Bill C-7 will be offering patients with mental illness the most readily available lethal means, instead of increased suicide prevention
March 17, 2021 (Ottawa, ON) - The Honourable Don Plett, Leader of the Opposition in the Senate, issued the following statement:
Honourable senators, I also rise today with tremendous sadness to speak to the government’s message on Bill C-7.
Before I go into my comments, I also would like to thank, first and foremost, the Legal Committee. They did a tremendous job of bringing in 130-some witnesses, and I thank the committee for that. I thank the chair of the committee, Senator Jaffer. I was able to be in on a number of the meetings, and Senator Jaffer had a difficult job keeping everything going and under control. I commend her for the good and impartial job she did of running the committee.
I thank the rest of the committee — committee members that were not on the same side of the issue as I was. However, I thank them for the work they did at committee. That is the great thing about this Parliament — the democratic process that we have — in that we do not need to agree with each other, but I believe we need to respect each other and each other’s opinions.
I want to thank my own caucus colleagues: Senator Carignan, the critic of the bill — I thank him for his work. I certainly want to thank the deputy chair, Senator Batters, for the tremendous job she did on the committee, as well as Senator Boisvenu. Then, of course, I’d like to thank those of our colleagues that subbed in occasionally. Thank you, each and every one of you.
I also, as Senator Martin did, want to thank the witnesses — witnesses who put themselves out — vulnerable — who opened themselves up. It’s tremendous to see that. We thank you for that, and for those of you who wanted something else than what we’re getting, I can only say that we will continue to fight; we will continue to fight for you, the vulnerable.
I want to thank all senators here. I actually believe that this bill showed that this is not a partisan issue. Quite frankly, I was saddened by Senator Dean’s comments about thanking those who independently voted as opposed to who voted along caucus lines. I’m not sure to whom he was referring. If he would check the records, he would see that, in fact, my good friend Senator Carignan, who was the leader of this caucus before Senator Smith, who was a leader directly before me — both Senator Smith and Senator Carignan, who were my leaders, voted differently on many of the votes that we had on this legislation.
So I’m not sure who is partisan — when Conservatives decide to vote together along with some other people, that it becomes a partisan issue. That is sad, colleagues. This legislation — any legislation before us — should not pull us apart and create partisan shots. This is not the legislation to do that with.
So please, colleagues, I have respect for each of you who will vote for the message later on today. I may not agree with you; I may even be angry at you, but that also is my right. I still respect your right to vote the way you do, and I fully hope you will respect my right to vote against this legislation and do everything I can to improve upon something I believe is not good.
Colleagues, with that, let me go into my comments here.
While the most troubling amendment that we are considering today originated in this chamber, I do want to say a few words about the process. We have heard that this amendment process represents Parliament at its best, and it has been a respectful process to date, so we should accept this message from the government. I respectfully disagree with that comment.
At the outset, Parliament was forced to begin consideration of a radical assisted suicide expansion proposal before beginning the mandatory parliamentary review of our current system. The five-year review was enshrined in the original legislation because we recognized the gravity of this paradigm shift. We all understood that any further expansion would have to take place after a careful, deliberate review of our current system.
This was not an optional review; this was mandatory.
We were then told that we are in this urgent situation because of a lower court ruling and an impending deadline. That is, of course, not the case. We are in this situation because of the personal agenda of the Justice Minister and the Trudeau government. And now, here we are, about to pass a piece of legislation that goes so far beyond the Truchon decision that any suggestion that this was ever intended to be a response to that ruling is absurd.
The government made an unprecedented decision to not appeal the Truchon decision made by one individual to the Supreme Court of Canada. As a result, we have been blindly making sweeping policy decisions based upon what some speculate they might say.
With an overhaul of this magnitude, it would have served us well to have some clarity on how to legislate going forward.
The government has also gotten in its own way repeatedly on meeting each extended deadline while blaming everybody else. The bill was first introduced over a year ago, a week after the government had already asked the superior court for its first extension. Then, instead of introducing a bill to simply respond to the ruling, the government introduced something far more radical and expansive, which would clearly require more time and scrutiny by Parliament.
Further extensions were requested, one due to the onset of the COVID-19 pandemic, which clearly limited Parliament’s ability to review and move the bill forward. Then the Prime Minister prorogued Parliament to avoid scrutiny of the WE scandal, which caused another missed deadline.
