Speech (House debate)

{
    "time": "2024-02-07 18:35:00",
    "attribution": {
        "en": "Mr. Alistair MacGregor (Cowichan\u2014Malahat\u2014Langford, NDP)",
        "fr": "M. Alistair MacGregor (Cowichan\u2014Malahat\u2014Langford, NPD)"
    },
    "content": {
        "en": "<p data-HoCid=\"8181613\" data-originallang=\"en\">Madam Speaker, I am pleased to be standing in the House today to join debate on Bill <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C-62</a>. Forgive me if I am feeling a bit of d\u00e9j\u00e0 vu right now, because it was precisely one year ago, in February 2023, that the House was in a similar position with the earlier bill, Bill <a data-HoCid=\"12189059\" href=\"/bills/44-1/C-39/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying)\">C-39</a>.</p>\n<p data-HoCid=\"8181614\" data-originallang=\"en\">That bill, of course, extended the delay of the implementation of the acceptance of mental disorders as a sole underlying medical condition to access MAID. That bill kicked the can down the road by one year. As a result, we find ourselves in a position where we are now approaching the deadline of March 17, 2024.</p>\n<p data-HoCid=\"8181615\" data-originallang=\"en\">To go into a bit of detail on what Bill <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C-62</a> contains, it is not a very complex bill. It should be clear that the bill itself is not relitigating the issue that was first brought in by Bill <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-7</a>. I will get into Bill C-7 in a moment. This bill is seeking to further delay the implementation of MAID for mental disorders as a sole underlying medical condition until March 17, 2027, essentially three years down the road from now.</p>\n<p data-HoCid=\"8181616\" data-originallang=\"en\">I also think an important part of the bill is that it inserts a legislative requirement that the Special Joint Committee on Medical Assistance in Dying be reconvened in advance of that change, so that a committee of parliamentarians made up of members of Parliament and senators can review our country's readiness and make a determination in advance of that date.</p>\n<p data-HoCid=\"8181617\" data-originallang=\"en\">I have been a member of the special joint committee from the beginning, all the way back in the 43rd Parliament, and, speaking for myself, I am very glad to see that we do have that legislative requirement in Bill <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C-62</a> and that, more importantly, the committee is actually being given the time it should have had to study this very complex and sensitive issue in advance of its implementation. That is something we could have been much better served by in previous iterations of this legislation.</p>\n<p data-HoCid=\"8181618\" data-originallang=\"en\">I think it is important that we explore a little of the history of how we got to this moment. As a member of this special joint committee, I personally have felt that we have been playing a game of catch-up to the change in law that was made in advance of any serious inquiry into this matter.</p>\n<p data-HoCid=\"8181619\" data-originallang=\"en\">Bill <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-7</a>, in the 43rd Parliament, was, of course, the Government of Canada's response to the Truchon decision. It specifically created a separate track in the Criminal Code for people whose death was not naturally foreseeable. Previous to that, one had to have a medical condition in which one's natural death was foreseeable, so essentially it was for people who were suffering terminal stage cancer, who were going through a great deal of suffering and so on.</p>\n<p data-HoCid=\"8181620\" data-originallang=\"en\">It is important to note, though, that when the government first brought Bill <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-7</a> in, there were already questions at that time, in advance of the legislation, about what we do with people who are suffering from mental illness, who have suffered, in some cases, as my colleague pointed out, for decades, for whom treatments have not worked. What were we to do with that?</p>\n<p data-HoCid=\"8181621\" data-originallang=\"en\">In the original version of the legislation, by law, the government was required to have the bill accompanied by a charter statement, but mental disorders were specifically excluded from the original version of Bill <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-7</a>. The government provided what I thought at the time was a fairly well-reasoned charter statement. It was understood that by excluding this, one could potentially engage two prominent sections of the Charter of Rights and Freedoms, namely section 7, which is the security of the person, the fact that everyone essentially has the right to make a decision about what happens to their own body, and section 15, the equality clause, that the law has to treat everyone equally. With reference, those two sections may potentially be engaged by an exclusion.</p>\n<p data-HoCid=\"8181622\" data-originallang=\"en\">The government identified the following in its charter statement:</p>\n<blockquote><p data-HoCid=\"8181623\" data-originallang=\"en\"> 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. </p>\n</blockquote><p data-HoCid=\"8181624\" data-originallang=\"en\">That is what the government's original position on Bill <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-7</a> was.