The House resumed from February 26, consideration of the motion that Bill , be read the second time and referred to a committee.
Mr. Speaker, we are debating a bill today that strips away safeguards from the existing regime for euthanasia and assisted suicide. Debate started yesterday, and I want to continue in the line I was talking about.
Yesterday, I spoke about some of the philosophical problems underlining the government's desire to remove safeguards. Those philosophical ideas are clearly best understood in the realities of life under legal euthanasia and assisted suicide, in the experience of people and families who have been affected by it and in the concerns of people who will be further impacted by the proposed expansion of the practice and removal of safeguards.
The fact is that the expectation at the time of the Carter decision was for a legal regime that would apply narrowly. However, we have seen the alarmingly rapid process of expansion at the level of policy and practice continuing with this legislation. Given that this bill comes ahead of a scheduled statutory review, it looks like the pace of expansion of removal of safeguards and enlarging eligibility will continue apace even after this. Rates of identified euthanasia and assisted suicide have gone up dramatically every year since legalization, from about a thousand in 2016 to over five times that in 2019. Those rate increases show no sign of abating.
More and more horror stories are coming out about how the current regime has already changed the dynamics of our health care system. My grandmother was a Holocaust survivor, so I know about the long-standing traumatic effects that stay with many survivors for the rest of their lives. One instance of euthanasia at the Louis Brier nursing home in Vancouver, a Jewish facility that has Holocaust survivors among its clientele, was particularly traumatic for residents and staff.
Doctor Ellen Wiebe met with Barry Hyman and his family in the spring of 2018 and determined that he met all the criteria. She later went to the nursing home and closed his door without informing or consulting with nursing home staff. Hyman was killed by Dr. Wiebe on the evening of June 29, without any consultation with his primary caregivers at the nursing home. Perhaps Dr. Wiebe had good intentions, but someone sneaking into a nursing home and then asking us to trust her own notes as evidence of consent raises serious concerns.
Dr. Keselman, CEO of the Louis Brier nursing home, agrees. He said:
Imagine the implications for our staff and our residents and their families. We have a lot of Holocaust survivors. To have a doctor sneak in and kill someone without telling anyone. They’re going to feel like they’re at risk when you learn someone was sneaking in and killing someone.
Clearly Dr. Wiebe, in this case, was pushing the envelope. I doubt most doctors would behave in such a fashion, but we do see from analyses that have taken place in other countries that a small number of activist, pro-euthanasia physicians are overrepresented in cases with problems. A majority of doctors are trying to do the right thing, but a lot of death can flow from the choices of a small number of envelope-pushers.
In a paper studying cases of euthanasia in Holland between 2012 and 2016, bioethicists David Miller and Scott Kim of the U.S. National Institutes of Health noted significant problems in the application of these laws for vulnerable people, if the screws were not tightened properly.
During that period, Miller and Kim found 33 cases in which doctors had broken at least one rule while killing someone, though apparently none of these justified prosecution. Miller and Kim specifically identified the overrepresentation of certain activist doctors in cases that raised red flags.
I spoke in the House in 2016 about another case in Canada, where a physician declared a depressed person eligible for euthanasia even before examining that person, because the patient “could easily get bed sores and then die of infection”. A person's death was, prior to examination, declared reasonably foreseeable because the person could theoretically die from an as-yet-uncontracted bedsore infection.
It is striking that we have these cases to look to at all in Canada, given the massive data collection gaps. There is no requirement for advance legal review to determine if criteria are being met. There are no national standards on tracking data. In fact, in many cases when a patient dies as a result of euthanasia, their death certificate will not even indicate that as the cause of death.
People who have had bad experiences cannot tell their stories in most cases. The data that the government refers to is severely constrained by these realities. We tried, during the debate on the last euthanasia bill, to push for mechanisms for better data collection and reporting to ensure evaluation and protection was possible, but at the time unfortunately the government did not listen.
Those who have had negative experiences and have lived are understandably reluctant to speak out. However, I want to share one story, with permission, of someone close to me who had a negative interaction with the system after this regime began. This is Taylor's story.