After the Senate’s cooperation, including an extensive pre-study, the government insulted the parliamentary process by insisting that we “put our shoulders to the wheel” and rush the bill through to meet yet another extended deadline.
After this latest extension request, the government decided to pre-emptively shut down debate at the suggestion, of the Bloc Québécois, a party that does not believe the Senate should even exist, yet is happy to take the Senate’s suggestion on an issue they did not study in the House of Commons. The government, in collaboration with the Bloc, shut down debate on a brand-new, significant proposal that received no scrutiny in their chamber.
The House of Commons Justice Committee called no witnesses to weigh in on the topic of MAID for mental illness because it was not part of the bill. Then, after receiving the Senate’s message, the government allowed for mere days — mere hours — of consideration before invoking a closure motion, putting an immediate halt to further questions, further study and dissenting opinions, and charged forward anyway. This was clearly done because the pressure was ramping up.
Outrage from mental health advocates, psychiatrists, professional associations and Canadians across the country was resounding. Word was getting out. The government needed this to be over quickly. Rather than give the House of Commons an opportunity to consider something as profound as offering assisted suicide to Canadians suffering solely from a mental illness, they put an end to the discussion. The contempt for Parliament this government has demonstrated with their handling of this life-and-death bill should concern all Canadians.
On Monday, Senator Gold said that the government had demonstrated an openness to considering any constructive amendments that were consistent with the objectives of the bill. But, Senator Gold, we have been told that the objective of the bill was to respond to the Truchon decision. The accepted amendments clearly did not reflect that. So what are the objectives of this legislation?
The government leader and the sponsor had prepared speeches in opposition to amendments that simply preserved existing safeguards before hearing supporting arguments and then voted against them. Yet, on a pillar of this legislation — the crucial exclusion defended by the government for several months — all three government senators and the sponsor of this bill pivoted from their second reading position and suddenly had no opinion and abstained.
Are we to believe that this was a coincidence and that the government was truly open to any reasonable amendment? Are we to believe that the government carefully considered our message after they received it, assessed its compliance with the Truchon decision and then made their final decision? Of course not.
They knew which amendments they would accept and reject long before the vote in this chamber. That became abundantly clear after the abstentions on the sunset clause amendment — an exclusion that both the sponsor and the government leader passionately defended in their second reading speeches.
Let’s be clear. The objective from the outset has not been to respond to the Truchon decision. The objective has been to bring the legislation in alignment with Minister Lametti’s and the government’s personal views on this matter.
This is an amendment, colleagues, that I suspect was drafted in Minister Lametti’s office. If this is Parliament at its best, I would hate to see Parliament at its worst. What is most concerning is the policy Canadians will be left with as a result.
Honourable senators, like many across the country, I am heartbroken. For the life of me, I cannot understand why we would move at this rapid pace with a clear absence of evidence and such dire consequences.
There are a wide range of views on this matter. While I have tremendous difficulty understanding the rationale behind including mental illness in this regime, I truly, would like to believe this perspective is born out of compassion.
However, the key to this discussion is that our entire MAID system in Canada, as stipulated by the Supreme Court of Canada, is founded upon the notion that only those suffering from conditions that are grievous and irremediable can qualify for assisted suicide. As psychiatrist Dr. Sonu Gaind, the former president of the Canadian Psychiatric Association said recently, “. . . it remains currently impossible to predict whether mental illness is irremediable.” “On this question, there is no legitimate debate.”
The Centre for Addiction and Mental Health has also concluded there is simply not enough evidence available in the mental health field to ascertain whether a particular individual has an irremediable mental illness.
The Canadian Mental Health Association echoed the concerns of the psychiatry associations and stated that Canada must continue to exclude mental illness as a sole underlying cause for medical assistance in dying.
Margaret Eaton, the CEO of CMHA, in her plea to Parliament, stated:
We have to cure our ailing mental health system in Canada before we even begin to consider mental illness incurable.
After 15 months of studying global evidence, the Council of Canadian Academies came to the same conclusion, as did the expert advisory group on MAID. Both the American Psychiatric Association and the Royal Australian and New Zealand College of Psychiatrists have also concluded that there is no evidence to support providing MAID solely for mental illness.
Minister Lametti himself said at the House Justice Committee, and again at our own Legal Committee, that there is no consensus in the mental health and psychiatric community that could justify moving forward with extending MAID access to those suffering from mental illness at this time. Then just last week, Minister Lametti said in the House of Commons that there is a large consensus to include mental illness in this regime. I’m assuming he read the same report that Senator Kutcher read.