</p>\n<p data-HoCid=\"8181625\" data-originallang=\"en\">The House passed Bill <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-7</a> and it went off to the Senate. There, for reasons that remain shrouded in mystery to me to this day, the government decided to accept a Senate amendment, essentially at the eleventh hour, which had significant repercussions for the bill. Essentially, the Senate was reversing the government's original position on whether mental disorders qualified for MAID. </p>\n<p data-HoCid=\"8181626\" data-originallang=\"en\">The government accepted that Senate amendment. Of course, Bill <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-7</a>, because it had been amended, had to come back to the House, and the government managed to cobble enough votes together to get it passed.</p>\n<p data-HoCid=\"8181627\" data-originallang=\"en\"> Therefore, we, as parliamentarians, were left with a law that had been changed in advance of the hard work being done to properly consult, research and discuss the issue with expert witnesses and with the health systems that have primary responsibility for the oversight of the change in law.</p>\n<p data-HoCid=\"8181628\" data-originallang=\"en\">Yes, an expert panel was convened. The special joint committee was convened. Of course, its work was interrupted by the unnecessary calling of an election in the summer of 2021. Some very valuable time was lost there, because, of course, we then had to reconvene in the 44th Parliament, and a considerable amount of time was lost due to that.</p>\n<p data-HoCid=\"8181629\" data-originallang=\"en\">However, it is important to realize that everything that has transpired since then has been as a result of that Senate amendment being accepted by the government. Again, I feel, and as a member of the special joint committee I think my feeling has some validity here, that we have been trying to play catch-up ever since that moment.</p>\n<p data-HoCid=\"8181630\" data-originallang=\"en\">My time on the special joint committee has been difficult. It is not an easy subject for anyone to sit through, because the opinions of the people with lived experience and those who work in a professional capacity really are on all sides of the spectrum and everywhere in between. It can be quite difficult for a parliamentarian to work their way through that to try and understand the complex legal and medical arguments that exist behind this issue, but it is important. </p>\n<p data-HoCid=\"8181631\" data-originallang=\"en\">I would say that, personally, my work on the committee has really been a struggle to find a balance between two concepts that sometimes seem to be in competition with each other. I am a firm believer in the Canadian Charter of Rights and Freedoms. I think it is a very important document in Canadian history, and I believe that we have to respect an individual's right to make decisions over their own body, but that belief system of mine was always struggling with another concept, which is that sometimes society finds itself in a position in which it is necessary for it to step in and protect its most vulnerable members. I think those two themes were echoed, not only for me but for many of the witnesses who appeared before our committee and in the many briefs we received.</p>\n<p data-HoCid=\"8181632\" data-originallang=\"en\">I also want to note that our special joint committee has existed twice in this Parliament. We tabled our second report in February last year, in advance of Bill <a data-HoCid=\"12189059\" href=\"/bills/44-1/C-39/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying)\">C-39</a>. The committee's mandate at that time was guided by five themes that we had to look at, and mental disorder as the sole underlying medical condition was one of those. Of course, we were reconvened after the passage of Bill <a data-HoCid=\"12189059\" href=\"/bills/44-1/C-39/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying)\">C-39</a>, but as my colleague from <a data-HoCid=\"278281\" href=\"/politicians/luc-theriault/\" title=\"Luc Th\u00e9riault\">Montcalm</a> pointed out, our runway was extremely short. It did not do justice to the amount of time that we actually needed and to the extreme complexity of this issue.</p>\n<p data-HoCid=\"8181633\" data-originallang=\"en\">Just to give this clarity for people listening, I believe our first meeting as a committee was on October 31, and we had to conduct some committee business, and elect the chairs and vice chairs. We really had only three three-hour meetings with witnesses, so nine hours of testimony. We excluded, by necessity, a lot of people who I would dearly liked to have heard from, namely administrators of our public health system, elected officials of provincial governments and so on. </p>\n<p data-HoCid=\"8181634\" data-originallang=\"en\">Because of the short timeline, we did not even have enough time to properly translate all the submissions that were sent to our committee because, of course, before they can be distributed to committee members, they have to be translated into French and English. That is a requirement that honours the fact that we are a bilingual country. We, as committee members, did not even have the opportunity to review important submissions, and those submissions came from people who had lived experience, who were dealing with the situation at home, but they also came from many professionals whose practice is involved in this specific area.