That (a) the House recognize that (i) the Supreme Court of Canada ruled that the prohibition on physician-assisted dying violates Section 7 of the Charter of Rights and Freedoms which states that “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice”, (ii) the Supreme Court has suspended the implementation of its ruling for 12 months, (iii) the expected federal election and summer recess limit the remaining sitting days in 2015, (iv) Canadians expect Parliamentarians to take a leadership role on this issue and engage with it in an informed and respectful way, (v) a non-partisan, deliberate and effective discussion took place on this issue in the Quebec National Assembly, (vi) Parliament has a responsibility to respond to the Supreme Court ruling; and (b) a special committee be appointed to consider the ruling of the Supreme Court; that the committee consult with experts and with Canadians, and make recommendations for a legislative framework that will respect the Constitution, the Charter of Rights and Freedoms, and the priorities of Canadians; that the committee consist of 12 members which shall include seven members from the government party, four members from the Official Opposition and one member from the Liberal Party, provided that the Chair is from the government party; that in addition to the Chair, there be one Vice-Chair from each of the recognized opposition parties; that the committee have all of the powers of a standing committee as provided in the Standing Orders, as well as the power to travel, accompanied by the necessary staff, inside and outside of Canada, subject to the usual authorization from the House; that the members to serve on the said committee be appointed by the Whip of each party depositing with the Clerk of the House a list of his or her party’s members of the committee no later than March 11, 2015; that the quorum of the committee be seven members for any proceedings, provided that at least a member of the opposition and of the government party be present; that membership substitutions be permitted to be made from time to time, if required, in the manner provided for in Standing Order 114(2); and that the committee report no later than July 31, 2015, provided that, if the committee has ready its report at any time the House stands adjourned, when that report is deposited with the Clerk of the House, it shall be deemed to have been duly presented to the House.
He said: Mr. Speaker, I will be sharing my time today with the hon. member for .
Earlier this month, the Supreme Court of Canada issued a landmark judgment, striking down the ban on physician-assisted death. Its decision was not only unanimous; it was unambiguous. For adults who are mentally competent but suffering grievous and irremediable medical conditions, the court ruled that the current prohibition in the Criminal Code infringes the right to life, liberty, and security of the person in a manner that is not in accordance with the principles of fundamental justice.
The court has ruled, and now it is up to us, as legislators, to act.
Death, and all the ways it affects our lives, is not an easy topic to discuss. In recent weeks, I have had several sensitive conversations with individuals who applaud the court's decision and with individuals who condemn it. Our responsibility is to create new legislation, even though the process may be difficult and may make some people uncomfortable. We are here to speak for our constituents. We must have the debate, despite how difficult it might be. We must make difficult decisions, and Canadians are aware of this.
The Supreme Court—perhaps taking into account the contentious nature of this process—judiciously set a deadline and gave us one year to draft legislation on physician-assisted death. Given this is such a deeply personal and controversial issue, one year is hardly enough. We are not talking here about an insignificant amendment to a minor law. When Quebec decided to begin drafting its own legislation on physician-assisted death, there were four and a half years between creating a new multi-party committee and passing the legislation. During those four and a half years, one full year was spent on holding hearings and public consultations, as well as proposing and debating amendments.
It took four and a half years in the Quebec National Assembly, including one full year of consultations and debate. The Supreme Court has given us 12 months, which is reasonable, but with the summer recess and the fall election, that gives barely more than 12 sitting weeks for us parliamentarians. That gives us enough time to do this, but no time to waste.
Today, we are putting forward a motion that calls on the House of Commons to take immediate action. We are asking that:
...a special committee be appointed to consider the ruling of the Supreme Court; that the committee consult with experts and with Canadians, and make recommendations for a legislative framework that will respect the Constitution, the Charter of Rights and Freedoms, and the priorities of Canadians;
As the hon. member for has noted, the Supreme Court's decision has given us a clear path to move forward quickly but thoughtfully. There is no advantage to delaying debate. Indeed, given the timeline offered by the Supreme Court, if the House has any intention of addressing this issue before the next election, those consultations must begin immediately.
When I asked the about this last week, he said in the House of Commons that physician-assisted death is a sensitive topic for many Canadians, and there are strong opinions on both sides. That is fair. I have a strong opinion. It is based on my personal experience, when I sat by my father in his final moments of life. I know that we must respect personal freedoms and choice while ensuring as a society that the most vulnerable among us are protected.
I believe that the Supreme Court made the right decision and that our laws must be consistent with its ruling because that is the right thing to do. That is my opinion, anyway. We have to hear what others have to say about this.
Last week, the himself indicated that he agreed. He said that we will “hold broad consultations on all aspects of this difficult issue”. Today, we can begin to keep that promise.
Quebec's experience shows us, reassuringly, that respectful and responsible deliberation is possible. It reminds us that when political parties set aside their differences in service of the public good, co-operation can follow. Consensus can be found, even on an issue as complex and sensitive as end-of-life care.
If we do nothing, if we do not get this important national debate under way soon, Canada will find itself without any laws governing physician-assisted death. That kind of legislative vacuum serves no one: not people who are suffering, not their anxious family members, and not the compassionate physicians who offer them care.
In the legal challenges leading up to the Supreme Court decision, one thing was constant: no one wanted to break the law. What they were asking for, and what the Supreme Court has now compelled us to provide, is a law that spells out the limitations on physician assistance to Canadians who wish to die with dignity.
The Supreme Court ruling applies to competent adults whose enduring suffering is intolerable and who clearly consent to physician-assisted death. Even within the scope of these provisions, Canadians have diverging opinions, as the remarked. Canadians have firmly held values. Whether those values are based on religious convictions, personal experience or professional experience, these voices deserve to be heard. In order for us to have a respectful and responsible discussion on this important issue, we need to have enough time to hear from Canadians and listen to people who are concerned by this legislative measure, their families and medical and legal experts. Part of this ruling calls for an honest look at the quality of care already being provided. Do Canadians who are suffering feel adequately supported by their community? Do they have equitable access to quality palliative care?
We need to have a national conversation on dying with dignity. That conversation needs to include how we care with empathy and respect for those who are suffering at the end of their lives.
The court provided a deadline. It is our job to take it seriously, to act quickly but thoughtfully, and to live up to our shared responsibilities as legislators. I ask every member to reflect on that responsibility today and to support this motion, this process. The court has spoken; Canada and Canadians await our response.
Mr. Speaker, I rise to speak to the Liberal motion to create a cross-partisan committee to examine physician-assisted death following the recent Supreme Court of Canada decision in Carter v. Canada.
Physician-assisted death is an emotionally charged issue and a very personal one. Of that there is no doubt. Too often issues that touch the deeply held values of Canadians are used as wedges to divide us politically. However, Canadians deserve a response from this House that addresses the substance of the Supreme Court's legal decision.
It must be made clear from the outset that this is not a debate about what is right or wrong for a person confronted with an end-of-life situation. Such decisions are often tied to a person's religious or moral convictions. However, for Parliament this must be a question of the proper role of government according to our Constitution, which is the fundamental law of Canada.
Our country is a democracy, but it is a constitutional democracy. The power of our legislature is subject to the legal limits that protect minorities and individuals from the tyranny of the majority. These limits are enshrined in the Charter of Rights and Freedoms, and the proper function of the judiciary is to interpret those limits.
On the question of how far the government can go to limit the rights of Canadians with respect to physician-assisted death, the Supreme Court of Canada has now given us clear and unanimous guidance. The criminal prohibition of physician-assisted death unjustifiably infringed the rights of Canadians to life, liberty, and security of the person. The decision was the result of the Supreme Court's rational interpretation of the law according to the evidence and best arguments. The unanimity of that decision adds special force to the Supreme Court's conclusions.
Those conclusions are not merely opinions; rather, they are the product of objective legal analysis and carefully weighed developments in our constitutional jurisprudence. The famous metaphor for our Constitution is that of a living tree. Anyone who thinks that this is an example of judicial activism should read Carter v. Canada. He or she will find that this new development in our constitutional law has firm roots indeed.
In its ruling, the Supreme Court makes it clear that we as legislators cannot stand in the way of a dignified choice for competent adults who are suffering from a prolonged, intolerable, and irremediable medical condition.
This decision was a powerful one. The Supreme Court ruled that the prohibition of physician-assisted dying violated each aspect of section 7 of the charter with respect to life, liberty, and security of the person. Specifically, the effect of the ban was to deny Canadians the right to life by forcing some people to commit suicide early out of fear of incapacity, to deny Canadians the right to liberty by depriving people of control over their bodily integrity and medical care, and to deny Canadians security of the person by leaving people to endure intolerable suffering.
The court found that these violations were unjustified. Constitutionally, the prohibitions went disproportionately beyond their purpose by affecting people who were not vulnerable to coercion in times of weakness. For that reason, the court held that the prohibition on physician-assisted death is of no force or effect to the extent that two conditions are met: first, that the person is a competent adult who clearly consents to dying; second, that the person has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances.
When I was in Charlottetown this past weekend, I had the chance to hear from many of the constituents I represent here in this House. They were pleased with the ruling of the Supreme Court of Canada. They, like many Canadians, have been at the bedsides of people who were terminally ill and in great pain at the end of their lives. They, like many Canadians, had a painful story of loved ones who were not given the dignity they deserved at the end of their lives. Many held back tears at the memories of being bedside when their loved ones were suffering. These conversations are why it is so important for the government to allow for a thorough debate on physician-assisted death.
The Canadian Medical Association supports the unanimous decision of the Supreme Court of Canada. The CMA, however, requests legislative protection for physicians who, for reasons of moral or religious conviction, cannot assist in death. The CMA has requested a determination on how consent would be determined, what safeguards would be put in place, and how patients would apply for assistance.
Doctors want to help their patients in all stages of life and death. Doctors deserve direction from this House. We should not pass the buck.
We have heard concerns that the Supreme Court ruling would unintentionally create a slippery slope, leading to the victimization of vulnerable populations. It is this slippery slope that has prompted the Council of Canadians with Disabilities to ask for legislative safeguards to protect vulnerable populations and to avoid potential distraction from current end-of-life strategies and palliative care.
I also want to be clear that I do not believe that palliative care and other end-of-life strategies will be less important because of this ruling by the Supreme Court of Canada. Canadians will have all options for end-of-life care. However, going forward, we have to recognize that physician-assisted death would be one of those options. Our constitution requires it.
We would be doing ourselves and this House a huge disservice by not listening intently to the concerns raised by the Canadian Medical Association and the Council of Canadians with Disabilities. The perspectives of organizations like theirs, and so many others, are why the Liberal Party believes in striking a committee to hear from witnesses, identify concerns and solutions, and present a carefully considered report to the House. How will we adequately address the issues if we do not seek to understand them?
