Parliamentary Speeches

Mr. Speaker, I want to thank the member for his intervention, although I ended up feeling a little confused. He started off talking about Liberal policies stalling and stifling major projects. In this bill, my understanding is that both the impact assessment and the permitting would be done concurrently and over the course of a year. I would think that would address his problem with our stalling major projects. Then he went on, and it seemed that at the end he was criticizing the one year as not being enough. Exactly where does the member stand on the one-year timeline to get projects approved?

Mr. Speaker, if we as Canadians ask ourselves what things, what events, define who we are as a people, I think we would be hard-pressed to find anything more quintessentially Canadian than the triumphant moment when the captain of the Stanley Cup-winning team hoists the cup over his head. It is the moment many of us grow up dreaming about. Very few of us actually get to live that dream. However, one of my constituents did last Sunday, as Jordan Staal accepted the cup on behalf of the Carolina Hurricanes, hoisted it in the air and, for a moment, became king of Canada. Not only that, but he won the Conn Smythe Trophy as the playoff most valuable player. Sincerely, I think a lot of Canadians would agree with me in saying that life does not get any better than that. I offer my congratulations to Jordan, and we look forward to him bringing home the cup this summer.

Mr. Speaker, I have the honour to present, in both official languages, the first report of the Special Joint Committee on Medical Assistance in Dying, entitled “Medical Assistance in Dying and Mental Disorder as the Sole Underlying Medical Condition: A Complex and Challenging Conversation Among Canadians”. I would like to thank all members of the committee, including members from the opposite side of the House, for their valuable contribution to the report.

Mr. Speaker, I talked about this bill a month or so ago at some length, and I am certainly not going to try to repeat that right now. I would like to, first and foremost, thank everybody here for staying up and being here, and the many people who actually seem to have read and understood the legislation. I have to say that a lot of the comments that we received, especially from the other side, were excellent comments. I have certainly taken them to heart. I would also like to thank those people with some experience with the program or those with family members who have benefited from the program. It is those kinds of experiences more than anything else that have motivated me in writing this bill. I would like to thank the very many people who helped me draft this bill, which I did not do the first time around. Let me start off with the SickKids hospital in Toronto. The Hospital for Sick Children is the number one ranked children's hospital in the world. I dare say, if our country ought to be good at one thing, it would be looking after the health of kids. I am really proud to have, at one point, actually studied at the SickKids hospital. It came to me a number of months ago with a number of valid concerns about the special access program and has been of tremendous assistance to me in drafting this legislation. I know I cannot refer to anyone in attendance in the gallery, but if I could I would refer to some people from SickKids, namely Dr. Charlotte Hepburn and Katherine Aldred. There are a couple of people who I do not think are here, Tamana Hafid and Rida Anmol, who are lawyers who work for the hospital. Let me also mention tangentially RareKids‑CAN. They worked along with SickKids in drafting this bill. I also want to thank my colleagues at Sainte‑Justine Hospital in Montreal who helped me a great deal with this bill. I especially want to thank the hospital's excellent chief pharmacist, Denis Lebel. I would also like to thank Catherine Litalien and Dr. Nguyen. I would also like to thank the doctors and pharmacists at a number of hospitals across Canada: Princess Margaret; Health Sciences Centre Winnipeg; Alberta Children's Hospital; BC Children's Hospital; Dr. Nigro and Dr. Del Paggio at Thunder Bay Regional Health Sciences Centre, who contributed in different ways to this; and Mrs. Lori Anderson and Dr. Philip Kuruvilla. Let me briefly mention a couple of the concerns that came up, both today and the other day, in debate. One of them was a concern about the two-doctor override and having too much faith in two doctors. From my experience at the MAID committee, I certainly share the concern about having too much faith in doctors. I think part of the answer lies in the regulation of the profession, particularly with specialists. The law requires two people with the requisite knowledge; they would be specialists. Certainly, if we are going to question their behaviour of prescribing things that may be inappropriate, the appropriate body to address that issue would be the Royal College of Physicians and Surgeons. I would also point out that in the law itself there is a section that allows the minister to prohibit the use of a drug if they believe the use poses a risk to health. I have, as a result of the concerns, suggested and would entertain an amendment that it be three physicians rather than two. I would also suggest there is a possibility that the advisory board, which would advise on a pre-approved drug list, would also advise the minister with respect to the special access program and have a role in recommending to the minister that perhaps there should be restrictions on the use of a drug under the program. Lastly, the issue of controlled substances is very important to me as well. I would hate for this law to fuel the fires of the drug problem that is ravaging our country. I will work with the members of the opposition on the issue to make sure there is no diversion. I will work with the members on the opposite side on all the provisions, because certainly there is a lot of work to be done here. I will do my best to work with everyone to that end.