</p>\n<p data-HoCid=\"8181635\" data-originallang=\"en\">I have taken a position on this. The member for <a data-HoCid=\"278549\" href=\"/politicians/ed-fast/\" title=\"Ed Fast\">Abbotsford</a>, in the fall, had introduced Bill <a data-HoCid=\"12210462\" href=\"/bills/44-1/C-314/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C-314</a>, and I did vote for that, so my vote on this matter is quite clear. I have been informed by the fact that at our committee, there has been a significant amount of professional discomfort expressed by people who practice medicine in this area, psychiatrists and psychologists. Sure, some of them may be acting in a paternalistic way, but I do not think that can be applied equally to everyone. I think for some of them, we have to review their opinions. We have to take them in the context in which they are given. I think we have to afford them a measure of respect, given the fact that these are their lifelong career choices and, in many cases, we can measure their experiences in decades.</p>\n<p data-HoCid=\"8181636\" data-originallang=\"en\">I want to take a little time to read from some of the testimony we received from witnesses. We did hear from Dr. Jitender Sareen from the department of psychiatry at the University of Manitoba, who was there also on behalf of psychiatry departmental chairs at the Northern Ontario School of Medicine, McMaster, McGill, Memorial University, the University of Ottawa and Queen's University. His testimony was that they strongly recommended \u201can extended pause on expanding MAID to include mental disorders...because we're simply not ready.\u201d He was quite emphatic on the point that we are not going to be ready in another year.</p>\n<p data-HoCid=\"8181637\" data-originallang=\"en\">Dr. Trudo Lemmens, who is a professor of health law and policy in the faculty of law at the University of Toronto, was there to clarify some constitutional arguments. He was really trying to underline the fact that we have to keep the section 7 and section 15 rights in balance with section 1 and that this issue has not actually been decided by the courts, contrary to what we heard from some witnesses. Previous speakers on tonight's debate have also pointed out that the Truchon decision did not include any reference to mental disorders. That is an important point we have to make.</p>\n<p data-HoCid=\"8181638\" data-originallang=\"en\">Dr. Sonu Gaind, who is the chief of the department of psychiatry at the Sunnybrook Health Sciences Centre, pointed out that:</p>\n<blockquote><p data-HoCid=\"8181639\" data-originallang=\"en\"> 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. </p>\n<p data-HoCid=\"8181640\" data-originallang=\"en\"> 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. </p>\n</blockquote><p data-HoCid=\"8181641\" data-originallang=\"en\">He also commented on the fact that the curriculum used does not teach assessors to distinguish between suicidality and psychiatric MAID requests, and so on.</p>\n<p data-HoCid=\"8181642\" data-originallang=\"en\">We also heard from Dr. Tarek Rajji; he is the chair of the medical advisory committee at the Centre for Addiction and Mental Health. He stated:</p>\n<blockquote><p data-HoCid=\"8181643\" data-originallang=\"en\"> CAMH's concern is that the health care system is not ready for March 2024. The clinical guidelines, resources and processes are not in place to assess, determine eligibility for and support or deliver MAID when eligibility is confirmed to people whose sole underlying medical condition is mental illness. </p>\n</blockquote><p data-HoCid=\"8181644\" data-originallang=\"en\">These provide a snapshot of the widespread professional discomfort that exists out there, and I do not think we can discount those voices.</p>\n<p data-HoCid=\"8181645\" data-originallang=\"en\">I would agree that there were also a number of professionals on the other side who did feel we were ready, and that is what makes this such an incredibly complex and sensitive subject to try to navigate as a parliamentarian. Again, we as a committee should have been afforded the time and space to really delve into these issues and to greatly expand our witness list to make sure we were in fact ready.</p>\n<p data-HoCid=\"8181646\" data-originallang=\"en\">Members will note that our recent committee report had only one recommendation in it. I recognize that the recommendation was a result of the majority of the committee members. There were some dissenting opinions, notably from the senators who were part of the committee. However, the committee did recognize that Canada is not prepared for medical assistance in dying where mental disorder is the sole underlying medical condition, and we did not attach an arbitrary timeline to the recommendation. Our specific call was that MAID 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.