The Supreme Court of Canada has given us a clear directive to develop a permissive regime that respects the rights of Canadians under the charter and that also protects the rights of vulnerable populations and the freedom of conscience of our physicians. Why then would the government want to delay examining the best ways to protect Canadians while upholding their constitutional rights?
I know that some of our colleagues across the floor have not always held the same reverence for the charter and the judges charged with its interpretation. This is not surprising, given how often the government's legislation and executive actions have been ruled unconstitutional by the courts. The losing streak does not need to be recited here. I encourage the government to take this opportunity to rethink its approach to our country's Constitution.
The Supreme Court of Canada has given us until February 5, 2016 to develop a framework before physician-assisted dying becomes legal in Canada. It is our duty as elected representatives to give this issue the respect, the time, and the thought it deserves. Looking to the work of the Quebec National Assembly and Bill 52 may prove useful, and its approach is something a parliamentary committee should consider. We must get this right.
Again, this is not an issue of personal morality or religion, nor should it be. It is an issue of constitutional rights in a free society and the limited power of the legislature. The Liberal Party is calling upon this House to remove political wedges from this issue and to support our motion.
The Supreme Court of Canada has called upon this House to set the direction for physician-assisted death. Sick and dying individuals have called upon this House to provide them with all options and to respect their rights and freedoms under the charter. Physicians have called upon this House for direction that respects individuals' freedom of conscience.
Canadians are calling on us to put aside our partisan allegiances and to work together on this historic ruling. My question is, then, are my colleagues in this House ready to put aside our political divisions, even temporarily, to respect the judicial branch of our government and talk about this serious issue?
Mr. Speaker, I am pleased to have an opportunity to participate in today's debate on the way forward in responding to the recent decision by the Supreme Court of Canada on the issue of physician-assisted dying.
The issue of physician-assisted dying is very complex and evokes a range of deeply held feelings and responses that depend in large part on the experiences of each individual. Perspectives cut across demographic, political, and religious lines. This is a personal issue, above all else.
The member for , the Liberal leader, mentioned earlier that his views were informed by the last days he spent with his father. I think we have all had those personal experiences. I certainly went through that with my parents, with other family members, and with good friends. I think every Canadian has lived through a situation with a loved one where they saw a difficult end-of-life situation. We all have a view on this, and I think Canadians broadly need to be consulted in the process, because it is such a personal thing to every Canadian.
This issue will require us to confront the reality that every one of us will face death and the possibility that each of us will experience suffering at some point in our lives that may make it necessary to seek the assistance and support of others. These are fundamental aspects of what it means to be human.
I would like to assure all members that our government fully appreciates the serious nature of the challenges that lie ahead. We will be opposing the motion, because we intend to launch meaningful consultations soon with Canadians and key stakeholders so that we can hear all perspectives on this difficult issue.
It will be imperative for Canadians to also appreciate the complex and difficult nature of these issues. There are no easy answers here. We will ensure that during the months to come Canadians understand the subtleties of the issues before us and also understand the existing landscape of health care options at the end of life. For instance, every person can refuse treatment or stop treatment that has already been started, even where the result is that they will die. Many Canadians may be unaware of this existing right. Many seem to believe that physician-assisted dying means that they would now have the right to refuse life-prolonging treatment at the end of life. We must ensure that everyone understands what is already legal so that they are not confusing these measures with physician-assisted dying.
More specifically, we are here today because on February 6, 2015, the Supreme Court of Canada concluded that the Criminal Code provisions on physician-assisted dying are contrary to the Charter of Rights and Freedoms. In so doing, the court reversed its own previous decision in the Rodriguez case, decided in 1993, just over 20 years ago. This time, the Supreme Court found that the prohibition deprived some people of the right to liberty and security of the person, which encompasses protection for choice and autonomy in fundamental life decisions about one's own body. It also found that the provisions deprived some people of the right to life, because they have the effect of forcing them to end their lives prematurely for fear that they will be unable to do so when the suffering becomes intolerable. These deprivations were held not to be in accordance with the principles of fundamental justice. The court also held that the charter recognizes the value of life and honours the role autonomy and dignity play at the end of that life.
The court came to its conclusion after having considered the situations of the particular claimants in this case, in particular Gloria Taylor. In 2009, Ms. Taylor was diagnosed with amyotrophic lateral sclerosis, also known as ALS, a fatal neurodegenerative disease that causes progressive muscle weakness. ALS patients first lose the ability to use their hands and feet, then the ability to walk, chew, and swallow, and eventually to breathe. For Ms. Taylor and people like her, the court found that the prohibition on physician-assisted dying left her with what she described as a cruel choice between killing herself while she was still physically capable of doing so or giving up the ability to exercise any control over the manner and timing of her death.
The court concluded that the charter protects the right to physician-assisted death for competent adults who clearly consent and who have a grievous and irremediable medical condition, including an illness, disease, or disability, that causes enduring and intolerable suffering. As a result, it found two sections of the Criminal Code to be unconstitutional: the criminal prohibition against assisted suicide and the rule that a person cannot legally consent to death being inflicted upon oneself. The court found that the purpose of these laws was to protect vulnerable individuals from having their lives ended in times of weakness or through the coercion or abuse of others.
Since these laws apply to everyone, the court found that they violated the rights of individuals who are not vulnerable and who want to have physician-assisted death when they are grievously or irremediably ill.
The court also confirmed that Parliament's criminal jurisdiction includes the power to prohibit or regulate medical treatments, because they are dangerous. At the same time, it also affirmed that both the federal government and the provincial and territorial governments can legislate with respect to health, depending on the aspect being legislated.
The court suspended the legal effect of its ruling for 12 months in order to give Parliament time to develop an appropriate legislative response. During this time period, physician-assisted dying remains illegal.
While the Supreme Court framed its judgment around the concept of physician-assisted dying, I believe it is important at this early stage of the debate to distinguish between physician-assisted suicide and voluntary euthanasia. Physician-assisted suicide is when a physician provides a patient with the means to end their own life, such as by prescribing a lethal dose of medication that the patient then self administers. Voluntary euthanasia occurs when a physician actively causes a person's death at their request, typically through a lethal injection.
From the perspective of a person who is suffering intolerably and wishes to die with a physician's assistance, these two practices may appear indistinguishable. However, from the current criminal law perspective, they are different crimes with different penalties.
Under the current law, voluntary euthanasia meets the definition of murder, even when it is motivated by compassion or mercy, and even when the person requests or consents to dying. Murder is the most serious offence in our criminal law and is punishable by a mandatory life sentence. In contrast, a physician who aids a person in taking their own life falls within the offence of assisting suicide. This offence is punishable by a maximum of 14 years in prison.
Of the few jurisdictions that now regulate physician-assisted dying, some permit only euthanasia, some permit only assisted suicide, and some permit both. There is evidence suggesting that the risks and implications of the two practices are distinct. These are important distinctions to bear in mind.
The Supreme Court was clear in stating that it was confining itself to assessing the rights of those who would seek assistance in dying, rather than of those who might be tasked with providing such assistance, namely physicians. However, the reality is that the legal effect of the ruling is to require that the criminal law free physicians from criminal responsibility for their participation in helping some people die, or in actively causing death.
The fact that the law must now permit a zone of lawful participation in bringing about the death of others, however, raises some concerns. Many such concerns were raised before the courts in the Carter litigation as reasons justifying the absolute prohibition of these practices. Although the court has now rejected those arguments with respect to an absolute prohibition, this does not mean that those concerns and risks are not important and legitimate considerations moving forward. Indeed, the trial judge and the Supreme Court were clear that those risks and concerns are real. I would like to quote from the trial judge, who said:
...the risks inherent in permitting physician-assisted death can be identified and very substantially minimized through a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced.
I consider this to be a key passage in the trial judgment, and it is one that is referred to several times by the Supreme Court. There are several things to note in this passage. First, the trial judge found that there are risks inherent in permitting physician-assisted dying. These risks will be borne by vulnerable individuals. Second, the risks can be identified and substantially minimized through a carefully designed regime with stringent limits and safeguards, although they cannot be eliminated entirely. Third, the limits and safeguards must be carefully implemented, monitored, and enforced.
This passage helps us see the path that lies ahead. We will need to identify the various risks to vulnerable individuals so that we can design a regime with limits and safeguards aimed at minimizing their occurrence. We will also need to consider mechanisms to ensure that physicians are clear about the law and how to apply it, and that the relevant authorities will be equally vigilant in monitoring and enforcing any violations.
The courts agree that there is no room for complacency, either in designing a legislative response or in its implementation. In my view, we must be very careful in designing these procedures. There is a lot that we already know about the nature of these risks. A great deal of evidence was presented to the courts in the Carter litigation about those risks.
Some risks that have already been identified relate to the difficulties that physicians may have in detecting whether a person's request to die is affected by depression or by the influence of third parties, such as family members. This last concern is especially acute in relation to the elderly. As we all know, elder abuse is a growing concern. All too often, people take advantage of a trust that an elderly person places in them. It is far from inconceivable that an adult child of an elderly person could suddenly suggest to him or her that he or she has lived a full life and no longer needs to suffer in a weakened or ill state. Adult children who may be eager to get at their parents' estate could conceivably try to influence their parent to choose assisted dying.
As a lawyer, I am very concerned about undue pressure on and manipulation of sick and elderly persons by unscrupulous beneficiaries. Anyone who has practised law in this country, and especially in the area of wills and estates law, would know about this. These lawyers have seen situations where elderly people have been subjected to a lot of pressure to enter into a certain will arrangement, in particular testamentary trust arrangements, which takes it to a different level. We need to be very cautious about how we proceed in this area. We would hope that such things would never happen, but in this process we will only hurt vulnerable individuals if we naively assume that such behaviour is outside the realm of possibility. The real question is how to guard against its resulting in an unwanted death.
Other risks relate to concerns that individuals could choose to seek death because of a faulty diagnosis or prognosis. While medicine is a science, diagnosing illness and disease and prognosticating over how long a person with an illness has to live are difficult medical determinations. My own father was a medical practitioner. He is retired now, currently in a hospital in Hamilton, Ontario. He told me many times about diagnoses that changed over time and test results that were inconclusive. As a child, I remember his telling me of a patient he had in Toronto about 40 years ago. A young man was injured in a high-school football accident and was in a coma for 21 years. After 21 years, he woke up and walked out of hospital one day. His mother sat by his side every single day for 21 years. Science is expanding all the time, but every day we learn more about the human body and its ability to heal itself.
