moved that Bill , be read the third time and passed.
She said: Mr. Speaker, I want to begin today by acknowledging the contributions of all members of the House, in particular, the members of the Standing Committee on Justice and Human Rights, for how they have approached our debate on Bill .
It is clear that members from all parties have engaged closely with their constituents, members of other parties, and their own experiences to make thoughtful and genuine contributions to our country's conversation on medical assistance in dying. This is one of the most important issues that this Parliament will address.
Bill represents the government's policy choice to address medical assistance in dying, a choice that is fully informed by consultations with Canadians and experts and takes into account all the interests and values surrounding this matter.
When the Carter decision came down in February 2015, one debate ended and another began. It was no longer a question of whether Canada would permit medical assistance in dying, but rather it was about how our country would do it.
Bill would create a statutory framework for medical assistance in dying that considers the perspectives of those who may wish to access it; those who are concerned about its consequences, including vulnerable persons who could be put at risk by the legalization of this practice; and those who may be asked to provide the assistance.
While the Carter decision told us that an absolute prohibition in the former law went too far, it did not tell us how medical assistance in dying should be implemented. The Supreme Court of Canada acknowledged that the issue “involves complex issues of social policy and a number of competing societal values”. The court stated that it:
emphasized that there may be a number of possible solutions to a particular social problem, and suggested that a “complex regulatory response” to a social ill will garner a high degree of deference.
The challenge facing Parliament is about setting new boundaries. Who should be eligible for medical assistance in dying; what safeguards should be required; how will it be monitored; and what issues require more study?
A proposed law that answers these questions must comply with the charter, but that does not require replicating the Carter decision. The Supreme Court of Canada has recognized that the relationship between the courts and Parliament should be one of dialogue. Just as Parliament must respect the court's ruling, so too must the court respect Parliament's determination of how to craft a statutory scheme in response to the court's judgment.
It is helpful to know how this dialogue has played out in previous instances. For example, in R. v. O'Connor, a 1995 charter challenge in a sexual assault case, the Supreme Court mandated the disclosure of therapeutic records in the Crown's possession and set out a common law procedure for the production of these records.
In response, Parliament enacted a statutory disclosure regime that differed in significant ways from the court's approach. The court upheld the constitutionality of that statutory regime, noting that it could not be presumed, just because Parliament's scheme looked different from what the court had envisioned, that it was unconstitutional.
Instead, there is this dialogue between the legislative branch and the courts. The court can provide the general parameters for a response, but it is for Parliament to craft the regime. Details of that regime matter because they necessarily engage fundamental choices of our rights and values and reconciling the tensions that sometimes exist between them.
In developing a response to the Carter decision, the government was called on to simultaneously promote autonomy, protect the vulnerable, affirm life, prevent suicide, support persons with disabilities, respect freedom of conscience, and fully consider many other valuable interests. As we went about this, we remained mindful of our constitutional framework and the divided jurisdiction between Parliament and the provinces and territories.
In weighing these values and making these policy choices, we were not alone. In the past number of months the national conversation on medical assistance in dying has been rich and fulsome, and no doubt it will continue.
Following the introduction of Bill , the relevant standing committees of Parliament, including the justice and human rights committee and the Senate legal and constitutional affairs committee, which conducted the pre-study of the bill, have heard diverse perspectives from stakeholders and experts on all aspects of medical assistance in dying. Bill C-14 strikes a balance regarding eligibility and safeguards, as well as setting out what the federal law should do and what should be left to the provinces and territories to regulate.
Not everyone agrees with these policy choices. Still, I am confident that the decisions fall squarely within the range of alternatives that are legally open to Parliament to adopt. It would have been easy for the government to cut and paste the language from the court's decision into a new federal statute, but such an approach would have meant ignoring all the consultations and evidence that I have just referenced. It would also have fallen far short of developing a complex regulatory regime to balance competing interests, which the court said was the task of Parliament to craft and not the courts.
That evidence, presented over the past year, confirms that medical assistance in dying may pose risks to the vulnerable, even in circumstances where there is a general consensus that the person should be eligible for the procedure. That is why the bill provides for significant procedural safeguards, even when all of the eligibility criteria are met. This is why the bill would also put in place the necessary legal framework to monitor how medical assistance in dying is implemented in Canada.
In terms of eligibility, the policy choice made by the government was to focus on persons who are in an advanced state of irreversible decline and whose natural deaths have become reasonably foreseeable.
Recall that medical assistance in dying is exceptional because, from a criminal law perspective, it is a situation where one person actively and knowingly participates in the death of another. We criminalize and strongly condemn this conduct in all other circumstances. The only place in our criminal law where this conduct is justified is in self-defence, where individuals are permitted to take a life but only in order to save their own life or someone else's. While medical assistance in dying has medical and health law aspects to it, we cannot lose sight of this dimension either, because it is the criminal law power that is the primary source of Parliament's jurisdiction to address this issue, and it was the criminal law that, before the Carter decision, stood in the way of medical assistance in dying.
Having given careful consideration to the risks that may be posed when anyone, even a physician or nurse practitioner, is permitted to end another person's life, the balance reflected in Bill is that medical assistance in dying should be a choice for Canadians about how they die, so that they may have access to a peaceful passing. The bill would create a complex regulatory regime to respect this choice and ensure it is exercised in a voluntary and fully informed manner. Equally, the criteria ensure that, for Canadians who are not declining toward death, the focus of medicine remains on improving life, not ending it.
We also recognize that there are those who believe that the law should permit access to medical assistance in dying in other situations. The government heard these concerns loudly and clearly. The Standing Committee on Justice and Human Rights amended the bill to ensure that one or more independent reviews be initiated within six months of the bill receiving royal assent to further examine issues around the eligibility for mature minors, advance requests, and requests where a mental illness is the sole underlying medical condition.
We welcome this amendment and want to emphasize that we will remain open-minded to the evidence that these reviews gather and as Canadian data begins to be generated on how medical assistance in dying is actually working.
The decision to study these three issues further is supported by people who work with patients day in and day out in these three areas, who have been some of the most prominent voices calling for Parliament to proceed with caution.
With respect to mature minors, the Canadian Paediatric Society, represented by Dawn Davies, testified before the Senate committee that there “is simply not enough information to reach an enlightened decision” on this matter and that “It is appropriate that the first iteration of legislation on physician-assisted death does not include...minors”.
She also stated that there have not been sufficient consultations on this issue. The usual capacity and assessment processes, which Bill supports as appropriate for adults, may not be the right approach for mature minors. We need to consider this issue further.
Advance requests is another area where additional evidence is needed. We have heard many times over the past year that advance requests are likely to be sought in circumstances where persons are suffering from diseases such as Alzheimer's or dementia, but even the Alzheimer Society of Canada has stated in its public position paper that medical assistance in dying should only be possible when a person is competent at the time the assistance is administered. It says that advance requests not only pose risks to vulnerable patients, but they could also contribute to false stereotypes, undermining its message that it is possible to live well with this disease. Further study on this issue is the right policy.
On mental illness as a sole condition motivating a request for assisted dying, it is not surprising that reputable individuals and organizations, including the Centre for Addiction and Mental Health and the Mental Health Commission of Canada, support further study before legislating in this area. Moving forward in this way does not deny the suffering that these illnesses can cause. Rather, it ensures that we get it right and protect some of the most vulnerable and stigmatized persons in our society. For these reasons, I believe that Bill represents the right policy choices to answer the difficult questions the Supreme Court of Canada left for us as parliamentarians to resolve for 36 million Canadians.
I will now turn to the legal considerations, which play a crucial role in this seminal piece of legislation.
A consistent area of discussion has been around whether Bill is constitutional. As the Minister of Justice and Attorney General of Canada, I am of the firm opinion that the bill is consistent with the charter and is a justifiable response to the Carter decision.
Bill 's eligibility criteria directly respond to the Carter decision. They clarify the intended scope of eligibility, acknowledging the submission of the Canadian Medical Association, which represents 83,000 physicians who will, with nurse practitioners, be responsible for implementing and applying this law in their daily practice. This organization has stated that the language in the bill is a significant improvement over what it views, from a medical perspective, as the court's unworkable term “grievous and irremediable”.
What was the scope of the Carter decision? I appreciate that there are many differing interpretations of the decision, and I acknowledge that the Alberta Court of Appeal recently read Carter in a broad way, while some judges in the Superior Court of Ontario have read it more narrowly. I believe that the Carter decision was about the factual circumstances of that case. At the end of the day, Bill will be measured against the charter as a whole and not the Carter case. As the Alberta Court of Appeal recognized, “the interpretation and constitutionality of eventual legislation should obviously wait until the legislation has been enacted”.
Bill addresses both dimensions of section 7 of the charter, respect for autonomy and respect for life. The bill would strike a new balance between these interests through a comprehensive regulatory regime, which would receive deference from the courts. The proposed law would respect individual autonomy for persons who choose medical assistance in dying, but would do so in a careful manner that preserves other crucial objectives: promoting suicide prevention, preventing social stigma of life with a disability, and protecting society's most vulnerable persons from a risk of premature involuntary death.
While Bill requires that an eligible person be on a trajectory toward death, the flexibility purposefully built into the bill's criteria would allow medical practitioners to respond to a wide variety of medical circumstances, not just predictable diseases that are subject to fixed prognoses of life left to live.
Indeed, unlike some U.S. state regimes that require a specific prognosis, Bill does not require a strict relationship between the medical condition and the cause of the person's reasonably foreseeable death.
I do not agree with those who say that the Carter decision means that Parliament is constitutionally mandated to enact one of, if not the broadest, assisted dying regimes in the world, and that Parliament has little scope to consider other societal interests aside from autonomy. The court acknowledged that medically assisted death involved complex issues of social policy in a number of competing interests. In matters of this nature, the charter analysis takes into account the fact that there is no single manifestly correct balance of competing interests that are engaged. Deference will be shown, provided that Parliament's solution falls within the range of reasonable alternatives.
Bill is reasonable. It would provide people who are in a path towards death a choice that would respect their wish to die with dignity. Equally, it would limit medical assistance in dying to persons in these types of circumstances in order to prevent the normalization of suicide, protect vulnerable persons who were disproportionately at risk of inducement to suicide, and affirm the equal value of every person's life.
This balancing of interests addresses the inherent risks associated with permitting medical assistance in dying, and represents what the trial judge in Carter described as a “carefully-designed system imposing stringent limits that were scrupulously monitored and enforced”. Such a system is necessary because the suffering that can lead someone to request assisted dying does not just come from the condition; it also comes from how our society too often treats people with such conditions.
Under an approach where any serious medical condition is eligible, the law would be saying that an assisted death could be an acceptable treatment for a soldier with post-traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind was haunted by memories of sexual abuse.
These are difficult but necessary situations to talk about, because cases like these are the unavoidable consequence of an assisted dying law where the only limit on eligibility is an individual's subjective experience of suffering.
As both the justice and human rights committee and the senate committee heard from several witnesses, the risk to vulnerable people, as well the crucial objectives of suicide prevention and affirming the value of the lives of all Canadians could be greatly increased unless eligibility was limited to persons who were approaching the end of their lives.