</p>\n<p data-HoCid=\"8181647\" data-originallang=\"en\">We keep getting ourselves into trouble by setting arbitrary deadlines for ourselves. Setting up an arbitrary timeline is not an adequate replacement for the qualitative work that needs to be done by these departments. I would much prefer that we satisfy the qualitative requirement in the recommendation, where departments, experts and our provincial and territorial colleagues are in fact saying that they are going to be okay with that.</p>\n<p data-HoCid=\"8181648\" data-originallang=\"en\">The recommendation and my reference to the provinces and territories is a great segue to the fact that there was also a letter sent to the <a data-HoCid=\"300010\" href=\"/politicians/mark-holland/\" title=\"Mark Holland\">Minister of Health</a>. It was signed by seven out of 10 provinces and all three territories. The signatures include those of all the ministers of health and ministers responsible for mental health and addictions in those provinces, including Adrian Dix and Jennifer Whiteside from my own province of British Columbia. They quite clearly say:</p>\n<blockquote><p data-HoCid=\"8181649\" data-originallang=\"en\"> The current March 17, 2024, deadline does not provide sufficient time to fully and appropriately prepare all provinces and territories across Canada.... </p>\n<p data-HoCid=\"8181650\" data-originallang=\"en\"> We encourage you and [the] federal Justice Minister...to indefinitely pause the implementation of the expanded MAID eligibility criteria to enable further collaboration between provinces, territories and the federal government. </p>\n</blockquote><p data-HoCid=\"8181651\" data-originallang=\"en\">I will wrap up by saying that this is a very sensitive issue. I do think we should pass Bill <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C-62</a> and honour the calls we are hearing from the professions intimately involved in this issue and the calls coming from the provinces and territories. We need to step up to the plate and make sure we have a fully ready system in advance of the changing of any laws.</p>",
        "fr": "<p data-HoCid=\"8181613\" data-originallang=\"en\">Madame la Pr\u00e9sidente, je suis heureux de prendre la parole \u00e0 la Chambre aujourd'hui pour participer au d\u00e9bat sur le projet de loi <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C\u201162</a>. Pardonnez-moi si j'ai une impression de d\u00e9j\u00e0 vu en ce moment, car, il y a pr\u00e9cis\u00e9ment un an, en f\u00e9vrier 2023, la Chambre se trouvait dans une situation similaire avec le projet de loi pr\u00e9c\u00e9dent, le projet de loi <a data-HoCid=\"12189059\" href=\"/bills/44-1/C-39/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying)\">C\u201139</a>.</p>\n<p data-HoCid=\"8181614\" data-originallang=\"en\">Ce projet de loi, bien entendu, a prolong\u00e9 le d\u00e9lai de mise en \u0153uvre de l'acceptation des troubles mentaux comme seule condition m\u00e9dicale sous-jacente pour acc\u00e9der \u00e0 l'aide m\u00e9dicale \u00e0 mourir. Ce projet de loi a retard\u00e9 d'un an l'entr\u00e9e en vigueur de la loi. Par cons\u00e9quent, nous nous trouvons dans une situation o\u00f9 nous approchons de la date limite, qui est le 17 mars 2024.</p>\n<p data-HoCid=\"8181615\" data-originallang=\"en\">Pour entrer un peu dans les d\u00e9tails du contenu du projet de loi <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C\u201162</a>, il ne s'agit pas d'une mesure tr\u00e8s complexe. Il doit \u00eatre clair que le projet de loi lui-m\u00eame ne revient pas sur la question qui a \u00e9t\u00e9 soulev\u00e9e pour la premi\u00e8re fois par le projet de loi <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u20117</a>. Je reviendrai sur le projet de loi C\u20117 dans un instant. Le projet de loi dont nous sommes saisis vise \u00e0 retarder davantage l'acceptation des troubles mentaux comme seule condition m\u00e9dicale sous-jacente pour avoir acc\u00e8s \u00e0 l'aide m\u00e9dicale \u00e0 mourir jusqu'au 17 mars 2027, c'est-\u00e0-dire dans trois ans.</p>\n<p data-HoCid=\"8181616\" data-originallang=\"en\">J'estime aussi que l'ajout d'une exigence l\u00e9gislative voulant que le Comit\u00e9 mixte sp\u00e9cial sur l'aide m\u00e9dicale \u00e0 mourir doive proc\u00e9der \u00e0 un examen avant la mise en \u0153uvre de ce changement, de sorte qu'un comit\u00e9 compos\u00e9 de d\u00e9put\u00e9s et de s\u00e9nateurs puisse d\u00e9terminer si notre pays est pr\u00eat avant la date butoir, est un aspect important du projet de loi.</p>\n<p data-HoCid=\"8181617\" data-originallang=\"en\">Je si\u00e8ge \u00e0 ce comit\u00e9 depuis sa cr\u00e9ation lors de la 43<sup>e</sup> l\u00e9gislature. Personnellement, je dois dire que je suis tr\u00e8s heureux que le projet de loi <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C\u201162</a> renferme cette exigence l\u00e9gislative et, surtout, que le comit\u00e9 ait le temps qu'il aurait d\u00fb avoir pour examiner cet enjeu extr\u00eamement complexe et d\u00e9licat avant l'entr\u00e9e en vigueur de ce r\u00e9gime. Avoir eu plus de temps dans les \u00e9tapes pr\u00e9c\u00e9dentes du processus l\u00e9gislatif aurait \u00e9t\u00e9 une tr\u00e8s bonne chose.