She said: Mr. Speaker, I would like to begin my comments by acknowledging the depth and quality of the thoughtful work that the other place has undertaken in its review of Bill .
The number of amendments that were presented and thoroughly debated speaks volumes, not only about the complexity of the issue at hand but also about the dedication with which members of the other place sought to improve the legislation.
Bill , as passed by the House of Commons, expressed our policy choice to address medical assistance in dying in a principled and cautious manner. This policy choice was deliberately and carefully crafted. The bill achieves the most appropriate balance between individuals' autonomy in deciding how their death will occur and protection of vulnerable individuals, as well as broader societal interests. These interests include suicide prevention, equal valuation of every person's life, and preventing the normalization of death in response to suffering. Several amendments were made to Bill C-14 in the other place.
The most significant amendment was the deletion of the definition of “grievous and irremediable medical condition”. The effect of this amendment essentially removes the eligibility requirement that “natural death has become reasonably foreseeable”. This amendment appears to have been motivated by a concern that this criterion is unconstitutional because it does not explicitly appear in the Supreme Court Carter decision.
Many legal experts have testified before the Standing Committee on Legal and Constitutional Affairs in the other place. Some expressed their views that Bill , as initially passed in the House of Commons, would be found unconstitutional if challenged in the courts.
However, other legal experts and professors took the opposite view, that Bill , as adopted in the House of Commons, with the requirement that natural death be reasonably foreseeable, is constitutional. In Carter, the Supreme Court was clear that it is the role of Parliament to craft a complex, regulatory regime with respect to medical assistance in dying and that such a regime would be given a high degree of deference by the courts.
Hon. colleagues, as Minister of Justice and the Attorney General of Canada, I am confident that Bill , as originally drafted and presented in this place, is constitutional. As outlined in an addendum to the legislative background paper that I distributed to all parliamentarians earlier this week, and which I am pleased to table in the House today, the question is whether the complex, regulatory regime found in Bill C-14 is consistent with the charter, not whether it exactly replicates the wording of the Supreme Court in Carter. In the dialogue that this Parliament has with the judiciary, Bill C-14 is our principled, cautious, and deliberate response.
This is a transformational discussion, and a significant first step for our country. It is important to note that Bill is very different from the former law that was before the court in Carter. Our proposed legislation permits medical assistance in dying for the overwhelming majority of those Canadians who would seek to access it, and it is motivated by broader, new legislative objectives that do not animate the former law.
Bill is a new law with new features, and an analysis of its constitutionality must reflect this. The Carter ruling alone is not the end of the story, nor is it the end of our national discussion. The conclusion to draw here is that there are diametrically opposed but reasonable points of view about the constitutionality of Bill C-14.
The situation is not unique. It is normal and part of a healthy debate for legal experts to differ on the merits of a particular piece of legislation that has not yet been examined by the courts. However, I would caution that fundamentally altering the delicate balance purposefully struck in Bill solely because of the existence of these differing views is ill-advised.
As the Supreme Court of Canada stated in Carter, “the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards”. The government's policy choices, as reflected in Bill , were specifically crafted to protect vulnerable Canadians from these different types of risks.
First is the protection of those who will ask for medical assistance in dying. Bill , as passed by this chamber, would limit eligibility to those whose death has become reasonably foreseeable and for whom the risks can be adequately addressed by the robust safeguards found in Bill C-14. However, if eligibility is drastically expanded to all Canadians who are suffering unbearably, regardless of whether or not their death is reasonably foreseeable, as in the amendments the other place proposes, there are more risks of different types that are much harder to detect.
These risks include the very real possibility that individuals may be motivated to request medical assistance in dying for a whole host of reasons, psychosocial, emotional, or systemic, which are separate from their medical condition but that exacerbate their suffering. People may die unnecessarily or prematurely, when other options for improving their quality of life are available. Cases from other jurisdictions that permit medical assistance in dying support these concerns. We do not believe that this is what Canadians want.
Importantly, while the other place expanded eligibility in the bill, it did not introduce new safeguards for the very circumstances where the most caution is required. The result is that any serious medical condition, whether it be a soldier with post-traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind is haunted by memories of sexual abuse, could result in eligibility for medical assistance in dying. I raise these examples from other jurisdictions not to be sensational, but to highlight the real risks at play.
However, beyond the risks for those who make a request for medical assistance in dying, making it available to all Canadians who are suffering would also have repercussions at a much broader level. It would alter our societal values and send the wrong message to our most vulnerable Canadians who may never even request assistance. These are risks for which there are no obvious safeguards.
Broadening eligibility for medical assistance in dying to situations where death is not reasonably foreseeable would contribute to negative perceptions about the quality and dignity of life of people with disabilities. Organizations like the Canadian Association for Community Living and the Council of Canadians with Disabilities, among other disability rights organizations, have cautioned us about the potential devaluation of the lives of Canadians with disabilities that broader eligibility criteria would attract. They tell us that such devaluation happens when the law presumes that life with a disability could be so unbearable that death should be a state-sanctioned option.
Broad eligibility criteria could also send the wrong message that society feels it is appropriate to address suffering in life by choosing death. This message may encourage some who are in crisis and already considering suicide to act, even privately and without assistance. Procedural safeguards would not help these individuals. The relationship between medical assistance in dying and suicide has not been sufficiently studied and we must have more information about this complex situation before we can decide what is right for Canada. I want to acknowledge the thorough and emotional discussion in the other place on this incredibly important issue.
We recognize the important amendments to Bill adopted by the other place, namely that a person signing on behalf of the patient requesting assistance cannot know or believe that they will benefit from the patient's death. This is indeed a thoughtful amendment that improves the bill and a valuable safeguard that we are pleased to support. Ensuring that a patient is aware of all means available to relieve their suffering, including palliative care, is of course important.
A further amendment concerning the monitoring system introduces mandatory language requiring the to make regulations and guidelines. The government appreciates the other place's concern that regulations to support the monitoring regime be put in place. Canadians want to know that this system will be well monitored and we support this well-crafted amendment from the other place.
Further, there was an amendment requiring that the issues to be studied in the bill, which are mature minors, advance directives, and requests where the sole underlying condition is mental illness, be completed in two years. This amendment from the other place reflects the concern that Canadians have for these incredibly complex issues, and the desire for this government to be held to account on each of them, and for that reason it is supported.
I would also like to acknowledge the substantive work of the Standing Committee on Justice and Human Rights, whose thoughtful study of the bill resulted in 16 amendments from all parties being adopted.
I would urge all members of the House to consider the pressing need for a federal legislative framework governing medical assistance in dying. With no such regime in place at this time, with the force and clarity of the criminal law, all Canadians face significant uncertainty.
It is crucial to keep in mind that Bill was carefully and deliberately crafted as a cohesive and balanced regime. The balance sought in Bill C-14 would be upset by the broadening of eligibility criteria to individuals who are not approaching death without the corresponding safeguards for these specific cases.
Since forming government, we have spent countless hours consulting with Canadians and stakeholders, carefully considering all of the evidence and diverse perspectives on this incredibly challenging issue. We are confident in the policy choices expressed in Bill . The legislation represents the right approach for Canada at this important time in our country's history. I encourage all members of the House to support the government's motion, which respects the other place's contribution to this important debate and maintains the most appropriate balance for all Canadians.
I am pleased to table, in both official languages, a document entitled, “Legislative Background: Medical Assistance in Dying (Bill C-14)--Addendum”.
Mr. Speaker, I will be sharing my time with the hon. member for .
I will be brief. I want to speak to a few of the amendments the government has chosen to accept and also express a few words of caution.
I want to thank the minister for keeping the language as tight as possible. “Reasonably foreseeable” is a much better situation than “grievous and irremediable”. As this is such a fundamental change to our society, we do not want to open the door to assisted suicide in such a manner that a large number of people who may be suffering from physical or mental ailments would have access it.
I understand the slight wording change on the palliative care amendment. It is important that any patient make an informed decision, whether it is about something as simple as a normal medical procedure, but certainly in a situation like this of such a grave and serious matter. In essence, as this may be the last decision some people make, making an informed decision is critically important. Knowing what other options there might to alleviate of pain as well as palliative care are also so important.
I hope the government will work with the provinces in the coming months and years to establish a robust palliative care regime so this type of decision is not made without having real and practical options to extend life in as comfortable a manner as possible, while understanding the significant challenges that are often placed on family members.