Taylor Hyatt is a twentysomething former member of my staff. She has cerebral palsy. She is vibrant, accomplished and full of life. She went to the hospital a couple of years ago with cold symptoms. She was told that she would probably need some oxygen and was asked if she wanted that. She replied, “Yes, of course”, but then the doctors pressed her on the point by asking if she was sure. Taylor was asked if she was sure she wanted oxygen. She just had pneumonia.
When we look at the government's proposal to further expand euthanasia and assisted suicide, and to expand eligibility criteria and remove the small number of safeguards that exist, we need to ask the same question: Is it sure?
As these cases illustrate, we have particular reason to be concerned about cases in which people receive euthanasia or assisted suicide immediately or alone. If multiple family members and health care staff can see, over a period of time, that a person is clear in the desire to have life end, then there is less risk of vulnerability or abuse.
Imagine a case, though, in which children visit their mother in hospital on a Monday. It seems like she is having a good day and she makes no mention of wanting to die. She is experiencing some pain, but the nurse says she has promising ideas about how to manage that pain. The nurse says she thinks she needs to adjust the levels of a few things that should settle the pain down, and she will work on that as soon as the doctor has a chance to see her. The children leave on Monday feeling reassured.
Then the children are informed on Wednesday that their mother is dead. They are told that when she met with the doctor, she was in extreme pain and expressed the desire to die, so she was killed right away. They did not get a chance to say goodbye and they do not know if the doctor got it right or wrong.
Perhaps their mother really wanted to die, but maybe she was just experiencing a temporary low point from which she would have recovered. Her children will never know the details or the situation. Because of the absence of witnesses and legal review, there is very little evidence left behind. If their mother really wanted to die, she could, but would it be so unreasonable for the doctor to have given it a few days for the children to have been able to talk to her about her wishes?
This particular case is exactly where we should focus our concerns as we look at this legislation. The current legal system requires at least two independent witnesses who are not paid personnel, and there is a 10-day reflection period. I would underline, as members have said and as the government has generally failed to acknowledge, that there is already a mechanism by which the 10-day reflection period can be waived.
However, the 10-day period sets out a rule of general practice that is open to variation. It establishes the general and important principle that people should not have their lives taken as a result of a fleeting sense of hopelessness or because their medication levels are off for a period of time.
It makes no sense, as the government is proposing to do, to reduce the number of witnesses and remove the reflection period when there are already provisions for waiving it and managing that effectively in different situations.
Other members may have had these same experiences. I can tell them I had a close friend dealing with depression a few years ago and his state of mind would fluctuate dramatically from day to day. On certain days, he could not imagine going on, while on other days he would feel, in his words, like himself again.
Recognizing the realities of fluctuations and the development of people's experiences, it is horrifying to me that someone could opt for, and receive, euthanasia or assisted suicide within a few hours without independent witnesses or any reflection period. Therefore, the government must remove the clauses of this bill that reduce witnesses and eliminate that reflection period.
The government has included a clause in this bill dealing with so-called advance consent. The mechanism is that I, as a patient meeting the criteria, might ask to die on June 1, even if I had lost capacity. My consent right now would suffice for the taking of my life on June 1. However, the legislation contains no requirement that I be asked how I feel on June 1.
Suppose that I am facing a loss of capacity and I am afraid of the implications of that loss of capacity, not knowing what it would be like to mentally regress in the way that doctors have predicted that I will. Suppose that, in light of this fear, I sign on to advance consent but then, on June 1, while I have indeed lost substantial capacity, I actually have a much higher quality of life than I expected to have.
Should the advance consent that I have provided, in ignorance of my future circumstances, overrule my feelings in that moment? This is not just idle speculation.
Let me read from an article in The Washington Post about a Dutch case involving an advance directive. It states:
The patient, referred to in official documents only as “2016-85”, had made an advance directive requesting euthanasia in case of dementia. But the directive was ambiguously worded, and she was no longer able to clarify her wishes by the time she was placed in a nursing home—though her husband did request euthanasia for her.
Despite the lack of a clear expression from the patient, a physician concluded her suffering was unbearable and incurable—though there was no terminal physical illness—and prepared a lethal injection.