</p>\n<p data-HoCid=\"8181618\" data-originallang=\"en\">Je pense qu'il est important de revenir un peu en arri\u00e8re pour voir comment nous en sommes arriv\u00e9s l\u00e0. En tant que membre du comit\u00e9 mixte sp\u00e9cial, j'ai eu l'impression que nous essayions de faire du rattrapage par rapport \u00e0 un changement apport\u00e9 \u00e0 la loi avant que nous ayons la possibilit\u00e9 de nous pencher s\u00e9rieusement sur le sujet.</p>\n<p data-HoCid=\"8181619\" data-originallang=\"en\">Le projet de loi <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u20117</a>, pr\u00e9sent\u00e9 au cours de la 43<sup> e</sup> l\u00e9gislature, \u00e9tait, bien s\u00fbr, la r\u00e9ponse du gouvernement du Canada \u00e0 la d\u00e9cision Truchon. Elle a cr\u00e9\u00e9 une voie distincte dans le Code criminel pour les personnes dont la mort n\u2019\u00e9tait pas naturellement pr\u00e9visible. Avant cela, il fallait \u00eatre atteint d'un probl\u00e8me de sant\u00e9 dont la mort naturelle \u00e9tait pr\u00e9visible. Donc, essentiellement, c'\u00e9tait pour les personnes atteintes d'un cancer en phase terminale, qui \u00e9prouvaient de grandes souffrances, et cetera.</p>\n<p data-HoCid=\"8181620\" data-originallang=\"en\">Cependant, il est important de souligner que lorsque le gouvernement a pr\u00e9sent\u00e9 le projet de loi <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u20117</a> pour la premi\u00e8re fois, il y avait d\u00e9j\u00e0 des questions \u00e0 ce moment-l\u00e0, avant le d\u00e9p\u00f4t du projet de loi, sur ce qu'il fallait faire pour les personnes atteintes d'une maladie mentale qui, dans certains cas \u2014 comme mon coll\u00e8gue l'a soulign\u00e9 \u2014, souffrent depuis des d\u00e9cennies, et pour qui les traitements n'ont pas fonctionn\u00e9. Que devions-nous faire dans ces cas-l\u00e0?</p>\n<p data-HoCid=\"8181621\" data-originallang=\"en\">D'entr\u00e9e de jeu, le gouvernement \u00e9tait l\u00e9galement tenu d'accompagner la mesure l\u00e9gislative d'un \u00e9nonc\u00e9 concernant la Charte. Or, les troubles mentaux \u00e9taient express\u00e9ment exclus de la version initiale du projet de loi <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u20117</a>. Selon moi, le gouvernement a fourni \u00e0 l'\u00e9poque un \u00e9nonc\u00e9 concernant la Charte plut\u00f4t bien \u00e9tay\u00e9. On savait qu'exclure les troubles mentaux pouvait faire intervenir deux articles majeurs de la Charte des droits et libert\u00e9s, \u00e0 savoir l\u2019article 7, qui porte sur la s\u00e9curit\u00e9 de la personne et qui indique essentiellement que chacun a le droit de d\u00e9cider quoi faire de son propre corps, et l\u2019article 15, qui porte sur le droit \u00e0 l\u2019\u00e9galit\u00e9 et qui indique que la loi doit s\u2019appliquer \u00e0 tous sans distinction. Ainsi, l'exclusion risquait d'enfreindre ces deux articles.</p>\n<p data-HoCid=\"8181622\" data-originallang=\"en\">Dans son \u00e9nonc\u00e9 concernant la Charte, le gouvernement a indiqu\u00e9 ceci:</p>\n<blockquote><p data-HoCid=\"8181623\" data-originallang=\"en\"> D\u2019abord, les donn\u00e9es probantes d\u00e9montrent qu\u2019il est particuli\u00e8rement difficile d\u2019\u00e9valuer la capacit\u00e9 d\u00e9cisionnelle des personnes qui sont atteintes d\u2019une maladie mentale qui est suffisamment grave pour justifier la pr\u00e9sentation d\u2019une demande d\u2019aide m\u00e9dicale \u00e0 mourir, et le risque d\u2019erreur est \u00e9lev\u00e9 lors d\u2019une telle \u00e9valuation. Ensuite, il est g\u00e9n\u00e9ralement plus difficile de pr\u00e9voir l\u2019\u00e9volution d\u2019une maladie mentale que l\u2019\u00e9volution d\u2019une maladie physique. Enfin, l\u2019exp\u00e9rience r\u00e9cente dans les quelques pays o\u00f9 l\u2019aide m\u00e9dicale \u00e0 mourir est permise (Belgique, Pays\u2011Bas et Luxembourg) a soulev\u00e9 quelques pr\u00e9occupations. </p>\n</blockquote><p data-HoCid=\"8181624\" data-originallang=\"en\">C'\u00e9tait la position initiale du gouvernement sur le projet de loi <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u20117</a>.</p>\n<p data-HoCid=\"8181625\" data-originallang=\"en\">La Chambre a adopt\u00e9 le projet de loi <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u20117</a>, qui a \u00e9t\u00e9 renvoy\u00e9 au S\u00e9nat. L\u00e0, pour des motifs qui demeurent obscurs \u00e0 mes yeux, le gouvernement a d\u00e9cid\u00e9 d'accepter, essentiellement \u00e0 la derni\u00e8re minute, un amendement qui a eu d'importantes r\u00e9percussions pour le projet de loi. En gros, le S\u00e9nat a renvers\u00e9 la position d'origine du gouvernement concernant l'admissibilit\u00e9 des troubles mentaux dans le cas de l'aide m\u00e9dicale \u00e0 mourir. </p>\n<p data-HoCid=\"8181626\" data-originallang=\"en\">Le gouvernement a accept\u00e9 l'amendement du S\u00e9nat. Bien entendu, comme le projet de loi <a data-HoCid=\"10648716\" href=\"/bills/43-1/C-7/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u20117</a> avait \u00e9t\u00e9 amend\u00e9, il a d\u00fb \u00eatre renvoy\u00e9 \u00e0 la Chambre, o\u00f9 le gouvernement est parvenu de peine et de mis\u00e8re \u00e0 recueillir suffisamment de votes pour le faire adopter. </p>\n<p data-HoCid=\"8181627\" data-originallang=\"en\">Nous, les parlementaires, avons donc h\u00e9rit\u00e9 d'une loi qui avait \u00e9t\u00e9 modifi\u00e9e avant le dur travail consistant \u00e0 mener des consultations et des recherches appropri\u00e9es, et \u00e0 discuter de la question avec des t\u00e9moins experts et des repr\u00e9sentants