I wish the government had included the amendment that dealt with beneficiaries of estates or insurance policies not being able to participate directly in the act of assisted suicide. That is an important amendment to keep. This is going to be a new thing in Canada and we do not know how it will unfold, so having some kind of safeguard in place to avoid pressure being put on people to make this decision is important.
Many members may be familiar with the Terri Schiavo case in Florida. It was a bitter dispute with a lot of allegations all around. One of the facts that came out was that one of the family members pushing for end of life care to be withdrawn from Terri Schiavo was a beneficiary of an insurance policy. That conjures up gloomy images of what might happen to people who do not wish to end their life and are not able to either grant consent or put up opposition to it and have those decisions made for them.
I want to touch on a few comments that are troubling to me. I have heard comments made by government members and the minister about how this is a first step and that this could be expanded in the future. Those types of things very much concern me. The House is taking this decision because of a court decision. The Supreme Court of Canada reversed its original decision that upheld the laws against assisted suicide and has thrown this on to Parliament.
I understand the need that the government had to fill in this legal vacuum, and I commend it for using the language “reasonably foreseeable” and not “grievous and irremediable”. However, I am wary about what might be coming down the pike. It really worries me when people talk about this being a first step. I shudder to think where this might go. If this type of regime is opened up more, people who may be going through difficult times in their life, maybe temporary difficulties, both physical and mental, will access it.
I hope we have created a tight box that will not be expanded. I will be watching in the future and will do everything I can to ensure that this is not expanded, and I hope many of my colleagues will do the same. I do not want to go down the road of what has transpired in some European countries where this is used in a much more aggressive and expanded way. Many times it involves vulnerable people or people with severe disabilities who are not able to communicate their desires and other family members or other caregivers make that decision for them.
Canada could be going to a very dark place if this is a first step. If it is filling in that legal void and we have created a strict enough and a tight enough box around it, then I hope this is as far as it goes. I will be doing everything I can to ensure that is the case.
Mr. Speaker, it is a pleasure to rise for what will probably be my last time speaking to this particular bill, though I am sure not to this issue in general.
I am going to give a fairly disparate speech addressing a number of different issues that have been raised and loose ends in this conversation.
First, it is important to underline that we do not exist in a legislative vacuum at the present time. The government has, in my judgment, created this sort of artificial sense of fear, this artificial timeline that says we have to pass its bad legislation, in my judgment, just because if we do not do it, there will be no legislation.
June 6 has come and gone. There are provincial guidelines in place. I do not dispute the fact that a better version of a federal framework would have many desirable things about it. I have not certainly opposed the principle of the federal government legislating in this area. We are, after all, talking about the contours of an exception to the Criminal Code. However, in the absence of the federal government having done the detailed work, in terms of actually coming up with a system of checks and balances, a system of safeguards, it may well be—and in my view, it is the case with the present legislation—that we are better off to defeat it, perhaps to bring back a better bill in the future. I will talk specifically about why that is and what a better bill would look like.
However, I think it is fundamental that we recognize the reality that there is not a legislative vacuum. It is not as if people are being killed without some kinds of systems, checks and balances, and safeguards in place. Provinces were ready in a way that the federal government simply was not.
I think we have a failure of process here. I will just briefly outline what that process was.
We had a Supreme Court decision at a time when the Conservatives were in government. We created this expert panel to review and report back, and it would have reported back after the election. It would have been difficult for politicians to be involved in a government consultation process in the immediate lead-up to and during an election. However, we had this external expert panel that was consulting Canadians and that was ready to report back the results of its consultation, as well as make policy recommendations.
When the new government came in, it removed the power of that expert panel to make recommendations with respect to policy. It only reported on its consultation. When we hear the government talk about this timeline, somewhat misleadingly, it will say that the previous government did nothing to advance this, when it was its decision to remove that essential power of the expert panel to make policy recommendations.
Then we had a motion in this House, in December, to create a joint committee of the House and Senate to review this issue. That panel could have sat during the Christmas break, but it did not. It faced a time crunch when it came back. Then we waited months before seeing any kind of federal legislation. The failure of process was that in every case, in as much as a year and four months is not that much time, we faced a time crunch toward the activities of the committee and toward the activities of the House and certainly the Senate, because we did not more effectively use the panel that was put in place by the previous government. That panel consulted far beyond what the special committee did, far beyond what the justice committee did—in the case of the justice committee, not for any ill intention, I am sure. I was concerned about the process of witness selection with the joint special committee. There were many people who were even intervenors in the Carter case who were not able to participate in those hearings. In any event, the point is that we had this artificial time crunch that was created, and we see it happening again today.
Again today, the government is trying to create this artificial urgency instead of delving into this substantive conversation. Quebec did this in six years. I am not saying we should, or could, take six years, but having the prudence to have introduced legislation earlier and to have drawn on the wisdom of the expert panel would have been much better because we are in this seeming time crunch. However, I think we need to reject the time crunch the government is creating and, instead, do the diligent work that we need to do to fix some of the big problems in the bill.
We see sloppiness in this legislation, especially around this discussion of reasonable foreseeability. The justice minister just spoke, and I actually share many of the concerns she raised about leaving this wide open, but I think what she neglects is that reasonable foreseeability is not clear enough to be, in any sense, a meaningful safeguard.
I have listened to the minister speak repeatedly about reasonable foreseeability, and I understand that in response to my short question, she did not have enough time to define it fully, even if she had wanted to. However, having listened to her speak many times on this subject, I am not at all clear—and maybe subsequent speeches will provide some clarity—what that term actually means.
Obviously, death is reasonably foreseeable for all of us. This is part of the human condition. We are born and we die. There was certainly nobody on either side of this debate who suggested that natural death is abnormal, bad, or something to be feared. It is a part of life and reasonably foreseeable for all of us. That does not mean that we should not be concerned, though, about policies that would artificially cut short the process of natural life and death.
However, if “reasonably foreseeable” is so important, then we should actually have a definition. There should be some clarity about what that means. Liberals have said they are not talking about imminent natural death, but at some point in the future. I have quipped before that, when I was learning to drive, my mother thought death was reasonably foreseeable every time we got in the car, but the central point is that death is reasonably foreseeable for all of us. It is part of the human condition.
Therefore, this is very sloppy. It is not a safeguard. We need real, meaningful safeguards. I suggest that the federal government should contemplate safeguards along the lines that the government of Manitoba has brought in, whereby some competent legal authority reviews cases to ensure that legal criteria were met, not a model of judicial review but government lawyers designated for this purpose.
Other provinces have put in place systems that necessarily involve the attending physician, or if the attending physician is a contentious objector, a different attending physician can assess the situation. However, it does not allow someone to just find any doctor anywhere who agrees that someone meets the criteria, but involves the physician or somebody actually involved in providing the person with care to make the assessment. If we look at what the provinces have already done in terms of safeguards, we see these are things that the federal government could adopt.
It is disappointing for me, frankly, as a member of Parliament, to see the government not doing the diligence that provinces have shown is possible when it comes to finding meaningful safeguards within a relatively compressed timeline. The government's approach has been to emphasize sort of an artificial timeline of urgency, but then not actually do the diligent work in advance. It created this time crunch by leaving it until the last minute and then said that it has to be passed or there is a legislative vacuum. There is no legislative vacuum, and again, the important work has not been done in terms of clarifying the safeguards.
I will make a general comment. I find myself repeatedly asking the government for definitions of things. On this issue and a range of other issues, it repeatedly uses words without actually clarifying what the words mean. It is true of the provisions of this bill, but more broadly, it is true of the underlying philosophy of this bill. So much of the motivating arguments for this legislation come from the concept of human dignity, human rights founded on an idea of human dignity. I think we would all agree that human rights have their foundation in human dignity. We give rights to people on the basis of what they are, intrinsically. Yet the government, in the context of talking about dying with dignity, has not told us what it means by dignity.
I believe in the idea of intrinsic human dignity. Dignity is present in all of us. I know that one member of the other place who was criticizing me in the media suggested that young people cannot understand this issue because they do not spend enough time in nursing homes. I have volunteered regularly in nursing homes for a very long time and, recently, my grandfather passed away in a care facility. It is important for me to believe, but more than that, to know, that he had dignity in spite of his suffering.
Many of us here have seen or been with people as they suffered and died. It is important that we know and believe that people, regardless of their circumstances, regardless of their suffering, have dignity.
Dignity is not conditional on circumstance. Dignity is intrinsic. If the government disagrees with that, if it has a different concept of human dignity, then it should at least define the term.