moved that Bill C‑265, An Act to amend the Food and Drugs Act (List of Therapeutic Products Pre-approved for Special Access), be read the second time and referred to a committee. Mr. Speaker, Canadian physicians are, at times, even in life-threatening situations, prevented from using the drugs they believe they should be using. My private member's bill looks to change this by making significant changes to the special access program, or SAP. These changes would considerably reduce the red tape associated with the program, create a pre-approved drug list for medications frequently requested and approved, and allow pharmacies to stock many life-saving medications in anticipation of their use. Furthermore, it would transfer the authority to make difficult decisions about whether to use an unapproved drug in a life-threatening situation, where the evidence of the efficiency of that drug is unclear, to the expert clinicians rather than the bureaucrats in Ottawa. The SAP was created under the food and drug regulations. It states that medications not approved by Health Canada may be made available for medical emergencies, which Health Canada interprets as “serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable” in Canada. Why are medications not approved by Health Canada? There are several reasons. Sometimes these are medications that are still undergoing clinical trials, but at times there are medications that have gone through vigorous testing. For example, the Princess Margaret Cancer Centre in Toronto told me that they are frequently part of big, randomized control trials. It can take four years from the time those trials show efficacy to the time they are actually able to give those medications to people. On average, it takes Health Canada a year to a year and a half longer than the FDA to approve a medication. For other medications, including, at times, medicines that have been previously approved in Canada, or medicines for rare diseases, the Canadian market is simply too small or the profit margin is too slim for manufacturers to want to seek approval in this country. Many drugs that are available under the SAP have been widely used for years. For example, IV caffeine, which is routinely used in neonates, was, for a long time, available only through the SAP. Similarly, ibuprofen lysine, which is a treatment for patent ductus arteriosus in premature infants, has been used for over 30 years, but again, only through the SAP. IV methadone, to prevent narcotic withdrawals in ventilated patients, has been available in the United States for over 20 years, but in Canada it still requires the special access program. As well, for drugs for rare diseases, the number of patients who have been treated may be too small to be able to statistically prove efficacy, which is what is required for Health Canada approval. Currently, medications that have not been approved by Health Canada can be accessed through the SAP or an N-of-1 clinical trial, with one patient, which is an even more cumbersome process. The SAP and the clinical trial process need to be reformed. Before telling this House some of the troubling stories as to why, let me say that I know there are a lot of really good people working for Health Canada. When I talked to clinicians about the SAP, many told me that, in general, Health Canada people were really good. However, many pharmacists, particularly pharmacists working in children's hospitals, told me about having to spend considerable time each week faxing or on the phone with the SAP, often for drugs they have been using for years. They repeatedly have to fax requests for the same medication the same week. Setting up a clinical trial with an N of 1, which is required for rare diseases and experimental drugs, is even more cumbersome and costly, so much so that one children's hospital told me they simply do not have the resources to do that. In another case, an ICU doctor at a children's hospital told me of spending six hours resuscitating a child with liver failure and bleeding esophageal varices. For four hours during that time, the pharmacist was on the phone trying to get approval for a drug that is the first-line treatment for this condition in the United States. They had it on hand, but it required SAP approval. Finally, they got it. The child lived. However, the clinician told me that had that child been on that medication to begin with, the child would have never been in that situation. In addition, I have heard of numerous cases of progressive neurological diseases in children where access to a medication that would have significantly delayed the progression of the disease was refused, stayed or significantly delayed by requiring it to go through the clinical trial process. This is even though, as one pediatric neurologist told me, if a kid is started on this medication while the kid is still able to walk, the child will continue to be able to walk, and if it is started while the kid is still is able to speak, the kid will continue to be able to speak, but if this is not done, the child will not be able to. Infectious disease people were particularly critical of the current program. One hospital told me about a neutropenic child, which means they have a low white blood cell count and are susceptible to infection, who had sepsis due to a drug-resistant organism. The hospital had the antibiotic, but it was only available through the SAP program. It was 5:30 at night and neither the SAP program nor the manufacturer were available. As a result, the child was only started on the antibiotic the next morning, 18 hours later, even though the evidence clearly shows that antibiotics ought to be started in the first hour in this situation. Another infectious disease specialist told me of having a patient in their ICU, again due to a drug-resistant organism. The patient was in their thirties. The drug could only be accessed through the special access program. It took seven days for approval. Unfortunately, the patient died one day before that. This specialist told me this was not uncommon. He also said that, if Health Canada did not think there was a problem, it was because it did not have to look family members in the eye and tell them that their loved one died when there was a treatment that could have saved the patient. In another case, a newborn with a mother who was HIV positive, the child should have received antiretrovirals within six hours. They applied, and the antiretroviral was given at 15 hours, even though it was yet to be approved. Health Canada finally came through with the approval 48 hours after it was requested. Someone from Alberta Children's Hospital sent me a very nice email. They told me they had recently conducted a retrospective review of all patients who received two antibiotics before and after the introduction of a future use pilot. This pilot enables hospitals to use on-hand stock and immediate treatment when certain criteria are met. Basically, it is similar to the pre-approved drug list in my bill, Bill C-265. They found that the program significantly reduced time-to-drug initiation from the time of request. In the case of one antibiotic, it was a little over seven days, and in the case of another, it was over 10 days, and both were reduced to less than an hour from the time of diagnosis. Of note, the pre-approved drug list in my bill would be akin to the future list program. The pharmacists, in their letter, concluded, “while we do now have these two antibiotics as future-use, the institutional approval to stock them took approximately six months per application, and there remain additional critical antimicrobials that are not included in the pilot.” They concluded, “Bill C-265 would go a long way towards addressing these issues.” I will give one last case. In pediatric ICUs, when there is a kid who will not stop seizing, they like to use pentobarbital, which is the go-to drug in the United States, but it is only available here under the special access program. Instead, they use phenobarbital in really high levels because it is simply easier to access. Access to medications under the SAP is often denied because the drug is somewhere on an ongoing clinical trial. Yes, where possible, people should go in clinical trials. However, in some cases, this creates considerable hardship for the patient. For example, I had one friend who had cancer. His brother had to bring him back and forth from Thunder Bay to Duluth to get chemotherapy because the special access program denied him access. Similarly, I heard from the pediatric hospital in Montreal that it has to send patients to Toronto because the randomized control trial is in Toronto. I trust my bill would go a long way in addressing all of these issues. Toronto's Hospital for Sick Children, the number one ranked children's hospital in the world, came to me with its problems with the special access program a number of months ago, and I said, “Why don't you write me a PMB?” The first version of the PMB was in fact the hospital's, and it has gone through several reincarnations since. Sick Kids has certainly had a lot of input. I also want to thank my colleagues who work at Sainte-Justine Hospital in Montreal, who helped me a lot with the bill. I would also like to thank Princess Margaret in Toronto, the Health Sciences Centre in Winnipeg, the BC Children's Hospital, London Health Sciences Centre, the William Osler Health System in Brampton and the Thunder Bay Regional Health Sciences Centre. I thank all the clinicians, pharmacists, lawyers and administrators who helped me draft this bill. This is as much their bill as it is mine. I would also like to thank William Stephenson, law clerk and drafter extraordinaire, for his magic in turning ideas into actual laws. What would the bill do? It would do a few things. First, it would establish a pre-approved drug list. Pharmacies could stock medications on this list in anticipation of their use and medications could be used without prior approval. There would be a requirement for notice afterwards. Presumably, the pre-approved drug list would include pretty well all the drugs in the scenarios I just talked about. I would also suggest that some of the chemotherapy drugs that it takes Princess Margaret four years to be able to use could be on the list. A committee of experts would advise the minister as to what drugs ought to be on the list. Furthermore, the minister would be able to limit the use of drugs on the pre-approved drug list. For example, they could limit the use of antibiotics to infectious disease specialists or require that they be used in certain settings, like an ICU, or that they be used only by doctors with certain qualifications. For other non-approved products, either for use in the emergency treatment or for the prevention of the progression of serious or life-threatening conditions, this requirement would remain. The special access program would still exist. However, the bill would explicitly address many of the current problems associated with the system. For example, once implemented, Health Canada could not deny someone access to a drug simply because a randomized controlled trial was going on somewhere in the world, all other available and approved drugs have not been tried or the evidence for the use of the drug was dated. These are all reasons I hear of frequently for access to a drug being denied. In addition, importantly, the act would create a presumption, which would be determinative when the evidence for use of a drug may be unclear. This presumption would allow two clinicians with the requisite expertise in the field to override a denial if they attest to the treatment plan as being the one in the best interest of the patient, to the benefits outweighing the risks and to the patient having given full and informed consent knowing of a higher risk with an unproven drug. The drug approval system needs to be improved for other reasons. For example, treatments in cancer are now targeted to the specific genetic sequence of that cancer, so being able to expeditiously do a randomized controlled trial and show statistical evidence of the efficacy of a drug rapidly is pretty well impossible. We need a drug approval system that is more nimble than what we currently have. In conclusion, to deny someone who may be dying access to a medication that expert clinicians believe might help them is, I think, cruel. I also think that most Canadians would agree that the decision of whether to try such a drug when the evidence is unclear is best left to clinicians with an expertise in the area rather than bureaucrats in Ottawa. I do have a word of caution. We also need to protect the public from unsafe medications and from the predatory marketing of pharmaceuticals. Health Canada certainly has a duty to look after the public interest. We must, as much as we can, continue to safeguard against the marketing of drugs that have not been proven. In addition, we do not want the SAP to be used as an end run around our drug approval system, and I have tried to put in provisions to ensure that in this legislation. There are competing interests involved, and what is required is compromise. I believe this bill is such a compromise. I again thank all those who helped me and all members who are here for coming out on a Friday afternoon.

Mr. Speaker, that is a difficult question. There is, as I recall, a provision that would allow the minister to restrict the use of a drug to protect the public interest. We certainly have to ensure, and I think this is most important, that there is no diversion of those drugs. There are examples, and I would suggest one would be IV methadone, which perhaps should be on the pre-approved drug list to only be used for ICU patients who are already on methadone and would otherwise be going into withdrawal. There are good reasons we might want to put that on the list, but I understand the member's concerns. It would certainly be something we could talk about when it goes to committee.

Mr. Speaker, I thank my colleague for this great question. People who work at Sainte‑Justine Hospital in Montreal helped me a lot with this bill. It is challenging to identify jurisdiction when it comes to health. The two levels of government each have a role to play in this field. The provinces are responsible for regulating medical professions, while the Government of Canada has responsibility over prescription drugs.