As I said, when Bill was introduced, assisted dying is a matter that touches us all and challenges us all. Divergent views on the bill remain, but we have a responsibility to act for all Canadians. The interim court approval process ends on June 6. If there is no legislation in place at that time, medical assistance in dying will lack a legal framework outside of the province of Quebec.
There is even uncertainty as to whether the court's remedy in Carter, if it came into force on June 6 in place of a statutory regime, would have the legal effect of completely striking down the existing criminal law that prohibits consensual killings and the aiding of suicides outside of an assisted dying context.
While most medical regulators have published interim guidelines, there would be no mandatory or consistent national safeguards. It could be possible, for example, for a physician to end a mature minor's life, depending on the province. Different jurisdictions require different numbers of witnesses, and some provide no waiting period at all.
Uncertainty around Carter parameters would persist and likely lead to inconsistent results in who would be found to be eligible, even between medical practitioners in the same jurisdictions.
We have a choice: To have a statutory framework in place with all of the national-level safeguards and protections that I have described, or having none. Bill reflects the kind of society we should aspire to be, one that respects individual autonomy and one that affirms that the lives of all Canadians have inherent value and are equally entitled to the protection of the law.
I call on all members of the House to support Bill .
Mr. Speaker, I want to thank the for being here today to speak in the House and for sharing her perspective and the government's perspective on Bill . I found her to be always available and very thoughtful, and I thank her for her involvement.
I have been honoured to be part of the joint committee that dealt with the bill starting in January. I was also part of the justice committee when Bill was sent there. As the minister said, the opinions on this issue of assisted suicide are very diverse. Within each of the parties it is very diverse. However, I want to thank all members of Parliament for being respectful and working together on this important issue.
We are dealing with this issue because of the Carter decision. The Supreme Court said in the Carter decision that this must be allowed. The Criminal Code will be amended, and it is up to Parliament to come up with safeguards, not that this is permitted. However, the Supreme Court decided that we are to create safeguards.
We have also heard that 84% of Canadians want this. However, that statement that we have often heard is a little misleading, because 84% of Canadians do support this under certain criteria, and that criteria is that the illness is terminal, and the person is suffering terribly and repeatedly asks to have assisted suicide to end their suffering. Therefore, it is important to remember that it is under certain conditions.
I have consulted with my constituents on this issue. I sent out a householder, and I was very thorough and non-partisan. The householder I sent out provided a background and laid out all the different issues that Parliament is having to deal with: conscience protection, palliative care, who can provide this service, should there be judicial oversight, should the cause of death be listed for data collection as assisted suicide or euthanasia, mature minors, and on and on.
I had response to this householder, and one week ago, I had our second town hall meeting on this. In both cases, we had a huge response from the constituents. Actually, we have had more of a response to this issue through emails, phone calls, letters, and responses to the householder. We have had more responses on this than on any other issue in the last 12 and a half years that I have been a member of Parliament. People are very engaged and understand what the issues are and the challenges that the House faces.
Again, I thank the , but as a critique, I think the government could have approached this a little differently, instead of dominating the committee structures, instead of bringing in time allocation, and instead of saying no to all the amendments.
The minister spoke about the 16 amendments, which, of course, were Liberal amendments. Of the amendments, there was one that the Conservative Party and the NDP at committee agreed with, and that was on conscience protection. We asked that all physicians, health care professionals, nurse practitioners, pharmacists, or anybody who is a health care professional who does not want to be involved with this have the right to say no. However, the government turned down that amendment.
The fact is, the parliamentary secretaries in the committee talked to each of the members on that committee and told them that the Liberals were not going to support that. Then the parliamentary secretary of justice actually spoke at the committee and said that the government did not support amending like that.
As the just said, the government is going to leave it to negotiating with the provinces, and download that responsibility to the provinces. However, what we are doing in Bill is amending the Criminal Code of Canada. Prior to the Carter decision, it was illegal to assist anybody in a suicide. It was legal to commit suicide but illegal to assist somebody. It was considered homicide if someone assisted somebody.
Under the Carter decision a physician can, under certain conditions, provide assistance in a suicide and euthanasia. That amendment to the Criminal Code also could be elaborated on to say that it would be a criminal offence to force health care professionals or any individuals through coercion or intimidation, to participate in the death of another individual against their will. That is what we suggested.
When Bill gets referred to the Senate it will have to deal with it. I believe the Senate will refer this legislation back to the House. It is going to refuse to accept Bill C-14 the way it is and it will provide proper conscience protection for physicians.
We heard from the Canadian Medical Association that 70% of physicians in Canada do not want to be a part of this. They do not want to be forced through coercion, intimidation, or threats that they will no longer be able to practise at this or that hospital if they do not participate.
In a National Post article called “'Killing' patients vs. 'doing their job': Sharp division of opinion on whether doctors should be required to assist in suicide”, a doctor says she has been practising medicine for 37 years. The family doctor has decided not to renew her medical licence in June of this year. Dr. Naylor has no desire to quit medicine but she says she is appalled at the thought of being forced to refer. Dr. Burke, who practises physical medicine and rehabilitation in Windsor Ontario, said he is renewing his medical licence in Michigan where assisted suicide is illegal.
I have heard this at town hall meetings across the country and at the two I had in my own community. A young medical student asked me if physicians were going to be forced to do this and I said that there is a good possibility because in Bill the government is leaving it up to the provinces. We have already heard that the College of Physicians and Surgeons of Ontario will require physicians to effectively refer, which means that a doctor must follow that person through the whole process to make sure he or she does get euthanized if that is what the individual requested. The doctor must participate.
Physicians across this country, like those I just mentioned, are going to refuse to participate, saying they are now of retirement age and will retire or will relocate to another jurisdiction where they will not be forced to be a part of this, which goes against their conscience. A shortage of physicians and nurses will create a medical emergency in Canada. We will have a shortage of physicians and nurses in Canada because they will be forced to participate in something that goes against their conscience.
The government has an opportunity to do the right thing. It refused to do it in the House so it will be left to the Senate. The Senate will decide and it will amend Bill . It will come back to the House in an amended form. We do not know how long that will take but it is obvious that the June 6 deadline will not be met. I hope the government will play differently then and will co-operate with the Senate and not strike down its amendments.
It is better to have Bill than nothing but it does need to be amended. The government needs to be more open-minded and congenial and work within this parliamentary environment and come up with legislation that represents where Canadians are at on this issue, not where the government is at.
Mr. Speaker, I rise in the House today to speak on an issue that may very well be one of the most significant, important social issues that this Parliament, in the life of this government, will ever face. This is not a matter that I take lightly, the issue of life or death.
Over the last few months, I have had the opportunity to speak with constituents in my riding. I have read the letters and emails they have written in. I have consulted with spiritual leaders from many faiths in the communities within my riding. I have sat through every single minute of this debate, because the magnitude of the legislation is something that deserves our thoughtful consideration. It is also something that has been weighing heavily on me, because regardless of my personal beliefs, I represent the tens of thousands of friends and families in the beautiful riding of Cariboo—Prince George.
For years I have worked toward my dream of becoming a member of Parliament, because I knew this opportunity would afford me the chance to make a difference, to be part of meaningful change, and to leave our country better for generations to come, but nothing truly prepares one to vote on a piece of legislation of this magnitude.
I am at the age and the point in my life where, unfortunately, I have seen my fair share of human suffering. It is a true test of humans to watch a loved one, a friend, or even a stranger, who is faced with intolerable suffering with no hope of recovery.
It is a reality that physician-assisted suicide will indeed become law. This we know is true. In 2015, the Supreme Court of Canada issued a landmark ruling in Carter v. Canada, stating that the laws preventing Kay Carter from ending her life in Canada were contrary to the Charter of Rights and Freedoms.
Kay Carter was a schoolteacher, a wife, and a mother. She was suffering from severe spinal stenosis, a disease that was making it impossible for her to move her body. She was 89, and because medical assistance in dying was illegal in Canada, Carter and her family travelled to a Swiss medical clinic, where she chose to end her life in 2010.
It is not in dispute that Carter was faced with intolerable suffering, but Carter's family and their lawyer have publicly stated that they believe that Kay Carter would have been ineligible for medical assistance in dying under Bill . Therefore, my question for my colleagues across the floor is this. If this legislation was built to address the decision of Carter v. Canada, then why would it likely exclude the very case that opened the door for physician-assisted suicide in our country?
Many have expressed their concerns that this legislation is unconstitutional. Benoît Pelletier, a professor from the University of Ottawa, appeared before the special committee tasked with studying assisted suicide. He said that people suffering with illnesses that are terminal or cause intolerable suffering are at risk of being encouraged to seek an assisted death. He also said:
...all persons are potentially vulnerable. Being vulnerable does not disqualify a person...from seeking an assisted death, but it does put that person at risk of being induced to request a death....
This is among the most troubling testimony. Beyond legal implications, the opposition to Bill crosses party lines. We have heard from Conservative, Liberal, and NDP members, as well as concerned senators, multiple witnesses, and organizations such as the B.C. Civil Liberties Association, the Alberta Court of Appeal, and the Canadian Bar Association. At the core of our democracy is the ability to have thoughtful debate and discussion on a wide range of issues. Some of these issues are easier to address than others. Sometimes there is a unanimous consensus, and sometimes there is not.
We need to acknowledge in cases where there is not consensus that more work needs to be done, amendments need to be considered, and a majority control of the House should not be used to thwart dissenting opinions, especially on an issue of this scope and magnitude.
Dealing with the sanctity of life and death should be cause for more consultation, more discussion, and more debate than that over a pipeline or a budget. We have debated this for approximately 20 hours. Over half of the Conservative caucus has not had the opportunity to debate this subject. Even more of my Liberal colleagues have not had the opportunity to speak on this. It is concerning to me that on a piece of legislation of this magnitude, my Liberal colleagues have not had the opportunity to speak on this. It would appear from the outset that perhaps the Liberal backbenches are, indeed, being muzzled on this important piece of legislation.
Quebec took six years in successive legislative assemblies to develop its physician-assisted suicide law, six years of consultations and commitment to ensure its bill was not just good enough but one that captured most, if not all, concerns and safeguards.
Time and again, we have heard it is good enough at this point. To me, good enough is not good enough when we are talking about life and death. I am a firm believer that it is better to miss a deadline than to get such an impactful piece of public policy wrong. This piece of legislation is likely the most important law in our generation.
The Liberal government should allow all members to speak on behalf of their constituents and engage in further necessary consultations in order to get the legislation right, because the alternative is passing a deeply flawed and in my opinion unconstitutional piece of legislation. Passing Bill in this manner will result in court challenges that will further deadlock the work of the House and parliamentarians in having a workable document that protects the most vulnerable members of society from abuse.
The debate on assisted suicide over the last few months has opened the door to some of the alternatives that also need to be considered when speaking about Bill . Palliative care is a critical component of this issue. We must always ensure that a proper palliative care strategy is in place. While the government likes to talk about this being core and an important piece in its budget and in moving forward, it has not even been mentioned once in the most current budget.