This work is sloppy, the philosophy is sloppy, the legislation is sloppy, and I encourage members to defeat this bill in every way possible.
Mr. Speaker, I am very pleased to rise to address the government's motion on a response to the Senate regarding the amendments it has made to Bill . My personal involvement in this process began in January when I had the honour to serve on a special all-party and Senate committee. My colleague, the member for , was a very important member of that committee as well. Our mandate was to advise the government on a response that would respect the Supreme Court of Canada decision in Carter, respect the Charter of Rights and Freedoms, and respect the priorities of Canadians.
I have told the House before how very proud I was of the work that we accomplished together, and the spirit as well with which we worked in that place. We knew that the government would not accept all of our recommendations, but each was based on the evidence and faithfully respected the testimony that we heard, testimony of experts who came to us from across this country and reached out to others in the process.
Since Bill was introduced in the House, I, like many others, have focused great attention on its most surprising feature. That feature was the decision of the government to narrow the declaration of the Supreme Court of Canada to a much smaller circle of eligibility, and it could have proved to be a fatal flaw.
That was the testimony, after all, of the Canadian Bar Association, the Quebec Bar Association, Jean-Pierre Ménard, Joseph Arvay, and later the testimony of Canada's foremost constitutional scholar, Professor Peter Hogg. That was the conclusion, as well, of the courts in Ontario and Alberta. That flaw was important, not only because it fatally weakened the bill against the charter challenge, but also because it would force suffering Canadians to launch a court battle. That flaw was so important and so glaring that it overshadowed much of what was good about Bill . Colleagues who have grown tired of hearing me warn about charter challenges and infringed rights will be pleased to hear little of that from me today, because that fatal flaw has been erased from the bill that is now before the House.
The bill as amended now combines a clear and faithful implementation of the Supreme Court ruling with a system of stringent medical safeguards to individually screen every request for assistance in dying. Those safeguards are based on the evidence received by the all-party committee. They reflect the best practices of other jurisdictions as well as made-in-Canada provisions, which members of all parties have helped shape over the course of this debate.
Without the amendment that came to us from the other place, as Peter Hogg has testified, the bill would not be consistent with the decision in Carter. That was his clear testimony. It also would remove a victory that would be taken from those individuals in Canada who could not comply with the very narrow, and frankly inexplicable restriction, of reasonably foreseeable death. Those individuals have that right as of today until Bill is enacted. Those rights will be taken away should the motion by the government be passed.
However, I am happy to say that the bill before us today, which contains the language of the Supreme Court decision, would of course be compliant with that decision and with the Charter of Rights and Freedoms. As Professor Hogg has said in the clearest possible terms, if it is not fixed as per the amendment that comes to us today, it will be struck down in the Supreme Court of Canada.
When I speak of Mr. Hogg and I hear the government saying we have different experts in different places, I suppose it is important to remind the House of the accomplishments of that individual. His decisions and his book have been cited over 200 times in the Supreme Court of Canada. By my reckoning, it has been cited 1,627 times in the courts of Canada. To suggest that this professor is just another person with an opinion is really quite disturbing, because the government itself, the Department of Justice, has retained that individual on countless occasions.
For him to say, as he did in the other place, that the bill, without the amendment before us today that would fix the problem, is somehow unconstitutional, that it is just another expert, that lawyers differ, economists differ, whatever, is simply misleading.
Canada's leading constitutional scholar has said in the clearest possible terms that without the amendment that happily is now in the bill before us for debate, it has to be fixed. I termed that testimony a game-changer, because I wondered how on earth a government that has retained this gentleman dozens of times could now turn around and say, as the minister did this morning in her speech, that constitutional scholars just differ and that is how it works.
Happily we have in front of us a bill as amended in the other place that we can support, and that is the good news for Canadians. Some amendments come before us to deal with things like palliative care, an amendment that would require all patients considering medical assistance in dying to get a full briefing on palliative care options.
Another amendment would deal with restricting people who help a person in assisted dying, tightening the rules around what role a person who could materially benefit from the death could do.
Another amendment that comes from the other place would compel the to draft regulations around death certificates and provide greater clarity on what information is collected by medical practitioners.
Another amendment calls for a report to be issued to Parliament within two years on issues that have arisen from the provision of physician-assisted dying. Finally, there are some minor language amendments.
The safeguards in the bill reflect many things. They provide the high degree of care, caution, and scrutiny that is necessary to match a court ruling that was broad in its compassion for the right of suffering Canadians to choose. They reflect the confidence that Canadians have in the skill and judgment of our health care professionals, and they reflect the realities of our vast and diverse country, and the principles of equity that undergird our public health care system, of which Canadians should be so proud.
Much has been said in this chamber about the need to balance respect for the autonomy and protection for the individual. We have heard that so often. The Supreme Court of Canada was unanimous in its analysis of our charter, and it ruled definitively on the question of whose autonomy must be respected on this deeply personal matter of choice.
It was for us, as legislators, then to choose what combination of safeguards might be necessary to screen out from that group those who, by virtue of diminished capacity or external pressure, must be denied this option for their own safety. We consider this question carefully, knowing that excessive caution would have its costs. Excessive barriers would not protect the vulnerable. Rather, they would condemn competent, autonomous, adult Canadians to intolerable suffering by wrongly denying their right to choose.
Neither could the solution be to presumptively deny the autonomy of a whole class of persons granted their right to choose by the Supreme Court of Canada. No matter the rhetoric, to presumptively deny people's autonomy, to assess them not as unique individuals, but to dismiss them blindly as a group, to me, is as deeply patronizing and offensive as it is unnecessary.
The Supreme Court expressed faith in us as legislators that we could devise what they called “a carefully designed and monitored system of safeguards” to address the risks associated with offering the compassionate choice of medical assistance in dying. I, for one, believe the court's faith was not misplaced.
We remember what the Supreme Court of Canada said in Carter:
|| We have concluded that the laws prohibiting a physician's assistance in terminating life...infringe Ms. Taylor's s. 7 rights to life, liberty and security of the person that is not in accordance with the principles of fundamental justice, and that the infringement is not justified under s. 1 of the Charter. To the extent that the impugned laws deny the s. 7 rights of people like Ms. Taylor they are void by operation of s. 52 of the Constitution Act, 1982.
Here is what the court went on to add:
||it is for Parliament and the provincial legislatures...should they so choose, by enacting legislation consistent with the constitutional parameters set out in these reasons.
There are two key points that came out of the Supreme Court's pronouncement. The first is that we did not have to do this at all. The court decision could have stood on its own, as in fact it is doing now, along with the safeguards that the provincial and territorial regulators have put in place. We did not need to do what we have done, but we did, in the words of the court, choose to do so.
The second point, though, is equally important: that we could only do so if what we enacted as legislation was “consistent with the constitutional parameters set out in [our] reasons”.
Here is what Professor Hogg testified in the other place. He said, “In my opinion, [the bill] is not consistent with the constitutional parameters set out in [the Carter reasons].”
The amended bill before us would fix it and be possible for all of us to work in the spirit of collaboration, as we did so effectively in the Special Joint Committee on Physician-Assisted Dying and the Standing Committee on Justice and Human Rights. We wrapped our hands around something that would make Canadians proud, wrapped our arms something that would show the compassion that the Supreme Court of Canada showed in the Carter decision, rather than dividing us on party lines or other lines.
All that the amendment the government announced today it wishes not to follow would do is to ensure that it is consistent with the Supreme Court of Canada and the charter. Much has been said about the fact that we need not follow and put into legislation the precise words of a court judgment. Of course, that is right. The simple path was to put the actual language of the decision into the legislation because that was clear and obvious, and certainly no one could say it would be unconstitutional to do so. Rather, the government wishes to use the words “reasonably foreseeable” natural death, which people on all sides of this place have demonstrated is ludicrous language.
Dr. Douglas Grant, head of the regulatory body for all medical regulatory authorities across the country, has pointed out that the language is vague and unworkable from a medical point of view. The government proposed to take the words of the Supreme Court of Canada, though it did not need to, but at least no one can say they are bad, and substitute words that are incomprehensible to the people, physicians and health care providers, who are being required to implement them.
I cannot understand that. I particularly cannot understand it when to do so would be to take away the rights of Canadians that were hard fought for and won in the Supreme Court of Canada. Why? What do I tell those people who call me and say they have to decide whether to take their own life now, because after this bill comes into force that may not be an option available to them? They won that right in the Supreme Court of Canada. In no way do they feel they are near end of life. They may have 30 more years of excruciating pain and suffering, and how dare we say that they do not have that autonomy as a Canadian individual? However, now the government purports to take away that right.