Mr. Speaker, I would like to thank the hon. member for asking me another question in French. It is a good question, but I find it difficult to answer it in French. It might be better if I answered it in English. This is something that I struggled with. We do not want companies to have their drugs go on the pre-approved drug list rather than seeking approval for them. There are provisions that would allow the minister to require the company to give reasons why the companies are not seeking approval from Health Canada and to remove the drug from the pre-approved drug list if it thinks it is necessary. I contemplated the possibility of putting penalty provisions in if a company were to use this process to circumvent authorization by Health Canada—

moved for leave to introduce Bill C-265, An Act to amend the Food and Drugs Act (List of Therapeutic Products Pre-approved for Special Access). Mr. Speaker, I rise to introduce my private member's bill, an act to amend the Food and Drugs Act with respect to the list of therapeutic products pre-approved for special access. My PMB would reform the special access program, which would allow doctors to access medications that are not approved yet by Health Canada. I will give an idea of the problem the bill seeks to address. A pediatric ICU doctor recently told me about spending six hours trying to resuscitate a child, the first four hours of which were spent trying to access a drug which is available only through this program, even though that drug is considered first-line therapy in the United States. This should not have happened. It should not happen in the future. The bill would reduce the red tape associated with this program and also leave the decision in life-threatening situations as to whether to use a drug not yet approved by Health Canada to the clinicians, not to bureaucrats in Ottawa. I would like to thank SickKids, the sick children's hospital in Toronto, which co-wrote the first draft of the bill with me. I would also like to thank all the other children's hospitals that had a lot of input. I would like to thank the member for Kitchener South—Hespeler, an ICU doctor, for seconding the bill. (Motions deemed adopted, bill read the first time and printed)

Mr. Speaker, I would note that some of the organizations that support this agreement are Cereals Canada, the Canadian Agri-Food Trade Alliance, the Wheat Growers Association, the Canadian Cattle Association and Soy Canada. That is a lot of agricultural associations. This seems to be a good deal for Canadian farmers. I do not know what trade barriers existed before with Indonesia, so could the member help explain how this is going to benefit Canadian farmers?

Mr. Speaker, I rise to pay tribute to a cornerstone of the Thunder Bay community, a great Canadian and a friend, Stephen Wright. Stephen used to say that his hobby was people, and he led his life that way. It was all about service to the community. He worked with Hockey Canada. He created PRO Kids to support underprivileged kids' participation in sports. He led no fewer than five winning political campaigns. Stephen was a tireless advocate for health care in northwestern Ontario. He was chairman of the board of Thunder Bay Regional and helped to bring it both a medical school and a cardiac care unit. To every endeavour, Stephen brought his characteristic wisdom, patience, compassion and sense of humour. Stephen represented the very best of Canada. His impact on Thunder Bay and those who knew him will be felt for many years to come. We thank Stephen for all he did, and we miss him.

Mr. Speaker, a few weeks ago I was in Fort Frances attending a municipal event. When I arrived at the Super 8 hotel, the very sheepish attendant apologized profusely, telling me there was a hockey tournament on and that it might be a little bit noisy. Yes, there was an under-13 AA tournament. Sure enough, it was noisy at times, with a bunch of raucous 12-year-olds playing floor hockey in the stairwells, while at the same time, their parents sat on the first floor pretending they were drinking ginger ale out of coffee cups. As I listened to the halls filled with the laughter of kids, and as I saw the parents having a good time with a bunch of people they previously hardly knew, all while it was 30 below outside and the wind was blowing, I realized, and this is with sincerity, what a wonderful thing minor league hockey tournaments are and how much they are a part of our identity and the Canadian culture. Everyone who puts them on, even the refs, who I sometimes criticize, should keep up the good work. I thank them.

Mr. Speaker, today is World AIDS Day, a day to remember the 42 million people who have died: our neighbours, friends and relatives. AIDS is an ongoing pandemic. It used to be a death sentence, but the discovery of antiretrovirals has really changed everything, turning AIDS, when treated, into a chronic disease. Making these drugs affordable to millions of people worldwide has been one of the greatest scientific and humanitarian triumphs of all time, yet today our progress faces a grave threat as major donors slash international assistance and HIV funding. The impact has been devastating. For example, in South Africa, treatment initiation has fallen 30%. The funding cuts could create a whole new wave of disease and tens of thousands more deaths. This is why our government's recent $1-billion pledge to the global fund is so welcome. As many wealthy nations backtrack on their commitments, we need to unite globally to ensure that decades of progress in fighting this terrible disease do not unravel.

Mr. Speaker, we get it. We do not agree on the issue of spending, but does the member not agree that the reality is that President Trump is going to be here for a while? The tariffs exist, much as we are trying to fight them. They are going to affect our economy. There is going to be a downturn in the economy. There are going to be more people on EI and more people relying on social assistance, which costs us money. Is this really a good time to start cutting spending, which would otherwise create those jobs that will stimulate our economy?