There has either been a sudden, drastic shift in the views of Canada’s psychiatric community coinciding with the government’s changing policy objective, or the minister is willfully misleading Parliament. The minister cannot answer any questions about his sudden change of heart, but rather suggested that because this will not be in effect tomorrow — that this would take place in two years — that somehow demonstrates an exercise of caution.
This amendment — and Senator Batters pointed this out clearly the other day again — does not give Parliament two years to study whether mental illness should be included. Rather, it makes the dangerous assumption that the evidence will somehow present itself and retroactively justify this leap. As psychiatrist Dr. Mark Sinyor stated:
In other areas of medicine, thoughtful scientists typically devote whole careers —
— Senator Martin said this earlier —
— to meticulously studying benefits and harms of treatments before rolling them out. Here, that proven approach has inexplicably been replaced with hand-waving and moralizing.
The sunset clause is being sold as a way to allow time to develop standards or safeguards, but this notion has been discredited by the psychiatry community, as it ignores the only true safeguard that we have.
Dr. Gaind noted:
Those who advocate expanding access to MAID propose mitigating this reality with “safeguards.” This ignores the fact that irremediability is itself the primary safeguard built into the MAID framework, and bypassing it renders all other supposed “safeguards” meaningless.
Because we cannot predict irremediability, there is 100 per cent certainty that MAID will be provided to some people who could recover — there is no safeguard against that.
Honourable senators, there is no comfort to be gained from a 24-month delay, as the consequences have already begun. We have all received emails from psychiatrists telling us of their patients who have indicated their intention to stop treatment because MAID access is imminent; patients who were making slow, yet steady progress.
The sunset clause is nothing more than an attempt to soften the blow of horribly premature and ill-conceived policy. The question I have is: Why now? There is not a single person in this chamber who can stand up and tell us that we have any degree of professional consensus. If some major swing happens in two years, where we suddenly find that we have a kind of general consensus in the field of psychiatry, as well as some insight as to a shift in the views of Canadians, then there is nothing that would prevent the government of the day from considering this expansion.
But it cannot be argued that we are anywhere close to that today. With the lack of evidence, the lack of consensus, and the enormous risk this amendment takes, this is objectively a terrible policy decision.
So again I ask: Why now? What could possibly be the rationale? Constitutionality? The judge in the Truchon decision made no such assertion. We have no idea what the Supreme Court of Canada would say, because the government’s failure to appeal deprived Parliament of that insight.
We had legal experts testifying on both sides of this argument at committee, some who strongly maintained that the exclusion of mental illness was necessary, and entirely constitutional as it would be saved by section 1 of the Charter. We cannot even begin to suggest we have a legal consensus that excluding mental illness would be unconstitutional.
Senator Gold made an impassioned second reading speech, with a well-reasoned case for keeping the mental illness exclusion intact, making strong arguments as to the constitutionality of such an exclusion. And now that the policy objective has changed, so has the accompanying constitutional analysis.
Colleagues, I sincerely hope we are not placing too much importance on fleeting constitutional alarms, especially given that we have no direction from the Supreme Court of Canada on this point.
And regardless, as Senator MacDonald rightly pointed out in this chamber in his third reading speech, constitutional arguments are not relevant to our decision-making process. He said:
Senators are not litigators. The Senate is not a court of law. We do not adjudicate; we legislate. We can have a constitutional opinion on anything we like, but we shouldn’t presume to declare how the court will probably rule. This work is best left — indeed, must be left — to the court itself.
So please, colleagues, let us make the right policy decision with the information and evidence that is available, as the wrong decision can and will have terrible consequences.
When it comes to mental illness, we need to offer hope to those who have lost all hope. If that is not our first priority, we have failed. We need to focus on investments in research, in improved access to mental health treatment, in suicide prevention. Instead, this amendment offers assisted suicide to those who may be in the darkest days of their lives and who could very well come out of it.
Many of us have seen the viral video that was circulated since the Senate first passed the sunset clause amendment entitled “Tell Me To Stay,” in which a young woman who has attempted suicide seven times makes a plea with Parliament not to allow doctors to end the lives of people like her. As she says, “I’m the future version of myself who survived to tell you this.” She said that some people living with mental illness will thank you for making this possible, and that is the problem. She stated:
Had someone been willing to assist in my suicide during one of those lows, I know the life I lived would not have happened.