To ensure that individuals are well informed about their end-of-life options not only physically but to deal with their emotions, palliative care needs to be a viable end-of-life choice. At a time when assisted dying is a hotly contested issue, it is important to engage in conversations around palliative care to ensure that people are making the best decisions to improve their quality of life. We need to protect our most vulnerable.
As I mentioned previously during this debate, I am a father of a mature child who is cognitively challenged. While a healthy and productive member of the community, who I am extremely proud of, my daughter could not, today, make an informed consent, let alone if she was dealing with a grievous and terminal disease.
We also need to consider the medical professionals, the doctors and nurses, who went into their chosen fields to save lives, to improve lives, to ensure that lives are not lost and continue to be healthy. We need to ensure that these individuals are also protected and that the responsibility for this is not downloaded to the provinces. We need to ensure that this piece of legislation does not become a vehicle for those suffering with mental health issues to end their pain or that physician-assisted suicide is not chosen or forced due to obligation or feelings of burden.
Catherine Frazee, professor emerita at the school of disability studies at Ryerson University, said it best when she stated:
At the heart of this debate, we must choose between competing visions of our social fabric. Shall we uncritically submit to the voracious demands of individual liberty no matter what the social cost? Or shall we agree that there are limits to individual freedom, limits that serve all of us when we are vulnerable and in decline?
When we start deconstructing the foundation upon which our society is built, the social fabric, we need to ensure that proper safeguards are in place, a system of checks and balances. This system is not built overnight and it is not built through a limited debate and time allocation. It is built through listening, learning, and acknowledging a wide variety of viewpoints, stories, and opinions, through co-operation and thoughtful analysis and acceptance of amendments, none of which seem to be in line with the Liberal government's priorities.
I would like to thank our colleagues from all sides who have shared their experiences with us over the course of this debate. I appreciate each and every one of their views and their openness in sharing these deeply personal experiences, and I thank those in my riding of Cariboo—Prince George, the countless numbers, who have shared with me their views and experiences.
I would also like to thank the members of the committee who worked tirelessly towards a solution. I thank each of them for taking the time to voice their feelings on this important piece of legislation.
For the reasons I stated throughout my speech, I will not be able to support Bill as it currently stands.
Mr. Speaker, I am honoured today to speak to Bill at third reading.
Four months ago, I walked into the first meeting of a special House and Senate committee, created to advise the government on its response to the Supreme Court of Canada's decision in the Carter case. We worked long hours and late nights, respectfully and constructively with all parties and involving both chambers. We heard from witnesses and experts from across Canada and from all walks of life.
As we worked, I know that many of us thought of those who had struggled and suffered for the right to control their own lives at the end: people like Sue Rodriguez, who died in 1994 after losing her battle with ALS and losing her battle in the Supreme Court of Canada a year before. I recognized important contributors like Svend Robinson, member of Parliament, in that earlier battle. I think of people like Kay and Lee Carter, Hollis Johnson, William Shoichet, and Gloria Taylor, who fought valiantly and won in the court last year.
The work of the Special Joint Committee on Physician-Assisted Dying proved that a thoughtful and respectful debate was possible, but more than that it proved that a well-crafted bill could win the support of all parties and members of both Houses. I say that because a broad majority of us from all parties and both chambers agreed on 21 recommendations to the current government. I never imagined that I would be standing here now to oppose this bill.
This government bill ignores or rejects the majority of recommendations of that joint House and Senate committee. I am proud of those recommendations. It is true that many would have required great political courage, but all of them faithfully followed the evidence we received from the majority of experts who appeared before us. For example, I sought to have advance requests accepted by people who may lose the ability to provide competent consent at the end. The vast majority of Canadians told us that they want that. However, not only does this bill reject those recommendations, the bill would defy the Supreme Court ruling, fall short of its requirements, and therefore would violate the Charter of Rights and Freedoms for suffering Canadians.
That is the opinion of the Canadian Bar Association, the Barreau du Québec, and many others. That was the ruling of the Alberta Court of Appeal a couple of weeks ago, and just days ago, a court in Ontario echoed the Alberta decision. Justice Paul Perell of the Ontario Superior Court of Justice ruled that the Supreme Court's basis for an assisted death “is the threat the medical condition poses to a person's life and its interference with the quality of that person's life”. He went on to say, “There is no requirement...that a medical condition be terminal or life threatening.”
Despite this, time and again the current government has limited debate and tried to strong-arm a flawed bill through this chamber.
To be sure, this is a complex and sensitive issue, but not a partisan one. The Supreme Court has given us as parliamentarians an opportunity, not an ultimatum, to craft legislation that is consistent with the Carter decision. As is so often the case in this debate, we ought to look at exactly what the court said. Here is what they said, in paragraph 126 of the decision, “It is for Parliament and the provincial legislatures to respond, should they so choose, by enacting legislation consistent with the constitutional parameters set out in these reasons.”
Today the again suggested that the court instructed us to enact a bill by a particular date. The court said the opposite. Each of us as parliamentarians, facing a free vote, has a simple question to answer: Does this bill obey the constitutional parameters set out by the Supreme Court in Carter? In my submission, that is the only question. If it does not, if it fails that test, then this House is being asked to knowingly infringe the charter rights of suffering Canadians and to enshrine that violation in law.
The Supreme Court of Canada established that all adult competent Canadians suffering intolerably from a grievous and irremediable medical condition have the right to choose assistance in dying. The government would have us honour that right only for patients nearing the end of life.
The Canadian Bar Association has said that such a restriction does not meet the floor of rights established by the court. The Barreau du Québec has said the same, and so has the Canadian Council of Criminal Defence Lawyers, the BC Civil Liberties Association, and many other respected legal organizations.
I suggested removing this line to help the bill comply with the court and the charter, but that idea was rejected by the Liberal majority. Now the Alberta Court of Appeal has ruled unanimously that the government's interpretation of Carter is simply wrong. In a crucial decision that the court wrote a couple of weeks ago, it said:
Carter 2015 does not require that the applicant be terminally ill.... The decision itself is clear. [...] The interpretation urged on us by [the Department of Justice] is not sustainable having regard to the fundamental premise of the Carter case itself....
This is a devastating indictment of the very argument that the government has relied upon to defend Bill against this rising chorus of critics. Surely that ruling should give us all pause. However, still some will argue that the Supreme Court cannot be obeyed right away, that medical reality dictates a balanced approach.
The government's restrictions have raised eyebrows in the medical community as well. The federation representing every medical regulatory authority in Canada has called this bill's end-to-life requirement “too vague to be understood or applied by the medical profession and too ambiguous to be regulated effectively”.
The College of Physicians and Surgeons of Ontario called it inconsistent with Carter and likely to cause confusion among physicians. The Canadian Nurses Association suggested going back to the words of the Supreme Court, as I have done in this place. If that were done, this controversial line could simply be deleted. I proposed doing exactly that, and my amendments were rejected by the Liberal majority on the Standing Committee on Justice and Human Rights.
Not only are medical groups concerned about the bill, many were not even consulted. According to testimony in the Senate, neither the Federation of Medical Regulatory Authorities of Canada nor any of the provincial or territorial colleges were consulted in the drafting of the bill.
We have a bill in which a few key lines have drawn heavy fire from both the legal and medical communities. These lines could be written on a napkin. They could easily be deleted, as my amendments would have done, and replaced with the exact words of our Supreme Court. Who could resist and oppose that in good faith? However, the government has refused precisely to do that.
On the first day of committee hearings, a Liberal member asked the a simple question: “Have we sought outside counsel to ensure charter compliance of this bill?” The minister chose not to answer, citing only her personal confidence in the bill. Clearly, no independent confirmation of its charter compliance has been found.
I appreciate what the minister told this House recently, that no one has a monopoly on interpreting the charter. Of course, the minister is right, but I am afraid that the outlier here is not the critics; it is the government. The Canadian and Quebec bar associations, eminent legal and medical experts, the lead counsel in Carter, all are saying that the bill does not obey the Supreme Court of Canada's ruling.
Against that array, the government stands almost alone, brandishing a backgrounder from the Department of Justice and refusing to refer the question to the Supreme Court, or even to obtain an independent legal opinion.
Now the Alberta Court of Appeal has unanimously rejected the government's argument that the Supreme Court limited its ruling to end-of-life patients. Let me repeat: A provincial court of appeal has already ruled that the government's narrow and selective reading of Carter, the legal argument that supports this bill, is not consistent with the Supreme Court's ruling and therefore infringes a patient's charter rights.
Now we are being asked to enshrine that violation in law, and with what justification? No argument has been made for the bill's compliance with Carter and the charter. The minister is right that Bill 's many critics cannot simply assert that the bill is not constitutional, but neither can the government simply assert that it is. No one can claim to know the inner thoughts of our Supreme Court justices, but neither can the government continue to suggest that the intention of their ruling is somehow opaque or unknowable. The ruling was not an ink blot test, it was quite clear. The court was looking at the law with the same objective as the bill, to protect specific vulnerable individuals suffering during moments of weakness. The court found that the previous ban was overbroad because it caught people outside of that class, competent people who were not vulnerable and therefore deserved to have their autonomy respected.
That would remain true under Bill . An entire class of competent adult Canadians would be condemned to intolerable suffering and denied recourse to assistance in dying. They may be forced to end their lives prematurely or violently. These are the same violations of section 7 rights identified already by the court in Carter. Although the court in Carter did not choose to proceed to an analysis of a section 15 infringement, the equality rights provision, the trial judge did. She concluded that the prohibition “imposed a disproportionate burden on persons with physical disabilities, as only they are restricted to self-imposed starvation and dehydration in order to take their own lives”.
As Quebec's minister of health warned us when he spoke out against the bill, this is precisely the same cruel option that will soon face patients if Bill 's end-of-life clause is not deleted. It is shameful that the bill leaves suffering Canadians in that cruel position.
At committee, I pressed the Department of Justice on this point. I told them the story of Tony Nicklinson. This story comes from an affidavit filed in the Carter case. During a business trip to Athens, Mr. Nicklinson suffered a severe stroke that caused what is called locked-in syndrome. In this state, he could not move a single muscle of his body except his eyelids. His healthy active mind was trapped in an unresponsive body, without remedy, without hope, and perhaps for decades more. He said he could not even drink and smoke in the hopes of shortening his life. Mr. Nicklinson wrote this in an affidavit, one blink at a time. He told the court this:
The flaw in the argument is the assumption that we all want to live whatever the cost in terms of quality of life when this is clearly not the case. I want to make that choice for myself. What prevents me is the fact that I am too disabled to take my own life and unlike an able bodied person I need help to die.
By all means protect the vulnerable (by vulnerable I mean those who cannot make decisions for themselves,) just don't include me. I am not vulnerable. I don't need help or protection from death or from those who would help me - if the legal consequences were not so huge....
I am asking for my right to choose when and how to die to be respected. I know that many people feel that they will have failed if someone like me takes his own life and that life is sacred at all costs. I do not agree with that view. Surely the right and decent thing to do would be to empower people so that they can make the choice for themselves.
Mr. Nicklinson did not live in a place which empowered him to make that choice. He did not have the option of medical assistance to die peacefully, and so he starved himself to death. If he were alive today, Bill would offer him no hope, no respect for his autonomy.