Mr. Speaker, is it a time to invest or a time to be frugal? Maybe the right answer is that it is a bit of both. First, we are in the fortunate financial position of being able to invest, create jobs, build infrastructure and stimulate the economy. According to the IMF, Canada's net debt-to-GDP ratio in 2025, if we look at all levels of government, is by far the best in the G7. In addition, our deficit-to-GDP ratio is second only to that of Japan. As a result, the director of the IMF has said that Canada and Germany alone in the G7 are in the fiscal position to be able to invest in order to spur the economy, in what is otherwise a time of global economic downturn. Our government also wants to decrease spending while at the same time investing more. We want to invest in order to create jobs, both directly and indirectly. We want to invest in building local infrastructure for things like roads, sewage and water, in order to build the homes Canadians need and want. We also need investment in road, rail and ports so we can efficiently get goods to market, which is increasingly important as our best trade partners have enacted all of their trade barriers. The budget projects that our capital investments will rise to nearly $60 billion in 2030, nearly double the $32 billion this year. Let us talk about some of the investments I like and that are good for my riding. Over 10 years, $51 billion will go toward the build communities strong fund to build local infrastructure. I will certainly try to use this money to build some of the things I would like built in my riding, for example, Fort William First Nation's chronic care home and a toll-free bridge between International Falls and Fort Frances. I would also really like some of the money to go toward things like hockey rinks. I, like a lot of Canadians, spend the winter watching my kids play hockey and drinking Tim Hortons coffee in aging arenas that need upkeep. Ports are also important. Thunder Bay is a port city, and as my favourite teacher in high school used to say, we owe our existence to the fact that we are an entrepot, which means a place where goods go from rail and trucks to boats, or vice versa. I am happy to say that the budget provides $5 billion to create the trade diversification corridors fund, which is money for ports, rail and roads. On a related note, the budget announced over $600 million for CBSA. This is in addition to the previous $1.3 billion, and it allows CBSA to hire 1,000 new officers, which will in turn allow it to open new custom facilities in a number of ports along the Great Lakes St. Lawrence Seaway. Currently, the only port on the seaway that allows customs clearance of container traffic is the port of Montreal, which creates a bottleneck: Boats go from Europe to Montreal in 10 days and then may end up waiting 10 days in order to clear customs. In addition, the lack of other inspection stations results in thousands of trucks on the 401 to the Trans-Canada Highway carrying containers that could be brought far closer to the destination directly by boat. I have spoken to the port authorities in Hamilton, Picton, Windsor and Goderich. They are all ready and eager to start handling more container traffic, the big obstacle being a lack of CBSA facilities. I know that the port of Thunder Bay is in a very similar situation. Critical minerals are also something near and dear to the hearts of the people in my riding. Frontier Lithium and Mitsubishi are looking to open the first lithium mine in northwestern Ontario, with the refinery to be in my riding. In a recent speech to the mining community, the Minister of Natural Resources made a statement that I think is worth repeating; he said that we all remember the awful situation President Zelenskyy found himself in a few months ago at the White House, where he was told, “you have no cards to play”. We as a country have lots of cards to play. We have a lot of natural resources, including critical minerals that are needed for the defence industry and for the green transition. Developing these resources will create jobs. It will also mean that, to the degree possible, we will no longer be as dependent on fair-weather friends. A priority for the government will be to help more critical mineral projects get to a final assessment decision within a two-year window. The budget proposes to provide $2 billion to create the critical minerals sovereign fund. The fund will make strategic investments in critical mineral projects and companies. In addition, the budget includes $370 million to create the first and last mile fund, which is a fund that would support the development of critical mineral projects and supply chains with a focus on getting near-term projects into production as soon as possible. The fund would also absorb the critical minerals infrastructure fund, providing $1.5 billion to support clean energy and transportation infrastructure projects related to critical minerals development. Forestry is a sector we all know is hurting. I grew up outside Thunder Bay in an area where most of my friends were the children of Finnish Canadian bush workers. Forestry is practically in our DNA. Last October, the U.S. imposed a 10% tariff on softwood lumber, which is in addition to the pre-existing duties, bringing the total tax on Canadian softwood lumber to over 45%. Our forests are one of our most valuable assets. In the long term, I think things look good for the industry. We and the Americans will continue to need lumber in order to build homes. In addition, our government will seek to use more wood in government-funded projects; encourage the development of things like cross-lamination, which would allow more building with wood and less reliance on concrete and steel; and encourage the development of novel uses for wood fibre, for example, biofuels. Although in the long term things look pretty good for the sector, the problem is obviously the short term and surviving the existing tariffs and duties. To help with that and to get the sector through this period, our government has created the $5-billion strategic response fund and regional tariff support measures. Also in the budget is, as of today, up to $1.2 billion in loan guarantees administered by the Business Development Bank of Canada to provide financial support to help companies maintain and restructure their operations; $500 million to renew and expand existing programs for the sector, focused on market and product diversification; and $50 million for re-skilling and income supports for affected softwood lumber workers. Alstom is currently involved in negotiating a single-source contract for the purchase of Toronto's line 2 subway cars, which will be built, I am happy to say, primarily in Thunder Bay. To some extent, the decision to have the cars built in Thunder Bay paved the way for the commitment the government has made, in the budget, that with federal procurement, we will as much as possible buy Canadian. There is no damn way the cars should ever be built in the United States, and I trust that when we replace the existing Via Rail fleet outside the Quebec-Windsor corridor, those trains will also be built in Canada, primarily in Thunder Bay, with some work also going to La Pocatière and to Kingston. I am a doctor, and I still practise once in a while, so what is in the budget for health care? There is $5 billion for health infrastructure, as well as money for, and this is important, credentialing. When I was an intern in Toronto in 1986, I used to joke that if I had a problem, I should ask the person mopping the floor, because they were probably a doctor from Brazil or Guatemala. Really, not a lot has changed in the intervening years with respect to credentialing, despite the fact that a lot of Canadians do not have a family doctor, particularly in rural areas. That has begun to change, and with the budget, we propose to provide $97 million towards establishing a foreign credential recognition action fund to work with the provinces to improve foreign credential recognition and bridging programs to help foreign-trained professionals, particularly in health care, meet Canadian standards. In this context, I would like to acknowledge two provincial programs that I think have been particularly successful in churning out doctors: PACE, the Physician Assessment Centre of Excellence in Halifax, and a one-year bridging program for foreign trained doctors run by the Manitoba College of Physicians and Surgeons and the University of Manitoba. These are programs we ought to emulate in other areas like northern Ontario. Last, Canada has historically underfunded research and development in comparison to other places. The international talent attraction strategy and action plan will go a long way to address underfunding. Every cloud has a silver lining. This is absolutely a time to start poaching top-notch American talent. The budget provides $1.7 billion for a suite of recruitment measures, including $400 million for a complementary stream of research infrastructure to be used by this new talent. In conclusion, I like the budget. It is good for Thunder Bay—Rainy River. I suggest that it is also great for Canada.

Mr. Speaker, I would like to thank my colleague for mentioning two things. One is Afghanistan. I, too, have worked a lot on that file. I think it is still an open file, and we have a lot more to do on it. A lot of people in Afghanistan who worked with our forces are still trying to get into this country, and I would certainly like to work toward that. In terms of the people, especially Canadians, who have been educated overseas, the health committee is currently studying that. We are looking at it, and we want to get those people here. They are Canadians and want to work in Canada. We have the need for it. We have to help, and with this money, hopefully we will open the doors to allow those people to work in Canada, which is what we all want on all sides of the House.

Mr. Speaker, I think I know what my colleague is referring to. When there is a trade dispute with the United States, particularly with respect to forestry and dumping, and companies have paid money, which is sitting in the United States Congress, they would like to access that money. I can certainly appreciate that, but I think our government has announced a whole range of measures allowing companies to borrow money, which will hopefully help them get through the next few years. We realize that it is worth loaning money to these companies, partly because we believe that, hopefully, some of that money will eventually come back to them.

Mr. Speaker, overwhelmingly, what our government wants to do is come to an agreement with the United States in order to reduce the tariffs on softwood lumber. That is absolutely critical. However, in the meantime, I think we have put a lot of measures in place, including some of the things that were announced by the Prime Minister today. For example, one thing the Prime Minister announced today was working with rail companies to try to reduce freight rates for Canadian steel and lumber by 50%. He also talked about the importance of using Build Canada Homes to use more Canadian lumber to try to offset the fact that we are not as able, obviously because of tariffs, to sell lumber to the United States. As much as we have tried to provide an alternative market for building with wood in Canada, the reality is that the United States is 10 times the size of our economy, and it is very difficult with the domestic market alone to make up for the deficit caused by the United States not buying as much Canadian lumber.

Mr. Speaker, the member talked about believing in people. She talked about the importance of the creativity of our ancestors when they came to the country and about how they created this country. I agree with all of that, but what does she think of the fact that our budget would provide $1.7 billion for a suite of recruitment measures to recruit top-level scientists, innovators and doctors to our country? Is that a good idea, or is that, too, as she would say, ludicrous spending?

Mr. Speaker, the Conservatives seem to have a great deal of trouble finding anything good in this budget. I would point out that, in the budget, there is $5 billion over seven years, starting in 2025-26, to Transport Canada to create the trade diversification corridor fund. I, too, have a large bit of the Trans-Canada Highway running through my riding. Does the member not see a possibility that some of this money will go toward the Trans-Canada Highway and help his riding?

Mr. Speaker, many years of underinvestment in affordable housing for indigenous people and northerners has resulted in a serious gap in affordable housing for both of these groups. Can the Minister of Northern and Arctic Affairs tell the House how the new government is working with indigenous leadership to close the infrastructure gap, and how Build Canada Homes is turning that partnership into new homes for both northerners and indigenous people?

Mr. Speaker, I would like to present a petition on behalf of the organization We the Nuclear Free North with 817 signatures. The signatories express their serious and heartfelt concerns regarding the safety of the transportation and storage of nuclear materials through and in their communities in northern Ontario. Although the decision has already been made, the signatories asked me to present this petition calling on the government to immediately direct the NWMO to stop the siting process for a deep geological repository.

Mr. Speaker, yesterday was World AIDS Day, a day to remember the 42 million people who have died from AIDS, to remember our relatives and our friends. I remember in 1982 as a medical student seeing a poster about a mysterious outbreak of a deadly pneumonia in the gay community of San Francisco. Four years later, we were seeing a lot of cases of AIDS in Toronto. In the late 1980s, when I was working in Swaziland in southern Africa, it went from zero cases of HIV to 26% of pregnant women being HIV positive within a few short years. AIDS was and is a pandemic. For a long time, HIV/AIDS was absolutely a death sentence. The discovery of antiretrovirals has turned AIDS into a manageable chronic condition. Although our work is not yet done, making ARVs available to millions of people globally has absolutely been one of the greatest triumphs of the modern era.

