approach since it is used to remedy painful deaths. However, expansion of MAiD to include those not at the end of life carries the inherent assumption that some lives are not worth living and cannot be made so. . . .

The association further stated:

Finding hope and reasons to live are a quintessential aspect of clinical care in mental disorders. Having MAiD as a treatment option is in fundamental conflict with this approach, is likely to have a negative impact on the effectiveness of some therapeutic interventions and may lead both patient and provider to prematurely abandon care.

Honourable senators, as you have heard, the final MAID report concluded that the medical system in Canada is not prepared for medical assistance in dying where mental disorder is the sole underlying medical condition. The committee recommended:

a. That MAID MD-SUMC should not be made available in Canada until the Minister of Health and the Minister of Justice are satisfied, based on recommendations from their respective departments and in consultation with their provincial and territorial counterparts and with Indigenous Peoples, that it can be safely and adequately provided; and

b. That one year prior to the date on which it is anticipated that the law will permit MAID MD-SUMC, pursuant to subparagraph (a), the House of Commons and the Senate re‑establish the Special Joint Committee on Medical Assistance In Dying in order to verify the degree of preparedness attained for a safe and adequate application of MAID MD‑SUMC.

Bill C-62 extends the exclusion of eligibility for receiving medical assistance in dying in circumstances where the sole underlying medical condition identified in support of the request for MAID is a mental illness until March 17, 2027.

I will support Bill C-62 because, without it, MAID for those with a mental illness as a sole underlying condition will become the law on March 17, 2024. However, I urge the government to take a close look at the issues of irremediability and suicidality when it comes to medical assistance in dying with mental illness as the sole underlying condition. A three-year delay will not fix this.

The Canadian Human Rights Commission said:

As the Government takes a critical look at the expansion of MAiD, the Commission encourages the Government to use this opportunity to conduct a thorough examination of what has happened since the coming into force of the existing legislation. This should include collecting the evidence and testimony necessary so that there is clear understanding of who is accessing MAiD and why — in order to identify and put in place the necessary safeguards to address the human rights harms experienced by already marginalized groups.

Honourable senators, the government needs to proceed cautiously with the MAID regime in Canada before any further expansion and needs to ensure that they also focus on and prioritize mental health.

We must do better to protect our most vulnerable.

Are honourable senators ready for the question?

Is it your pleasure, honourable senators, to adopt the motion?

Some Hon. Senators: Agreed.

An Hon. Senator: On division.

(Motion agreed to and bill read third time and passed, on division.)