She said that while she was fighting those internal battles. She did not need someone willing to assist in her death; she needed someone to be her advocate and to fight for her.
Mental illness, colleagues, affects people of all ages, education, income level and cultures. We need to remind ourselves that the lives of people at stake here are our neighbours, our friends and our family members.
I recently heard from a person who has suffered from depression and anxiety for decades and has had varying success with treatments, yet has been doing well for quite some time. She said she was baffled and heartbroken that we would even be considering this at a time when we are finally, colleagues, on the cusp of a major societal shift — a shift which normalizes therapy, reduces stigma, and prioritizes access to mental health supports. As someone who has been silent and ashamed of her illness for decades, she can now feel the transformation happening. We are almost there, she noted, and the impact of this change on people like her could be profound. And now, before we get there, we are taking a giant leap backwards; a leap that could end lives like hers, in the name of autonomy.
We have all received correspondence from Canadians who have suffered from mental illness, who state unreservedly that had assisted suicide been available to them at their lowest points, they would no longer be here today. If we would have offered them a surefire way to end their suffering, they would not have bothered attempting suicide themselves with less certain means. Often, sadly, these unsuccessful suicide attempts are the first step toward treatment, toward healing and toward building a future.
We can look to Malcolm Gladwell’s research on coupling to understand this better. The work of Gladwell and others on this topic confirm, quite conclusively, that it is not simply the suicidal ideation of an individual with mental illness that results in their death. Rather, it is the suicidal ideation coupled with a particular circumstance.
For example, in 1963, poet Sylvia Plath, who had long suffered from depression, turned on the gas on her kitchen stove in England, placed her head inside the oven and took her own life. In the years after the First World War, many British homes began to use “town gas” to power their stoves and water heaters. This gas contained a variety of different compounds, including the odourless and deadly carbon monoxide. This gave individuals in Britain a simple means of dying by suicide in their own homes, and they used it. In the same year that Sylvia Plath ended her life, 5,588 people in England and Wales also died by suicide. Of those, 2,469 — or 44.2% — did so in the exact same manner as Plath. No other method came close.
In that same period, the British gas industry underwent a transformation. Town gas was increasingly expensive and dirty, so they converted to natural gas. By 1977, all town gas appliances were switched over to natural gas. The drop in gas suicides was significant: from 2,469 in 1962 to 0 in 1977. The assumption that many people make is that those who are so set on wanting to end their lives will simply switch to another method, that blocking one option will not make much difference. The reality is, after town gas was phased out, the overall suicide rate in England plummeted.
Similarly, Gladwell notes the Golden Gate Bridge in San Francisco has been the site of more than 1,500 suicides since it opened in 1937. No other place in the world has seen as many people take their lives in this short a period. When the City of San Francisco was deliberating whether to install a net or barrier to prevent people from jumping off the bridge, many believed this to be a wasted effort. After all, those who had decided to end their lives would surely find another point to jump from, or another method altogether. However, this proved not to be the case. Their decision to die by suicide was coupled to that particular bridge.
Psychologist Richard Seiden followed up with the 515 people who tried to jump between 1937 and 1971 but who had been unexpectedly restrained. Just 25 of those 515 people persisted in attempting suicide some other way. Overwhelmingly, the people who wanted to jump off the Golden Gate Bridge at a given moment wanted to jump off the Golden Gate Bridge only at that given moment.
In one national survey, three quarters of Americans predicted that when a barrier is finally put up on the Golden Gate Bridge, most of those who wanted to take their life on the bridge would simply take their life in some other way. But again, that assumption was wrong. Gladwell and others found that suicide is a behaviour coupled to a particular context. He concluded:
It’s the act of depressed people at a particular moment of extreme vulnerability, and in combination with a particular, readily available lethal means.
Colleagues, with this new proposal, we will be offering patients with mental illness the most readily available lethal means. We will be offering them a certain, fail-safe way to end their suffering and their lives, which, as the data demonstrate, will make it far more likely for them to go through with it. In passing this, we are not just providing the means, but we are sending a dangerous message — the message being: “We agree with you that in your darkest moments, your life must truly not be worth living, and we will even help you end it.”