Please understand that as of June 6, the Supreme Court decision stands alone, carefully governed by rules that apply to health care practitioners from coast to coast to coast. It is not the wild west, as colleagues have already pointed out. We have rules in place that are being enacted and carefully followed. If this motion passes, the moment the current government takes away those rights by saying that people have to have a reasonably foreseeable natural death, they will lose that right.
How can the Liberals possibly argue that this somehow would not deprive Canadians of rights that they won in the court? These are real people. This is real suffering. The government says no, that it has this delicate balance right, and it calls it a public policy choice. Some Canadians think that the government goes too far and some Canadians say it does not go far enough, so it will come right down the middle. That frame is wrong. We are here because we chose to implement a unanimous Supreme Court of Canada decision.
We are not here to say we will pick and choose what we like about this issue.
Can we add additional safeguards? Absolutely, and I am proud of what we did. Can we deal with palliative care? Yes. Can we deal with conscience rights? Of course, and we did, and I am proud of what we achieved.
The elephant in the room is that an entire class of successful litigants have had those rights deprived in this place.
The good news is that we can fix that. We have a path to do that, which comes from the other place. It is language we tried to get through the House before. I do not care where it comes from. I am on the side of suffering Canadians who want the rights that they had before.
It is worth reminding ourselves of a very simple fact. We are not called upon to legalize medical assistance in dying. That was already done by the Supreme Court of Canada and is now the law of the land. Instead, we were invited, if the government chose to do so, to offer the broader framework necessary to give clarity and comfort to all Canadians.
I believe that balance has been achieved in the bill that we have before us, as amended. The words of the Supreme Court are there to speak to whose autonomy must be respected, and the work of all parliamentarians is reflected in the system of safeguards before us. The onus must now be on the government to explain why it proposes to cut the words of the Supreme Court judgment out of the bill we have received from the other chamber.
I know that many of us share a common belief that no one can ever make this difficult choice of medical assistance in dying for another. but by rejecting the ruling of the Supreme Court and removing its words from the bill, that is exactly what the government suggests that we do. I cannot accept that, and on a free vote, it is up to all members to decide whether they can accept that.
I would ask all members in this place to consider the alternative; that is, to accept that what we now have is a balanced bill that bears the marks of the Supreme Court, of Parliament, and of thousands of Canadians who participated in consultations and town halls along the way.
I feel we have in our hands, now, what the special all-party committee set out, in January, to produce; that is, a bill that respects the Supreme Court ruling, respects the Charter of Rights and Freedoms, and respects the priority of Canadians.
We do not need to reopen the debate and cut out the words of the Supreme Court. We do not need to reject the charter fix, which was proposed in this chamber, adopted by the other chamber, and confirmed as constitutional by a most respected scholar on the charter.
|That the motion be amended by:
||a) Deleting the paragraph commencing with the words “respectfully disagrees with amendments 2b, 2c(ii) and 2c(iii)”; and
||b) Replacing the words “agrees with amendments numbered 1, 2d, 2e, 4 and 5” with “agrees with amendments 1, 2b, 2c(ii), 2c(iii), 2d, 2e, 4 and 5”;
Madam Speaker, I want to say before I begin that I will be splitting my time with the hon. member for .
I am pleased to be here today to continue our important discussion on Bill concerning medical assistance in dying.
We have seen the serious thought and deliberation that hon. senators have put into this bill over the past few weeks. It is now up to us to carefully examine the amendments that the Senate has presented.
Medical assistance in dying is only available in a very small number of jurisdictions around the world and it is brand new to Canada. What we are talking about with this bill is a fundamental change to social policy in this country. We are pursuing transformative change at the same time as we are facing incredible time pressure to put federal legislation in place. It is, therefore, critically important that we move forward with great care.
There are a number of paths that we could choose to follow with respect to medical assistance in dying in this country. I believe that the choice we have made with Bill represents the approach that is most appropriate and responsible for Canada, and here is why. It strikes a careful balance between respecting the autonomy of patients seeking assistance in dying and protecting vulnerable people. It would protect the conscience rights of providers and support those who choose to participate. It would put measures in place to study the legislation over time as we understand and gather further data to deal with the issues.
I would first like to bring to the attention of hon. members the ways in which the bill respects the autonomy of patients. Under this legislation, eligible patients approaching the end of their lives would be able to choose a peaceful medically assisted death. This represents a significant shift in the way we approach suffering at the end of life in this country. It provides patients with greater autonomy over their decisions.
The bill also improves access for patients. By allowing nurse practitioners to administer medical assistance in dying, the bill recognizes Canada's unique geographic and demographic realities. Nurse practitioners often work alone to provide vital health care services in underserved regions.
In addition to supporting access and autonomy, Bill also takes care to protect patients who may be vulnerable. When changing social policy, we must proceed with great caution if there is a chance that those who are most vulnerable among us may be negatively affected. Without appropriate safeguards, the availability of medical assistance in dying could pose threats to marginalized people and those who may lack access to adequate familial, social, or economic supports. This bill would establish robust safeguards and procedures to protect vulnerable persons from being encouraged or coerced into seeking medical assistance in dying.
It is important to recognize that there has been significant support in this piece of legislation from the health care sector, including the Canadian Association for Community Living, which includes 40 individual advocates and 50 organizations. It includes various medical associations, both provincially and federally, the Canadian Nurses Association, the Canadian Association of Advanced Practice Nurses, the Canadian Pharmacists Association, the Canadian Psychiatric Association, the Canadian Association of Social Workers, and many more.
This legislation also complies with the vulnerable persons standard, which I believe sends a strong message to all Canadians about our support for those among us who need most protection.
The bill recognizes that medical professionals have the right to follow their conscience and choose whether or not they want to participate in medical assistance in dying. For those who do choose to participate, the bill ensures that the doctors and nurse practitioners who administer this assistance will not be prosecuted. It also exonerates those who may assist, such as pharmacists and authorized nurses.
Finally, it outlines criteria to help support providers in assessing patients. It is important to keep in mind that health care providers are required to assess the condition of their patients on a regular, if not daily, basis. Assessing the level and type of suffering is already part of medical practice and it is very common in all end-of-life care. It is, for example, a crucial element in determining the best approaches to alleviate suffering in palliative care.
Our eligibility criteria and safeguards offer providers direction and flexibility within their field of expertise and scope of practice to make an assessment about the condition and circumstances of a patient seeking medical assistance in dying on a case by case basis.
Given the complexity and often personal nature of this issue, there is significant debate in terms of the correct approach from many different perspectives. What we have with Bill is an approach that would put a cautious assisted-dying framework in place while leaving the door open to adjust as we better understand more challenging issues. In the legislation, there is a commitment to independent studies on challenging issues that need to be investigated further before determining what policy considerations the government should make.
One thing is certain, these are issues that present real risks to people in vulnerable circumstances and highlight the complicated nature of balancing autonomy against the protection of vulnerable patients. There is also, of course, a mandatory parliamentary review of this legislation after five years.
I would be remiss if I did not reaffirm here today the importance of improving access to high quality palliative care for all Canadians. Our government has committed to investing in this area. I continue to work with provinces and territories to help support access to all options for care at the end of life.
The motion today has given thoughtful consideration to the work of the upper chamber. I thoroughly appreciated the opportunity to take questions for a two-hour period at the committee of the whole, in addition to the time that I appeared before the committee's pre-study.
There are two amendments made by the upper chamber where we respectfully disagree. As captured in the motion today, we as a government reviewed and sought a path forward that encompasses the Senate's amendments where possible, resulting in our agreement with the five remaining amendments. There is alternative text proposed to reflect the upper chamber's desire to recognize the vital importance of palliative care options for patients. As I have said repeatedly, this is a positive outcome if the result of this legislation allows tangible improvement to access palliative care in Canada.
We also have a responsibility to provide language in the legislation that health care professionals can understand in order to provide access to assisted dying. As is stated in the proposed message to the Senate, removing the criterion of the reasonable foreseeability of natural death would undermine the objectives of Bill to recognize the significant and continuing public health issue of suicide, to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill, or disabled. Bill C-14 strikes the right balance for Canadians between protection of vulnerable individuals and choice for those whose medical circumstances cause enduring and intolerable suffering.