To ensure the patient's compliance, the doctor gave her coffee spiked with a sedative, and, when the woman still recoiled from the needle, asked family members to hold her down. After 15 minutes were spent by the doctor trying to find a vein, the lethal infusion flowed.
The government has tried in this legislation to avoid this most extreme case by saying that advance consent would only apply to a particular date and that the procedure should not proceed if the patient was clearly refusing euthanasia. Unfortunately, the space left for abuse is still massive.
In the case just given, suppose the patient was given stronger sedatives so she was completely unaware of what was happening, and therefore offered no resistance. That would be allowed under the framework established by this legislation. It does not require that patients be informed or consulted at the time of their death. If they have provided advance consent, that is considered sufficient.
In virtually every case, the requirement for contemporaneous consent is important in our law and is a necessary part of autonomy. If I am to be truly free, then I must be free from the directives of my past self. My past self should not irrevocably be able to bind my future actions.
Even so, it may be possible to still allow advance consent, but to have some mechanism through an amendment to ensure that a patient, even with limited capacity, is informed and consulted at the time when his or her life is to be taken. I would encourage the government to consider that.
The government should be open to considering these problems and these fixes, taking out sections of the bill that dangerously remove safeguards and strengthening the section on advance consent to ensure a patient is informed and consulted contemporaneously.
Finally, on the point of safeguards, let us go back and reflect on what the purposes of safeguards are.
Some members will feel that meaningful safeguards are not necessary because we should trust medical professionals and patients to get it right. The parliamentary secretary has used general data about trends in this area to suggest that there are no problems with abuse.
Let us be very clear that the reason we have safeguards is not to deal with general cases, but is precisely to deal with exceptional cases. Even if there are not problems in the vast majority of cases, we try to introduce reasonable verification mechanisms, because those verification mechanisms will catch instances of abuse and cases where vulnerable people might be pushed toward a death they do not want.
The reason we need law enforcement is not because most people are lawbreakers, but because some people are lawbreakers. The reason we have fire departments and expansive rules and protocols around fire prevention is not because most houses are on fire, but it is because some houses could catch fire.
I hope we will see through this debate that the safeguards in the current legal region really are a minimum and that we can provide reasonable safeguards like a short reflection period that can be waived and a requirement for independent witnesses which, like sprinkler systems in this room and security guards watching over us, insulate us against the possibility of something going very wrong.
For the sake of the vulnerable, let us not fire the security and rip the sprinklers out of our system just to make an ideological point.
Mr. Speaker, I am very pleased to rise in the House today to address Bill and to speak to our proposed changes to Canada's medical assistance in dying legislation.
The proposed measures respond to the Superior Court of Québec's Truchon decision, in which it ruled that it is unconstitutional to deny access to medical assistance in dying to individuals who meet all the other eligibility criteria but are not near the end of life.
In responding to this ruling, the Government of Canada has had the opportunity to consider some additional measures for which there is strong support. That is why we are proposing changes that will help clarify and add precision to Canada's medical assistance in dying legislation.
Over the past few months, I have had the honour of listening to many Canadians, and it was important for me as the Minister of Health to hear first-hand what they had to say. My colleagues and I hosted a series of round tables and heard from more than 125 experts, academics, ethicists, doctors, nurse practitioners, members of the disability community, indigenous groups and key stakeholders. I also engaged my provincial and territorial colleagues, and my officials worked closely with their counterparts across the country.
In January, I was in Calgary and spoke to Cynthia Clark, who saw her husband through the process of medically assisted death last summer. Her perspective, as well as those of so many others with first-hand experience were invaluable.
I also listened to practitioners who have been providing medical assistance in death in a very thoughtful, compassionate way over the last four years. They had a lot to say about what was working well but also about what was not working well.
We heard many personal stories like Cynthia's, and they helped shape the changes that we are proposing today. In addition, the feedback received from our online consultation was astounding. In two weeks we had more than 300,000 responses.
It is clear that certain aspects could be improved in order to facilitate access, protect the vulnerable and respect personal choice.