My father graduated from medical school in 1953, and his entire career was about prolonging life and saving life. I worry about future generations of medical students and how they will deal now with the added responsibility to consider how to end a life.
There was also evidence presented to the court that persons with disabilities would face special risks under a regime that is overly permissive. The trial judge accepted evidence that people with disabilities face prejudice in the health care context because some physicians have subconscious biases that cause them to presume that the quality of life of disabled individuals is lower than those disabled individuals subjectively experience it to be. One concern is that a request to die from a person with a disability would too easily be accepted by his or her physician and that not enough time and energy would be spent looking behind the words to understand the reasons for the request. At a more general level, the concern of disability rights groups is that physician-assisted death would suddenly reinforce the more generalized social prejudice and stereotypes that disabled lives have less value and quality than those of other Canadians. Many disabled individuals find the assumption that life with a disability is less meaningful or somehow of lesser quality to be devaluing. We must take these concerns seriously.
Again, my experience is informed by my own personal experience with my late mother who passed away three years ago, suffering from the effects of Alzheimer's. Her last five years were not good. She was confined to an over-sized wheelchair. She had to be lifted in and out of that chair and in and out of bed. Many times she did not know where she was or who she was or to whom she was speaking. However, even in the final year, some days, out of the blue she would say something that was extremely appropriate, that was pithy, that was apropos to the moment, that was insightful, and we never knew when that would happen.
My brother and sister and I struggled to bring her out of the care home she was in to attend family events. There had to be special logistical arrangements and special caregivers, but every moment we spent with her was worthwhile, and we all wish that she was still with us today.
At a more general level, to be sure, there are differing views within the disability community, but these are the concerns that have been voiced by large national organizations in Canada and abroad. Hearing all voices over the coming months will be of critical importance, so that we can develop adequate responses and safeguards that affirm the equal and inherent dignity and value of all Canadians, including those with disabilities.
Many are likely to view the question of physician-assisted dying as a private matter between patients and their doctors when viewed through the lens of the single individual who genuinely and desperately wants to die because he or she has a medical condition that is causing intolerable suffering. The question of legalizing physician-assisted dying does appear to be a private one.
From the perspective of a person who truly wants to die, the issue may seem like a relatively simple one. However, as I have described, there are many issues that must be considered from the broader public perspective.
Some people may choose assisted dying after having lived a vibrant and full life, with the support of family and friends, after having been able to accomplish all of their dreams. However, not everyone is so fortunate. Some people may choose death as the most reasonable option because they are not supported by their families, they are lonely, or they are lacking the resources necessary to make life manageable. If these individuals request assistance to die from their physicians, how should they be treated?
There are likely several different options for a possible way forward on this issue. It would be critical to review the existing regimes internationally, as was done by the courts in the Carter decision. At present, they seem to fall into two groups. In the United States, there are three states—Oregon, Washington, and Vermont—that have legalized physician-assisted suicide only through a prescription of a lethal substance for those who are terminally ill. By contrast, three countries in Europe—Belgium, the Netherlands, and Luxembourg—have legalized and regulated euthanasia for persons suffering intolerably from any kind of medical condition.
Under these regimes, most people who obtain euthanasia are cancer patients at the end of life, but there are a growing number of people with psychiatric disorders and other types of conditions that are not life threatening. Difficult choices will need to be made. Do we as a society see the suffering of those who are dying differently from the suffering of those who still have a lot of life left to live? Are we doing all that we can to alleviate suffering in various forms?
I would like to mention palliative care at this point and pay special tribute to those very special people, the caregivers, nurses, and doctors, who work in the palliative care field. They are truly special angels and deserve our supports and thanks. I have seen family members go into palliative care and have a much better situation at the end of life than without it. That needs to be part of our debate. Any time that I think I have a difficult day at the office, I think of those who work in palliative care. God bless them.
How will we ensure that suicide prevention initiatives continue to improve while we offer assistance in death to some people? How can we help Canadians be less afraid to talk to their doctors and families about death and dying and consider preparing advance directives setting out their wishes if they should become unable to express their wishes?
Physician-assisted dying raises many difficult issues of great importance to all Canadians. It involves matters of life and death, questions of human dignity and suffering, and the inherent value and equality of all Canadians no matter what their medical conditions, age, or physical limitations and challenges. These are very profound questions. Our government opposes this motion because we have committed to consulting widely with Canadians in a meaningful and effective way. This will take some time and it behooves us to take the appropriate time now to carefully consider all perspectives and options.
We must all come together to work out solutions in a respectful and compassionate way. How we resolve these often conflicting values will speak to who we are as a society for many years to come. In my view, the special committee structure and the timeframe suggested in the Liberal motion would not allow for the proper consideration of all aspects of this very serious matter.
Mr. Speaker, I will be sharing my time with the member for .
There are times in a person's life that are of critical importance. There is nothing more important than anything that affects our health and our lives and anything that affects the lives of the people we represent. There is likely nothing more important we will debate, except security, because this is once again an issue that affects the lives and freedoms of the people we represent. It is therefore an extremely important issue.
When I was fairly young—the word “young” is relative in this caucus—I suddenly had to deal with terms that I was completely unfamiliar with. When I was 29 years old, we learned quite suddenly that my father had cancer. He had only a short time to live. The doctors gave him two or three months. Even with treatment, he would have five months at most. I had to reconsider what principles and concepts such as quality of life and human dignity meant to me. There is nothing worse in life than being faced with your own mortality or the mortality of your loved ones. How should anyone deal with all of this? I think that the most important thing to focus on is being compassionate.
I am also lucky to be a Quebecker and to have observed the process in Quebec with the Select Committee on Dying with Dignity. One of my good friends, Maryse Gaudreault, the MNA for Hull, was a member of the National Assembly when her party was in power, and she chaired the committee.
What I found fascinating was that politicians of all stripes were able to come together to address this very complex issue. There were as many different positions as there were people around the table, but they were able to put their differences aside to work for the people they represented, for the greater good, as they say. These people were all open to ideas throughout the process. It is true that they took as much time as they needed. I agree with the parliamentary secretary: if we want to carry out a thorough study of the many different aspects of this issue, we should think about the time we will have to spend on it. That is why we cannot wait until tomorrow; we must start today.
The committee produced a report. There is an English version. I encourage members to consult the report on the Government of Quebec site by clicking on the Select Committee on Dying with Dignity tab. This is a model of political co-operation between politicians of all stripes. Call them what you will—federalists, sovereignists or separatists—whether they were on the left, on the right, in the centre or on the centre-left, these people all sat down around a table in a non-partisan way to listen to what Quebeckers had to say and to make recommendations.
It did not stop there. Indeed, after that, a committee of experts was put together to try to create a somewhat more legal context on the issue. Three prominent individuals took part: Jean-Pierre Ménard, an authority on medical law, Michelle Giroux and Jean-Claude Hébert. Work continued, and it was agreed that if the next government was not the same as the government that chaired the committee, they would carry on and continue the process. Therefore, it did not end when the government changed hands. The Parti Québécois minister, Véronique Hivon, took over and continued to handle the file, and then the Couillard government completed the process.
This shows how a cross-section of people with different backgrounds all got involved in this issue. They took the time to listen to the public and tried to develop a humane process that is respectful of rights and of people at higher risk in order to avoid what no one wants to see happen.
That being said, under the Canadian Constitution, the provinces have jurisdiction over health. That includes end-of-life care, regardless of when that happens.
I have a lot of respect for Quebec law, and I fully recognize Quebec's right—and the right of every province in the same circumstances—to do what it did. We are dealing with the Carter decision, which was rendered by the Supreme Court on February 6. The decision was very clear. It deals with section 241(b) of the Criminal Code, which states that anyone who aids or abets a person to commit suicide is guilty of a criminal offence. According to section 14 of the Criminal Code, “no person is entitled to consent to have death inflicted on him”.
The Supreme Court of Canada was very clear. In the words of the leader of the third party, the court provided “clear and unanimous guidance”. The Supreme Court of Canada could not be any clearer. We must therefore examine this issue in a very specific context. The Supreme Court of Canada stated unequivocally:
Section 241(b) and s. 14 of the Criminal Code unjustifiably infringe s. 7 of the Charter and are of not force or effect [it is important to clearly understand the Supreme Court's decision] to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. The declaration of invalidity is suspended for 12 months.
In other words, there are not 36 possible scenarios. This has been discussed at length. We know the score. Everyone is talking about three possible scenarios and a fourth. The fourth scenario would be to seek an extension from the Supreme Court because we were unable to move forward with this matter quickly and do what we should have done a long time ago. The NDP started working on this long before the Carter decision, knowing full well that we must deal with this issue, even if only because Canadians asked us to. I keep getting the impression that Canadians are ahead of us on this issue.
The Supreme Court of Canada was clear. One of the three possible scenarios is to use the notwithstanding clause. We know that some Conservative colleagues are fond of that clause. I was pleased to hear the say that the notwithstanding clause would not be used. Thank God. To make this clear to those watching us, using the notwithstanding clause in relation to the Canadian Charter of Rights and Freedoms means that we know we are not complying with the Charter, but we are knowingly doing that anyway. So far, every party has stayed far away from using that type of clause and I am glad about that.
The second scenario would be to say that nothing is happening and that we will not ask the Supreme Court of Canada for an extension. What is happening? A journalist asked me that question yesterday. It is interesting because the more we read the decision, the more things we see come to light. In fact, my opinion, for what it is worth, is that section 241 (b) will continue to apply, except for prohibiting “physician-assisted death for a competent adult person who (1) clearly consents...” or what I was referring to earlier. The laissez-faire or leave-it-alone scenario would mean that the courts would rule on a case-by-case basis.
The third scenario is to take the bull by the horns and provide clarification. The courts will nevertheless have to know what is meant by “competent adult”, “clearly consents to the termination of life”, “grievous and irremediable medical conditions (including an illness, disease or disability) that causes enduring suffering”, and so forth.
The New Democrat caucus has all kinds of opinions, just like the Canadian public. However, I think that we need to listen to Canadians, experts and people who have a special interest in this issue, so that we can be clear about how paragraph 241(b) should now read in light of the Supreme Court's ruling, and what would be an acceptable form of consent, as given by an adult, and so on. The idea of a committee is not a bad one.
We will support the Liberal motion. However, I have some serious doubts about whether the process can be non-partisan, in light of the history we have with the current government.
Mr. Speaker, I have the honour of rising today to speak to assisted suicide and the motion by the third party in the House.