In conclusion, I would like to underline to my fellow parliamentarians that the approach set out in Bill C-14 is the result of tremendous thought and deliberation over the course of many months. There have been extensive consultations over this past year on the issue of medical assistance in dying with Canadians, stakeholders, and relevant experts. The findings have been reviewed carefully to inform the legislation.
I hope both the House and the Senate are able to support the motion. I would like to thank, from the bottom of my heart, all the parliamentarians from both the upper and the lower chamber who have professionally and thoroughly debated this issue. It is a transformative social policy that governments debate once in a generation, and this piece of legislation is one of those remarkable debates. Make no mistake, this will be a dramatic change for Canada.
In the Carter decision, the Supreme Court acknowledged that it was up to Parliament to craft an appropriate regime. I believe we arrived at the best approach for our country.
Madam Speaker, I would first like to thank the for sharing her time with me. This clearly demonstrates that she believes in fair play and democracy, since she knows that I am opposed to the motion and the bill.
That being said, I am wondering how I will say everything I have to say in 10 minutes.
I will begin with the heart of the issue. The premise of the fundamental debate relates to our understanding of the principle of self-determination. Here are the main questions that the Department of Justice and the two ministers should have asked themselves. Why and on what grounds would we take away people's right to self-determination throughout their lives? When, even in urgent medical situations, no medical intervention can happen without a patient's free and informed consent, why and on what grounds would we take away people's right to self-determination at a time when they are enduring intolerable suffering, when they are about to die, when they are their most vulnerable?
The government says that it is in order to strike a balance, but that has never been proven, and the Supreme Court thought it was futile. Had it been referred to the Supreme Court, the bill would have been amended and considered unconstitutional. I imagine that is why the bill was never referred to the Supreme Court. It said that three rights had been violated by the total prohibition.
If we carefully study the Morgentaler ruling, we see that the court agreed to strike down the law that allowed abortions under certain conditions on the basis of just one right: the pregnant woman's right to security of the person. How can anyone seriously believe that the security of the person who is enduring intolerable suffering from a grievous and irremediable illness, disease, or disability would be protected by section 1 of the charter, which states that any limits must be reasonable in a free and democratic society?
It is quite unreasonable for a person who is among the most vulnerable in our society, the one who is suffering, to have to bear the burden of proving to the courts that he or she meets this criterion of reasonably foreseeable natural death or, as we saw recently, to have to go on a hunger strike in an attempt to meet the criterion.
I remind members that this criterion discriminates on the basis of age. The motion states “...to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill or disabled...”. Whose negative perceptions? Where are these negative perceptions coming from, exactly? As far as I know, when someone has a degenerative disease, and this will come as no surprise to the , medical practitioners follow their patients' cases.
Is she assuming that medical practitioners, doctors, nurses, and health care professionals have a bias against their patients because of their age or social condition? Is she assuming that health care professionals have bad intentions?
If they have bad intentions, we should get rid of them. This rationale shows a bias against health care workers. Is she saying that seniors need to be protected from the people who care for them? This bill is a bad cut-and-paste version of the Quebec law.
We were able to move somewhat quickly here because Quebec has already gone through this, and its focus was the area of palliative care. Quebec achieved an amazing feat by not pitting euthanasia against palliative care and by ensuring that patients have access to a wide range of palliative care options.
Why would the bill limit itself to this one aspect or even to a degenerative disease like ALS? The idea is that death is reasonably foreseeable in this case, and this is where there is discrimination among degenerative diseases.
Who are we to pass judgment on someone's quality of life? It is not up to the doctor to pass judgment on a patient's quality of life or compare one life to another. These are basic principles of ethics.
We trust the health care workers who provide care, and obviously, they will see their patient's quality of life change over the course of a year. If the patient says he cannot take it anymore, the request can be made.
Quebec's law is not a response to the Supreme Court's directive. Why? Because the Carter decision came afterward. Quebec's lawmakers sought to comply with the Criminal Code and respect each authority's prerogative in its own jurisdiction.
Now we have the Carter decision and this bad bill. Quebec's minister of health and social services was right when he told his doctors that this approach is unworkable and asked them to be prudent because this government lacked the courage to respond when the Supreme Court ordered us to create a framework for assisted suicide.
I read the motion and asked the minister a question today. The government is rejecting Senator Joyal's amendments, which are also those of the Bloc Québécois, the Green Party, and the NDP, who are calling for the elimination of this utterly vague criterion and a return to the terms in Carter, to what really matters for people who have a grievous and irremediable health condition that causes them persistent and intolerable suffering.
The motion says we struck the right balance and want to reject these amendments “to recognize the significant and continuing public health issue of suicide”. What is that all about? No one working in suicide intervention would ever confuse the two states.
As far as I know, a suicidal state is reversible. It is not irremediable, but indeed remediable. There are treatments for suicide. However, something like Alzheimer's is irremediable, as far as I know. Such is the confusion that was created here this morning, and the argument that was made.
That is the only argument that the Department of Justice is going to make at the Supreme Court and patients will have the burden of going to court in order to have access to medical assistance in dying. I will weigh my words carefully and say that I find that to be indecent.
Madam Speaker, I will be splitting my time with the hon. member for .
I have had the privilege of following, from a distance, the proceedings in the Senate over these last days. I am disappointed that a number of the options that were given to the Senate were not adopted.
Senator Plett's amendment to make it a criminal offence for anyone to compel an individual, organization, or medical practitioner to provide medical assistance in dying or to refer was rejected by the Senate.
I wish I could share the optimism of our when she assured me a few minutes ago that no one would be compelled to participate in this. I do not share that optimism. I am hopeful I am wrong on that. I am hopeful there will never be a case where a medical professional, a health care worker, a health care institution will be obligated to participate or to refer for this practice when they find it morally objectionable.
The other amendment Senator Plett put forward was adopted by the Senate, however, rejected by the government today in its response. That is the amendment relating to not allowing a beneficiary of a person who is seeking medical assistance in dying from assisting that person.
It seems quite clear to me that if we are to protect vulnerable people, this was one of the key points that needed to be adopted. By rejecting this amendment that was passed by Senate, we are actually increasing vulnerability. That is a sad result of rejecting this amendment.
It goes without saying that this is a very sad day, a disappointing day for me. This is a day when choices will be made that will affect generations to come, and it is without question the most important choice that I and most of my colleagues will make in our parliamentary careers.
It is disappointing on two points. First, it is disappointing to see the activism of the Supreme Court. I mentioned earlier in my comments on this topic that it was unfortunate the Supreme Court of Canada had taken it upon itself to force legislation to be written which would overturn hundreds of centuries of our understanding of the intrinsic value and dignity of every human life. The Supreme Court has done this, completely rejecting the fact that as elected members of the House, we have rejected initiatives to legalize physician-assisted suicide on at least 15 occasions since 1991, the most recent one in 2010 by a vote of 59 to 226.
The other reason this action is disappointing for me is because of the many years I have worked on the issue of suicide prevention. I have worked with people who have been left to suffer the aftermath of suicide, parents who have lost children, children who have lost parents, and more. To know there are groups across Canada today that are working very hard to prevent suicide, to save lives, and to see we are now, in a way, normalizing suicidal behaviour is disappointing.
Bill was an initiative that the House passed almost unanimously, calling on the federal government to initiate a federal framework for suicide prevention. Just a few weeks ago, the indicated that the bill was almost ready to be fully implemented by the Public Health of Canada.
On one hand, we are working as hard as we can to prevent suicide, which I applaud and will continue to give my efforts to. On the other hand, it appears that we have given up and we are allowing those who are losing hope to actually access assisted suicide.
Ten Canadians each day lose their life to suicide. In Canada, groups are working hard on the ground to prevent suicide. Mental health care workers, experts, are providing safe talk training so front-line workers, such as teachers and our volunteers in our minor sports programs, can observe these first signs of suicidal ideation, and intervene with the intent of restoring hope to that person who has lost hope and is now in despair. Their motivation has always been to save lives.
Now, to turn 180 degrees and begin the path towards normalization of suicide, is a tragic course, a tragic course of action for all of Canada.
Again, I want to quote from an expert in this field. Aaron Kheriaty, an associate professor of psychiatry and director of the medical ethics program at the University of California, Irvine school of medicine, states:
|| The debate over doctor-assisted suicide is often framed as an issue of personal autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who — assuming they are of sound mind — are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences.
|| What if it turns out that the individuals who make this choice in fact are influencing the actions of those who follow?