This is the point I made to the Department of Justice. I was told that I was wrong. I was told that Mr. Nicklinson would not have to starve himself to death in Canada. He would just have to starve until a doctor declared his life “reasonably foreseeable”. Those are the words used in Bill .
This is what we are talking about when we say that the bill infringes on the Charter of Rights and Freedoms for Canadians. Quebec's minister of health warned the government that the bill would force competent, consenting patients to endure starvation to win from the current government the rights that were already granted to them in the Carter case.
The court found the previous ban unconstitutional, not only because it violated the rights of competent patients but also because it was unnecessary. A better system was possible. Vulnerability, it said, could be assessed on an individual basis, and well-designed safeguards are capable of protecting the vulnerable. With these facts, the court could see no justification for continuing to deny the autonomy of whole classes of competent patients, like Mr. Nicklinson.
There is still no justification. In fact, the last refuge for the government would be to accept what is now clear, that Bill does not meet the test of the Supreme Court, and to argue that somehow it is necessary to violate the charter or even wise, because the safeguards the Liberals have developed are too weak to handle more complex cases. The bill is flawed, and I cannot accept that argument.
I was proud to serve on the joint House-Senate committee that offered recommendations to the government before the drafting of Bill . We studied best practices around the world and recommended many of the robust safeguards found in the bill. Above all, I have great confidence in the care and professionalism of Canadian medical practitioners, and so I cannot accept that the Supreme Court was wrong in saying that well-designed safeguards can protect vulnerable people. I cannot accept that this regime is so weak—or Canadian doctors so careless—that it cannot be trusted to faithfully uphold the full charter rights of patients and to filter out those who are not able to make this choice.
Therefore, I am left with a simple conclusion. Enacting the bill would revoke from an entire class of competent and suffering adult Canadians the rights established for them by the Supreme Court. It would do so in a manner that is neither medically necessary nor legally justified.
I have sought to amend the bill and have seen those solutions rejected. I have requested independent constitutional analysis, and found none. I have called on the government to refer it to the Supreme Court of Canada, and it has not. Now I cannot, as a lawyer and a parliamentarian, support the enactment of a law that I believe would be unconstitutional from the outset. To vote for Bill , against the charter rights of suffering patients—and I know some of them by name—I cannot do.
The government may try to excuse the bill's imperfections as inevitable in the circumstances, and I know there are members here who recognize that the bill is flawed but have been told they simply have to pass it by June 6.
Let us be clear about what happens on June 6. The absolute ban on medically assisted dying will not be restored, nor will the offences that prevented it, such as aiding suicide, disappear from the code. In other words, crime will not become legal, nor will medical assistance in dying become illegal. Rather, an exemption will open for patients and physicians acting within the parameters of the Carter decision. Of course, every provincial regulator has made rules to deal with safeguards over the last year anyway. They are ready to go. A federal law is not necessary to provide basic access and safeguards.
I call on my colleagues across the aisle, with whom I have worked constructively and collaboratively, to give real meaning to this free vote, to prove by their example what Canadians know to be true, that the final word on our constitutional rights comes not from the PMO but from the Supreme Court of Canada.
That the motion be amended by deleting all the words after the word “That” and substituting the following:
“Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be not now read a third time but be referred back to the Standing Committee on Justice and Human Rights for the purpose of reconsidering Clause 3 with a view to ensuring that the eligibility criteria contained therein are consistent with the constitutional parameters set out by the Supreme Court in its Carter v. Canada decision.”
Mr. Speaker, I am humbled to stand in this place and take this opportunity to speak to Bill .
I will be splitting my time with the member for .
I know that this issue is very personal to Canadians. It is about quality of life and dignity. It is about autonomy. Most of all, it is about compassion.
I listened to many people in the constituency of Brampton South on this issue. I heard support from most people in my riding. I also heard sincere and heartfelt concerns, particularly from our Orthodox-based communities. I appreciate their conviction, and that they have raised their voices with respect to this important issue.
I will use my time today to explain why I will be voting for this important legislation.
My heart goes out to all of those suffering and their family members, who are facing circumstances I cannot imagine. I think we can agree that it is those who are suffering, and their families, who this debate should be about. I hope that hon. members will not forget that fact. We must lean toward a compassionate approach for those who are affected. This is a serious matter and a complex issue. Therefore, we must find the right balance.
Our government must address this now. The Supreme Court made a unanimous decision, and soon there will be a legislative vacuum.
I think we can agree that a patchwork approach by the provinces would be the wrong approach. We would be ignoring our responsibility to show national leadership on this matter.
The framework laid out in Bill provides a solid, focused and detailed plan, which will meet the June 6 deadline set out by the court. Let me explain why.
Permitting medical assistance in dying will extend more control to eligible terminally ill patients on how to live out their last days. This legislation also provides important safeguards and limitations. It requires the and the , in consultation with the provinces, to create regulations that will protect all of those involved.
By permitting medical assistance in dying for competent adults, whose deaths are reasonably foreseeable, I believe we are striking the right balance between the patients' autonomy who seek this medical assistance and the interests of patients in need of protection.
It is important to note that this bill does not stand alone. I would point out the critical work of improving palliative care in this country. The ideas of medical assistance in dying and a strong palliative care system are not in conflict. Rather, the two are complementary and are both important issues to address. That is why I am proud that the has recommitted to home care and palliative care improvements in response to a question that I asked during question period on May 2. In her reply to my question, the minister quoted Dr. Atul Gawande, who talked about how people want not only a good death but a good life to the very end. The minister reiterated her commitment to palliative care and providing dignity when Canadians are suffering. She announced how she will work with the provinces to ensure the high quality care of all Canadians. She also brought up how the Government of Canada is committed to an investment of $3 billion over four years to support that goal of palliative care and home care improvements. I commend this step forward.
We cannot view assisted dying legislation separate from investments in our health care system. Quality palliative care is a critical priority of this government. Indeed, as our government renegotiates the health accord with the provinces, I look forward to seeing palliative care discussed. The work with the provinces, territories, and stakeholders is essential to providing options to end-of-life care.
My background is as a research coordinator and diabetes educator. I know how the roles and views of physicians and nurse practitioners are vital to this issue. As a member of the health committee, and someone who worked in the health care field for almost 20 years, I understand the importance of consulting the people on the front lines. Physicians and nurse practitioners are central to the end-of-life process. Their conscience rights will be respected in this legislation. We are working on the best way to ensure their views are always taken into account.
The rules in this legislation are clear and eligibility has been carefully defined. I want to be clear. There is nothing in the legislation that would compel any medical practitioner or authorized nurse practitioner to provide medical assistance in dying. The legislation is meant to balance access to medical assistance in dying while respecting the personal convictions of health care providers. This is about finding the right balance.
Canadians are looking to their doctors and nurses to provide health care and to help them maintain their quality of life. However, when the quality is no longer attainable, Canadians want to know that their health care providers will also help them when their choice is a dignified end to their lives.
We have struck the right balance in my view by having proper procedural safeguards. Access to medical assistance in dying would only be available to those who meet the following conditions: be a mentally competent adult who is at an advanced state of irreversible decline in capability; have a serious and incurable illness, disease, or disability; experience enduring and intolerable suffering; and whose death is reasonably foreseeable.
It will also remain a crime to assist a person either in dying or in causing a person's death in a situation other than lawful medical assistance in dying. Protective measures are a key part of the legislation to ensure that eligible patients have given informed consent. Patients have to make a written request for medical assistance in dying and have it signed by two independent witnesses. Two independent medical opinions have to confirm that the patient meets all the criteria. These first two criteria are intended to ensure that requests for medical assistance in dying are truly voluntary, that they reflect the wishes of the patient, and are not made as a result of external pressure.
Our evidence-based approach will include regulating, monitoring, and reporting. This monitoring and reporting system will also be able to signal any issues or unexpected consequences. We want Canadians to see a system that is functioning and preventing abuses or errors. This will build up confidence and allow Canadians to make informed decisions about how the system should operate.
I appreciate how other members have spoken about how we will look to international models in terms of ways to work with the provinces and territories. This end-of-life coordination system will respect the role of the provinces, while providing access and respecting people's rights.
I want to recognize the work of the committees and the senators who have studied this matter and made recommendations around this debate. These recommendations and testimony from those on all sides of this issue should be taken into account. There have been a number of informative and heartfelt speeches by fellow members who I also want to take a moment to applaud. I also thank the and the for their work in introducing the legislation.
Bill strikes a proper balance in view of the Supreme Court of Canada's decision and provides a needed legal framework. As parliamentarians we have the final say on behalf of the people we serve who elected us to be their voice. This is a debate that engages our morality, our sense of justice, and our compassion. It asks tough questions of our legal and medical systems.
We have talked to one another and heard some touching stories. We have reflected on how this issue affects all of us. It has called on us to hear the stories coming from the prospective Canadians who are suffering. It is often all too easy to forget what we would do if we were in their shoes. We often fail to truly appreciate the perspective and experience of those diagnosed with a terminal illness. Their dignity is challenged more and more as they reach their end.
We need to pass this legislation at the soonest possible opportunity. I hope all members will support the bill with me.
Mr. Speaker, it is an honour to have this opportunity to speak to this legislation and enter this debate. First, I want to thank the leadership of all the parties for making this a free vote. This is such an emotional, difficult, and personal debate. Having had the opportunity to sit in the House since the eighties, I have had the opportunity to be involved in many debates. From my experience, this is one of the most difficult debates that as a parliamentarian I have entered into.
I want to be clear, as we start this discussion, that I support the legislation, and I will lay out to some extent the reason why I feel this way. This decision has to be based on our own personal life experiences and some would say, our own values. However, the reality is that all members in this place come from different parts of Canada, come from different experiences, and have different understandings in some respects of what we are entering into.
We all have to keep this in mind. This is fundamental societal change. This is fundamental because we are moving to allow individual Canadians, people we love, people we are close to, people who are our neighbours, our friends, the ability to have medical assistance in dying. It should be one of those debates that should not be taken lightly. Nor should it be a debate where we talk specifically about what the lawyers or the courts are saying. Yes, we have a court case to deal with and the Supreme Court has told us what its sense is, that in fact people have a right to assisted dying. However, we should not diminish the importance of what that may do to our country over the long term.
I want to use my experience as a member of Parliament to explain the rationale for being extremely careful and diligent in our decisions as we move forward over the next number of years.
I represent a riding that probably has the most suicides of anywhere in Canada. Over the last decade, I have watched hundreds of young people take their lives, people who I know their families, their moms and dads, and have watched with some horror as they have made that kind of decision. Yes, it is a little different than what we are debating today, but it defines how we feel about the objective of allowing people to make that ultimate decision of taking their own life with the medical assistance of others.
We should in some regard be careful not to assume what is being said by others in the House, for example, that the legislation does not go far enough, or that it may be not charter compliant because it is too restrictive, or that it goes too far for some people who have made equally compassionate arguments in the House. This decision has to be based on where we think we want our society to go. It is not up to the courts to define and to suggest, as some have suggested even today, that we have not gone far enough so therefore we have to go all the way to a particular place because it may not potentially be compliant with the charter.