Honourable senators, we do not have to do this. We do not have to move forward with this amendment just because it originated in this house. The outpouring of concern from those who have suffered from mental illness and the psychiatric community has been profound. There are plenty of reasons for this chamber to have a change of heart and to pump the brakes.
If there was ever a time to exercise sober second thought, that time is now. It is not often that we can truly say that, with this vote, we have the opportunity to save lives and to prevent the unnecessary, premature deaths of the vulnerable and to offer hope to those who have lost it, but today, we do. Please, colleagues, let’s not let the weight of today’s vote be lost on us.
If you are adamant that in 24 months we will have all the answers and we will have enough of a professional consensus to move forward, then, by all means, it is your right to work towards that. New legislation will be required anyway to enact the new proposed safeguards and parameters. But there is absolutely no reason and no justification for proceeding with this now.
Why not permit the advisory panel to have true independence in their deliberations? If they determine that in two years’ time it is safe to proceed with offering assisted suicide to those suffering with mental illness, Parliament can act accordingly. But why would we limit their ability to study this matter and presuppose their conclusions when we know the psychiatry community remains so divided? The risk is simply too great.
As we bring this discussion to a close, I want to leave you with some powerful insights from Canadian psychiatrist Dr. John Maher. He wrote this letter last Friday, the day after the vote in the House of Commons, a letter that even caught the attention of The Globe and Mail today. I think it is important that his words be considered in their entirety. He writes:
Several years ago I was on the promenade at Niagara Falls with my 3 young children. As we stood at the railing some 20 feet from the roaring cascade, with a cooling mist on our hot summer faces, a young man, maybe 18 years old, climbed over the low railing and walked out to a small rock promontory that jutted out immediately over the 150-foot drop onto the rocks and churning waters. The happy crowd of tourists seemed to magically come to a standstill as everyone looked at the young man and knew that a life stood in the literal balance. The young man looked down and never back. His clothing was dirty and he seemed like he was talking to himself. An existential conversation, or hearing voices, or both?
I am a father. I turned my children away from what I feared was about to happen. They, all under 9, asked, “didn’t that man know it was dangerous to get that close to the edge… it was wet and he might slip”. They were scared for him. So was I.
I am a psychiatrist. I wondered, what could I do? What should I do? He couldn’t hear anyone over the thunder of the water. I weighed trying to grab him and pull him back, but knew I could go over with him. Would I risk dying to save him? What of my children that I was shielding and held close?
The world stood still. Seven very long minutes. No one watching moved, and the dead still crowd had grown to hundreds watching from the safety of the low fence. A fence that any one of us at any moment could easily step over.
I knew the suicide numbers for Canada. Of the 100% of people who attempt suicide, 23% try again, but only 7% complete suicide. That 7% is 4000 human beings each year. I knew that most suicidal thinking is ambivalent and transient and that people can be helped. Would this young man, with a whole life ahead of him, choose help?
I am also an ethicist. Last night I watched the televised proceedings from the House of Commons as the Liberal government shut down debate on the MAID bill. As I listened to the combined pleas of the Conservatives, NDP, and Green Party (right joined with left in their common humanity) to not extend Medical Assistance in Dying to people with mental illness I thought of Niagara Falls.
The image that came to mind was the young man on the edge of life with two groups standing to either side of him. On one side, stood a Liberal MP and a Bloc Quebecois MP saying to the young man that they respect his autonomous right to choose death, and that if he has been suffering a lot and has a mental illness, that is good enough for them, and they will get a doctor who can push him over the edge. On the other side stood a Conservative MP, an NDP MP, and a Green MP. They told the young man that he mattered, that despite what he might be feeling right now, there was hope. They said they would try to help. They would try to get him some money so he wasn’t living in poverty. They would try to get mental health care for him, even though it was hard to find and there are long wait lists. They would try to get people to stop making fun of him because of his mental illness. And in that moment, they held the doctor back, who was all too ready to give a hefty push in the name of autonomy.
What happened that day? He turned back from the edge in a daze, in his own world. He climbed the railing. Strangers spontaneously hugged him. Some cried. He was genuinely surprised by the attention and seemed pulled into the sudden awareness that he was not alone. Several people walked away with him, fearing leaving him alone when he was fighting despair. I want to believe that he got help and is living a good life. He was a stranger, but his life mattered. Which side of him would you stand on?
Colleagues, which side will we stand on? Thank you.
The full speech can also be found here: https://sencanada.ca/en/senators/plett-donald-neil/interventions/555393/19