With this bill, I think we have achieved a balanced approach that reflects the best interests of all Canadians.
Protecting the safety of vulnerable people while respecting the autonomy of Canadians remains our central objective. That is why the bill proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.
Reasonable foreseeability of natural death would no longer be a requirement for determining whether a person can access medical assistance in dying. It would, however, be used to guide practitioners in determining which safeguards to apply. This is consistent with what we heard at the round table meetings.
Providers involved in assessing the eligibility of applicants for a medically assisted death told us they have a good understanding of the concept and are comfortable applying it. Under the amended law, they would use reasonable foreseeability of natural death to determine not eligibility, but rather which safeguards would apply.
For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards. Under the current system, there is a requirement for a 10-day reflection period. We are proposing to eliminate this reflection period. For those who are at the end of their life, the decision to request medical assistance in dying is well considered, and this additional period only serves to prolong suffering unnecessarily.
The current system also requires that two independent witnesses confirm that the person who has signed a request for medical assistance in dying is who they claim to be and that no fraud has occurred, such as the forging of someone's signature. During our consultations, we heard that this requirement was a significant barrier for many people at the end of their life.
We propose requiring only one witness and allowing this witness to be a paid personal or health care provider. These individuals naturally would be excluded from acting as a witness if they are a beneficiary of the person's will or if they would receive a financial or material benefit from the person's death. Anyone involved in assessing or providing medical assistance in dying would continue to be ineligible to serve as a witness.
For those whose death is not reasonably foreseeable, we would create a new, more robust set of safeguards. We think it is important, even while improving access, to ensure that people who are suffering but who are not dying are given full and careful consideration as they assess whether or not to pursue an assisted death.
Strengthened safeguards would also serve to protect vulnerable individuals. For example, the bill proposes a minimum period of 90 days for assessing a MAID request in the case of a non-imminent death. This period would allow for exploration, discussion and consideration of options to alleviate suffering by the person seeking medical assistance in dying and with the practitioner.
The bill would also require that the person requesting MAID be provided with information on available counselling, mental health supports, disability supports and palliative care as part of the informed consent process.
We know that the majority of practitioners are already ensuring that their patients are aware of all of the supports and options that are available to them. This provision underscores the importance of the doctor-patient relationship. It allows for a practitioner and a patient to decide whether medical assistance in dying is the right step and provides sufficient time for the patient to discuss and consider other treatment options, which is crucial for patients weighing this kind of decision. This provision supports fully informed decision-making and individual autonomy.
Under the current legislation, those who become incapacitated lose their eligibility for medical assistance in dying because the person must give their consent immediately before the procedure. This means that some individuals deemed eligible for medical assistance in dying have chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive this service.
That is why we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable and who have been assessed and approved to receive medical assistance in dying. Individuals at the end of their life who risk losing their decision-making capacity before their chosen date would have an avenue to receive MAID without worrying that loss of their decision-making capacity before their chosen date would disqualify them. Support for this amendment is strong among stakeholders, Canadians and health practitioners.
Canada has had four years to reflect on the current MAID legislation passed in June 2016, and there are many complex issues that require further study.
In December of 2016, the Government of Canada asked the Council of Canadian Academies to conduct independent reviews on three specific types of requests for medical assistance in dying that are currently outside of the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying medical condition.
The Council of Canadian Academies convened a multidisciplinary panel of 43 experts to review an extensive body of evidence, including Canadian and international academic and policy research.
We tabled those reports in Parliament in December 2018. They provide us with a thorough, thoughtful examination of these very difficult subjects. I encourage all members to read those reports as we continue our deliberations on the proposed legislative amendments and the parliamentary review that will be conducted later this year.
There is agreement among experts that allowing advance requests for people with illnesses such as Alzheimer's disease well before they would otherwise be deemed eligible is very complex and will require careful consideration and consultation before it could be included in legislation.
During the round tables I heard directly from health care providers who expressed discomfort because they have seen patients who, as their position progressed, might not have the same desire for medical assistance in dying as when they were first diagnosed. The Council of Canadian Academies' expert panel report on advance requests came to the same conclusion.