des syst\u00e8mes de sant\u00e9 qui \u00e9taient les principaux responsables de superviser le changement dans la loi. </p>\n<p data-HoCid=\"8181628\" data-originallang=\"en\">Un groupe d'experts a effectivement \u00e9t\u00e9 form\u00e9. Le comit\u00e9 mixte sp\u00e9cial s'est r\u00e9uni. Bien entendu, ses travaux ont \u00e9t\u00e9 interrompus par le d\u00e9clenchement inutile d'\u00e9lections \u00e0 l'\u00e9t\u00e9 2021. On a ainsi perdu un temps tr\u00e8s pr\u00e9cieux car, bien entendu, il a fallu attendre la convocation de la 44<sup>e</sup> l\u00e9gislature. </p>\n<p data-HoCid=\"8181629\" data-originallang=\"en\">Cependant, il est important de comprendre que tout ce qui s'est pass\u00e9 depuis lors d\u00e9coule du fait que le gouvernement a accept\u00e9 l'amendement du S\u00e9nat. Comme je l'ai dit, j'ai l'impression \u2014 et je pense que l'impression d'un membre du comit\u00e9 mixte sp\u00e9cial a une certaine validit\u00e9 \u00e0 la Chambre \u2014 que nous avons essay\u00e9 de faire du rattrapage depuis ce moment-l\u00e0.</p>\n<p data-HoCid=\"8181630\" data-originallang=\"en\">La p\u00e9riode pendant laquelle j'ai si\u00e9g\u00e9 au comit\u00e9 mixte sp\u00e9cial n'a pas \u00e9t\u00e9 de tout repos. Il ne s'agit pas d'un sujet facile \u00e0 traiter, car les opinions des personnes ayant une exp\u00e9rience v\u00e9cue et celles des professionnels vont vraiment d'une extr\u00e9mit\u00e9 du spectre \u00e0 l'autre. Il peut \u00eatre assez difficile pour un parlementaire de s'y retrouver et d'essayer de comprendre les arguments juridiques et m\u00e9dicaux complexes qui sous-tendent la question, mais c'est important.</p>\n<p data-HoCid=\"8181631\" data-originallang=\"en\">Personnellement, je dirais que, dans le cadre de mon travail au sein du comit\u00e9, j'ai vraiment eu de la difficult\u00e9 \u00e0 trouver un \u00e9quilibre entre deux concepts qui semblent parfois s'opposer. Je crois fermement en la Charte canadienne des droits et libert\u00e9s. Je pense qu'il s'agit d'un document tr\u00e8s important dans l'histoire du Canada, et je crois que nous devons respecter le droit d'une personne de d\u00e9cider de ce qu'elle fait de son propre corps. Cependant, mon syst\u00e8me de croyances a toujours eu du mal \u00e0 concilier ce droit avec un autre concept, \u00e0 savoir que la soci\u00e9t\u00e9 se trouve parfois dans une position o\u00f9 il est n\u00e9cessaire qu'elle intervienne pour prot\u00e9ger ses membres les plus vuln\u00e9rables. Je pense que ces deux th\u00e8mes ont \u00e9t\u00e9 repris non seulement par moi, mais aussi par de nombreux t\u00e9moins qui ont comparu devant notre comit\u00e9 et dans les nombreux m\u00e9moires que nous avons re\u00e7us.</p>\n<p data-HoCid=\"8181632\" data-originallang=\"en\">Je tiens \u00e9galement \u00e0 souligner que le comit\u00e9 mixte sp\u00e9cial s'est r\u00e9uni \u00e0 deux reprises au cours de la pr\u00e9sente l\u00e9gislature. Nous avons pr\u00e9sent\u00e9 notre deuxi\u00e8me rapport en f\u00e9vrier de l'an dernier en vue de l'\u00e9tude du projet de loi <a data-HoCid=\"12189059\" href=\"/bills/44-1/C-39/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying)\">C\u201139</a>. \u00c0 l'\u00e9poque, le mandat du comit\u00e9 \u00e9tait guid\u00e9 par cinq th\u00e8mes que nous devions examiner, et l'aide m\u00e9dicale \u00e0 mourir dans les cas o\u00f9 le seul probl\u00e8me de sant\u00e9 invoqu\u00e9 est une maladie mentale \u00e9tait l'un d'entre eux. Bien s\u00fbr, le comit\u00e9 s'est r\u00e9uni de nouveau apr\u00e8s l'adoption du projet de loi <a data-HoCid=\"12189059\" href=\"/bills/44-1/C-39/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying)\">C\u201139</a>, mais, comme l'a soulign\u00e9 mon coll\u00e8gue de <a data-HoCid=\"278281\" href=\"/politicians/luc-theriault/\" title=\"Luc Th\u00e9riault\">Montcalm</a>, le d\u00e9lai \u00e9tait extr\u00eamement court. Ce d\u00e9lai ne rendait pas justice \u00e0 l'extr\u00eame complexit\u00e9 de la question, qui n\u00e9cessitait une r\u00e9flexion plus longue.</p>\n<p data-HoCid=\"8181633\" data-originallang=\"en\">Pour que les choses soient bien claires pour les gens qui nous \u00e9coutent, pr\u00e9cisons que la premi\u00e8re r\u00e9union de notre comit\u00e9 a eu lieu le 31 octobre. Nous avons d\u2019abord d\u00fb nous occuper de certaines formalit\u00e9s administratives et proc\u00e9der \u00e0 l\u2019\u00e9lection des pr\u00e9sidents et des vice-pr\u00e9sidents. Nous n\u2019avons tenu que trois r\u00e9unions de trois heures pour entendre des t\u00e9moins, soit neuf heures en tout. Par la force des choses, nous avons exclu beaucoup de gens que j\u2019aurais beaucoup aim\u00e9 entendre, notamment des administrateurs de notre syst\u00e8me de sant\u00e9 publique, des \u00e9lus des gouvernements provinciaux et ainsi de suite. </p>\n<p data-HoCid=\"8181634\" data-originallang=\"en\">En raison du court d\u00e9lai, nous n\u2019avons m\u00eame pas eu le temps de faire traduire ad\u00e9quatement tous les m\u00e9moires qui nous avaient \u00e9t\u00e9 envoy\u00e9s parce que, bien s\u00fbr, avant de pouvoir les distribuer aux membres du Comit\u00e9, ils devaient \u00eatre traduits en fran\u00e7ais et en anglais. C\u2019est une exigence qui fait honneur au bilinguisme de notre pays. Les membres du comit\u00e9 n'ont m\u00eame pas eu l\u2019occasion d\u2019examiner des m\u00e9moires importants, qui provenaient de personnes ayant une exp\u00e9rience personnelle et devant g\u00e9rer la situation \u00e0 la maison, mais aussi de nombreux professionnels dont la pratique est li\u00e9e \u00e0 ce domaine en particulier.