Madam Speaker, I am proud to rise today to recognize and honour the life of a good Canadian, Michael Robert Ellchook, who everybody knew simply as “Hoss”. Like the Bonanza character, Hoss was a gentle giant of a man. A good Ukrainian boy, he grew up on a farm in Murillo. Hoss loved cooking. He worked as a chef in Europe and various places in Canada before returning home to open up his own restaurant. Hoss was a volunteer in a wide variety of community activities, none more important than his role as a volunteer firefighter with the Oliver Paipoonge Fire and First Response. That is where I first met him years ago when he brought someone into the emergency room while performing CPR on them. That was Hoss, always helping others. That is why he was such a beloved member of the community and why he will be missed by so many people from Murillo, Kakabeka and Thunder Bay. Most of all he will be missed by his loving family, his mother Betty, his sister Jeanne and his brother Dennis. Thanks, Hoss.

Madam Speaker, under the statute, there would be a requirement for the government to come up with an essential drug list within a year of its getting royal assent. It would seem to me this would be a difficult process. I am sure all kinds of doctors are going to want different things to be part of the essential drug list. What does the member think about our ability to do that and to do it within one year?

Mr. Speaker, I appreciate the passionate speech by the member from the NDP. I agree that this is really a milestone. There are medications for rare diseases, which are very expensive. There are medications for cancer treatment, which are very effective but cost hundreds of thousands of dollars a year. How would this national pharmacare program help to ensure that these medications are affordable to our society? I would give a hint: It is probably because it actually looks like a national pharmacare system would end up saving health care dollars rather than costing.

Mr. Speaker, I would like to congratulate his father on behalf of the Liberal Party. We will share a beer in his honour tonight. The member at least implied in his speech that he took part in ensuring that young diabetics in Saskatchewan have the cost of their medication paid for. Maybe he could speak a little more about that. I would also say, is that not what we are trying to do with our bill here? Would it not be a good thing if the health minister did this in Saskatchewan? If he did, great.

Mr. Speaker, I am pleased to rise to speak to this issue and this bill, finally. As others have already pointed out, Canada is the only country with a universal health care system that does not provide some sort of universal drug coverage. Under the British, Australian, New Zealand, French and Belgian systems, basically to some degree or another, people's medications are paid for by the government and they do not have to pay for them. Having said that, admittedly, in some countries there is copay. This is an important bill. It is the first step in creating a national pharmacare system, and this I truly support. However, I did not always feel this way. As somebody who has long practised in the health care system, I was a bit worried, because with the health care system as it presently is, we are struggling to pay for it. It occurred to me that what the government ought to be doing in health care is making sure that this sucker stays on the road. Certainly, I had a bit of trepidation with the idea that we were going to add another cost like pharmacare. However, having thought about it and having sat through committee meetings where we talked to experts, I have changed my mind because I think that a national pharmacare system would save the health care system money, not increase costs. The current system, as we have it, which is a patchwork of private and public plans, is really inefficient. Multiple studies and recommendations since the 1960s have all basically said that. In fact, one study from the Canadian Medical Association Journal in 2017 concluded that we in Canada pay 50% more for our drugs than people do in 10 other wealthy countries that have national pharmacare programs. In addition, the inefficiency of our pharmaceutical system is demonstrated by the fact that we in Canada pay the second most for drugs of any people in the world. The Americans pay more, but other than that, we pay more for drugs than anyone else. The inefficiency of our system comes from the fact that we provide pharmacare in Canada like the United States does. We, like the United States, have a patchwork system of private and public providers, and the private providers are often set up through employers. At times, these are non-profits, but for the most part they are for-profit companies. Similarly, there are public systems and public plans, and there are multiple public plans. For example, in Ontario, there is the Ontario drug benefit plan for those over 65, there is a Trillium plan for higher-cost medications and there is OHIP+. Basically, we pay for our medications in Canada like Americans pay for all parts of their health care system, but our system for paying for medications, like the U.S. health care system, is really inefficient. Americans pay twice as much for health care as Canadians do. On average, Americans pay $12,000 per person for health care, and in Canada we pay $6,000 for health care per person, and they have worse outcomes than we do. For example, they have a lower life expectancy than we do in Canada. I studied health law and policy both in Boston and at Georgetown University in Washington, D.C., and learned a bit about the health care system. I was certainly impressed by the inefficiency of the American health care system. They have private hospitals, private health care providers and private insurance companies, and each of these organizations has administrators who basically spend half of their time scheming on how they can decrease costs and increase profits. They have to pay for these administrators. Similarly, they have to pay the CEOs and the higher-up executives, who all bring in the big bucks, for working in those positions. On top of that, and most of all, a lot of money goes to the shareholders of corporations, which are legally obliged to financially benefit shareholders. All this money comes out of the health care system, money that ought to be going toward trying to improve the health care of Americans. Similarly, in Canada, we currently have 1,100 private and public plans according to a Lancet 2024 study, although according to the Hoskins report, we have 100,000 private plans. If instead of having all these plans, we just had one plan, then surely there would be tremendous savings coming from economies of scale. We would not need 1,100 organizations with 1,100 sets of administrators administering their own plans. We would not need hundreds of CEOs siphoning money that would otherwise go to health care, and there would be no profits going to shareholders rather than going to health care. There would be all sorts of savings from economies of scale and increased bargaining power. For example, if someone went to a provider or manufacturer of drugs and bought 10 million pills rather than 10,000 pills, I am sure they would get those pills at a cheaper cost, so there are savings there. Also, shipping costs are lower when buying in bulk, and there are fewer inspections needed. When we add up all these savings, how much do they add up to? Well, according to the 2019 Hoskins report, with national pharmacare by 2027, which is when it would come into effect, total spending on prescription drugs would be $5 billion lower than it would be without national pharmacare. That is money we could use in the health care system for other things. That means more money to afford expensive cancer therapies, more money to address the long waiting times for either surgeries or diagnostic tests and more money to do research and try to find new cures for things like cancer, ALS, etc. However, it is not just about saving money in the system. It is also about helping Canadians who struggle to meet the high costs of medications. According to the Hoskins report, between 5% and 20% of Canadians are either uninsured or under-insured, which amounts to two million to eight million people. Furthermore, one in five households reported that a family member in the past year had not taken a prescribed medicine due to its high costs, another three million Canadians said they were not able to afford one or more of their prescription drugs in the past year and almost one million Canadians borrowed money in order to pay for prescription drugs. For all these reasons, I support this legislation and moving to the next step toward a national pharmacare system. I also welcome that we will be able to provide diabetic medications and contraception to people as one of the next steps in getting to a national pharmacare system.

Mr. Speaker, this is a step toward universal health care. Yes, it does not bring us to that point yet, but it is a step. With respect to the committee that is going to be involved in this, I thought the member was going to ask me about the fact that those two people were not consulted in the process. That is too bad. However, I agree with the member that how we do this is really important. If we have an efficient system and an efficient bureaucracy, this can save Canadians money. If we create a gigantic bureaucracy that costs a whole ton of money, more than the private system, then it will not end up benefiting Canadians. It is really crucial who we put on that committee and the steps we take in subsequent days, weeks and years.

Mr. Speaker, the member's question is very pertinent. I have some background in this. Once upon a time, years ago, I worked in a tiny country in the South Pacific, Vanuatu, on its essential drug list, which was its first essential drug list. The WHO is trying to do this with a lot of countries. Similarly in Canada, this act calls for the creation of an essential drug list. On that essential drug list, we would have the input of physicians and other specialists from across Canada to determine what the priority drugs are that a government finance system ought to supply its citizenry. That is an important question, and it is one of the next steps. I, like her, realize that this does not bring us to a national pharmacare system, but it is an important step on the way to that.