At the same time, we know that many Canadians have expressed an interest in advance requests so that they could have the comfort of knowing that they could avoid extreme suffering at some future date.
For all these reasons, we believe this issue deserves deeper examination through parliamentary review. That will be our opportunity to tackle questions that are profound and difficult to answer, even for practitioners who have been providing this service over the past four years.
The proposed changes to the medical assistance in dying legislation would exclude persons if mental illness is the sole underlying medical condition.
This does not mean that people with mental illness are ineligible; it means that mental illness cannot be the sole underlying condition. This is another complex aspect that warrants a more thorough discussion.
Since the federal legislation came into force in 2016, Health Canada has released four federal interim reports that provide more information on how the legislation is being implemented across the country.
In November 2018, we implemented regulations that resulted in the creation of a permanent monitoring regime that sets out obligations for reporting on medical assistance in dying cases by doctors, nurse practitioners and pharmacists. The first monitoring report under these regulations is expected to be released in spring 2020.
Since MAID legislation was enacted in 2016, more than 13,000 Canadians have chosen this option of a medically assisted death. This is not unexpected. We have seen a gradual increase in the numbers over the last three years. The number of MAID deaths in Canada, slightly under 2% of all deaths, is in line with international regimes. The increasing use of MAID is largely a result of enhanced awareness of it as a legal option and greater acceptance by Canadians.
The federal government recognizes that public reporting is critical to ensuring transparency and also to ensuring public trust in the legislation. That is why we are proposing changes to expand data collection to help provide a more complete picture of medical assistance in dying in Canada.
Under the current legislation, only practitioners who receive a written request for MAID and pharmacists who dispense a MAID substance are required to provide information, but it has become clear that capturing information based solely on written requests for MAID received by physicians and nurse practitioners has resulted in an incomplete picture on who is requesting MAID across the country, and why.
The amended legislation would authorize new regulations to be developed in partnership with provinces and territories to allow for the collection of data on all assessments for MAID, and this would include those undertaken by other health professionals on the care team. It also clearly aligns with the original intent of the legislation to collect information on all requests for, and cases of, MAID in Canada.
I think we can agree that Canadians with life-limiting illnesses deserve the best quality of life possible as they approach the end of their lives. Palliative care and end-of-life care provide patients with relief from the pain and distress associated with a life-threatening illness. Supporting home care and palliative care is a key priority in our ongoing efforts to improve our health care system.
Through budget 2017, we made historic new investments in health care to improve access to mental health and addiction services, as well as home and community care, including palliative care.
To further support access to palliative care across the country, the government worked closely with provinces, territories, and stakeholders to develop the framework on palliative care in Canada, which we tabled in Parliament in 2018. We have released an action plan to support each of the priority areas identified in the framework.
I want to assure the House that the proposed bill responds to concerns identified by practitioners and experts through the round table discussions.
I will continue to work closely with the provinces, territories and key partners to support the implementation of the proposed legislative amendments, if they pass in Parliament.
This includes working with provinces, territories, health system partners and regulatory bodies to support best practices and information sharing on clinical guidance and other aspects of implementation, which includes training and retrospective reviews.
I have a great deal of respect for the practitioners who have been providing this service over the last four years with immense diligence and a huge amount of compassion. Their experiences have helped us craft legislation that much better meets the needs of Canadians. This law is constructed in a way that supports autonomy, but it includes the flexibility to allow a practitioner and a patient to work more closely together.
Medical assistance in dying is a complex and deeply personal issue. In tabling these changes, our government has considered carefully the need for personal autonomy and the protection of vulnerable people.
There is strong public support for change, and I believe we have found an approach that reflects the best interests of all Canadians. I urge all members of the House to support the proposed changes.
Mr. Speaker, I am happy to stand today to add my voice to this debate. I think it is a particularly important debate. It is an important subject, and I think there are a lot of issues that need to be discussed.
I am going to confine my comments to issues I have with the bill, things I am concerned about, and my genuine belief that the government will take a very collaborative approach to this legislation. If we take a collaborative approach to this legislation, Canadians will have trust and faith that we developed legislation to actually address their needs and protect their concerns.