</p>\n<p data-HoCid=\"8181635\" data-originallang=\"en\">Ma position est claire l\u00e0-dessus. Quand le d\u00e9put\u00e9 d\u2019<a data-HoCid=\"278549\" href=\"/politicians/ed-fast/\" title=\"Ed Fast\">Abbotsford</a> a pr\u00e9sent\u00e9 le projet de loi <a data-HoCid=\"12210462\" href=\"/bills/44-1/C-314/\" title=\"An Act to amend the Criminal Code (medical assistance in dying)\">C\u2011314</a> l'automne dernier, j'ai vot\u00e9 en faveur, ce qui veut dire que mon vote sur la question est bien clair. Je m'appuie sur ce que j'ai constat\u00e9 au sein de notre comit\u00e9, c'est-\u00e0-dire que des m\u00e9decins dans le domaine, ainsi que des psychiatres et des psychologues, ont dit \u00e9prouver un grand malaise sur le plan professionnel. Bien s\u00fbr, certains d\u2019entre eux agissent peut-\u00eatre de fa\u00e7on paternaliste, mais je ne pense pas que ce soit le cas de tout le monde. Je pense que dans le cas de certains, nous devons r\u00e9\u00e9valuer leur point de vue. Nous devons tenir compte du contexte dans lequel ce point de vue a \u00e9t\u00e9 exprim\u00e9. Je pense qu'ils m\u00e9ritent notre respect, \u00e9tant donn\u00e9 qu\u2019il s\u2019agit d'une vocation et que, dans bien des cas, ils comptent des d\u00e9cennies d'exp\u00e9rience. </p>\n<p data-HoCid=\"8181636\" data-originallang=\"en\">Je vais prendre quelques instants pour lire des extraits des t\u00e9moignages entendus. Nous avons accueilli le Dr Jitender Sareen, du D\u00e9partement de psychiatrie de l'Universit\u00e9 du Manitoba. Il repr\u00e9sentait \u00e9galement les directeurs des d\u00e9partements de psychiatrie de l'\u00c9cole de m\u00e9decine du Nord de l'Ontario, de l'Universit\u00e9 McMaster, de l'Universit\u00e9 McGill, de l'Universit\u00e9 Memorial, de l'Universit\u00e9 d'Ottawa et de l'Universit\u00e9 Queen's. Il a dit que tous ces directeurs recommandaient instamment de \u00ab suspendre durablement l'\u00e9largissement de l'aide m\u00e9dicale \u00e0 mourir aux troubles mentaux [...] tout simplement parce que nous ne sommes pas pr\u00eats \u00bb. Il a insist\u00e9 sur l'id\u00e9e que nous ne serions pas pr\u00eats dans un an.</p>\n<p data-HoCid=\"8181637\" data-originallang=\"en\"> M. Trudo Lemmens, qui est professeur en droit et en politique de la sant\u00e9 de la Facult\u00e9 de droit de l'Universit\u00e9 de Toronto, est venu t\u00e9moigner pour pr\u00e9ciser quelques arguments constitutionnels. Il a vraiment voulu insister sur l'id\u00e9e qu'il fallait trouver le juste \u00e9quilibre entre les droits pr\u00e9vus aux articles 7 et 15 et l'article 1, un point qui n'a pas \u00e9t\u00e9 tranch\u00e9 par les tribunaux, contrairement \u00e0 ce que certains t\u00e9moins ont pu pr\u00e9tendre. Dans le cadre du d\u00e9bat de ce soir, des intervenants pr\u00e9c\u00e9dents ont aussi soulign\u00e9 que la d\u00e9cision Truchon ne faisait aucune mention des troubles mentaux. C'est un point important \u00e0 prendre en compte.</p>\n<p data-HoCid=\"8181638\" data-originallang=\"en\"> Le Dr Sonu Gaind, qui est le chef du D\u00e9partement de psychiatrie du Centre des sciences de la sant\u00e9 Sunnybrook, a dit ce qui suit:</p>\n<blockquote><p data-HoCid=\"8181639\" data-originallang=\"en\"> L'AMM est offerte aux personnes atteintes de probl\u00e8mes de sant\u00e9 irr\u00e9m\u00e9diables dont on peut pr\u00e9voir qu'ils ne s'am\u00e9lioreront pas. Or, les donn\u00e9es produites un peu partout dans le monde d\u00e9montrent que le caract\u00e8re irr\u00e9m\u00e9diable ne peut pas \u00eatre pr\u00e9dit dans le cas des maladies mentales. Autrement dit, la premi\u00e8re mesure de sauvegarde de l'AMM serait d\u00e9j\u00e0 court-circuit\u00e9e selon les donn\u00e9es qui r\u00e9v\u00e8lent que les pr\u00e9dictions sont erron\u00e9es dans plus de la moiti\u00e9 des cas. </p>\n<p data-HoCid=\"8181640\" data-originallang=\"en\"> Les donn\u00e9es scientifiques d\u00e9montrent l'impossibilit\u00e9 de distinguer entre les id\u00e9ations suicidaires caus\u00e9es par la maladie mentale et les conditions qui conduisent \u00e0 faire une demande d'AMM pour des motifs psychiatriques. Les caract\u00e9ristiques en commun dans les deux situations laissent entendre qu'il n'y a peut-\u00eatre aucune distinction \u00e0 \u00e9tablir. </p>\n</blockquote><p data-HoCid=\"8181641\" data-originallang=\"en\">Il a aussi indiqu\u00e9 que le programme utilis\u00e9 n'enseigne pas aux \u00e9valuateurs \u00e0 faire la distinction entre les pens\u00e9es suicidaires et les demandes d'aide m\u00e9dicale \u00e0 mourir pour des motifs psychiatriques, et ainsi de suite.</p>\n<p data-HoCid=\"8181642\" data-originallang=\"en\">Nous avons \u00e9galement entendu le t\u00e9moignage du Dr Tarek Rajji, m\u00e9decin-chef du Comit\u00e9 m\u00e9dical consultatif au Centre de toxicomanie et de sant\u00e9 mentale. Il a dit:</p>\n<blockquote><p data-HoCid=\"8181643\" data-originallang=\"en\"> Le CTSM craint que le syst\u00e8me de soins de sant\u00e9 ne soit pas pr\u00eat pour mars 2024. Les lignes directrices cliniques, les ressources et les processus ne sont pas en place pour \u00e9valuer les personnes, d\u00e9terminer leur admissibilit\u00e9 et dispenser l'aide m\u00e9dicale \u00e0 mourir lorsque l'admissibilit\u00e9 est confirm\u00e9e pour les personnes dont la seule condition m\u00e9dicale sous-jacente est la maladie mentale. </p>\n</blockquote><p data-HoCid=\"8181644\" data-originallang=\"en\">Ces t\u00e9moignages donnent un aper\u00e7u du malaise g\u00e9n\u00e9ralis\u00e9 qui existe parmi les professionnels, et je ne pense pas que nous puissions \u00e9carter ces voix.