Senators Pamela Wallin, left, Stan Kutcher, and Marie-Francoise Megie attend a press conference to call on the government to fulfill its obligation regarding access to Medical Assistance in Dying (MAID) where mental health is the sole underlying condition, in Ottawa on Feb. 1.PATRICK DOYLE/The Canadian Press
If you’ve ever wondered why substantial change never seems to come to health care, look no further than the federal and provincial government handling of medical assistance in dying and mental illness.
Any time there is a moderately difficult decision to make, we seem to punt it forward. We do nothing because we’re “not ready,” without defining what readiness means. The institutional and political cowardice is dispiriting.
In 2015, the Supreme Court ruled on the case of Kathleen Carter, saying Canadians do have a right to MAID, but gave legislators time to fashion a law. A year later, Parliament passed Bill C-14, which legalized MAID, but only if people suffered from a “grievous and irremediable condition” and their death was “reasonably foreseeable.” The latter condition was struck down in a 2019 Quebec court decision.
The federal government was given a year to adjust MAID regulations, but took two to do so. In March, 2021, Bill C-7 removed the “reasonably foreseeable” clause and created two tracks for MAID requests. But legislators delayed access for it if the sole underlying condition was a mental disorder (MAID-SUMC for short) until March, 2023. That was delayed another year, to give time for committees to study the matter. With that deadline imminent, a joint committee of MPs and Senators decided last week they again need more time. The federal government jumped on that recommendation and proposed extending the delay for legalizing MAID-SUMC to 2027.
There is no question that allowing people with mental illness to access MAID is a complex and fraught issue. We need to balance individual rights with protecting the vulnerable. But these decisions need to be made on a case-by-case basis, between an individual and medical practitioners.
The role of government here is mostly to get out of the way. Politicians should no more be deciding who accesses MAID than they should be deciding who gets a heart transplant.
We keep hearing that Canada is “not ready” for MAID-SUMC. But readiness has two aspects. Legally, governments need to respect the court rulings and ensure that there is no discrimination in accessing MAID in the legislation. Medically, with the expansion of MAID, readiness means practitioners have to be prepared to tackle three key issues: Establish that a condition is irremediable; ensure the requester is competent; and distinguish between patients who are suicidal and those making a rational and sustained request for MAID.
None of these issues are unique to people with mental disorders, though some are slightly more complicated. There are some psychiatrists who argue that no mental illness is untreatable, but there are patients who have suffered for decades who take issue with that position. Ultimately, we have to find the balance between individual autonomy and protecting the vulnerable.
Canada has about 96,000 physicians; at last count (in 2021), only 1,577 of them had provided MAID. By all accounts, they have done so in a responsible and ethical manner, relieving the suffering of almost 45,000 Canadians as of 2022.
There are practice standards for medical assistance in dying, and they need to be tweaked. Practitioners will get additional training on how to handle some of the issues that are especially challenging in reviewing requests from patients with a mental disorder.
The same will apply in dealing with MAID requests from mature minors and advance requests from people living with dementia. (By the way, both of these were endorsed by the joint committee of MPs and Senators, but have generated little media coverage.)
MAID is an emotional issue, with many political, moral, and social entanglements. We hear repeatedly of fears that people with disabilities – mental, physical and developmental – will seek assisted death because of difficulties accessing care or social supports.
There is no question we need to bolster access to mental health care, especially for the sickest. If we are worried about rates of suicide – and with 3,593 suicide deaths in 2022, according to Statistics Canada’s most recent data, we should be – then why doesn’t Canada have a national suicide strategy?
Unquestionably, too many people with disabilities are living in poverty. But that doesn’t mean we should deny MAID to those who are eligible and request assisted death. No one should be coerced. But neither should we hold individuals hostage until we fix systemic problems.
If legislators have doubts about their ability to draft legislation, they should refer the issue directly to the Supreme Court of Canada – an eminently sensible recommendation from Senator Pierre Dalphond.
There is no reason we have to wait until 2027 to fix the law when solutions are at hand. The job of legislators is to legislate, not procrastinate.
Simon Jolin-Barrette, minister responsible for consumer protection, has tabled a bill to force merchants to calculate tips based on the price before tax.
That means on a restaurant bill of $100, suggested tips would be calculated based on $100, not on $114.98 after provincial and federal sales taxes are added.