I sat in cabinet for a number of years and I have seen many legal arguments put to cabinet on different issues by legal counsel and on many occasions. On many occasions I have had the opportunity to see the decision made right or the decision made wrong, or the advice to be given not exactly as we had anticipated. Therefore, we cannot stand in this place and assure Canadians that this legislation is absolutely perfect one way or the other.
That is why I like the approach the government has taken. It has taken an approach that it is very restrictive. It gives society time to look at the other areas that we may consider, as parliamentarians, to allow people to take their own life, for example, minors.
As I said, I have had the experience of watching many young children take their lives. To talk about minors who are willing to take their lives and make it legal and easier, if I could put it in those terms, is not something I totally support. I am very concerned about that.
I am worried about the whole issue of advance requests. It is hard to predict the situation a person will find themselves in, so we need to have more study of the whole issue of advance requests, and minors and mental illness.
I support the legislation, not because the leadership told me to do it. I do not tend to work that way and never have. I think it is the best approach for something that would fundamentally change our society forever.
We have to remind ourselves as we stand here, and when we vote tonight, that someone close to us very soon will use this legislation. It may not be as comfortable and as simple as some people have made it sound. We have had this discussion today.
The legal framework is important. It is important for the Senate not to get into this discussion about whether or not it goes far enough. The reality of it is that if it is a framework that allows us to get the compliance we need through the charter, we should move forward on it. I want to make this clear. I do not care which legislation we would pass, the one the NDP seems to favour or the one the Conservatives seem to want to have, and I am not sure exactly which way that would go. That legislation will go to the Supreme Court to be tested as we move forward. It does not matter which legislation we pass because this is such a fundamental change to our society, there is no doubt people will go to the Supreme Court to test the reality of the legislation.
Here is the reality we face. Under the legislation, we allow mentally competent adults who are in an advanced state of irreversible decline in capability, have a serious and incurable illness, disease or disability and are experiencing enduring and intolerable suffering caused by their medical condition, and whose death has become reasonably foreseeable, taking into account all of their medical circumstances, to seek assisted dying. That is a pretty large amount to start with.
I know this will change our health care system for the next generations. I strongly recommend to members of Parliament not to be too quick to judge what other generations will want to have 50, 100 years from now. We should be very careful about that.
I believe, as most Liberals do, in individual rights. I am not suggesting we restrict those, but the right to choose for people who are competent is fair. Having control and obviously the dignity in dying are very important concepts for me as a member of Parliament.
Today I am pleased to have this opportunity to make these comments. This is not a partisan issue. This will not get any member of Parliament more votes, one way or the other. This is a profound fundamental change in how I will deal with individuals every day with whom I am close. I want to ensure we get it right. If we did restrict it too much this time, I would rather do that than go too far.
Madam Speaker, I want to start by saying that I will be splitting my time with the member for .
I want to say right from the outset that I am conceptually opposed to Bill . I believe in the sanctity of life, and I believe that all life, from conception right through to natural death, has value, has worth, and has purpose.
As a sitting member of the committee for justice and human rights, I spent several weeks together with the committee in significant and lengthy meetings examining Bill . We spent long days listening to witness testimony from experts and organizations from all over the country, and then doing a clause-by-clause analysis of the bill. Despite the many concerns voiced again and again by witnesses, there were no meaningful amendments made to the bill.
Bill is called medical assistance in dying, but make no mistake, Bill C-14 is physician-assisted suicide. It is important that we make this distinction. The gravity of the bill should not be undermined by the colourful wording. The bill would change Canada forever, and it would be naive to think that Canada's most vulnerable people would not be at risk under the bill in its present state. This is the most significant social re-engineering bill in the past 25 years, because it changes how we view the sanctity of life.
The Supreme Court was very clear that physician-assisted suicide is not a charter right, but it is an exemption that could be provided on an exception basis providing individuals meet certain criteria. The person must be a competent adult who clearly consents to the termination of life, who 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.
Bill clearly goes beyond the Supreme Court decision with a mandate to study making physician-assisted suicide available to mature minors, exploring the concept of advance directives, and providing physician-assisted suicide to mentally disabled individuals. This is just not acceptable.
The committee heard testimony from approximately 42 individuals and/or groups who all have a vested interest in this issue. Over 100 amendments were presented to committee based on evidence from witness testimony provided to committee. Sadly, the Liberals did not present any substantive amendments, and in fact, voted against any meaningful amendments presented by any of the opposition parties. The Conservatives presented many thoughtful amendments that would have strengthened the bill and added important safeguards, as they did last night at report stage. This is a missed opportunity.
Let me highlight just a few of these missed amendments, these missed opportunities.
These amendments included things like assuring that only trained and qualified medical practitioners, in other words physicians, would assess the individual and administer the lethal cocktail that would eventually procure death. The way the legislation is presently drafted, it would allow a person to obtain the lethal drug from pharmacists, take it home, self-administer, and procure their own death. This worries me, and it should worry every Canadian. Witnesses presented testimony that in other jurisdictions that permit this practice, 30% to 40% of prescriptions for death go unused.
What happens to these unused drugs? What if the drugs fall into the wrong hands? What if the drugs were not administered properly? What if they did not take all of it and complications set in as a result? How can we be sure that the individuals were not at some point pressured into it? There are just way too many unanswered questions in the bill.
The bill would also make it near impossible for medical practitioners to monitor and report on subsequent events. Did the patient self-administer the drug or did the patient die from an illness? How do we ensure that we have the correct data to track euthanasia in Canada? These are valid concerns being voiced by Canadians, and it could have been addressed in the amendments that we proposed at committee.
The Liberals are unwilling to consider an amendment to ensure physician supervision during the procedure.
In addition, Bill allows for nurse practitioners to provide medical assistance in dying. There are substantial differences between a medical practitioner and a nurse practitioner, including the length of time spent training and the ability to prescribe various narcotics, yet suddenly, in this bill, we are affording them the ability to assess an individual's eligibility for physician-assisted suicide and prescribe life-ending cocktails, which is in stark contrast to the typical expectations we have of nurse practitioners.
This goes too far and is another issue we sought to address in the bill. Again, this is a missed opportunity.
We also provided an amendment that would have removed psychological suffering as an eligibility consideration for physician-assisted suicide. This, quite simply, leaves too much room for interpretation. Allowing for psychological suffering as an eligibility consideration is the start of a very slippery slope in terms of who can receive physician-assisted suicide and for what purpose.
We also suggested that “reasonably foreseeable death”, as defined in the bill, would be replaced with imminent death or at least death expected within 30 days. We heard testimony from witnesses on either end of the spectrum raising various concerns about this wording. “Reasonably foreseeable” in one physician's eyes could be completely different in the eyes of another. This will certainly open the door to uncertainty among patients and practitioners, and will definitely lead to subsequent lawsuits.
To further strengthen safeguards, we proposed an amendment requiring that prior judicial review had occurred to ensure that all criteria for physician-assisted suicide eligibility had been met.
Dr. Will Johnston, chair of the Euthanasia Prevention Coalition of British Columbia, came to testify before committee. He said the following:
...although it might be assumed, nowhere specifies that doctors must actually examine the patient, the extent to which they must do so, or the extent that doctors must inquire into the internal and external factors that create vulnerability for the patient.
Dr. Johnston brings forward a valuable consideration. Bill does not stipulate to what degree a patient should be examined nor does it require examination of the factors creating vulnerability for the patient.
In addition, we know that this is a complicated matter and difficult to address in legislation. Every individual and every disease presents a different set of challenges. Judicial oversight would ensure that individuals meet all the criteria given their unique set of circumstances and would further protect Canada's most vulnerable people. Again, this very reasonable amendment was rejected.
We also put forward a request that palliative care consultation be included as a criterion for seeking physician-assisted death. Patients would be made aware of all options available to them and ensure palliative care options were understood, offered, and available.
We heard time and again in committee that access to palliative care is a problem in this country. We also heard that palliative care, especially chronic pain treatment and counselling services, is very successful at alleviating the suffering, depression, and anxiety, things that lead people to wish to hasten their death.
The minister spoke on palliative care, and insisted that palliative care and physician-assisted suicide go hand in hand, yet the committee refused to adopt palliative care consultations as a prerequisite component in the bill.
The Canadian Society of Palliative Care Physicians outlined the issue well before committee. They wrote:
In order to ensure that medically assisted death is not our first or only response to human suffering, we need to build in an explicit legal requirement to identify, explore and record the sources of a person’s suffering and attempt to address the motivations of his/her request for death. This should not be undertaken as a screening or determination process, but rather an opportunity to ensure that a person who requests an assisted death is fully informed of available options for treatment.... The Bill should be amended to incorporate a meaningful right for patients to be informed of the full range of available treatments, technologies and supports that could ease their suffering, whatever its source.
Palliative care consultations would protect patients and ensure that physician-assisted death does not become the first response to human suffering. I cannot understand why the government would not want to ensure patients have sought out all other alternatives before requesting physician-assisted death.
One of the things we were very clear about, which the evidence produced over and over again in committee, was the whole need for conscience rights protection, not only for individuals but institutions. This came across as a large concern. We presented several amendments to committee that would have met the concern of many institutions and individuals that may be forced or required to offer this service. These amendments were all rejected, not only at committee but they were rejected here last night at report stage as well. We find that unacceptable.
Madam Speaker, I rise somewhat concerned today that I am finally, for the first time, able to speak to Bill . We are at third reading. This bill has been rammed through the House. The Liberals have brought in closure time and again with this bill. Every time it was debated, whether at second reading or report stage, I was not available, or the time was so constrained and the list of speakers of the members of Parliament was so long, that I could not get on the list. Finally, I am able to speak today to Bill to reflect my concerns and those of my constituents on this bill.
When closure is used in dealing with issues of conscience like we are dealing with today with respect to physician-assisted death or doctor-assisted suicide, whatever we want to call it, we need to take the time to have the debate. We need to have the discussion among parliamentarians and talk to the appropriate experts to ensure that we get this right. If the Liberals rush this bill through the legislative process in the House and if they try to do it in the Senate, I can guarantee that mistakes will be made and this bill will be facing court challenges in a relatively short period of time.
I also have to reflect what my friend from the riding of Provencher said today. It is extremely disappointing that so many reasonable amendments were presented by members of the opposition parties, and not one of them found their way into this bill at report stage last night. That truly is disappointing.
In my riding of Selkirk—Interlake—Eastman, the topic of physician-assisted suicide is divisive, as it is right across the country. The majority of constituents who have contacted my office have been opposed to this policy, on two fronts: first, many people have deeply held moral, ethical, and religious beliefs that are strongly against assisted suicide; and, second, many believe that the policy will be used prematurely to end the lives of those who have become a burden to their families, society, or the medical system.
It is important to note that the Liberals broke a key election promise to invest $3 billion into-long term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. There was unanimous agreement on the Special Joint Committee on Physician-Assisted Dying and among stakeholders, including the Canadian Medical Association, on the need for a pan-Canadian strategy on palliative care, with dedicated funding. This would be an important step forward for Canada. It is something that the Liberals have glossed over in favour of introducing this legislation in a very careless and expeditious manner.