I would like to start by echoing the comments of all my colleagues. I will not go into a lengthy debate. This is a sensitive, very polarized issue that engages people personally because we have all directly or indirectly gone through a tragic situation where someone we know has lost a loved one or we ourselves have lost someone very close to us or seen a loved one suffer. Parliament's role is to guide Canadians in this kind of situation, to reach out and tell them that we will listen, answer their questions and ease their insecurity.
The debate is necessary today, and I would like to thank my colleagues in the Liberal Party for moving this motion. As they said, we are dealing with a very important Supreme Court decision because, as my colleague from just said, it overturns another decision, the Rodriguez decision. It sets out new principles regarding euthanasia and assisted suicide. It is important that we, as parliamentarians, consider this decision and listen to the many Canadians from all walks of life who have been asking the government to do something for a long time.
My colleague from mentioned this, and I could perhaps repeat certain principles set out in the court's decision. In its decision, the court indicates that paragraph 241 (b) and section 14 of the Criminal Code infringe Canadians' right to life, liberty and security of the person. Why? Because a blanket prohibition does not achieve the objective of protecting vulnerable people from being counselled or encouraged to end their lives. The blanket prohibition infringes the right to dignity. The Supreme Court speaks of autonomy in making decisions, liberty of the person, dignity of the person. It is important to acknowledge and espouse these concepts and to go back to Canadians so they can tell us what they think and what they expect from their Parliament.
It is unfortunate that the Conservatives believe that only the government can consult Canadians. That is false. We are all here as parliamentarians, and it is the role of parliamentarians and Parliament to consult Canadians.
With regard to what was done in Quebec, on behalf of all my colleagues, I would like to congratulate the members of the National Assembly. They were truly able to completely set aside political partisanship and finally passed the bill on June 5, 2014.
Quebec's process was very interesting. It began in 2009. From 2009 to 2014, a select committee mandated by the assembly to study the issue of the right to die with dignity came up with principles and considered the issue of assisted suicide very carefully. It consulted experts from September 2010 to March 2011.
Then it asked legal experts to comment on its 24 recommendations and table a report on the legal issues that were raised. That report was submitted to the government on January 15, 2013, and to the Committee on Health and Social Services.
People from every field affected by this issue were consulted, including legal experts and health and social services professionals. It is worth mentioning because the provinces have to be involved in the process, whether there is a special committee or consultation. The government has to understand that the provinces are key players in providing health care.
It is therefore extremely important for the provinces to be an integral part of the government's consultations. We must consult Canadians, legal experts and health professionals, but the provinces are on the front lines of health care delivery. Their point of view must be heard by the government.
This is not the first time a bill on assisted suicide has been introduced. In this case, it is a motion, but a number of bills have been introduced, including one sponsored by my predecessor, Francine Lalonde. She was a leader on the issue of assisted suicide. She introduced a bill to amend the Criminal Code a number of times. Parliament can also draw from the many initiatives by parliamentarians and the debates that have been held in Parliament.
People often contrast assisted suicide with palliative or end-of-life care even though the two go hand in hand. My colleague from moved a motion calling on the government to establish a pan-Canadian palliative care strategy in partnership with the provinces and territories in order to enhance the quality of life and dignity of people who are, unfortunately, dying.
All of this warrants an extremely important discussion on the role that Parliament will play in this issue. The fundamental principles of this debate are very important. They are freedom, choice, dignity and, most importantly, health and security. These are the fundamental principles established by the Supreme Court in Carter v. Canada.
We need to see to it that all Canadians are heard and that they can end their lives in a dignified manner. The freedom to make decisions is extremely important.
The provinces must be the primary stakeholders consulted by the government, but Canadians need to feel that the government is listening to what they have to say and that it will do everything in its power to comply with the Supreme Court's decision and find a solution that respects the fundamental principles set out in Carter v. Canada.
Mr. Speaker, I will be sharing my time with the member for .
This motion is fairly simple. It is asking for a special committee to be set up to seek input from experts and to have a broad consultation with the public and with physicians because we are talking about physician-assisted death. The Supreme Court has actually talked about the very complex and controversial nature of the whole issue of the idea of assisted death. We know that some people are anxious and concerned that vulnerable people would be coerced. The Supreme Court spoke clearly to the idea that people could be coerced and abused and pushed into making decisions to end their life when it is not necessary. The court has balanced that with the idea that some people do feel they need to end their life for various reasons. Because of the very complex nature of this ruling and because of the very controversial nature of how Canadians see this, many groups should be consulted. It is important for us to deal with this controversy within the public realm, and also to speak to physicians who would be the people dealing with the issue of physician-assisted death.
The Supreme Court was very clear that this legislation has to be balanced. It must balance protection of the vulnerable from coercion, et cetera, and allow for that right to life, liberty, and security of the person, for people who are:
...a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.
That is particularly clear. What the Supreme Court said is that any law must have “...properly designed and administered safeguards...capable of protecting vulnerable people from abuse and error”. The Court was very clear that we need to balance this. It is something about which we need to talk to the public. We need to hear from all the various groups and experts and from physicians.
The courts also said something very important. In the context of medical decision making and informed consent, physicians are fully competent and capable of assessing all of the criteria that the court spoke about earlier, which is about the adult person who is competent, et cetera. Physicians are the ones who diagnose a patient's condition, who know the prognosis of a patient, who understand all of the available choices that a patient has in order to relieve suffering and in order to look at the choices in terms of his or her life. Ending his or her life has to be one of those choices. Assessing competency is core when a physician is dealing with a patient.
Every day as a physician, I spent a lot of time with my patients, giving them the options for treatments and interventions, telling them exactly what their illness is about, what the prognosis is, and what the treatments may or may not be; and giving them every single option, so that at the end of the time patients are the ones who actually choose. It is called informed consent. They are given the information about what to do, where to go, and what decisions to make. This is just one more part of that informed consent, and physicians are the only persons capable of doing that, because they know how to assess competency. Physicians know when a patient is being coerced or abused. They know when a patient is able to understand the nature of his or her illness. Physicians are able to diagnose whether a situation is irremediable. They are able to assess whether the patient is in intolerable pain and whether there is no hope for the patient. In fact, in the context of life and death decisions, physicians are very capable of assessing these criteria.
In some jurisdictions, such as Oregon and Belgium, in Europe, we see that, in the decisions where there is physician-assisted death, there is always a second opinion. Many physicians, in the course of their discussions with their patient, will suggest getting a second opinion, so that patient hears from another qualified physician whether those options are indeed the only ones, and the patient is able to make the choices.
I think it is really important that physicians be able to do this, and I think the courts have said that they believe that physicians are capable of doing it.
One of the things we would have to look at, which is not widely accessible to anyone across the country right now, is an option for many patients who are finding themselves in intolerable pain or who are totally unable to have their condition remedied. That is the idea of palliative care. There is no palliative care accessible. I know that a physician would like to be able to tell a patient that there is a choice, that there is a place to go to for good palliative care, to relieve the pain a person may be experiencing and to do the kinds of things to help them die with dignity. Patients could then have a choice, but this is not a choice that is currently available across the country.
I want to stress that the Canadian Medical Association and I as a physician believe that palliative care is a key component to create as some kind of parallel program that would assist us when the legislation is being written, thereby offering these kinds of informed consent and real options to patients.
Suicide prevention programs need to be maintained, because we know that many patients who face a chronic, debilitating disease or an intractable illness become extremely depressed. It is one of the first things that happens to a patient when they are diagnosed with something that is intractable or life threatening. Therefore, they are not really making competent decisions because of depression. Good mental health care for patients who have been diagnosed with these illnesses is another option that is not currently available to patients. If we look at dealing with this issue, we have to give patients real options, so we need to expand these programs where necessary.
The second piece we need to discuss is to talk with physicians about legislation. The CMA has said clearly that it believes that the medical profession should be given adequate opportunity to comment or to have input into any kind of legislation, because we see clearly that physicians will be playing a great role.
We also know that physicians themselves are quite split down the middle on this issue. We know that physicians are torn between the two primary ethics. One is to consider first the well-being of the patient, which may very well be to assist that patient in dying with dignity. Second is to do no harm, which many physicians feel is an ethic that conflicts with that.
Therefore, there need to be clear protections, as currently exist in all jurisdictions globally that have legal physician-assisted suicide. They say that physicians who do not wish to assist a patient dying, for moral, religious, or other reasons, have an ethical and moral duty to refer that patient to a physician who will assist that patient.
These are some of the reasons that physicians have to be protected if they make a decision, as is currently the case in regard to abortion. If a physician for moral or other reasons will not perform an abortion, that physician has an ethical duty to refer the patient, if the patient wishes that to be done, to a physician who will do so.
These are very important issues on which we need to hear from physicians as we are crafting legislation. We need to look at best practices in other jurisdictions. That is an important piece.
However, the procedural component of this is very clear. The House will only sit for another 12 weeks. If we in fact get a committee to go now, to travel, to listen to Canadians and meet with experts and listen to physicians, we would be able, after an election with a new government of whatever political stripe, to meet the Supreme Court's deadline with a committee report.
Using a special committee is not without precedent. In fact, other special committees, such as the committee on solicitation, the special committee on the non-medical use of drugs, and the special committee on missing and murdered aboriginal women, have been precedents for this. It is because parliamentary committees have other roles to play in the course of their duties in looking at legislation and would not be able to carry out this job as completely and fully as a special committee could, whose only job would be to do that.
Mr. Speaker, it is with some sadness that I rise today in response to what we have heard so far from government members. This issue should have been an opportunity for Parliament to show itself at its best. It is about the relevance of Parliament and Parliament doing what the Supreme Court of Canada has asked it to do.
We on this side had hoped that this motion would nudge the government to do the right thing, as it did two years ago when we asked for a special committee on missing and murdered indigenous women. The at the time had no objections to the establishment of a special committee. Now we have a reference, literally, from the Supreme Court and somehow, all of a sudden, government members are objecting. What is also extraordinary is that if their strategy is to get an extension, there is absolutely no reason that I can see for the Supreme Court to grant one if there seems to be no work under way on what it has asked Parliament to do.
I come from an institution whose Latin motto was non quo sed quomodo: it is not only what we do, but how we do it. This is the time for Parliament and parliamentarians to demonstrate to Canadians that the way we will go about making decisions will be in an open way, by tackling the tough things, hearing all points of view, and not in a closed-minded way where it will appear to Canadians as if the government has already made up its mind and Parliament will not have a say and, therefore, that citizens and Canadians will not have a say.
There is no question that this debate evokes strong feelings. Therefore, it is really important that Canadians see that we are prepared to tackle this very difficult decision and important challenge that the Supreme Court has given us to get this right and put in place the safeguards that it and all Canadians know need to exist. As physicians, the member for and I both know when it is not time to prescribe. It is not time for us to prescribe what to do; it is a time for us to listen. It is the only way that we will get it right.