Professor Kheriaty goes on to report that in states where physician-assisted suicide has been legalized, there has been an increase in suicides of 16.3% overall, but among those over 65 an increase of 14.5%. He further states:
|| [These] results should not [be surprising to] anyone familiar with the literature on the social contagion effects of suicidal behavior. You don’t discourage suicide by assisting suicide....
||...Aside from publicized cases, there is evidence that suicidal behavior tends to spread person to person through social networks, up to three “degrees of separation” away. So my decision to take my own life would affect not just my friends’ risk of doing the same, but even my friends’ friends’ friends. No person is an island.
|| Finally, it is widely acknowledged that the law is a teacher: Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms. Laws permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living — and that suicide is a reasonable or appropriate way out. This is a message that will be heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.
|| Debates [around] physician-assisted suicide raise broad questions about our societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?
I believe life is to be chosen over what some would call “death with dignity”. There is nothing dignified about deciding someone's life is not worth living. If a patient has a need, let us address it. Our goal should be to eliminate the problem, not the patient.
It is my firm belief that the House and the current government should be invoking the notwithstanding clause in order to protect Canadians. For thousands of years, all caring societies have agreed that it is not okay to kill another human being. We can try to soften that language. We can call it physician-assisted death. We can call it medical assistance in dying. We can use any euphemism we want, but the reality does not change.
Today, we are intentionally throwing away the wisdom of our faith foundations and the wisdom of centuries of civilization. My fear is that in a few short years, we, our children, and our grandchildren will live to see the folly of allowing physician-assisted suicide.
Madam Speaker, I am pleased to speak to the NDP amendment, as well as to the underlying issues raised by Bill , and to address some outstanding issues.
The first thing I want to do is pick up on a question that my colleague from the NDP just asked with respect to choice. Many of the arguments in favour of this legislation have been framed around this idea of choice. However, at the same time we have to acknowledge that this bill is designed to impose significant limitations on choice as well. It does not legalize suicide in every case. Clearly, I think it suggests that there still ought to be limits on choice. That is a good thing. However, those limitations do not at all protect the vulnerable. They do not go nearly far enough. We would understand the limits of choice in that choice is shaped by values and social norms, and my colleague touched on this as well. The stigma and social acceptability around something shapes the kinds of choices that are made.
In light of the Supreme Court decision and the fact that we have to respond to it, I am very concerned, and I think many of my colleagues at least on this side of the House but perhaps in other corners of the House are concerned that suicide remain a socially unacceptable choice, and that maybe it should be allowed in certain narrow circumstances as required, but that we do not allow ourselves to shift in a direction where we remove the fundamental stigma around taking human life, and that we maintain a fundamental respect for the intrinsic value and dignity of all human life. It is my belief that going down that road only a little bit is very difficult and perhaps even impossible. In the debate around this issue, we have already seen that, as soon as the can of worms is opened a little bit, there is a major push for expansion to all kinds of other different situations.
The language used, and the language that some members and the NDP amendment want to limit this to, is “grievous and irremediable”. It seems to me that people who take their life do so because they consider themselves to be facing grievous and irremediable suffering. Clearly, there is no one who takes his or her life who does not think that. Therefore, it is not at all a simple matter, as some members have suggested, to clearly demarcate suicide; and then, on the other hand, what is covered by this issue? Choice always has limits. It must have limits, especially when choices may impact the broader social architecture of choice under which other people operate. I think that is an important point that is underlined here, that we need to try, as much as possible, to preserve that underlying concept of the value of human life. I do not think that Bill has nearly the safeguards to do that. What we could have had, and what we should have at the very least, is some kind of clear legal criteria.
It has been interesting in the discussion today that we have the minister really highlighting the importance of the “reasonably foreseeable” criterion. I do not support the NDP amendment. All things being equal, I would still like “reasonably foreseeable” to remain in the bill, although I agree with the NDP that it is not at all clear what that means. Then the minister talks about the importance of this criterion and how the entire bill, the system of safeguards, was developed with that criterion in mind. She said that, clearly, if we did not have that aspect in the criteria, we would need additional safeguards. Therefore, she is putting a very large amount of weight on those two undefined words. She said that the Liberals would not want “reasonably foreseeable” to apply to a young person who had some kind of an accident and became permanently disabled. They would not want “reasonably foreseeable” to apply to somebody with just a mental health challenge. However, without meaning to those words, without some kind of clarity, it is not at all clear that those cases that the minister has identified are even excluded by this legislation. Therefore, in a sense, she defeats her own argument by saying that this legislation has limited safeguards because of the narrowing of the criteria, such as only a 10-day waiting period, but given that there was no meaningful, well-defined, narrowing of the criteria, then she acknowledges effectively that the safeguards in this bill are inadequate.
If this legislation were written with a tighter narrowing of criteria in mind, then perhaps we should have actually had some definition of what constituted the new criteria. We should have had some kind of definition of what this means. Of course, Conservatives proposed an amendment to add the word “imminent”. We can say that death is reasonably foreseeable for all of us, but death is not imminent for all of us. That would have at least provided some metric for establishing a distinction between some cases and other cases. The lack of criteria is a huge problem.
It is important, in recognizing the absence of clear criteria, that we again investigate putting review criteria in place. We have seen what the provinces have already done. The reason I say we are not in a legal vacuum is that there is no federal legislation but there are provincial rules in place, so we are not in a legal vacuum, as such, strictly speaking. There are policies and procedures in place at the provincial level. The provinces have introduced many very good safeguards that are not in this federal legislation, and it is important to say that those safeguards, in many cases, would not apply after the federal legislation passes.
Provincial guidelines, in most cases that I have seen, refer to the involvement of the attending physician. They do not just say any two physicians. They say there is some role for an attending physician and a consulting physician, implying that the person involved in adjudicating the case should be, in some ways, involved in the care of the patient and not be some doctor somewhere else who has agreed to sign all the forms for almost anyone. The involvement of the attending physician is important. It could have been included in the federal legislation, but if the federal legislation passes saying any two doctors, then the requirement for an attending physician being involved would no longer apply, because it would be prescribed a certain way in the Criminal Code.
I would encourage the government to take the experience and wisdom of the provinces seriously on this, recognizing that there are no effective legal criteria up front, there are only undefined legal criteria, and we should add in some of the more effective review mechanisms to ensure that, however ambiguous the criteria are, the legal criteria are being met, in fact, such as they are.
I have advocated for the Manitoba model, or some element of it, to be incorporated into the federal model, which involves government lawyers looking at each case. I asked my friend from about this, and he said that could pose an unnecessary barrier, such as if there are no lawyers available. The model that the Government of Manitoba has put in place includes government lawyers available to review each case. It is not as if one has to go out and find someone, and it is not a process of needing to make an application to the court, although there are, frankly, plenty of cases in the world where someone might need to make an urgent application to a court and there are provisions to allow that to happen.
Therefore, it is not at all true that this is sort of an impossibly onerous barrier, but the Government of Manitoba has done something much less than requiring judicial review. It has simply put in place a system where there is advanced legal review by government lawyers. Recognizing the value of that model, that review process, the government should think about incorporating that into federal legislation or, at the very least, ensure it is not proceeding in a way that interferes with or overturns that provincial set-up.
In conclusion, I want to speak briefly to the issue of protecting the vulnerable. There has been some discussion here about what constitutes vulnerability and who is vulnerable. We can understand “vulnerable” as referring to people who probably, in ideal circumstances, would not choose death, but are in some way in not ideal circumstances, which limits them and propels them toward a choice they would not otherwise make. This can happen often, whether it is a person who does not have perspective because of his or her situation, or whether someone is sort of the victim of suicide contagion and is responding to other things and situations happening in his or her life. It could be someone who is influenced more by social than physical circumstances. We need to be attentive to these things, and that speaks to the importance of robust safeguards.
I hope we can, as a House, still at this last stage, try to bring in some meaningful definitions and safeguards that would protect the vulnerable and protect Canadian society.
Madam Speaker, it is a privilege for me to rise again in the House to speak about the sensitive and complex issue of medical assistance in dying.
This morning, I had the honour of seconding the motion of my colleague, the member for . I would like to reiterate how much I admire and respect the commitment and sense of responsibility he has shown throughout the process that has brought us here today.