Mr. Speaker, I welcome the very perceptive question by the member from Ottawa. This is a very important point. We heard from a lot of people, and there was a lot of concern about having a basic system. What if we needed more expensive medications for certain things? Would we be getting rid of private drug plans? That is not necessarily the case. There will be a public plan, but I think there would still be the option, if people wanted, to pay additional money for a private plan that would cover all the things that are not currently insured, as there is for other kinds of health care at the moment.

Mr. Speaker, last Saturday night, Ukrainian boxer Oleksandr Usyk defeated much bigger fighter Tyson Fury to become the undisputed heavyweight champion of the world, the first in 24 years. Ironically, Fury himself first became a champion in beating another Ukrainian fighter, Wladimir Klitschko, the brother of the current mayor of Kyiv, Ukraine. As Ukraine continues to defend itself against a much larger Russian invader, it has been struggling to hold the front line in recent weeks, largely due to a shortage of ammunition, which is thankfully starting to arrive from the United States. Saturday was a great victory for Usyk, a great victory for boxing and, most of all, a great victory for Ukraine, as Usyk showed the world how, with sufficient heart, strength and intelligence, a smaller fighter can always defeat a larger one. Slava Ukraini.

Mr. Speaker, I have been truly blessed in life to have been able to have six children. They are absolutely one of the best parts of my life, but unfortunately not all Canadians have the same good fortune. In fact, one in six Canadians, at some point in their lives, has some sort of fertility problem. I would like to present a petition on behalf of Fertility Matters Canada, with 5,300 signatures. The petition calls on the government to develop a national fertility strategy and, in collaboration with provinces, to build a more equitable future for fertility care in Canada.

Madam Speaker, every three minutes in Canada, someone is diagnosed with cancer, a diagnosis that will change their life and the lives of all their family members forever because, if one is diagnosed with cancer, pretty well everything else in life, including much of what we do here, seems pretty insignificant in comparison. The COVID pandemic showed us what the global scientific community can do when it puts its collective mind toward something. Experts were predicting it was going to take us years to come up with vaccines, and we came up with several within a year. Why can we not do the same thing to try to beat cancer? In the United States, the Biden administration has pledged to prevent four million deaths by the year 2047. We in Canada can and ought to make a similar commitment. Nothing in life is ever accomplished unless one tries.

Madam Chair, I will be sharing my time with the Minister of International Trade. I think it is really unfortunate that I am here yet again to talk about Ukraine and the war and using those two words in the same sentence. I wish, when I thought about Ukraine, my thoughts would be limited to growing up with my baba in Fort William. We would sit on the front steps of her corner store. She would bribe me with Coca-Cola and chips to get me to sit and listen to her Ukrainian hymns and stories about the old country. I wish my thoughts of Ukraine were limited to thinking about my family in Odessa, which I visited, and visiting the village of my baba, which was near Horodenka in Chernivtsi, or the village of my dido, which was near Kamyanets-Podilskyy. Instead, here we are talking yet again about the war, an unprovoked attack by the Russian state, led by Vladimir Putin, in complete and utter disregard for the most fundamental principles of international law. In starting this war, Putin has committed what is known in international law as the crime of aggression, which in the words of the Nuremberg judgment is “the supreme international crime...[as]...it contains within itself the accumulated evil of the whole”, the evil being all other international war crimes. I would love to talk more about how the invasion has affected the international legal order, which grew out of the horrors of the Second World War, and how the resulting international trade rules have brought prosperity to millions of poor people around the world. However, time is limited, there is a war on, so let me talk about some of the specifics and highlights of the agreement. In 2024, Canada will provide $3.02 billion in macroeconomic and military support to Ukraine. The agreement states: In the event of renewed Russian aggression or attacks against Ukraine following the cessation of current hostilities, and at the request of either of the Participants, the Participants will consult within twenty-four...hours to determine measures needed to counter or deter the aggression. There is a section of the agreement that commits both countries to establish closer defence industrial partnerships. In that, there is an explicit recognition of the acute need for ammunition in Ukraine. There is talk of the need for Canada to continue to support demining. As a doctor who has operated on land mine injuries, that is really important to me. Canada, in this agreement, commits to supporting Ukraine in making sure it holds Russia to account for war crimes, including in front of the International Criminal Court. Lastly, the agreement commits Canada to working with other countries to establish a compensation mechanism whereby Russia would pay for the damages done to Ukraine. I read a quote earlier about how starting a war is the supreme international crime. That quote came from the International Military Tribunal at Nuremberg. There were eight judges on the tribunal; two of them were Soviet judges. As we all know, both Russia and Ukraine were part of the Soviet Union. It is ironic that Russia not only committed the supreme international crime but also committed it against its own brothers and sisters in Ukraine. It is also ironic that two of the judges on that tribunal were American. The United States is the historic champion of the international legal order. However, right now, we are seeing the United States struggle in order to continue to finance military assistance for Ukraine; much assistance has been absolutely crucial in preventing a Russian victory. Crass political gamesmanship and unbridled self-interest seem to have guided many American Republican congressmen to try to block the Biden administration's attempt to provide a further $60 billion in security assistance for Ukraine. This is an affront to the memories of those esteemed American jurists who sat at the Nuremberg trials and to the millions of people who fought and died on the side of the allied nations, both to fight the Nazis and to create the present international legal order. Thankfully, we know that the war in Ukraine will eventually come to an end. Ukrainians will then be able to return to what they do best, which is to grow cucumbers, tomatoes, sunflowers and dill and, occasionally, to be able to sit down and calmly enjoy a nice glass of horilka. Unfortunately, that day will not come soon enough. Slava Ukraini.

Madam Chair, to tell the truth, I went through the whole agreement, but I did not see anything on medical assistance. However, that is exceedingly important. In fact, I know that Canadian surgeons, as part of teams with American surgeons specializing in plastic surgery, orthopaedic surgery and neurosurgery, have gone to Ukraine to assist people who have been injured in the war. They try, as much as possible, to make them as close as they can to what they were before their injuries. Therefore, I think Canada has really contributed a lot in that respect, and, certainly, continuing to do so is important. However, I will stress that it is far better to prevent injuries and death than having to send surgeons and medical teams to try to undo what war has done.

Madam Chair, I would like to thank the member for his compassion for the Ukrainian people. As to what Canada has to do at the moment, certainly, it has to hope for a good result in the upcoming election in the U.S. We certainly fear what is going to happen should Trump be re-elected. What the member said earlier about the effects on children was very apropos for me, because the harm caused by this invasion will go on for years. The effect on the education of children is something that we are going to feel for years. The fact that the Republicans are blocking this is absolutely terrible in my mind. The reality is, perhaps, that we in the western world, parts of NATO that are not the United States, need to contemplate the possibility that we will have to do far more on our own. At some point in the future, should Trump be elected, we may need to do things without the support of America. I certainly hope that Canada would be willing to make the commitment that is needed to continue support of Ukraine against Russia with or without the United States. However, I would certainly like to see the United States continue its historical role in promoting and supporting the international legal order.

Mr. Speaker, I can understand the argument that the carbon tax would be inflationary. The problem is that the experts do not seem to think that. For example, the Governor of the Bank of Canada, in September, said that the carbon tax only contributed about 0.15 percentage points to inflation. A Policy Options review in 2023 estimated that carbon taxes increased consumer prices between 2018 to 2023 by 0.6%. Stats Canada, in a B.C. study, figured that only about 0.33% of the increased cost of food was attributable to the carbon tax. I am not sure where the Conservatives are getting their statistics from, but I would like to hear some of their statistics.