The bill would also increase the rebate offered to consumers when the price of an item at the cash register is higher than the shelf price, to $15 from $10.
And it would force grocery stores offering a discounted price for several items to clearly list the unit price as well.
Businesses would also have to indicate whether taxes will be added to the price of food products.
This report by The Canadian Press was first published Sept. 12, 2024.
Quebec legislature member Youri Chassin has announced he’s leaving the Coalition Avenir Québec government to sit as an Independent.
He announced the decision shortly after writing an open letter criticizing Premier François Legault’s government for abandoning its principles of smaller government.
In the letter published in Le Journal de Montréal and Le Journal de Québec, Chassin accused the party of falling back on what he called the old formula of throwing money at problems instead of looking to do things differently.
Chassin says public services are more fragile than ever, despite rising spending that pushed the province to a record $11-billion deficit projected in the last budget.
He is the second CAQ member to leave the party in a little more than one week, after economy and energy minister Pierre Fitzgibbon announced Sept. 4 he would leave because he lost motivation to do his job.
Chassin says he has no intention of joining another party and will instead sit as an Independent until the end of his term.
He has represented the Saint-Jérôme riding since the CAQ rose to power in 2018, but has not served in cabinet.
This report by The Canadian Press was first published Sept. 12, 2024.
MONTREAL – NDP Leader Jagmeet Singh says he will not be taking advice from Pierre Poilievre after the Conservative leader challenged him to bring down government.
“I say directly to Pierre Poilievre: I’m not going to listen to you,” said Singh on Wednesday, accusing Poilievre of wanting to take away dental-care coverage from Canadians, among other things.
“I’m not going to listen to your advice. You want to destroy people’s lives, I want to build up a brighter future.”
Earlier in the day, Poilievre challenged Singh to commit to voting non-confidence in the government, saying his party will force a vote in the House of Commons “at the earliest possibly opportunity.”
“I’m asking Jagmeet Singh and the NDP to commit unequivocally before Monday’s byelections: will they vote non-confidence to bring down the costly coalition and trigger a carbon tax election, or will Jagmeet Singh sell out Canadians again?” Poilievre said.
“It’s put up or shut up time for the NDP.”
While Singh rejected the idea he would ever listen to Poilievre, he did not say how the NDP would vote on a non-confidence motion.
“I’ve said on any vote, we’re going to look at the vote and we’ll make our decision. I’m not going to say our decision ahead of time,” he said.
Singh’s top adviser said on Tuesday the NDP leader is not particularly eager to trigger an election, even as the Conservatives challenge him to do just that.
Anne McGrath, Singh’s principal secretary, says there will be more volatility in Parliament and the odds of an early election have risen.
“I don’t think he is anxious to launch one, or chomping at the bit to have one, but it can happen,” she said in an interview.
New Democrat MPs are in a second day of meetings in Montreal as they nail down a plan for how to navigate the minority Parliament this fall.
The caucus retreat comes one week after Singh announced the party has left the supply-and-confidence agreement with the governing Liberals.
It’s also taking place in the very city where New Democrats are hoping to pick up a seat on Monday, when voters go to the polls in Montreal’s LaSalle—Émard—Verdun. A second byelection is being held that day in the Winnipeg riding of Elmwood—Transcona, where the NDP is hoping to hold onto a seat the Conservatives are also vying for.
While New Democrats are seeking to distance themselves from the Liberals, they don’t appear ready to trigger a general election.
Singh signalled on Tuesday that he will have more to say Wednesday about the party’s strategy for the upcoming sitting.
He is hoping to convince Canadians that his party can defeat the federal Conservatives, who have been riding high in the polls over the last year.
Singh has attacked Poilievre as someone who would bring back Harper-style cuts to programs that Canadians rely on, including the national dental-care program that was part of the supply-and-confidence agreement.
The Canadian Press has asked Poilievre’s office whether the Conservative leader intends to keep the program in place, if he forms government after the next election.
With the return of Parliament just days away, the NDP is also keeping in mind how other parties will look to capitalize on the new makeup of the House of Commons.
The Bloc Québécois has already indicated that it’s written up a list of demands for the Liberals in exchange for support on votes.
The next federal election must take place by October 2025 at the latest.
This report by The Canadian Press was first published Sept. 11, 2024.