I have had the opportunity to learn from his great expertise in constitutional law on many different occasions. I am a new member who was elected on October 19, 2015. The Special Joint Committee on Physician-Assisted Dying was the very first parliamentary committee that I have ever been a member of. It was a great privilege for me because all the members of the House of Commons and the senators who worked on that committee did so in a spirit of co-operation in order to achieve the best possible outcome. We did not always agree, but we had a lot of respect for one another and we listened to what everyone had to say. We wanted to ensure that we made the best possible decisions and recommendations for the benefit of all Canadians, while respecting their rights. The 21 recommendations that we did make reflect that desire. One of our main goals throughout our discussions was to ensure that no one was discriminated against.
Naturally, Bill could not include all 21 recommendations. As I said after our report was released, I think it will continue to be useful for years to come.
My colleague from and I felt it was important to augment the committee's work with a supplementary opinion. The one thing all of the witnesses agreed on is that medical assistance in dying is linked to palliative care.
We also felt it was important to write a supplementary opinion to connect this issue to all other social determinants. It is important to say that we all have equal rights. However, because of certain social constraints, we must ensure that social determinants are taken into account in implementing medical assistance in dying.
As a member of the committee, I was astounded at the level of expertise we have in Canada on this issue. We heard from more than 60 witnesses, and we read thousands of pages before drafting our report and recommendations. I have a great deal of admiration for many of the witnesses who appeared before us because they put a lot of careful thought into this sensitive issue.
Our thinking on medical assistance in dying has changed in this country. The Supreme Court's Carter decision is proof of that. The witnesses talked to us about the change that has taken place in society. Looking back at the Rodriguez ruling from 20 years ago, it is clear that our society's thinking on end of life has changed.
I believe that our report and recommendations attest to that, and that is why it is so important to me that the bill we pass in the House reflect our constituents' thoughts on this matter. The witnesses, particularly groups representing people with disabilities, put a lot of careful thought into this matter and came to share their ideas with us.
I found it particularly hard when some of these groups told us that a few of their members had had friends or loved ones commit suicide prematurely. We currently have no measures to give these people hope that they will be able to freely choose at which point they will make a request for medical assistance in dying. That concern stuck with me.
I was also struck by the testimony from doctors who came to tell us that the Carter decision, which was handed down on February 6, 2015, changed their profession drastically. These doctors, like the ones I met in my riding, told us that throughout their training and their careers, they have been taught to heal and, failing that, to extend life. Now, they are being told that, according to what the public wants, what the law allows, and what their rights allow, patients in our country will be able to submit a request for medical assistance in dying.
I listened carefully to a number of speeches since we started having this discussion. During my many meetings in my riding of Saint-Hyacinthe—Bagot, I pointed out that it is not up to us, in the House, to decide whether medical assistance in dying should be available or not. The Supreme Court has already ruled on that issue. It is up to us to amend the Criminal Code.
I am from Quebec. The people of Quebec have had the Act respecting end-of-life care since December 2015. As many people have said in the House, that act was the result of six years of work to reach a broad consensus. Of course, in order to reach that broad consensus in Quebec, the legislation still had to comply with the federal Criminal Code. The province could only go so far within its areas of jurisdiction. Now we can pass legislation that allows us to go even further.
The consensus that emerged in Quebec and that was confirmed in my discussions with my constituents is that we now recognize that we have reached a time in our civilization when, as citizens, we want to be able to choose. What the Supreme Court told us is that the Canadian Charter of Rights and Freedoms gives us the freedom to request medical assistance in dying.
In order to deepen my reflections throughout our deliberations in the Special Joint Committee on Physician-Assisted Dying, I felt duty-bound to seek out people and groups in my riding, Saint-Hyacinthe—Bagot, who are dealing with this situation every day and meet with people who are sick or dying. This includes stakeholders and volunteers with a community organization called Les Amis du crépuscule, which provides assistance to people receiving palliative care and later to their grieving families. There are user committees for health care institutions, as well as the Hôtel-Dieu-de-Saint-Hyacinthe hospital foundation. That institution is one of the largest long-term care facilities in Quebec. Hundreds of people spend their last days on earth at the Hôtel-Dieu-de-Saint-Hyacinthe. I think it is around 500 people. That hospital has hundreds of beds, but only 12 palliative care beds.
That is why it has been important from the start of this debate on medical assistance in dying to talk about developing and implementing a real national palliative care strategy. For medical assistance in dying to be a real choice, palliative care also has to be offered as a choice. Unfortunately, many people have limited access to palliative care.
In Saint-Hyacinthe—Bagot, people have access to Maison Victor-Gadbois, a home for end-of-life care for those with cancer. This home receives 800 applications a year, but can house only 200 people.
Doctors have told us that we have developed a health care system based on hospitals and healing. When I met with Monsignor Lapierre, bishop of the Saint-Hyacinthe diocese, to talk about this issue, he made a comment that was full of wisdom. He told me that we should be just as concerned about aggressive treatment as we are about medical assistance in dying. He is sometimes called to the bedside of people who tell him they have had enough.
We must vote on this issue of medical assistance in dying here in the House with a sense of the responsibility we have to represent our constituents who are living with a serious and irremediable illness and intolerable pain.
Every time I rise in the House to speak to this issue, and during each meeting of the joint committee and the Standing Committee on Justice and Human Rights, which studied this bill, I think about the people who are suffering. They are the ones who are at the heart of our discussion on Bill . There are people who are suffering now, and they have high expectations for the bill we are going to pass. When the Supreme Court rendered its decision in Carter, people who were suffering had hope that their right to request medical assistance in dying would be respected.
The amendments in the motion by my colleague from say that we must not disappoint these people who are suffering and awaiting our decision. They hope that we will allow them to make this request for medical assistance in dying soon and that their rights will be respected.
These people who are suffering need not go to court. I was touched by the testimony given by members of the Carter family, who spent many years before the courts with their mother. When Bill was introduced, they came to tell us that the bill would not even give their mother the right to request medical assistance in dying. I cannot rise in the House and vote in favour of this bill, knowing that I am leaving people who are suffering to their own devices because they are not in the right class to be eligible for medical assistance in dying.
This week, the told us that we need to think not only about the rights of Canadians, but also about the work of doctors. Since I began thinking about this issue, I have realized how much respect I have for all health care professionals. I also have a lot of faith in their judgment.
The doctors who testified in committee said that, while requests for medical assistance in dying are a new part of their reality, they have been dealing with difficult requests from patients that require them to use their judgment every day since they became doctors.
The difference since the Supreme Court ruling in Carter is that now they must deal with requests for medical assistance in dying. These decisions will be difficult for some. Fortunately, the bill gives them the right to conscientiously object and tell the patient that they are not comfortable complying with their request. We think it is important for the health care system to ensure that patients will not have to find a new doctor in the yellow pages. They must have support in order to exercise their right to ask for medical assistance in dying.
We also believe that sufficient safeguards have been put in place. I was really moved by the representatives of organizations for the disabled who asked us not to be paternalistic or treat the disabled like children. The fact that they have an incurable disease or are living with a degenerative disease or suffering a great deal is no reason to treat them like children. They are autonomous and can provide informed consent.
The Supreme Court talked about suffering that an individual deems intolerable. Nobody can judge another person's suffering. We all react differently to illness. That respect for individuality must permeate the medical assistance in dying law we implement. We must ensure that each individual, each citizen of this country, has the freedom to make that choice if the situation arises.
Nobody in this country wants to be in the position of having to make this request. Nobody wants to face the choice of whether to request medical assistance in dying. Nobody wants to support a loved one in making a choice about requesting medical assistance in dying. Nevertheless, we all hope that, when that day comes, every person will have all the resources they need to give free, informed consent. We hope that every person will feel their rights are being respected and will not be told that, unfortunately, they belong to a small class of people who are not eligible because it is felt that their death is not reasonably foreseeable.
Many, including the Barreau du Québec, the Collège des médecins du Québec, and Quebec's health minister, came and told us that “reasonably foreseeable natural death” does not mean anything and is impractical. In my opinion, we are putting doctors in a position where they cannot reasonably use the flexibility we are trying to give them in a fair and equitable manner because this criterion has no clear meaning for a doctor.
We must ensure that the legislation we pass is consistent with the Supreme Court's decision in Carter and with the Canadian Charter of Rights and Freedoms. We must ensure that once this legislation is enacted people who are suffering will not be required to ask a lawyer to go before the courts to uphold their right to seek medical assistance in dying. At the Special Joint Committee on Physician-Assisted Dying, we heard that the provinces are ready to continue their work to enact provincial legislation. Quebec's health minister said that he was pleasantly surprised at the work of his colleagues from the other provinces.