Mr. Speaker, as I was saying, the experts seem to think the carbon tax only minimally contributes to inflation. Let me quote a few of those experts. The Governor of the Bank of Canada in September came to the conclusion that the carbon tax only contributes 0.15% to the inflation rate. In a recent review in Policy Options, a couple of Alberta economists calculated that the carbon tax increased consumer prices by only 0.6% in the last eight years. Stats Canada, in a B.C. study, estimated that the carbon tax only contributed or increased the cost of food by 0.33%. Where are their statistics from? I quoted some. I would like to hear from the opposition. Where are they getting their stats from?

Mr. Speaker, let me start by apologizing to the four or five people who might have listened to my last speech and who are here listening again today, because this is going to sound a little repetitive. I certainly support the legislation, and I know there are a lot of people out there who are really worried about allowing MAID for mental illness. There are people who are worried about their friends. There are people who are worried about their parents. I am most sympathetic to people who are worried about their children. I have six children, and I know that they are going to, at some point in their life, go through difficult times. I would certainly be a little worried for them if we were to allow MAID for mental illness to be implemented with the current safeguards. I know that there are also many psychiatrists who are worried about and/or oppose the legislation. In fact, the latest statistic I heard was from a survey that showed that about 75% of psychiatrists were against it. They are worried that their patients who would otherwise get better would instead resort to MAID. Let me take a step back and look at the arguments coming from the other side. People are going to say, “Why not? Is it not a matter of personal autonomy? Is it not my body and my choice?”. This is not about the state's dictating to the individual what they can do with their own body. It does not criminalize trying to commit suicide or committing suicide. This is about what role, if any, the state should have in assisting people to commit suicide. I am going to come back to the issue of whether MAID for mental illness is the same as assisting suicide. The question of whether the state ought to take a role in assisting people in ending their lives is, I think, a little like the question of whether the state should try to prevent people from killing themselves. This is a topic I know something about, having worked a lot of years as an emergency room physician. In that role, my job, if somebody came before me and was suicidal, was to keep them in the hospital, even against their will, to prevent their suicide from happening. Occasionally people would ask why I should I have that power, saying, “ Is it not my body, and my decision to make?” I think that there are two legitimate reasons for the state to try to prevent people from killing themselves. One is to protect someone from themself. When one is in the depths of depression, they cannot realize that things will get better; that is partly why someone is so depressed and wants to kill themself. The reality for most people is that they do in fact get better. The other legitimate reason for the state's intervention is to protect the family. The person who commits suicide is dead. The rest of the family lives on and lives with the pain, but it is not only that; they are constantly haunted by whether the death was because of something they did or did not do. Some people are going to say that, no, MAID for mental illness is not the same as assisted suicide, that we are talking about a small group of people who have intense, prolonged suffering and have tried every form of treatment but nothing has worked, and that it is cruel and unconstitutional to not allow those people access to MAID. I disagree. The Canadian law is far more permissive than, for example, the Dutch law. There is absolutely no requirement that all forms of treatment have been tried and been unsuccessful. Our law does not even require patients to have tried any treatment at all; it requires only that the patient have no other treatment that is acceptable to them. There are going to be people who refuse all forms of treatment altogether. I know that there are people who support MAID for mental illness who will say that the safeguards are going to come from the medical profession, that they are going to require someone to have tried all forms of treatment beforehand. Unfortunately, I do not have the same sort of faith in the medical profession's doing that. Why do I not? If we look at what has happened with the MAID regime for people with physical illnesses, we see that there are a lot of MAID practitioners who are very zealous about its being all about one's personal autonomy and saying it is not for them to question someone's suffering, and who are quick to approve people. Let me give some examples from the media. The Fifth Estate aired a program that said that a 23-year-old diabetic going blind in one eye was granted MAID. Another person, a 54-year-old man, had back problems, but his main problem seemed to be that he was worried about losing his housing and ending up on the street. He too was granted MAID. CTV published a couple of relevant articles. A 51-year-old woman was actually granted and got MAID for multiple chemical sensitivities. Again, from CTV, a 31-year-old woman who seemed to use a wheelchair from time to time and had multiple environmental allergies, applied and was approved for MAID; again, however, her main problem seemed to be that she could not find suitable housing. There are those who have such faith in my fellow doctors to come up with the system and all the safeguards, but I do not share the same sort of faith. I, as someone with a lot of children, realize it is inevitable that at times in their life they are going to go through a hard time, the breakup of a relationship or financial hard times. I am really worried that they would walk through the door of a zealous practitioner who will tell them it is all about personal autonomy and is their decision to make, because who is the doctor to question their suffering. There is not any requirement in the current legislation that the MAID practitioner talk to the family or the previous treating practitioner to find out whether in fact the depression was motivated by, for example, the breakup of a relationship. I also want to talk about what I think is a really fundamental and perhaps fatal flaw in the current regime with allowing MAID for mental illness, which is the problem, the impossibility, of determining irremediability: Who is not actually going to get better? I have spoken previously about the inability of suicidal individuals to appreciate the fact that they are going to get better. Some people would ask whether there are people who are not going to get better, who are irremediable. That is in fact the requirement of the legislation. The problem is that doctors do not have a crystal ball. They are not really good at being able to determine who really is irremediable. In fact, a recently published study looking at the ability of clinicians to determine irremediability for treatment-resistant depression concluded: Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard of irremediability cannot be met.... Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of [MAID] assessments. For me, as a long-time medical doctor, it is absolutely mind-boggling that there are medical practitioners and psychiatrists who are not particularly bothered by the fact that they really cannot say whether the illness is irremediable, and would grant MAID. If we allow MAID for one such person who would actually get better, to me it would seem tantamount to the same sort of tragedy as the state's hanging someone who later turned out to be innocent. We in this place cannot let that happen. Last, let me address the assertion of proponents of MAID who say that it is inevitable that the Supreme Court would find not allowing MAID for mental illness unconstitutional because it is allowed for physical illness. I think that, yes, there would be a finding that such a provision would violate section 15 or section 7, but as always, the question comes down to the section 1 analysis and whether the state's actions constitute a reasonable limitation as prescribed by law that “can be demonstrably justified in a free and democratic society.” I do not think the answer to that is clear. It is not just me; there was a letter written by 32 law professors who came to the same conclusion: it was not clear whether it would be found unconstitutional. I am not going to say that we should never allow MAID for mental illness; in fact, I know personally of a case where this might have been the ethical thing to do, but I think we are a long way now from being in a situation where we should start to allow it. I would prefer the pause be indefinite, but so be it. We have what we have. Let us look at it in two years and see what has changed. I doubt very much will have changed.

Mr. Speaker, I absolutely support that. What a humane society does when someone who is suffering comes before it is that it tries to help them. Maybe that means better psychiatric care, but maybe it means addressing their socio-economic problems. Certainly I do not think that a humane society's first response to that person ought to be to offer them death. That is an absolute failure and a solution of an inhumane society. We ought to be helping people who are suffering, not ending their lives.

Mr. Speaker, I am not against MAID for physical illnesses. That is a totally different situation. The problem with MAID for mental illness is the inability to determine who is not going to get better. The unfortunate reality is that there are a lot of doctors who have a very cavalier attitude toward taking someone's life, and that there are people who could or would get better with a little time and with better treatment who would otherwise have their lives foreshortened by one of these zealous practitioners. Certainly it is very different from, for example, the Carter situation, or someone who has ALS and is terminally ill with a neurodegenerative disease. That is a totally different story, and in those cases I certainly approve of MAID if that is what the person wants.

Mr. Speaker, I would approve of that. However, as a medical practitioner, I would not volunteer to become a MAID practitioner. If this position is going to be created, the only people who are going to take on the job are people who believe in MAID, believe that it is all about personal autonomy and believe that it is not for others to question a person's suffering. Whatever they are going to be taught, a lot of them are going to be the kind of people who do have a cavalier attitude toward taking life. Those of us who disagree with it are not going to accept the position to begin with.