Many medical doctors, nurses, and health care professionals are conflicted with the ethical and moral conundrum that assisted suicide presents, as it runs counter to the modern adaptation of the Hippocratic oath. The University of Ottawa captures the challenge of this principle. It states:
Given the complexity of medicine in the 21st century, an ancient oath cannot possibly encompass current values. Therefore, the significance of the Hippocratic Oath does not reside in its specific guidelines, but rather, in its symbolism of an ideal: the selfless dedication to the preservation of human life.
I would stress “the preservation of human life”.
Although the Canadian Medical Association in the last year has turned its back on its previous position on physician-assisted suicide, the Supreme Court of Canada went to great lengths and grasped at straws to change its position from its previous rulings as to whether there should be exemptions offered for physician-assisted suicide.
The Canadian Medical Association is a member of the World Medical Assembly, which adopted a resolution back in 1992 on this. It revised it slightly in 2005, but reaffirmed it in April of 2015 in Oslo. It states:
Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.
Quite clearly, the World Medical Association, doctors and physicians from right around the globe, is saying that this is unethical.
As has been pointed out, we are quite concerned from our side, and I am in particular, about the charter rights under sections on the freedom of conscience. As has been noted, there was a minor amendment made to Bill in the preamble to allow for the protection of individuals but not of institutions. Is it strong enough to be considered legal in a case that goes before the courts, the Canadian Human Rights Commission, or one of the provincial human rights commissions, if section 2 is defined in the preamble but is not actually in the clauses of the legislation itself?
Institutions would be exempt, and I know that some members have had conversations with people at some institutions who are very concerned about this. I looked to the St. Boniface General Hospital in Winnipeg, a Catholic-run hospital. They are quite concerned that they, as an institution, will have to violate their own religious and moral beliefs to provide assisted suicide. They believe in the sanctity of life, as many of us on our side do also.
Like most Canadians, I have watched loved ones succumb to lengthy and chronic debilitating illnesses. Dying with dignity is desired by all Canadians. Unfortunately, only a handful of us will die in our sleep with minimal discomfort or pain. I do not believe that we should institute a policy that will provide physician-assisted suicide to every Canadian when they are near their end of life. Dying with dignity does not apply only to physician-assisted suicide. Expanding and improving palliative care services is by far the better public policy, and should be a priority of all health care providers across this country. I am recommitting to working with like-minded Canadians and policy-makers, and parliamentarians right here, who want to enhance palliative care in Manitoba and across the country. My wife Kelly works as a nurse in a personal care home and provides palliative care services all the time. She agrees that strengthening palliative care services will allow more Canadians to die with dignity.
I have met with the Manitoba League of Persons with Disabilities and talked to Carlos Sosa, who is the Manitoba representative on the Council of Canadians with Disabilities. They are very concerned with the way that Bill is laid out right now because it would do little to address the concerns of the vulnerable and how the law would deal with people in the disabled community. In particular, the bill would not provide for an assessment of vulnerabilities that may induce a person to assist and seek an assisted suicide. It does not have an expedited prior review and authorization by a judge or independent body with expertise in fields of health care, ethics, and law. This was one of the amendments we brought forward last night, and it was defeated.
Rhonda Wiebe, who is the co-chair of the Canadian Council of Disabilities end of life ethics committee, said:
In the Carter decision, the Supreme Court of Canada gave the Government of Canada two assignments (1) develop a regime to provide dying people access to assisted suicide and (2) protect vulnerable Canadians who at a time of weakness may be influenced to accept medical aid in dying. Unfortunately, [Bill] C-14 has some serious gaps when it comes to protecting the vulnerable..... Canada must do enough to protect people like [her] and other Canadians with disabilities who can be made vulnerable by both [their] health conditions and [their] social and economic circumstances.
I am privileged to belong to a political party that allows for free votes on issues of moral and religious beliefs. On policies such as physician-assisted suicide, Conservative members are free to either reflect the will of their constituents or to vote according to their personal beliefs. As someone with very strong Christian values, I cannot support Bill . Bill C-14 needs better protection in place for youth under the age of 18, and safeguards for those who are vulnerable, including those who are dealing with mental health challenges.
Madam Speaker, I will be sharing my time with my hon. colleague from .
In this postmodern world of ours, with its tendency at times toward a certain kind of what some might call libertarian relativism, we must continue to believe and affirm that there exist values that we can all agree are objectively good and worth protecting and promoting, values that should inform, motivate, and guide us both individually and collectively. Namely, we must subscribe to the imperative that we as human beings have a duty to support each other in our struggle in this fight for life, as some colleagues have put it, this struggle against the undeniable reality of our finite existence, our mortality. Every moment of life has value. This truth is to be asserted and upheld. This is the prevailing consensus, one that has become deeply rooted and entrenched in society over the course of history. It is also our best instinct. Many of my constituents fear that Bill would undermine this consensus, this instinct. I understand this fear.
We cannot allow ourselves to fall into indifference, to be quietly seduced by the facile notion found in the well-worn phrase “to each his own”, whereby we agree on everyone's right to choose, but beyond that we do not think it our business to provide reinforcement for the desirable and good choice. When I hear anyone appear to frame the debate on medical assistance in dying as one of pure libertarian choice, I must admit that a little part of me shudders.
After much reflection, I do not believe that Bill would necessarily lead us down a path to an increasingly permissive and contagious attitude toward self-directed death.
I would like to quote bioethicist Margaret Somerville, someone generally identified as a philosophical conservative on bioethical matters, someone who has written on the dangers of legalized doctor-assisted death:
The bill would legislate these actions as an "exemption" from—an exception to—prosecution for the Criminal Code offences of culpable homicide and assisted suicide that would otherwise be committed. Treating medically assisted dying as an exception will help to ensure, as is essential, that it does not become part of the norm for how Canadians die;
In other words, Bill would not normalize medically assisted dying as perhaps has occurred in Belgium and the Netherlands, the two most often cited examples of the slippery slope.
Dr. Sommerville goes on to say that:
Recognizing medically assisted dying as an exception also helps to establish that access to it is not a right but rather, under certain conditions, an immunity from prosecution for a criminal offence....
This approach, she further states, “carries an important anti-suicide public health message.”
I would add that the government has taken care to emphasize this message in the bill's preamble, which acknowledges that “suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities”.
I am not a doctor who deals with life and death on a daily basis and I have never been at death's door.
Like every one of us here, I am an elected member trying to make the best possible decision in the context of the undeniable reality that the Supreme Court made a unanimous decision in the heart-rending Carter case.
The court's decision requires Parliament to create a new legal framework to regulate a specific aspect of end of life. If we fail to do our jobs now, the result will be a partial legal and regulatory vacuum. To quote the Ontario Hospital Association, if the bill is not passed by June 6, “Assisted dying would be lawful where it is provided in accordance with the parameters established by the Court and provincial regulatory bodies.”
The parameters set out by the court are fairly general. The court did not offer precise prescriptions for what an operative medical assistance in dying framework should look like. It is not the role of the courts to be so prescriptive.
This is not to say that I do not have concerns in voting for this legislation. Absent a Supreme Court ruling, and had the issue been raised once again through a private member's bill, I would very likely not have voted for medical assistance in dying. I have already, in the past, voted against a private member's bill on doctor-assisted suicide.
However, we do have a Supreme Court decision that creates a requirement to act. The and the and the have, in my view, acted wisely in taking a cautious approach to the issue, notwithstanding the excellent work of the special joint committee under the capable and intelligent stewardship of my friend and colleague the member for .
The bill may not be perfect, but I believe it would be a mistake to suggest that it leaves a wide-open field in medically assisted dying, a fear expressed to me by many thoughtful constituents committed in the highest degree to the protection of human life.
Bill would establish numerous criteria to be met before access to medically assisted dying could be granted. In addition to being 18 years of age, the person must have a grievous and irremediable medical condition that meets four distinct criteria: the illness, disease, or disability must be serious and incurable; the individual must be in an advanced state of irreversible decline; moreover, the illness must be causing enduring physical or psychological suffering that is intolerable; and natural death must be said to be reasonably foreseeable. In addition, the person must make a voluntary request that is free from external pressure and that is the result of informed consent.
The bill also includes a number of safeguards, and the individual must make a request in writing or through another reliable means. If the request is being signed by a proxy, that proxy must be at least 18 years of age and understand the nature of the request. The request must be made after the person has been informed that his or her natural death has become reasonably foreseeable.
The request must be signed and dated before two independent witnesses, and in turn, these witnesses must not consciously be beneficiaries, financial or in any other material way, of the individual making the request, and they must not be directly involved in providing personal care to the person making the request.
Two medical practitioners must provide a written opinion confirming that the person meets the eligibility criteria, and these medical practitioners must be independent. For example, one cannot be a supervisor of the other or a mentor of the other.
Crucially, the person must be informed that he or she has an opportunity to withdraw the request at any time.
All of this said, I am not at all convinced that medical assistance in dying is a serene and dignified phenomenon, even if often depicted in this way. I suspect that complications may arise. This is why it is crucial and to the government's credit that the bill allows for monitoring of medical assistance in dying through detailed reporting.
A few years ago, a handful of parliamentarians, including the members for and , the former members for Newmarket—Aurora, Guelph, and Windsor—Tecumseh, and myself, wondered about enhancing and improving palliative care in Canada.
We founded the committee on compassionate and palliative care and produced a report. The silver lining in this debate is that palliative care is receiving a degree of attention never before seen in this chamber or in national discourse at large.
It is my sincere hope that, once quality palliative care of the kind provided by the West Island Palliative Care Residence is available through appropriate federal and provincial funding to all Canadians approaching death, this legislation will become somewhat of a relic, and medical assistance in dying will no longer be considered the default option in relieving end of life pain and suffering.
In this regard, I am heartened that, in addition to the government's existing commitment to do more to fund palliative care, the bill makes specific reference to this commitment. The advent of universally available quality palliative care will hopefully one day be seen as the high-water mark in the measure of a truly just society.
Madam Speaker, there is a poem by the great Welsh poet, Dylan Thomas, entitled, Do Not Go Gentle Into That Good Night
. It is a poem of a son calling out to his dying father to fight his imminent death, and it ends as follows:
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
He is imploring his father to fight to the very end, to rage against the dying of the light. I believe this stanza describes the very essence of western philosophy when it comes to dying. Simply put, do not accept death.
However, life is terminal. The very definition of life is to die. A rock does not live, because a rock does not die. A tree lives, because a tree dies. A person lives, because he or she dies. So, am I going to die?
This is the subject of an excellent Ted Talks by a first responder. It is about a paramedic who would often arrive at the scene of an accident only to find a victim whose injuries were so severe that he or she was not going to survive. These victims would inevitably look up to this paramedic and ask: “Am I going to die?” In those moments, he would always lie and say no. He did so because he thought that was the kind, caring thing to do. Then a few years ago, he arrived at the scene of a severe motorcycle accident to find a victim who again asked the same question. For some reason, he told the truth and said yes. The reaction was not what he expected. The victim showed calm, inner peace, wisdom, and acceptance. From that time forward, he always told the truth.