</p>\n<p data-HoCid=\"8181645\" data-originallang=\"en\">Je conviens qu'il y avait aussi un certain nombre de professionnels qui, d'un autre c\u00f4t\u00e9, estimaient que nous \u00e9tions pr\u00eats, et c'est ce qui rend le sujet tr\u00e8s complexe et d\u00e9licat \u00e0 traiter pour les parlementaires que nous sommes. Comme je l'ai dit, le comit\u00e9 aurait d\u00fb avoir le temps et les moyens n\u00e9cessaires pour vraiment approfondir ces questions et \u00e9largir consid\u00e9rablement sa liste de t\u00e9moins pour s'assurer d'\u00eatre vraiment pr\u00eat.</p>\n<p data-HoCid=\"8181646\" data-originallang=\"en\">Les d\u00e9put\u00e9s remarqueront que le r\u00e9cent rapport du comit\u00e9 ne contenait qu'une seule recommandation. Je reconnais que la recommandation \u00e9manait de la majorit\u00e9 des membres du comit\u00e9. Il y a eu des opinions dissidentes, notamment de la part des s\u00e9nateurs qui si\u00e9geaient au comit\u00e9. Cependant, le comit\u00e9 a reconnu que le Canada n'est pas pr\u00eat \u00e0 offrir l'aide m\u00e9dicale \u00e0 mourir lorsqu'un trouble mental est le seul probl\u00e8me de sant\u00e9 invoqu\u00e9, et nous n'avons pas fix\u00e9 d'\u00e9ch\u00e9ance arbitraire pour la recommandation. Nous avons demand\u00e9 express\u00e9ment que l'aide m\u00e9dicale \u00e0 mourir ne soit pas offerte au Canada tant que les ministres de la Sant\u00e9 et de la Justice ne seront pas convaincus, \u00e0 la lumi\u00e8re des recommandations de leur minist\u00e8re respectif et des r\u00e9sultats des consultations aupr\u00e8s de leurs homologues provinciaux et territoriaux et des peuples autochtones, qu'elle peut \u00eatre offerte de fa\u00e7on s\u00fbre et ad\u00e9quate.</p>\n<p data-HoCid=\"8181647\" data-originallang=\"en\">On s'attire toujours des ennuis quand on fixe des \u00e9ch\u00e9ances arbitraires. L'\u00e9tablissement d'un \u00e9ch\u00e9ancier arbitraire n'est pas un substitut acceptable au travail qualitatif qui doit \u00eatre fait par ces minist\u00e8res. Je pr\u00e9f\u00e9rerais de loin que nous respections l'exigence qualitative de la recommandation, car les minist\u00e8res, les experts et nos coll\u00e8gues provinciaux et territoriaux se disent favorables \u00e0 cela.</p>\n<p data-HoCid=\"8181648\" data-originallang=\"en\">La recommandation et mon allusion aux provinces et aux territoires constituent une excellente transition vers le fait qu'une lettre a \u00e9galement \u00e9t\u00e9 envoy\u00e9e au <a data-HoCid=\"300010\" href=\"/politicians/mark-holland/\" title=\"Mark Holland\">ministre de la Sant\u00e9</a>. Cette lettre a \u00e9t\u00e9 sign\u00e9e par 7 des 10 provinces et par les 3 territoires. Les signatures comprennent celles de tous les ministres de la Sant\u00e9 et des ministres responsables de la sant\u00e9 mentale et des d\u00e9pendances dans ces provinces, y compris Adrian Dix et Jennifer Whiteside, en Colombie\u2011Britannique. Ce qu'ils disent est sans \u00e9quivoque:</p>\n<blockquote><p data-HoCid=\"8181649\" data-originallang=\"en\"> L'\u00e9ch\u00e9ance actuelle du 17 mars 2024 ne laisse pas suffisamment de temps pour pr\u00e9parer pleinement et de fa\u00e7on appropri\u00e9e toutes les provinces et tous les territoires du Canada [...] </p>\n<p data-HoCid=\"8181650\" data-originallang=\"en\"> Nous vous encourageons, ainsi que le ministre f\u00e9d\u00e9ral de la Justice, \u00e0 suspendre ind\u00e9finiment la mise en \u0153uvre des crit\u00e8res d'admissibilit\u00e9 \u00e9largis \u00e0 l'aide m\u00e9dicale \u00e0 mourir afin de permettre une collaboration accrue entre les provinces, les territoires et le gouvernement f\u00e9d\u00e9ral. </p>\n</blockquote><p data-HoCid=\"8181651\" data-originallang=\"en\">Je conclurai en disant qu'il s'agit d'une question tr\u00e8s d\u00e9licate. Je pense que nous devrions adopter le projet de loi <a data-HoCid=\"12840488\" href=\"/bills/44-1/C-62/\" title=\"An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2\">C\u201162</a> et honorer les appels que nous entendons de la part des professionnels intimement concern\u00e9s par cette question, ainsi que les appels provenant des provinces et des territoires. Nous devons prendre les devants et faire en sorte de disposer d'un syst\u00e8me pleinement pr\u00eat avant de modifier la moindre loi.</p>"
    },
    "url": "/debates/2024/2/7/alistair-macgregor-5/",
    "politician_url": "/politicians/alistair-macgregor/",
    "politician_membership_url": "/politicians/memberships/4409/",
    "procedural": false,
    "source_id": "12565551",
    "h1": {
        "en": "Government Orders",
        "fr": "Ordres \u00e9manant du gouvernement"
    },
    "h2": {
        "en": "Criminal Code",
        "fr": "Le Code criminel"
    },
    "document_url": "/debates/2024/2/7/",
    "related": {
        "document_speeches_url": "/speeches/?document=%2Fdebates%2F2024%2F2%2F7%2F"
    }
}