It is a very serious piece of work that we have been asked to do, but it is very serious that Canadians understand that it is Parliament that has been asked to do this work and to consult Canadians. It is not okay for Parliament to abdicate from this challenge that it has been given by the Supreme Court of Canada and to abdicate it to a government that has a terrible track record in consulting Canadians, asking civil servants to attend information sessions but then not listening to what was heard. We have a responsibility to develop a very transparent and accountable process so that Canadians will know what we heard and that we listened to them.
It is about listening to people with expertise and those with lived experience. It is about an opportunity for a democracy between elections to show Canadians that they were listened to and allowed to shape public policy. It is what Jane Jacobs said, that good public policy comes when the decision-makers can see in their mind's eye that people are affected. We need to listen to the people who will be affected by this legislation and get it right.
The words in paragraph 127 of the judgment, even as my colleague said, are clear, but Canadians may have very different interpretations of what constitutes a “competent adult person”, what “clearly consents” means, what “grievous and irremediable” are, what is “enduring suffering that is intolerable to the individual in the circumstances of his or her condition”, and how we can ensure that Canadians are not intimidated and the vulnerable are not put at risk.
I can only interpret this as the government's refusal to govern, its refusal to tackle the tough stuff. It is hiding from it and I hope that it still has time today to take the little offering that Liberals have given on how we can show that Parliament will do its job, and that the government is not merely an administration in campaign mode that refuses to deal with the tough decisions.
It is very clear that there are many ways the government could go about this, such as a white paper for consultation or a draft bill. The online consultation that it talks about just will not work unless there is an understanding of what the questions are and whether they actually will be listened to. Some of the members are already suggesting that they need an extension or that they need to use the notwithstanding clause.
There is no question that the Supreme Court of Canada did its job unanimously. It is time for us, as parliamentarians, to do ours.
I attended probably over 2,000 births in my career as a family doctor, and I felt that my job was to ensure they were safe, elegant and what the family wanted. I attended far fewer deaths, but it was also my job to see they were serene, pain-free, and that people were able to die in dignity. All of us in the House have our stories, and we know that we have to do better.
Initiating this debate will be imperative for us to get on with the other undone business in the country in terms of the serious approach to palliative care and end-of-life care, and a serious approach to a pain strategy.
Doctor Chochinov's article from The Star, on Wednesday, February 18, really spoke to the fact that doctors were not well trained to engage in the end of life conversations. Many of the goals of care are unclear. In view of the Supreme Court's decision, these issues have never been more important and they have to be dealt with, not only by Canadians but by medical schools and associations. We have to know that real choice in end of life does not happen if people do not have optimal palliative care and optimal dignity in their lives.
I was lucky enough that my mom, at the end of her life, was able to die in dignity with a pain pump that she controlled. With my dad, on the other hand, it was not to be the end of his life. He broke his hip. He was in unbearable pain and had unacceptable pain relief, and he died 72 hours later. We did not want him to die then. Again, without a decent pain strategy and without decent palliative care, we will be unable to give people real choices.
As members know, the Canadian Medical Association has said that it wants clarity on how the courts actually distinguish between the definition of euthanasia and physician-assisted suicide. Canadians expect us to do differently.
We know the safeguards have to be there. The Council of Canadians with Disabilities has been eloquent in terms of the need to protect the vulnerable. We know from our history with HIV-AIDS, when it was a death sentence, that people whose physicians chose to help them take their lives woke up and realized that they were merely depressed.
We know there are power differentials. Families descend on a vulnerable senior who they say has had enough. Mainly, there is a financial reward, or they are just tired of providing care.
As the member for has said so often, our society is judged by how we look after the most vulnerable in our society. We cannot let them down.
There are need objectives that we could use. Ontario has an objective where 70% of people over 70 would have an advanced directive as they go forward.
We need everybody to read Willie Molloy's Let Me Decide. We need to get on with the kind of efforts that the Canadian Society of Palliative Care Physicians has mentioned.
Dame Cicely Saunders said:
You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.
There is no question that too many are suffering at the end. Too few die peacefully and with dignity. We need a process that uses the research, the knowledge translation, the policies, the political will, the practice, and the applied research to ensure we design a truly excellent and exemplary process for the people who expect this of their Parliament.
We must tackle this as a Parliament. We cannot let the government do this in some sort of backroom way. We cannot deal with what is practically prorogation and padlocking this place any longer, thinking that things will happen elsewhere or will not happen at all until the next government.
We implore the government members to do the right thing and let Parliament do its work. The Supreme Court and Canadians ask no less of us.
Mr. Speaker, I would like to note that I will be sharing my time with the member for .
It is a privilege to rise today to speak to the Supreme Court of Canada's decision regarding physician-assisted dying. As we all know, end-of-life issues are deeply emotional. Questions about how our family and loved ones hope to go through their final days will not be answered easily. However, anyone who has had to support a family member during a difficult time will understand that these conversations are essential to respecting the wishes of our loved ones and ensuring that we all have dignity in our final days.
We also know from recent polls and media coverage that this is not an academic topic. Canadians are having these discussions around the dinner table, and it is important that government is equally engaged. Despite the differences Canadians experience in their respective lives, be it the jobs they have held, the lifestyle they have chosen to adopt or the contributions they have made to society, all people ultimately have one thing in common; this being that we will eventually face the end of life.
Given advances in modern medicine and care practices and the fact that we are living longer lives, the reality around this experience has changed. In the past, when deaths resulted from serious or contagious diseases, accidents or otherwise natural causes, many Canadians died in their own homes in the midst of their family and community members. Now Canadians more typically spend their last days in the clinical environment of hospitals, often after a long and arduous course of battling debilitating illnesses, disease or coping with chronic conditions.
Those who are in need of palliative and end-of-life care and who are admitted into hospital settings often find themselves surrounded by medical professionals, strangers who strive to provide the best care even when death is imminent. In such cases, people are provided with very well-meaning care, but there may be little that can be done to make patients more comfortable near their lives. These situations are distressing for both the patients and the families.
That leads me to the Supreme Court of Canada's decision. I will quote from its conclusion, which states:
—prohibit physician-assisted death for a competent adult person who...clearly consents to the termination of life and...has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.
It is important to reflect a bit in terms of those different pieces, which I know some people who have already spoken have done. When we hear that 80% of people actually support this measure, I really think they do not understand the full scope and if they did understand it, they might have a different perspective.
I thought this was well said, when Andrew Coyne stated:
When most people think of assisted suicide...they have in mind not only a competent adult, capable of giving consent, but someone suffering unbearable physical pain and in the last stages of a terminal disease, for whom suicide is no more than a way to hasten an end that is already both inevitable and near.
He goes on to say:
First, it is clear from the ruling that the “enduring and intolerable suffering”...is not limited to physical pain, but also psychological pain—which, besides being a murkier concept by far, raises the question of how competent the subject really is. Nor is suffering defined further: it is enough that it is intolerable “to the individual.”
Second, nothing in the words “grievous and irremediable medical condition,” the court’s other requirement for the exercise of this right, suggests that death is near, or even likely.
Certainly many people share that perspective with respect to people who are near their end of life. However, I have heard many concerns with respect to the comments “intolerable psychological pain”. The disability associations have spoken to this very articulately. We must also look at other countries, such as Belgium, where I understand assisted suicide is now provided to children. Those comments tell me that we have to be incredibly careful in how we craft the legislation.
It is important to look at the concerns I have regarding this motion.
The first and most obvious concern is the timeframe. The leader of the third party stood up in the House and talked about how Quebec took four and a half years to craft its legislation. It took an important length of time for Quebec to get it right. As well, it took the Supreme Court of Canada well over a year just to strike down the legislation.
Crafting careful legislation will require important conversations. My colleague talked about the special committee on missing and murdered women and girls. It is important to recognize that the committee was struck for 12 months, yet it still required an extension to complete its work. It is also important to note that it was through a unanimous motion put forward by the Liberals, which we supported. However, when we got into the special committee structure that they had presented, they soon realized that there was a real flaw in terms of a special committee's structure. We needed the Native Women's Association of Canada to be an equal partner at the table, but through the unanimous motion of the House they had not struck a committee that allowed for the important partners to play a role in that conversation.
The Liberals like to use that as an example, but there were some important flaws in how that process moved forward.
One obvious partner that I see missing in this is the Canadian Medical Association. It is going to be, and must be, intimately involved in terms of the kind of legislation that ultimately comes out.
Those are my concerns with the timeframe.
We know that there will ultimately be a committee structure to deal with this particular issue, but more importantly, how many of our 308 members of Parliament will get to sit on such a special committee? There will be only 12. Therefore, all 308 members of Parliament have a responsibility right now to be talking with groups and individuals in their communities. If every single member does not send a letter to the outlining the consultations they have had, they are, in my opinion, not doing the job properly.
We do have a critical job ahead of us. We have to get it right. The motion before us today is, in my opinion, very restrictive in terms of the timeframe, and it is very restrictive in terms of the structure to be used in moving forward, since there would be no critical partners at the table. We know that committees can do great work, but they have limitations in terms of the number of witnesses they can hear from and for how long.
Again, we must do this right. Having dealt with people with ALS and terminal cancer, we know that compassion needs to be shown in what we do and how we do it. We need to move forward, but to be quite frank, the motion that the Liberals have put forward is not going to provide the comprehensive response that we are going to need.
Mr. Speaker, I am pleased to have the opportunity to participate in today's debate on the way forward in responding to the recent decision from the Supreme Court of Canada on the issue of physician-assisted dying.
On February 6, the Supreme Court of Canada concluded that the Criminal Code provisions on physician-assisted dying are contrary to the charter. The court suspended the legal effect of its ruling for 12 months to give Parliament time to develop an appropriate response.
The government opposes our motion because we have committed to hearing from all perspectives on this issue. This consultation process would provide an opportunity for Canadians and stakeholders, such as physicians and nurses, disabled people, and patients' rights groups, to share their views and perspectives.
We cannot underestimate the importance of engaging all Canadians in this dialogue. It is hoped that everyone will work together so that we can create a regime that would meet the needs of those who are grievously ill and who want to die in order to escape intolerable pain, while at the same time protecting vulnerable individuals and affirming our shared value that all human beings, no matter their condition, have inherent dignity and worth.