Dylan Thomas in his poem tells us “wise men at their end know dark is right”. Therefore, am I going to die? Yes. We are all going to die.
Now we find ourselves discussing an issue that is foreign to many of us. With Bill , we are trying to determine when it is acceptable to accept to die. That is to say, when it is acceptable to go gentle into that good night. This is essentially what we are debating with this bill.
Some argue that the bill should follow the Supreme Court's ruling to the letter. Some argue that the bill should be broad to encompass all possible scenarios. Some argue that the bill should be narrow and restricted so as to protect the vulnerable. Some argue that there should be no bill at all, and we should not be on this path regardless of what the Supreme Court says.
Here in the House we have had great debate on this matter. It has been passionate, intelligent, and respectful. It has been the House of Parliament at its best. For example, the member for , who was on the special joint committee that prepared the guiding report for this legislation, has spoken eloquently on why he believes this bill is missing certain key protections. On the other hand, the member for , who was also on the special joint committee, has expressed, in a thoughtful, intelligent manner, his strong belief that the bill is too restrictive in certain areas.
I have received numerous personal letters from many sides of this argument, letters from people who are suffering now and fear not being able to access this gentle path when their time comes. Other letters are from caregivers who look after the grievously sick, the aged, and the mentally incapacitated. They are deeply concerned that these vulnerable people will not be protected. My own father has written on this bill.
I was out meeting constituents a few weeks ago and a lady came up to me. She said that she really liked what my father had written in the newspaper. Now, people get confused at times, and I did not know about this, so I just thanked her. When I got home, I called my father and asked if he wrote something in the paper. He said, “Yes”. I asked to see it, if he could email it me. He said, “No, I've erased it”, because he does not like to keep clutter on his computer.
I asked him to explain the gist of what he said, and he went on to explain that the term “reasonably foreseeable natural death” was a difficult one, even for a physician. My father had suffered severe heart attacks 25 years ago and was told to put his affairs in order by his physician.
Here he was, using the example of his own life to say, “I am alive 25 years later.” He is alive because on a dark night 25 years ago, he chose to “rage against the dying of the light.”
None of these people are wrong. Everyone has an opinion, and everyone's opinion is valid. For each person, that destination, that moment in time when it is acceptable to accept death is different, and rightfully so.
If the destination is uncertain, how do we arrive at it? Cautiously. There is a concept in engineering called “overshoot”. Simply put, the faster one arrives at the destination, the more likely one is to overshoot it. For example, if someone is driving in a car toward a stop sign and if he or she is going very fast and slams on the brakes, the individual will shoot past the stop sign. On the other hand, if someone goes very slowly, it will take that individual a very long time to get to the stop sign and he or she may even stop short.
We have an uncertain destination that is different for each person. How do we get there? Cautiously. We go toward that destination slowly. This is precisely the approach that the and the have decided to take.
With Bill , we are moving forward to this destination slowly, and we accept that we may even stop short. The bill acknowledges this. It is explicitly written into the law that it will be re-examined in a few years' time, precisely to allow for adjustments.
This is a very wise approach, and I commend the and the for the work they have done to bring us here.
In summary, we will all face our death. At that time, some of us will choose to fight death to bitter end. As a society, we already support that decision and we use the full weight of our medical system to help those people who choose to "rage against the dying of the light".
On the other hand, some of us will choose to accept death with inner peace and calm. As a society, we must now accept their decision and allow our medical system to help them. With this bill, we will help some of those people to "go gentle into that good night."
Madam Speaker, I will be sharing my time with the member for .
It is with great humility that I stand in my place today as the member of Parliament for Renfrew—Nipissing—Pembroke to represent the good people of my riding on such a weighty issue as the one before Parliament today, medical assistance in dying.
The debate strikes right at the heart of who we are as a nation, and I pray we get this right, as is humanly possible.
I thank all those constituents who answered my call to contact me regarding their thoughts on the legislation. I am pleased to confirm I have sought out the views from as many constituents as possible to guide, when the time comes, to support or oppose the government, or the Supreme Court, who are driving this issue today.
I have listened carefully to my fellow MPs on this topic. They have expressed various points of view eloquently. In keeping with my principles, and those for which my voters have elected and continue to re-elect me, I believe it is important to give a voice to those individuals who have not been given the opportunity to speak in this place, but should be heard.
I am pleased to add to the debate on medical assistance in dying with a sampling of letters and comments that have been received by my office to guide me in the debate. While time does not permit me to read all the correspondence I received onto the official record, I want to assure them that all points of view are important and will be considered.
This is a letter from Carmel in Pembroke. It reads, “Dear honourable member, I understand that the government plans to introduce a law regarding medical aid in dying. I totally disagree with many of the recommendations of the special joint committee on physician-assisted dying. Once euthanasia and assisted suicide are legalized we have embarked on a slippery slope. The boundaries will continue to be challenged. I urge you to write a law as restrictive as possible, and to respect and include the rights of many Canadians, who see any legalization of euthanasia and assisted suicide as murder. As a former health care worker for many years, I urge the government to invest more money in palliative care. I know from experience, pain can be controlled. They will receive passionate loving care and death will come naturally. Trusting that common sense will prevail in your good judgment.”
This email was received from David in Arnprior:
“Hello Member of Parliament. I do not support this legislation, not because I do not firmly believe in a competent citizen's right to commit suicide at the end of life as determined solely and completely by that individual, but because C-14 does not go far enough. This bill certainly needs to be passed federally so a provincial regulatory ragtag patchwork does not evolve. As well, C-14 needs expansion in at least four areas: Enshrine my right to predetermine through a pre-arranged power of attorney for personal care that suicide is my wish if I become incapable of making that choice later on; in other words, similar to my legal right now to refuse treatment before treatment is ever needed. Enshrine my right to commit suicide on my own, without a doctor's direct assistance. This change will allow “medical practitioners” to merely prescribe requested and appropriate meds for this most personal action, not to have to do it themselves in an environment perhaps not of my own choosing. Following from number 2, ensure that a broad array of competently trained, caring “medical practitioners” beyond merely MDs are available to assist as I may desire; the so called “death doula” model. Ensure that the so-called mentally ill can benefit from the legislation if they are deemed competent to do so by due process, since by virtue of being labelled mentally ill, a person should not also be deemed mentally irrational or incompetent in all areas or aspects of life. This is very unlike children under 18 or the developmentally delayed however, who must be closely protected, at least by benefit of clear due process. At the same time, there is a clear need for those ethically opposed in both caring professions and institutions to be able to opt out because of their beliefs, but only insofar as they must also be compelled to refer me to those who are non-opposed. This should also hold true by the way, for abortion, legalized marijuana, and like matters. There is also a clear case for broadly based, publicly funded “palliative care” services for those who want this kind of assistance. At the end of one's life it must always be about informed and competent personal freedom of choice, whatever that choice may be. This is in fact the basis of all quality of life and death, as entrenched in our Canadian charter, as decided by our Supreme Court. A national referendum on the matter is unwise and not needed. Similarly, I refer you back to Conservative P.M. Mulroney's 1980s second election, which was a referendum/vote writ large on free trade. He won then, as did NAFTA. Therefore, I largely agree with the previous Pierre Trudeau's 1960s statement when he was Liberal justice minister: “The state has no right in the bedrooms of the nation”. I think that goes a bit too far. The state does have a "limited" right, but only to ensure vulnerable persons, as well as persons who may become vulnerable, are not exploited, and are always treated with dignity and respect. In this, the Dutch, Swiss and Oregon models serve well. Thank you; please do acknowledge this email and feel free to share your thoughts.”
This note was received from David in Combermere. It states, “Our local newspaper here in Barry's Bay featured your request for input on Bill C-14. Thank-you for doing that. I personally view the bill as a Pandora's box and with so much language that leaves it ambiguous enough for the Liberal government to permit almost anything for the killing of Canadians. I don't know if you follow the studied newsletters of the Euthanasia Prevention Coalition and its editor, Alex Schadenberg, but I am enclosing their latest issue on Bill C-14. It's a whopper. EPC clearly presents the issues I endorse and in a more studied way than I could present to you. Please consider it my opinion on this vital life and death issue that you are wanting to present to Parliament. Thank you for all that you can do in this matter. God bless you.”
This letter was received from Betty from Killaloe. It reads, “Dear Member of Parliament, I strongly oppose physician-assisted suicide. I believe that life is given to us by God and should be taken away by Him as well. We don't know what his plan is for us and we need to trust Him with our lives. Even for non-believers, once that door is open to taking the life of a patient who is terminally ill, how long will it be until a needle will be given to those who are in long-term care, who are costing the health care system a lot of money to keep them there? How about the disabled whom a lot of people believe are a burden to our society, the mentally ill, etc. Let us put money into our palliative care and hospices where people can die naturally. History has shown us that where people interfere with the natural order and God's plan, evil and disaster follow. God's law states "thou shalt not kill" which should be above all the laws of the land. Thank you for giving me a chance to express my views.”
This email came from a couple in Arnprior. It says, “Dear Member of Parliament, Both my wife and I are advocates for doctor-assisted dying. We not only would like to see assisted dying for those people who are in need of this procedure and who have their full faculties but even more so for the thousands of poor souls suffering from Alzheimer's and who cannot make an informed decision. What we suggest is that it be made legal for people to choose this option during the preparation of their will with family and/or doctor as witness to this wish. We have a mother in long-term care in Almonte and the number of people suffering from Alzheimer's disease far outnumber the people who are lucid. I am sure if these people had a choice it would be to end their lives rather than sit in wheelchairs all day and to be treated, through no fault of their own, like babies. Our total hearts and admiration go out to the nurses and aides who care for those in need. We cannot thank them enough.”
Nancy from Deep River wrote, “Dear Member of Parliament, I'm answering your request for feedback on the specific euthanasia bill. First, a few generalities. I see the entire dynamics against a background where there is a movement for a culture of death, COD, and a movement for a culture of life. The culture of death tends to be hidden and manipulative. The well researched documentary CD called ‘Agenda’ provides evidence of this. There are elitists who want to reduce the world population by almost any means. Some of them want to make a shambles of the capitalist system so that their socialist ideal swoops down as the saver of the world. It is ironic that these elitists are socialist. I have read that the CIA supported the radical feminist movement, which has been instrumental in tearing down family structures and consequently economic stability. Hilary Clinton said, quite clearly even if not in these exact words, because I don't remember exactly how she expressed it, that in our society there are Judeo-Christian values that ‘we’ have to get rid of.”
“Specific examples show this. ‘They rope in well-intentioned liberals, like fools conned into their service. Now to the specifics. The most dangerous thing about the bill is that there is nothing in the law to protect the conscience rights of medical personnel. This means we would have legislated immorality if the bill passes in its current form. Such a law would corrupt an important sector of the citizenry. Corrupt citizens are antithetical to a healthy democracy. If conscience protection is not in the law, it is almost certain that somehow the “inconvenience” of non-participating physicians will be swept aside by a bureaucracy, just as it is now in Quebec. The bill does have some restrictions. I can believe that it was drafted in order to satisfy the Supreme Court's mandate in a careful manner. There are two facts against an optimistic view of these restrictions. Note the language we hear on the news, about beginning gently with euthanasia. Such language indicates that the plan is over time to include more situations where euthanasia would be permissible. Make no mistake about these restrictions. Like dew on roses, they will evaporate. This has been the experience in Europe.”