Madam Speaker, let me start by saying that I am sharing my time with the member for Sarnia—Lambton, which, I have to say, is a little bizarre. I support this legislation, a further three-year hold on allowing MAID for mental illness, and, in addition, imposing a requirement in two years' time to reform the MAID committee to re-examine this question. I know there are a lot of people out there who are worried about MAID for mental illness. People are worried about their parents. People are worried about their siblings, and I can most appreciate that people are worried about their children. I have six kids and I, frankly, would be worried if we were to implement this legislation as is, because I do not think there are adequate safeguards. Everyone who is a parent realizes that our children will inevitably, at some time, go through difficult times. I also know that there are many psychiatrists out there who are worried about this, and the majority of psychiatrists are against this. They are worried that their patients, who would otherwise probably get better, would instead resort to MAID. To all these people, I think their concerns are totally justified. I do not think there are adequate safeguards in place at the moment. Let me step back a bit and look at the approach of those who are advocating for MAID for mental illness to start right now. For them, it is all about personal autonomy: “It is my body, my choice. Who are you to second-guess whether I want to live or not?” This is not the state dictating to people what to do with their own bodies. It is not criminalizing either suicide or attempted suicide. This is a question of what role, if any, the state should have in assisting people to commit suicide. I am going to get back to the question: Is MAID for mental illness really the same as suicide? The question of whether the state should be assisting people in committing suicide is closely akin to the question of whether the state should help to prevent people from committing suicide. This is something that I have a bit of experience with, because for a lot of years, as an emergency room doctor, I would see people who were suicidal, and it would be my role, if I thought they were suicidal, to keep them in the hospital, even against their will. People would ask me why I should have this power. They would ask, “Is it not my right to decide what to do with my own body?” In thinking about it, I thought, well, the state has two legitimate interests in trying to prevent people from killing themselves. One is to protect people from themselves, because when they are in the depths of depression they do not realize that things will get better. That is partly why they are so depressed and why they want to kill themselves. However, the vast majority of people do get better. The other legitimate reason for the state to intervene is to protect the loved ones. The person who dies is dead; they are not suffering any more pain. The people who continue to feel the pain are those who have lost their loved one. In addition, they often spend the rest of their lives thinking about whether this had anything to do with something they could or could not have done. I know there are people who are going to say this is different: MAID for mental illness is different from assisting suicide, and the people they are talking about with respect to MAID for mental illness are people who are chronically, desperately ill, who have tried all forms of treatment and for whom nothing has been effective. They say that it is really cruel and unconstitutional not to help those people. I disagree. First of all, the Canadian law, unlike the Dutch law, is very permissive as to who meets the requirements. There is absolutely no requirement that the person has tried all forms of therapy and they have failed. In fact, they do not have to have tried any form of treatment at all, because the legislation would require only that there are no other treatments acceptable to the patient. I know, from being a doctor, that people are going to refuse all treatment. They are going to refuse medications. I know those who support MAID for mental illness are going to say, “Okay, it is not in the legislation, but it is up to the medical profession, the doctors, to impose these requirements, like trying all forms of treatment, even if the law does not.” I hate to say it, but as a doctor I do not have the same faith in my own medical profession, and the reason for that is that we ought to have learned from what has happened with MAID for other forms of physical disability. There are a lot of zealous MAID practitioners out there who absolutely believe that personal autonomy is paramount and do not think we ought to be questioning why somebody decides to take their own life. Let me give some examples from the media. The Fifth Estate, a very good show, talked about a 23-year-old diabetic person who was losing sight in one eye, who applied for and was granted MAID. Another story was of a 54-year-old man with back problems, but his real problem seemed to be that he was afraid of losing his apartment and ending up on the street. He too applied for and was granted MAID. CTV documented the story of a 51-year-old woman, who applied for and actually received MAID for multiple chemical sensitivities. Another story was of a 31-year-old woman approved for MAID for needing a wheelchair. I do not think she actually really needed it, but she usually used a wheelchair and had multiple environmental allergies. Again, her problem was mostly that she could not find adequate housing. Again, this person was approved for MAID. To those who have such faith in the medical profession that they say we are going to create the safeguards, they are perhaps a little naive. I would sincerely worry if we were to implement this legislation with the safeguards in it right now. I have six children, and I know, almost inevitably, that life is such that they are going to go through difficult times, such as the breakup of a relationship or hard financial times. I would be worried they would see one of these zealous practitioners who believe in personal autonomy, who would say, “Who am I to question your suffering?” Part of the problem is that the current legislation would not require the MAID practitioner to talk either to the family or to the treating doctor, so they are not going to find out that the depression was the result of the breakup of a relationship or the person's not taking their medication. I also want to briefly talk about the problem with allowing MAID for mental illness and the question of irremediability. Part of the problem with allowing it for people who are depressed is the fact they cannot see that things are going to get better, but people are going to say that surely there are people out there who are not going to get better, which is the requirement of the legislation: One needs to have an irremediable illness. The problem, though, is that doctors are not really good at predicting who is not going to get better, especially with respect to mental illness. With things like cancer, it is different. A recently published study that looked at clinicians' ability to determine irremediability for treatment-resistant depression concluded, “Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard for irremediability cannot be met”. Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of MAID assessment. For me, as a long-time doctor, it is almost mind-boggling that there are practitioners out there, psychiatrists, who are not particularly bothered by the fact that they cannot be sure somebody's condition is irremediable. It would be absolutely terrible to take someone's life when they could actually get better. Lastly, let me address the assertion of some proponents of MAID that it is inevitable that if this was to go to the Supreme Court, it would find it to be unconstitutional, because it discriminates against people who have mental illness rather than physical illness. I do not think it is at all inevitable. Yes, a court would probably find this to be a violation of section 15 or section 7, but the real question, as in a lot of constitutional questions, is the section 1 analysis. Does it constitute a reasonable limitation “prescribed by law as can be demonstrably justified in a free and democratic society”? I think that is highly questionable, but never mind my opinion. There was a letter written by 32 law professors to the relevant ministers a year ago, stating the same thing, which is that it was not clear this would be found unconstitutional. I am not going to say I do not think we should ever allow MAID for mental illnesses. I, in fact, know someone to whom perhaps the only humane thing would have been to offer it. However, we are very far at the moment from being in a position in which I would be willing to advocate for MAID for mental illness. Let us vote for this legislation. Let us re-examine it in two years' time.

Madam Speaker, as the member knows, I am not free to discuss what I did or did not say in caucus. However, we did delay this for one year and a further three years. Obviously there are the considerations of what the Senate is going to do and what the courts are going to do. The issue will come back. Yes, I would have liked to have seen the pause be indefinite, but it is what it is. Let us go one step at a time, and I think in the end we are going to come to the right conclusion.

Madam Speaker, I thank my colleague from Montcalm, who sits with me on the Standing Committee on Health. I am worried about something. I was a doctor and I still practise medicine, but now I am here in the legislature. We make the rules, and I think one of our responsibilities when we make rules is, like a doctor, to do no harm. If we implement this legislation, I am genuinely concerned that, although I know my colleague from Montcalm is a great individual, and I trust him, there are a lot of zealous MAID practitioners who are very cavalier in allowing MAID for various forms of illness. I do worry that my kids and the kids of my constituents are going to go through hard times and see one of these zealous practitioners, who will say, “Well, it is your decision to make." It is our job to protect those people. That is why I am here.

Madam Speaker, I absolutely have comments on that. Sometimes court decisions deal with difficult ethical problems that involve balancing competing interests. They say these sorts of difficult decisions should be left to the elected representatives who are held accountable to the people, not left to the non-elected courts. That is absolutely right, and with respect to this issue, it ought to be us in the House, who are the elected people, who make the decisions, not the Senate.