We are, thankfully, not starting at zero. There is much that we already know about the risks that are inherent in the practice of physician-assisted dying, the types of safeguards that can help mitigate those risks, and how these practices can be monitored. Much of what we know was presented at the courts as evidence in the Carter litigation. I believe it could be helpful if we consider some of the filings of the trial judge. The trial judgment itself is full of relevant information about how these laws work where they exist.
This is definitely an issue upon which people can have differing views about what is appropriate or acceptable for a societal response, but we should all be striving to form a common understanding of the facts.
One important question that was raised many years ago was whether legalization of physician-assisted dying would have the unintended effect of impeding progress in improving the quality and availability of palliative care services.
With regard to palliative care, I would remind all members that in May 2014, this chamber overwhelmingly passed Motion No. 456, calling upon the federal government to establish a pan-Canadian palliative and end-of-life care strategy.
After examining the evidence from the jurisdictions that permit some form of physician-assisted dying, the trial judge in Carter found that palliative care services were not undermined in these places; in fact, in some places, more physicians now seem to have a better understanding of palliative care than they did before the legalization of physician-assisted dying.
While the court did not find that these improvements were the result of legalizing physician-assisted dying, it is nonetheless good news that palliative care can be improved alongside an assisted-dying regime. I think this will be important to bear in mind going forward.
Another concern that is sometimes expressed is that legalizing physician-assisted dying can have a negative impact upon the doctor-patient relationship, as some may come to fear their doctors once they are empowered to help end life.
Moving forward, we as a society must be mindful of this relationship. For example the trial judge found that, if a future law were carefully designed with appropriate safeguards, patients' trust in their physicians and physicians' commitment to their patients' well-being would not necessarily change for the worse. Furthermore, the risk of misconception and distrust may be counterbalanced by the possibility of enhanced trust arising from more open communications.
However, there does appear to be evidence that, in Canada, not all physicians are having honest conversations with patients about their prognosis and options at end of life to the degree we would hope.
Perhaps the prospect of legalizing physician-assisted dying presents us with an opportunity to help physicians improve their skill set in this area, for the good of all patients, not just those who would seek to have assistance to die.
The evidence from the Carter case also revealed interesting facts about the reasons people provide for seeking medically assisted death. I think most Canadians believe that those who seek assistance to die are suffering from intolerable physical pain. The media often describe cases involving horrific diseases that lead to painful and debilitating deaths.
The data that is collected from places where people can access assistance to die tells us a very different story. In fact, inadequate pain control is almost never a reason people seek assistance to die. On the contrary, almost all people who have received assistance wanted it because they were suffering from loss of physical autonomy, reduced ability to engage in activities that made their life enjoyable, feelings of loss of dignity, losing control of bodily functions, and feeling like a burden on family.
People are seeking to die, not because they are in physical pain, but because they are in emotional and psychological pain. It is important to know this if we strive to provide real options to Canadians at the end of life.
The data tells that, in every place where these practices are legal, the clear trend is increasing for numbers of people accessing assistance to die with each passing year. Even in places like Oregon, where the law has been in operation since 1997, the number of people seeking assistance to die continues to grow with each passing year.
The data reveals another interesting fact about the Oregon model. In Oregon only physician-assisted suicide is legal, and only for people who are terminally ill. The law permits a physician to write a prescription for a lethal dose of medication to a person with an illness that is reasonably expected to cause death within six months.
The data tell us that, every year, about one-third of the people who receive this prescription do not use it. Are people obtaining a lethal prescription when their wish to die is temporary or they are not entirely firm in their desire? On the other hand, some say that simply having the prescription and knowing it is available for use if one's situation becomes unbearable is in itself a way to ease their psychological suffering so that they can continue to live.
The data also shows that some people who receive the lethal prescriptions die more than two years later, even though according to the law, the prescription is only available to a person who is reasonably expected to die within six months. This fact suggests there are real challenges associated with physicians' ability to predict how close a person is to death.
Our challenge would be much more difficult without all this information. This information is available to us because every jurisdiction that legally regulates physician-assisted dying has a legal requirement for physicians who provide assistance to report that they have done so on some authority. In some cases, the relevant authority is the health department of the state; in other cases, it is a specially created commission. In all cases, the relevant authorities are required to compile and analyze data and to issue public reports on key facts, such as the kinds of medical conditions of the people who are aided to die.
This data is invaluable to Canada and no doubt to other countries that are grappling with these issues. Their reporting requirements also serve as an accountability measure, which is just as important. These are just some of the important facts we must all come to appreciate as we move forward with this conversation.
Mr. Speaker, first, I should say that I will be sharing my time with my colleague, the hon. member for .
I rise today to speak to the opposition motion moved by the leader of the Liberal Party of Canada, my colleague, the hon. member for . This motion has two main provisions: that the House recognize the Supreme Court ruling on physician-assisted dying and that a special committee of the House be appointed immediately to consult with experts and with Canadians and present a legislative framework on which legislation on physician-assisted dying can be based.
On February 6, 2015, the highest court in the country handed down an historic decision. The ruling indicated that paragraph 241(b) of the Criminal Code of Canada, stating that every one who aids or abets a person to commit suicide is guilty of an indictable offence, and section 14, stating that no person is entitled to consent to have death inflicted on him, will be invalidated 12 months after the February 6, 2015, ruling. These measures violate the right to life, liberty and security of the person guaranteed under section 7 of the Canadian Charter of Rights and Freedoms.
My parliamentary colleagues and I have a duty here. At our best, we write laws worthy of the people who elected us. Each one of us is aware of how emotionally charged this sensitive issue is, regardless of our personal opinion. This issue is both sensitive and complex. It is very difficult to set legal parameters that can apply to a wide range of unimaginable scenarios. I am supporting this motion because it calls on Parliament to face this challenge. We have 11 months left to come up with a solution, and we will have to get around a number of obstacles in our parliamentary schedule, including, of course, the election, which will interrupt the legislative work of the House this fall.
I invite my colleagues not to waste one second because we have an enormous task ahead of us. Canadians deserve a solution that will protect their rights and reflect their values. That is what we can deliver if we get to work right away and do our best. That is why we were elected and that is what Canadians deserve.
The medical field is evolving in Canada. One only need step inside a hospital to know that the aging population is putting more and more pressure on the system. The data confirm the fact that Canadians are living longer than ever, and the baby boomers have already started retiring. This new reality is a testament to the success of medicine. The new generation of retirees is essentially in excellent health. The geriatric wards of hospitals are overflowing, but the number of seniors flocking to recreation centres and yoga studios is also growing. The challenge of an aging population is the result of our success. This makes it no less of a challenge. A new generation of seniors is making itself known. They will live longer and their bodies will age differently because of medical innovations.
Once they were members of the flamboyant rock and roll generation and the largest cohort of workers in our history, and now more of them than ever before need medical care. That is quite natural; however, it shows that the reality of health care, especially health care for the elderly, is constantly evolving because of the people of that generation. Their physiological needs and their medical needs have changed. The anticipated aging of the population will inevitably lead to an increase in the number of people with cancer, for example, and other illnesses. This is the context for the debate on physician-assisted death and, more broadly, the future of palliative care in Canada.
As is the case for many of my colleagues and many Canadians who have been in similar situations in their lives, I thought about this when my mother died. She had to have an operation on her foot and the family asked her to agree to the operation. There were complications and she was told by her doctor that she had no choice but to have her leg amputated. Given her suffering, we told our dear mother that it was her decision to make. She immediately told the doctors that she wanted to be buried with both of her legs. It was her decision to put an end to the treatment.
I also experienced a similar situation with my children's adoptive grandmother, Olyve Pelletier, who was on dialysis. Shortly before Christmas, she brought in my children and all of her family to tell them that she was going to stop her dialysis treatment. These two people who are very dear to me were able to make that choice because justice allowed them to do so.
I understood from those experiences that our decisions regarding palliative care must be guided by the rights and wishes of seniors. We must make dying with dignity a priority and limit suffering as much as possible. What is more, that is precisely the instruction received from the court.
Canada is in desperate need of a good palliative care system. The health care system is not prepared for the massive generation I just mentioned, which will soon need access to this type of care. The cracks are already growing. Fewer than 30% of Canadian seniors currently have access to the care they need. A new strategy, a federal leadership and Canada-wide co-operation are absolutely necessary if we want to continue to be proud of having the best health care system in the world.
I cannot help but think of my experience at the Quebec National Assembly as we take on this noble yet colossal task. A few years ago, public discourse was constantly and convincingly changing in Quebec. As we are seeing in the rest of the country today, the tides had been turning for some time in favour of new measures surrounding and allowing physician-assisted death. The premier at the time, Jean Charest, created a select committee very similar to the one called for in the motion we are debating today in Parliament.
Under the Canadian Constitution, the federal Parliament is responsible for criminal law. According to the Criminal Code, euthanasia and assisted suicide are criminal acts. However, it is up to the provinces to administer justice and enforce criminal law.
I remind members that this debate has already taken place in the Quebec National Assembly. It was a non-partisan debate, and party lines never came into play. We are asking that these measures be taken here.
I also want to congratulate my former colleagues in the Quebec National Assembly, in particular the chair of the committee, Maryse Gaudreault, from the Liberal Party of Quebec, and Véronique Hivon, from the Parti Québécois, who was the co-chair of the committee.
Since an election is impending, the Supreme Court is calling on us to immediately study this issue, which is what the motion calls for as well.
I once again congratulate the member for , the leader of the Liberal Party of Canada, for having the courage to move this motion and to call on the House to immediately address this issue.
Mr. Speaker, I appreciate the opportunity to address both Parliament, and of course the country, on this issue.
The Supreme Court has spoken. The Supreme Court, in a very declarative, very clear way has asked Parliament, not the government or a minister but all of us as parliamentarians, to be seized of this issue and to deliver a response quickly back to Canadians waiting for answers and direction.
This is extraordinarily important. We have a duty to respond. I understand and we all appreciate the complexity of this issue and the sensitivities around this issue. However, we also have a responsibility to make sure that we do not simply put this off for a very simple reason: people are suffering. The longer we take to make a decision on this, the longer some people's suffering will deepen and extend. As well, those who wish to seek to provide assistance to people are being held in abeyance. Their capacity to act as caregivers is limited by our inaction. We have a responsibility not to ask for a deferral while we do no work and not to put off until tomorrow what must be debated and decided today.
When hon. members stand up in this House and read emails and correspondence from their ridings, it shows us that Canadians are eager to contribute. That is good. It is very good.
We need to respond quickly, because waiting until after the next election will have the next Parliament starting flat-footed, and more extensions and delays will be required. That is just unfair.
The Supreme Court understands fully what our electoral cycle is. It understands entirely what our responsibilities are, and it has given us these responsibilities.