Today we must pass legislation that is consistent with the Supreme Court's decision in Carter, that is consistent with the Canadian Charter of Rights and Freedoms, and that allows every Canadian to request medical assistance in dying.
Madam Speaker, I will share my time with my hon. colleague from .
I rise today in the House to speak to Bill , for the last time, I hope.
Although it was sometimes quite heated, I think that the debate on Bill brought out the best in us as parliamentarians. All parliamentarians showed a great deal of respect, even though we all have different perspectives on a very sensitive and emotional topic.
Today, I will talk about the amendments that were proposed by the other chamber. I support the motion by the to accept some amendments and reject others.
The palliative care amendment that was brought in by the Senate is a good amendment. We had a lot of discussion at the Standing Committee on Justice and Human Rights and here in the House on the balance between access to medically assisted dying and the importance of ensuring quality palliative care. The fact that the Senate has once again reinforced the importance of ensuring that information be provided on palliative care before someone has access to medical assistance in dying is something that we should accept. I am pleased that we are going to accept that as amended by the .
I am also pleased that the will be required to set out guidelines for death certificates within one year. We made amendments at the Standing Committee on Justice and Human Rights to require the Minister of Health to work with her provincial and territorial counterparts to set standards to include coroners. This amendment falls well in line with what the House has already accepted.
It is entirely legitimate for the Senate to ask for a deadline with respect to the studies that will be done on advance directives, mature minors, and psychological illnesses, and to require them to be delivered back to Parliament within two years from the time the studies begin. We in committee amended this to say “must commence within six months”, which is also a reasonable requirement.
What is also eminently reasonable and strongly follows the will of the House of Commons is the minister rejecting the amendment to remove the criteria of death being “reasonably foreseeable”. Removing that requirement entirely changes the bill from applying to someone who is near the end of his or her natural life to encompassing people who may have 30 or 40 years left to live. It may encompass people who have purely psychological illnesses, which was not the intention of the bill, because we have specifically stated that we are doing a study about people who have psychological illnesses.
However, if we look at the definition of “grievous and irremediable” and take out subsection (d) on reasonable foreseeability, then we fall into a situation where someone who has a psychological illness may meet the criteria of subsections (a), (b) and (c), thus completely changing the position of the bill on whether people with purely psychological illnesses can have access to medically assisted dying.
I want to emphasize from a public policy perspective that this legislation took a prudent approach. We can argue back and forth about what medical doctors and lawyers and law professors have said. I sat in committee and listened to well over 40 witnesses. I also had the pleasure of periodically glimpsing in on the Senate Standing Committee on Legal and Constitutional Affairs and listening to its witnesses.
Doctors, lawyers, professors, distinguished people came down on all sides of this issue. There are those who say that the bill is not Carter-compliant or charter-compliant and there are just as many, if not more, who say that the law is Carter-compliant and charter-compliant. In my view, it is the role of Parliament to determine what we believe to be charter-compliant. It is the role of Parliament to determine the best public policy within a charter-compliant law.
Medically assisted dying to me is meant to help people who are suffering intolerably but have an illness that will extinguish their life at some future date.
The court, in Carter, talked about Gloria Taylor and people like Gloria Taylor. Gloria Taylor had ALS. Gloria Taylor was undisputedly going to die from the illness she had.
I believe that ensuring that death is reasonably foreseeable falls entirely in line with public policy guidelines that we expect. Doctors and nurses, many of them, came before us and said that they did not go to school for many years to end people's lives. They went to school to try to help people who were suffering, to try to prolong life as long as possible within the framework that we currently have in the profession. They did not go there to be told that someone who comes to them and who may have many years left to live, and who has an illness that we may find a cure for in four or five years, should have their life extinguished.
As such, I do believe the minister is making the right decision to reject that Senate amendment. I also believe the government carefully researched what was being done in other jurisdictions. There are only nine jurisdictions in the entire world that have legally regulated medical assistance in dying. In all but three of them, there is a requirement that the person's life be near its end.
Whether it is Colombia, or the four United States' states that have these rules, or whether it is Quebec, which adopted its own end-of-life framework, which I understand is different and was pre-Carter, all of them require that a patient be dying, at the very longest, within the next six months, under reasonable medical certainty.
Only in the Netherlands, Belgium, and Luxembourg do we allow people to have their lives taken by medically assisted dying if their natural life is not close to an end. What kinds of situations have we seen in those jurisdictions? We have seen people who I believe many of us in this House would believe should not have access to medically assisted dying being given medically assisted dying.
We saw twins in their 40s, who were blind and starting to go deaf, for example, but had no other conditions that would end their life. Those people needed help, real help, psychological help, help to live their lives, not being told, yes, they should go die together now. People who were purely psychologically ill, who could not get over traumas related to sexual assault. These may be incredibly traumatic psychologically, but there are ways of helping those people that do not involve medically assisted dying.
I do not think Canadians, when we are talking about all the opinion polls that are being cited, where there is support of over 70% for medically assisted death, are contemplating those situations. They are contemplating situations where someone is nearing the end of their natural life and is in intolerable pain.
For me, if we removed reasonable foreseeability, we would be asking the medical profession in Canada, the nursing profession in Canada, other medical practitioners in Canada to be participating in medically assisted death beyond where they decided to do, and even more importantly, we would be doing so without the safeguards that would have been put in the bill had we intended that that class of people be covered. There is no way that a 10-day waiting period suffices when somebody could have 40 years left to live.
In conclusion, I want to say that I support the motion from the , and I will be voting in favour today.
Madam Speaker, what a debate this has been. Bill has been at times a very emotional discussion, both inside the House and outside the House, whether it has been at committee or other places. I have learned a great deal from it. I really appreciated the many members on all sides of the House, no matter what their position has been on Bill C-14, who have been able to articulate and share quite candidly some real life stories, whether it was during second reading, at third reading, or at the committee stage. A number of members of Parliament were engaged in this debate and I would like to acknowledge their contributions.
It has been an interesting process from its beginning. We can talk about the Supreme Court decision and then fast-forward it to December, when there were heavy discussions on how we could come up with a report. We had a joint committee of the House and the Senate where we saw members of both places coming together to work and get a better sense of recommendations, ideas, and thoughts through consultation to make sure we could advance to where we are today. We saw ministers of the crown, two in particular, those for Justice and Health, pull it all together into something that sets a good, solid, legal framework, but will stand up to a charter challenge. l truly believe that to be the case.
From the ministers, to the individuals who sat on the committee, to the individuals who have spoken on this at different levels of readings, to those individuals outside of the House, people throughout our great country have been involved and engaged as much as one can expect on a piece of legislation that is so very important to each and every one of us. I have on numerous occasions stood with petitions dealing with this issue. I know other members have done likewise. I know that all members of the House have had consultations with their constituents, have received correspondence, and had telephone discussions.
I was able to cite a very personal experience with my father and what had taken place at the time of his passing. I was only one of many who was able to share stories. I thought I would provide a highlight in terms of why we are here. As members will know, it was a unanimous decision. All nine Supreme Court judges made the decision that we had to bring in a new law. That is really what Bill deals with, a new law regarding medical assistance in dying.
The Supreme Court of Canada made that decision and they put in a time frame. We have passed the deadline, but not by too much. It would have been nice to have achieved that deadline, but that is where we are today. If I could make reference to what this is, it is that access to medical assistance in dying would only be available to those who meet certain conditions: mentally competent adults who are in an advanced state of irreversible decline and capability; have a serious and incurable illness, disease, or disability and are experiencing enduring and intolerable suffering caused by their medical condition; and whose death has become reasonably foreseeable, taking into account all of their medical circumstances.
Something that is not highlighted very often is the fact that after four years this whole process will be under review, which is really important to emphasize.
Earlier today at the beginning of the debate, there was a comment that captured the essence of the bill and hopefully will put to rest many minds in regard to the issue that we have been debating. This is a quote from the this morning. She said, “The bill achieves the most appropriate balance between individuals' autonomy in deciding how their death will occur and protection of vulnerable individuals, as well as broader societal interests.”
That is something the minister said earlier today, and that I concur with 100%.
I will now go to what the has said, and this is a great way to conclude my remarks. He recognized that Bill does not end the national discussion that needs to take place
We have seen a budget that has brought forward an incentive to ensure we build on a health care accord. This is something we believe is important to all Canadians, because Canadians from coast to coast to coast have told us that. We will continue to build and look toward palliative care as a part of that ongoing discussion.
It is such a privilege to be able to stand up and share a few thoughts and words before the bill ultimately passes.