Madam Speaker, it is a pleasure to speak to the bill today in the House of Commons and share my time with the hon. member for .
I am pleased to rise in the House today to speak to the legislation, as I said. I have had the honour of being a member of Parliament since 2004. I can honestly say that this is one of the most sensitive and controversial pieces of legislation that I have spoken to in the House. This is an issue that many Canadians have very strong opinions on, so it is very important that throughout this process we respect all sides and ensure that we can come up with the best legislation possible, which responds to as many concerns as possible.
Today I would like to share some of my personal opinions on the legislation, as well as the expressed opinions of my constituents, many whom I have heard from. My vote on the bill will be based on what my constituents want and what my own conscience is telling me.
I recently wrote an op-ed in my local newspapers and distributed it to all media in the riding to connect with and consult with my constituents on the bill. I asked them to send their concerns to my office so that when I vote on the bill, I can be confident that I am voting in a manner that represents the views of my constituents. As of right now, the majority of my constituents, almost 80%, have told me to vote against the legislation. I want to point out that some of them are totally opposed to the bill and some would support some small amendments but are against it in its current form.
Emails and letters are still coming in as we speak. The main concerns that have been presented by those who disagree with the bill are the need for further protections for the vulnerable, further protections for the conscience rights of health care workers, and the need for an improved national palliative care strategy.
I share many of the same concerns as my constituents. It is absolutely vital that there are safeguards for those who are vulnerable. For me, this includes three different groups of people. The first group would be children. We need to have a more robust discussion and study whether children under 18 years old should be allowed access to physician-assisted dying and who has the authority to make that decision.
Second, it is paramount that those who have debilitating diseases, such as Alzheimer's, have a number of safeguards to ensure that they have fully consented to physician-assisted death while they were in a sound state of mind. The bill, as it is currently drafted, has a number of important first steps, but I feel it could go much further. The question is simple. Are there enough safeguards? Are we certain that we have it right?
I appreciate the work that was done by the special committee that was struck to hold consultations before drafting the bill and also the work done by the justice committee. This has been a very one-sided and rushed process. When it comes to protecting the vulnerable, I do not want to leave any stone unturned. A matter like this deserves an intense and lengthy study by parliamentarians, all parliamentarians. It is very disturbing to know that at this point the government is not willing to have that full debate.
Furthermore, it was made very clear in the House last night that the government is not willing to even entertain the notion of adopting any amendments, and that is wrong. On such a sensitive matter, it would have been my hope that the government would take a more sincere approach to working with other parties in an attempt to get the bill right.
A number of important amendments that would have addressed some very serious concerns were voted down by the government last night. I was deeply disappointed to see partisanship take precedence over common sense. It was refreshing to see some individuals, in all parties, vote according to their consciences and beliefs. That does not happen enough in this place, so I thank those members.
Finally is the question of whether the bill would allow those with mental illnesses to have access to physician-assisted death, as expressed by some of my colleagues. I would be very troubled if this was the case. It is my firm belief that mental illness is, in fact, an illness.
That being said, I would find it very troubling if an individual who was suffering from a mental illness had access to physician-assisted death. Mental illness quite possibly could mean that someone in a very poor state of mind, to use that terminology, could ask for assisted suicide when he or she would in all likelihood maybe not make this choice if in a sound state of mind. I believe this would send a wrong message to others suffering from mental illness. I am afraid that it would encourage more suicide, assisted or otherwise.
There are many groups in my riding who have put in a tremendous amount of work to combat mental illness and educate those suffering with mental illness that help is always available. We need to send that message that help is always available. Being able to seek physician-assisted death for a mental illness would, in my mind, run counter to this work. This is another area that deserves much closer study so that we as members of Parliament can be confident that the bill would not allow this.
Furthermore, National Nursing Week was only a few weeks ago. In light of this, it is very important to reiterate that we need robust protections for the conscience rights of health care professionals. Last night, the government had an opportunity to recognize the conscience rights of health care professionals, but chose not to take it. An amendment proposed by my colleague, the member for would have recognized that medical practitioners and health care professionals are free to refuse to provide direct or indirect medical assistance in dying. Unfortunately the government voted against this amendment.
The Charter of Rights and Freedoms states, “Everyone has the following fundamental freedoms”. What is first on that list? It is freedom of conscience and religion. I urge the government to put partisanship aside and recognize the charter rights of health care professionals. No one should be forced to perform any task that goes against his or her freedom of conscience or beliefs.
I am not trying to reopen a previous debate held in the House, but I have to use an example that is very similar to the point that I am trying to make right now. Therefore, I would compare this to ministers or clergy who do not believe in performing same-sex marriages. Freedom of conscience and religion are fundamental freedoms that protect individuals who do not wish to take part in something that runs counter to their beliefs. This same kind of thing is not in the bill. Simply put, someone should not be required to participate in something or provide any service that she or he does not believe in. This must be an important consideration in designing the regulatory framework. Again, I wish that we had more time to hear from concerned health care professionals about this.
I would like to conclude with a comment on the timeline of this issue, and voice my concerns around putting forward legislation in such a rushed manner.
As I said earlier, I have been a member of Parliament since 2004, and in that 12 years that I have spent in this place, this bill is near or at the top of the list of the most intense and deeply sensitive matters I have spoken to.
I fully recognize, as we all do in the House, the limitations on the orders that come from the Supreme Court. However, having said that, rushing through the bill and getting it not right is not worth the sake of a few days or weeks, whatever it takes. I urge all members to think about that. June 6 is a date that everybody has hard ingrained in their minds, but I am quite sure the courts would allow flexibility.
Let us take the time and do it right. Given the sensitivity and public concern with this issue, I do not think that it is appropriate or prudent to rush through this process. I fully understand that there is a stated deadline, as I said, that the court has given Parliament to have it done. However, with this in mind, once again I have to point out that I have a number of concerns with the Supreme Court's limiting the ability of members of Parliament to have the time to have a robust debate and to allow for a more intense study of this important issue.
On too many instances I have heard some members say they will just have to revisit this in the future or they will revisit that part of it, as if they are admitting that this is a flawed bill, and it is a flawed bill. As members of Parliament I do not think that we can—
Madam Speaker, I am going to be splitting my time with the member for .
The topic we are addressing today is a solemn one. As a result, the past few weeks have been emotional for all parliamentarians, myself included, as we have wrestled with the matter of assisted dying.
The government had the responsibility to respond to the Supreme Court decision that was made in February 2015. I joined my colleagues in addressing that responsibility after we formed government in November 2015. Thus, in the very short time since forming government, there has been an incredible amount of work by officials and parliamentarians, with input from Canadians with a diverse range of views.
Before us today is a legislative framework that we believe is the right approach for Canada. It is transformative. It would forever change the range of options that Canadians would have as they approach the end of their life. I would like to reflect on the principles that make up the foundation of our government's legislative approach in developing the legislation that is before the House today.
First, it is about the principle of personal autonomy, in helping people to write their own story, in a sense, in providing Canadians with access to medical assistance in dying, for the Supreme Court made it clear to us that Canadians must have that access.
We have the responsibility to abide by the Charter of Rights and Freedoms, and we have the responsibility to put forth legislation that respects the decisions of the Supreme Court of Canada. This legislation before the House today, if passed, would do just that.
The legislation also respects the principle of the inherent value of life. It is written, therefore, with appropriate safeguards that would protect vulnerable individuals. It would also firmly uphold the conscience rights of health care providers.
Over the past several weeks and months, I have had conversations with members in this chamber from all sides of the House. The and I have appeared at committees in the House and the Senate. I have personally had numerous meetings and phone calls with many interested advocates, in addition to the witnesses whom committees have heard on this particular legislation.
It is worth noting today that the professional bodies that represent health care providers are supportive of this legislative approach. These include the Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, and HealthCareCan, which represents our nation's hospitals and academic health sciences centres.
Just today, parliamentarians received an open letter from 36 organizations representing the vulnerable, including the Canadian Association for Community Living, which has come out in support of this bill. Each organization may have continued areas of interest in which they wish to seek clarifications or undertake work with my department or with provinces and territories so that they can properly work with their members on implementing assistance in dying.
As I have said in the past, this is an iterative process. It is why not only would we study further potential areas of assisted dying within a short period of time, if the legislation passes, but there would also be a parliamentary review of this important legislation.
Let us discuss the matter of timing. The Supreme Court of Canada gave our government an extension to put a legislative framework in place by June 6. Before going further, allow me to say that I respect the roles and responsibilities everyone has here as parliamentarians, as well as the responsibilities that senators hold in the upper chamber.
There is a good reason for all of us to want to reflect upon and investigate this legislation in a thoughtful manner on behalf of Canadians. The reality is that we are facing a finite amount of time before there is a legal void, an absence of legislation to address the matter.
Despite what some may say, there are real and very serious challenges if there is no legislative framework in place. As I said yesterday, there is a real risk that there could be no law in place by June 6. It is important to underscore what is at stake.
First, organizations like the Canadian Medical Association and the Canadian Medical Protective Association have made it clear that they believe there is a vast majority of doctors who would not participate in assistance in dying without a legislative framework, despite the protections that some say the Carter decision provides.
Doctors are being advised by the appropriate associations to seek legal counsel before proceeding with any form of assisted dying, including consulting patients, and this would pose significant access issues and result in a situation where the Supreme Court's decision is not being realized.
Second, it would be illegal for any other health care providers to offer assistance in dying. That means that nurses, pharmacists, social workers, and other providers recognized by amendments passed at committee would face no legal protection. In particular, pharmacists who are needed to dispense medications required for medical assistance in dying require clarification.
Finally, there is the possibility that some could receive assistance in dying without a legislative framework in place, who would not otherwise have been eligible under the government's approach. This means, for example, the risk that someone facing severe depression could seek assistance in dying and that the safeguards to protect that individual would be inadequate or nonexistent.
I also want to remind members that medical assistance in dying is unlikely to be the choice for the vast majority of individuals at the end of life, and at its core our health care system is there to keep Canadians healthy. Canadians should have access to high-quality palliative care. This is something to which I have been, and will continue to be, committed to addressing with our provincial and territorial colleagues, along with the delivery of our government's platform commitment of $3 billion for home care.
Our government put forth this legislation that would transform end-of-life care options for Canadians. It is an approach that respects their rights under the charter, protects our most vulnerable, and considers the needs of health care providers.
I want to thank my fellow parliamentarians for their attention to the bill. Many of us are new to this role, and this is no small matter that we have been asked to address on behalf of the 36 million Canadians whom we represent. I thank them for engaging in the conversation with respect and dignity. I thank them for doing their utmost to consider the perspective of others, even if it differs greatly from their own. I thank them for the serious discourse we have undertaken in a situation where it is likely impossible to write legislation that would entirely satisfy every diverse view.
Recognizing our responsibility to implement legislation, I urge members to support Bill for today's final vote. I look forward to working with the Senate, if the House wishes to proceed to the next stage of our legislative process.