We are also lucky. The province of Quebec, the National Assembly, has given us context and guidance and a body of evidence from which to act. That is important, because it means that there is legislative precedence. There is also, from that process, a spirit of nonpartisanship that I think we can embrace and move forward with. I would like to thank the National Assembly and the people of Quebec for giving that gift to the rest of Canada as we consider this very difficult issue.
It is equally important to speak of the principles which need to frame our conversation around this issue. People with disabilities are also looking to this Parliament to protect their dignity, their charter rights, and their existence as part of the Canadian community.
Whatever decisions we make, they will not just be about the ease of suffering but also about making sure that charter rights and people's proper place in our democracy is protected and included in this process.
While we talk about the parliamentary process, the root of that word being “speaking”, it is really a process about listening. We need to listen to the courts. We need to listen to Canadians, then we have to take on the duties we have sworn an oath to and act. We have to act swiftly.
As I said, this is an issue that defines many of our lives. We have heard from both sides of the House about personal experience in carrying people towards the end of life and carrying them beyond. We have all had that, in my life included. As I sat with my mother and watched her live out her final days in suffering, seeking to ease the pain of her children, as all good mothers do, there was no capacity, there was no framework, to have a rational adult conversation with loving members of a family solving a crisis that is present in many households, too many households, today.
I urge members in this House not to look towards the politics of this event, not to look to the shortcomings of a parliamentary system that sometimes does not give us the space or the time to deal with these issues, but to open their hearts to this issue, to open their minds to this issue, to listen to the way people have described this phenomenon we are now charged with resolving, and to please support this motion. Make it a better a motion. Make it as nonpartisan as possible. Include those groups whose voices need to be heard on this issue. Above all, act to end the suffering, act to provide clarity, and act to provide a swift response to the Supreme Court.
Now is not the time to dither. It is not the time to debate between the libertarian values or the humanitarian values that are present in this conversation. Rather, sit down with Canadians, sit down with members of our ridings, sit down as parliamentarians, and come up with an answer Canada can be proud of.
We have a basis from which to act. We have a compelling set of arguments presented to us by the Supreme Court. We have to act.
I would ask all members to support the motion being presented to us by our leader today, to move forward together to resolve this issue as Canadians in a compassionate way, in a principled way, and above all, to act immediately to end suffering for those whose only option is to wait for us to respond.
Mr. Speaker, I will be splitting my time with the member for , with whom I have the honour of working on the justice committee. It is also an honour to know him as a former RCMP officer. I have a tremendous amount of respect for his thoughts on a number of justice issues, and he does a fantastic job on our committee.
It is also my pleasure and honour to speak today to the Liberal supply day motion. To be frank, I appreciate today's motion. We have had a number of supply day motions recently that have been less about what Parliament should be engaged in, in terms of discussion between parliamentarians. However, this one certainly goes to that point, and I do appreciate it. I also believe that this is a non-partisan issue, and the discussion has been very respectful, as it should be, on this particular tough issue.
I am going to spend most of my time talking about the procedural issues. In my view, this is a motion to deal with procedure on a policy issue. The Liberal motion today puts out a direction for, or a way of tackling, the issue. It recommends that this be done through a special committee. The Liberals have highlighted the membership of the committee, which would be roughly 60% Conservative, 30% NDP, and 10% Liberal. I made the point earlier about how the committee structure now is for a standing committee of 10 members. This would be for 12, which is the old way of doing things. It really does not matter. It is still a percentage. The new way would give the Liberal Party a little more presence on committees, with two fewer opposition members there, but that is what the Liberals have chosen to present today.
Here is why I do not think this is the right approach to this very important issue. I have been here nine years and have sat on a number of committees. I have been the chair of the justice committee for the last couple of years. In my view, the best use of time at committee for members of Parliament is to deal with actual legislation. That is when there are words on paper about the direction of the government or a member, depending on the type of bill. The wording is there, the clauses that we are dealing with are there, and the changes are all there.
Dealing with legislation is a better use of members' time. I have been on a number of committees that do studies, and they are interesting. Sometimes they are useful, and sometimes they are not. This particular item needs a very broad consultation before it goes to committee.
The committee that the Liberals are highlighting in today's motion is would be a special committee that would not deal with an actual piece of legislation. The Liberals are saying, let us study it and have it back by July 31. I assume that out of that study, they are thinking that there would be a piece of legislation that would come after the election. The public still would not know what Parliament's direction would be, based on the study that would be done by July. It would be an overview of the issues and a number of questions might be asked. There may be directions and recommendations coming out of it, but there would be no piece of actual legislation. Of course, there are a number of options that will be available to Parliament, including not doing anything. That is one of the options.
The motion would not really advance the issue to a point where people would think that by July, they will have an answer on where the Government of Canada and Parliament of Canada are going on this particular issue. Based on today's motion, that would absolutely not be the case.
It would have recommendations. No committee study can compel the government to do anything. That is standard, whether it is a standing committee or a special committee. A study cannot compel the government of the day to do anything. Even if, God forbid, after October 19, there is a change in government, the study could not compel that next government to do anything at all.
Today's motion does not do what I think the Liberal Party thinks it would do and wants to present it as doing. It is a reasonable approach, and I am not saying that what the Liberals are doing is wrong. I do not think it is what the public is anticipating based on this particular motion.
The other issue is that when I consider broad consultation, I think of a variety of different groups. At present when we call witnesses to committees, as chair of the committee I try to achieve a balance. We get submissions from all parties. Normally we try to accommodate everyone's witnesses, and that has happened 99% of the time. On some occasions, we cannot accommodate everyone. Then the witness list is based on the size of the committee membership. Approximately 50% of the witnesses then would be from the Conservatives; approximately 40% from the NDP, the official opposition; and approximately 10% or so from the Liberal Party.
The record of the justice committee shows that the number of witnesses from the Conservatives is much less, maybe 45%, and that witnesses from other parties fill in that space. We deal very little there with legislation that is a matter of life or death. If we do something right, it is great. If we do something wrong, normally we can change it, or the next government changes the policy or legislation to improve it or to make changes.
The hardest vote for me thus far has been when we commit the men and women of our armed services to foreign conflicts, whether in Afghanistan or to what is going on in the Middle East right now, because we know there is the potential for a Canadian to die. In this case that is what it is all about, someone having the option to proceed in that manner.
The consultation with Canadians needs to be broader than the witnesses we pick to come to committee. There is a whole basket of opportunities. We should all be able to contribute those we consider to be experts. There are experts in this area who have different opinions in their particular fields, but there needs to be a broader way of consulting the public.
To my view, and I might be a bit biased, I think this issue should go to the justice committee and, based on the broad consultation at committee, the government should bring forward a piece of legislation. The justice committee, in its current form, has been working very well on a number of very difficult files, including the prostitution bill. The prostitution bill only really affected a small portion of the population, but this affects everyone, so we need a broader approach.
I am not supporting the motion today, because the process gives a false image that we will have legislation by July. The leader of the third party, the mover of the motion today, indicated that this does not create legislation. He said that directly to the House, that it is a study, a consultation. I do not disagree with him that we need broad consultation. I am not sure that the committee structure in the House of Commons is the appropriate structure to use to get that consultation, to develop legislation that should go to the standing committee process and result in witnesses being called to talk about actual legislation that will be developed.
Mr. Speaker, I am pleased to join today's debate in response to the Supreme Court's decision in Carter, which found two Criminal Code provisions prohibiting physician-assisted death to be unconstitutional and provided one year to Parliament, to February 5, 2016, to develop its response.
Physician-assisted death raises complex ethical, legal, and medical issues. Many of these issues involve competing interests and values, such as preservation of human life, individual autonomy, the protection of vulnerable individuals and groups, and human dignity and suffering. End-of-life decisions are very personal and sensitive questions for many Canadians, with deeply held beliefs on both sides of the issue and far-reaching implications for our society as a whole.
At this early stage of the debate, I believe the experience and evidence from foreign jurisdictions that have implemented permissive regimes by regulating euthanasia, assisted death, or both, are invaluable in providing input to our discussion, including with respect to eligibility criteria or procedural safeguards to protect vulnerable individuals from unwarranted deaths.
In the United States, for instance, there are only three states that provide access to physician-assisted death: Oregon, since 1997; Washington, since 2008; and Vermont, since 2013. Their legislative schemes all allow terminally ill patients to end their lives through the voluntary self-administration of a lethal dose of medication prescribed by a physician, although presence of the physician is not required during the self-administration of the medication.
Eligibility criteria for making such a request include that the patient be diagnosed with a terminal illness, which is defined as “an incurable and irreversible disease which would, within a reasonable medical judgment, result in death within six months”; that the patient be a competent adult, over the age of 18, able to make and communicate health care decisions; that oral and written requests be submitted to the attending physician; and that the oral request be reiterated no less than 15 days after the initial demand.
The legislation also provides procedural safeguards that address the physician's responsibilities when granting such requests, including confirming that the patient is terminally ill; is capable of making a voluntary and uncoerced decision; has been duly informed of the diagnosis, prognosis, potential risks, and alternative options to the end-of-life medication; and has been referred to a second physician to confirm the diagnosis and other eligibility criteria.
Attending physicians must also refer patients for counselling when they may be suffering from a psychiatric or psychological disorder impairing their judgment.
In the U.S. state approach, as is the case in all permissive regimes, reporting requirements have also been enacted. In the three American states, physicians are required to report to health departments further to prescribing the lethal dose of medication. This process allows for relevant information on the implementation of the laws to be gathered, analyzed, and reported to the public. There is no question that such information and data will be invaluable to our Canadian discussion as we delve deeper into this societal debate.
In terms of enforcement provisions, although offences for falsifying and coercing patients have been enacted in the states of Washington and Oregon, it appears that no specific enforcement mechanism has been put in place to assess physicians' compliance with the applicable rules and safeguards.
If we now look at European regimes, which currently allow both assisted suicide and euthanasia, we will notice subtle differences.
By contrast to the U.S. state approach, the European countries, specifically Belgium, the Netherlands, and Luxembourg, have broader laws that permit euthanasia or assisted suicide to be administered to a person who is suffering unbearably, either physically or psychologically, from an incurable medical condition, regardless of any proximity to death.
Since 2002, in Belgium adult patients or emancipated minors who are in a “...medically futile condition of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident” can request to be euthanized.
Patients must be legally competent and conscious at the time of the request, and their demand must be voluntary, repeated, and not result from external pressure. Procedural safeguards in place are similar to the ones in the three states in the United States, but also include the requirement to consult with a psychiatrist if the patient is not expected to die in the near future.
The legislation in Belgium was amended in 2014 and now allows euthanasia to be practised on children of any age if they are in constant and unbearable suffering that cannot be alleviated and are likely to die in the short term. In those very sensitive cases, an explicit request must be made and parental consent must be granted.
Once euthanasia has been performed, physicians must submit a detailed report to the Federal Control and Evaluation Commission, a panel of 16 experts that determines whether euthanasia was practised in accordance with the law and that has to turn cases involving non-compliance over to the Public Prosecution Service.
In the case of the Netherlands, although euthanasia and assisted suicide are both offences under the Dutch penal code, the Termination of Life and Assisted Suicide Act came into force in 2002, providing an exemption from criminal liability for physicians who perform such practices if they report their actions and comply with the due care criteria included in the act. The criteria are even broader in this jurisdiction, since patients are eligible to request that their life be terminated if they endure “...unbearable physical or psychological suffering with no prospect of improvement”, regardless of how close they may be to death.
Competent and informed adults are eligible to receive such assistance, but so too are children between the ages of 12 and 16 if their parents consent to the request, as well as minors between the ages of 16 and 18 if they consult with their parents prior to requesting euthanasia.
Here again, regional review committees are responsible for ensuring that physicians comply with the due care criteria provided in the law, and in the case of non-compliance with the safeguard measures, they must turn the case over to the Public Prosecution Service.
Most European laws also allow euthanasia of mentally incompetent individuals, such as patients suffering from dementia, when they have written, while they were still competent, advance directives requesting euthanasia under certain circumstances.
In all permissive regimes, physicians have the right to refuse to provide assistance in dying or to perform euthanasia and have at times refused to do so when there was treatment capable of addressing the suffering of the patient.
In conclusion, these are just a few examples of the manifold dimensions of this issue that will require close scrutiny and in-depth discussions over the next months.
The government opposes the motion to appoint a parliamentary committee to consult on a legislative framework and response to the Carter decision and instead plans to engage with Canadians, the provinces and territories, the medical profession, and the many affected groups in a national conversation on these very important issues.
This debate is one that concerns each of us individually, as well as all of us collectively. It speaks to our shared values and our responsibilities to protect the most vulnerable in our collective aspirations as a society.
Mr. Speaker, I would like to share my time with my colleague from .
I have the pleasure of speaking to this difficult subject because I think it is an extremely important one, not just for me, but for many Canadians.
I realize this is primarily a debate about process, but since my position is already on the record, I will start briefly with that point.
I was part of the minority who voted in favour of the Bloc Québécois bill a few years ago. Naturally, I am in favour of the Supreme Court decision.
I think I could say that perhaps I have a libertarian streak in me, because I always favour the right of individuals to make their own choices if it does not hurt other individuals.
I was in favour of the right of gay couples to make their free choice to marry because it certainly did not impact my marriage negatively by one iota. I am in favour of the right of a woman to wear a niqab at a citizenship ceremony if that is indeed her religious belief. I am in favour of a women's right to choose. I am in favour of this decision by the Supreme Court, although I would like to see in its implementation a great deal of attention paid to true consent and a great deal of attention paid as well to expanding our palliative care system, because the stronger that system, the fewer people will be obliged to take this decision.
I understand that while this is my view, Canada is a diverse country. My riding of Markham is particularly diverse, having been declared by Statistics Canada to be the most diverse city in the country. I understand that not all Canadians will agree with me, and I certainly respect their right to a different opinion for religious reasons or other reasons.
I was born in Quebec. Up to now, I spent most of my life in Quebec. I must say, as a former Quebecker, that I am extremely proud of the measure implemented by the National Assembly of Quebec. It truly took courage for the MNAs to act on this difficult issue; they put their partisanship and even their personal ideology aside. They formed a committee. They heard a number of witnesses and, at the end of the day, they reached not only a consensus, but a unanimous decision.
Therefore, what I am proposing to the chamber and my fellow federal parliamentarians is that we show similar courage that was shown by our provincial counterparts in Quebec. Indeed, it was more difficult for them because they acted before the Supreme Court decision. We will be acting after the Supreme Court decision, so in that sense the parameters or the guiding rules have already been laid down for us.
Federal parliamentarians have often been slow or weak in dealing with these difficult moral questions and they have been left to a legal void. We should do our jobs for Canadians to take part in the debate on these difficult issues for the sake of Canadians and we should not be obsessed with our own personal ideology or partisan issues. That is what was done in Quebec and we, in this Parliament, should be willing to do no less.
I also believe it is in all of our interests to engage in such a process as we in the Liberal Party have proposed, whatever our personal views on this matter. Let us, for example, suppose that a group is opposed to the Supreme Court decision. If there is a committee and witnesses are called, those groups will be allowed to make representations to make the interpretation of the law narrow, to ensure consent is real, to ensure everything is done to increase palliative care. On some of these issues, I have already indicated that I agree.
That side will have an opportunity to make representations, but absent such a committee, absent such a process, we will be in a legal void, in which anything can happen and the people on that side of the debate may not have any influence at all on what the outcome is. Similarly, those on the other side who favour the Supreme Court decision, they too will have an opportunity to make their cases known, to present evidence and will then have an impact on the ultimate decision.
Quebec, in some ways, is more homogeneous than Canada, so I would not anticipate a unanimous decision on this issue by the federal Parliament, certainly not before the next election. However, it is incumbent on us to do our job for Canadians, to do as our Quebec counterparts did, which is to put aside our partisan inclinations and personal beliefs and get down to the very difficult, arduous work of listening to Canadians, hearing witnesses, debating and debating until we come up with a position that will not necessarily satisfy everybody, but which, one would hope, will command a large consensus in this place.
To put it briefly, we federal parliamentarians should do what we were elected to do. We should work on behalf of Canadians on a very difficult issue and follow the spirit of our counterparts in the Quebec national assembly.
Mr. Speaker, it is rare for a motion to contain its own purpose and justification as clearly as the motion before us today.
The motion moved by the Liberal leader, the member for , calls for a special House committee to be appointed to consider the February 6, 2015 ruling of the Supreme Court, which stated that in certain specific circumstances, a prohibition on physician-assisted death violates the Canadian Charter of Rights and Freedoms. The court gave Parliament 12 months to amend the law accordingly. This means that a new legal framework must be put in place by February 6, 2016, at the latest, or else physician-assisted death will become legal, without the necessary guidelines and parameters set out in legislation. As a result of the summer recess and the upcoming general election, we have just 12 weeks of sitting time before February 6, 2016.
Canadians expect parliamentarians to fulfill their responsibility as legislators and hold this important discussion in a calm and reasoned way, rather than in haste. That is why we need to get started on this right now. This 12-member committee, including seven government members, four official opposition members and one Liberal Party member, should begin its work in March and report to the House no later than July 31, 2015.
That would give the committee time to properly consult legal, medical and other experts, as well as the general public. The committee would be able to travel both within and outside Canada, accompanied by the necessary staff. It would be able to make recommendations on how to give effect to the Supreme Court's decision with a view to establishing a legal framework that is consistent with the Constitution, the Canadian Charter of Rights and Freedoms and Canadians' priorities.
Let us summarize the court's decision. Right now, under section 241(b) of the Criminal Code, anyone who aids or abets a person to commit suicide commits a criminal offence. Under section 14 of the Criminal Code, no person is entitled to consent to have death inflicted on him. Together, these provisions prohibit Canadians from providing or receiving assistance in dying.
It is precisely these provisions—section 241(b) and section 14 of the Criminal Code—that the Supreme Court has indicated violate section 7 of the Canadian Charter of Rights and Freedoms, which guarantees the right to life, liberty and security of the person.
The prohibitions unjustifiably violate section 7 of the charter in three ways, according to the court. First, they violate the right to life by forcing some people to commit suicide early out of fear of incapacity. Second, they violate the right to liberty by denying people the right to make decisions on their own bodily integrity and medical care. Third, they violate the security of a person by leaving people to endure intolerable suffering.
The court was very clear about the legislator's duty.
It is for Parliament and the provincial legislatures to respond, should they so choose, set out in these reasons.
The court describes these parameters in paragraph 127 as follows:
…[physician-assisted dying applies only to] a competent adult person who (1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition…that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.
The parameters are there: a competent adult person who clearly consents and who has a grievous and irremediable medical condition causing enduring and intolerable suffering.
The court also gives parliamentarians the responsibility of establishing how the charter rights of patients and physicians will be reconciled and notes that a physician's decision to participate in assisted dying is a matter of conscience.
The court clearly stated that the task of setting these parameters fell to both levels of government, since both the Criminal Code and health are constitutional jurisdictions.
Federal MPs have responsibilities here. We cannot hide from it. The judges did their work, and now it is our turn to do ours. We need to get started right away.
The judges are not the only ones reminding us of our responsibilities. The Canadian Medical Association wants the law to clearly lay down the legal framework within which a doctor can participate in physician-assisted dying, and the association has emphasized the importance of improving palliative care in Canada. It issued a news release about that today and expressed support for the motion by the member for . The Council of Canadians with Disabilities wants the law to establish clear guidelines to prevent abuses. Canadians in general want the best possible legislative framework.
There is no doubt that medical aid in dying is a complex and highly emotional issue, but if legislators had to resolve only simple problems, that would be too easy. It is our role to take a close look at public policy issues no matter how difficult they are.
That is why it makes no sense that the Conservative government announced its intention to vote against the motion by the member for . I would ask my Conservative colleagues to reconsider that decision. The government says that it would rather undertake a different consultation process, but it did not provide any details. That seems like a cop-out.
Why would our Conservative colleagues lack such courage? After all, the special committee we are calling for could draw on a considerable number of studies, insights, foreign examples, and expertise, including the legislative work done by our colleague from and by our Senate colleagues.
This committee would benefit especially from the endless goodwill of Canadians. They would all support us throughout this process. We could move forward with confidence.
Just look at what was accomplished by our colleagues at the National Assembly of Quebec. Following an exemplary non-partisan process, they ended up voting together on legislation on physician-assisted death that can be used as a benchmark for establishing what works at the federal level.
In sum, because Parliament has limited time to respond to the Supreme Court of Canada's decision to strike down the ban on physician-assisted death, in order to thoroughly and comprehensively consult with Canadians and experts on this complex and emotional issue, this House must act responsibly by immediately striking a special committee of the House.
This committee would immediately begin consulting with Canadians and experts on strengthening end-of-life care and support, including palliative care, with the aim to have enacted a charter-compliant legal framework before February 6, 2016.
That is what Canadians expect from us, their members of Parliament. That is what they deserve to get from us. That is why we must vote in favour of the motion moved by the hon. member for .