Speaking of concerns, I have a number of them. I will start off by talking about what I consider to be a significant lack of consultation.
This legislation will come up for review in June. It is the five-year mandated review of the legislation. My understanding is that the government has applied for a four-month extension with respect to the implementation of this legislation, which the Quebec court struck down.
If we have this four-month extension and have the mandated review of the legislation scheduled in June, what is the rush? Why have we rushed to introduce legislation prior to that mandatory review, which would, of course, be extensive and broad and far more in depth than any consultation that has been done with respect to the current legislation? My understanding is that there was only about two weeks of public consultation for this legislation. In my opinion, that is woefully deficient given the gravity of the topic we are discussing today.
This is my first real concern. What is the hurry? What is the rush? The court has given us more time to do this, and I believe we should be taking the time to go through the mandatory review and consult with Canadians, and then decide on the path forward. That is my number one concern.
I want to mention that I will be sharing my time with the member for . My thanks to the page for bringing that to my attention. She is doing an excellent job.
The next thing I want to talk about is palliative care. The has made comments in the House today espousing the great investments that are being made by the government in health care, but has not really talked about any specific investments with respect to palliative care. I think that is a critical thing to look at when we discuss this legislation. I want to remind the minister that Bill , an act providing for the development of a framework on palliative care in Canada, was passed in the previous Parliament in 2017, and clearly states in the preamble:
Whereas the Final Report stated that a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person’s suffering;
This was passed by Parliament, so if we are looking to expand the scope of medically assisted death without also expanding the availability of palliative care, we are doing an incredible disservice to Canadians, because the availability of palliative care in this country is poor at best. I am going to speak about this personally just for a moment.
Both of my parents suffered from terminal cancer. My mother was not able to get into a palliative care facility because there was no palliative care facility available for her, so she passed away in the hospital. My father was also not able to get into palliative care, but fortunately his illness was longer than my mother's, or unfortunately, depending on how one looks at it, and we were able to get private home care that eased his suffering and made sure he was being taken care of. However, there was no way that he was going to be able to get into palliative care within the scope of his illness.
This is affecting Canadians from coast to coast to coast, and the minister has rushed to introduce this bill. Why would the minister not have introduced corollary legislation, or legislation in tandem, or announced increases in funding for palliative care?
In my riding of Dufferin—Caledon, there is a fantastic hospice for palliative care. It is called Bethell Hospice. It only has approximately 15 beds. That is the palliative care option in my riding. For approximately 200,000 people, there are 15 palliative care beds.
Members can imagine that there is a significant number of people who are not able to get into palliative care. Therefore, the option of medically assisted death becomes far more attractive for someone who is not able to enter into a palliative care facility.
I will repeat that it is clearly a violation of legislation that was passed by the House. When people do not have the option for proper palliative care, their consent for a medically assisted death is significantly in question. I am extraordinarily concerned by the lack of any plan by the government to deal with investments in palliative care.
The minister has suggested that there are significant safeguards in place for people who suffer from any type of mental illness. However, I am not sure what those safeguards are. She suggested that just having that condition would exclude someone from obtaining a medically assisted death. What is the definition of that? How are we proving that is the only issue?
There is no requirement for individuals to go to a psychiatrist in order to assess that they are not suffering from a severe bout of depression. In my own life, I have gone through extraordinary stages and phases of depression during which I actually did not want to live anymore. I was not seeing a psychiatrist at the time. Would I have then been able to avail myself of these services while I was in a period of particular darkness? We know that mental health is an issue that is rampant throughout this country.
Again, I will go back to my first point, which is: Why are we rushing to do this? Why are we not taking the time to go through the five-year review? We need to take the time to find ways to make sure we are safeguarding all Canadians in providing them the option of medically assisted death, if they want it, but also ensuring that people who are choosing this, maybe because of a lack of palliative care, or maybe because of underlying mental health issues, are going to be protected.
These are some of the major concerns I have with respect to this piece of legislation.
Going back to the consultation, two weeks for online submissions with respect to concerns by Canadians is not anywhere near a sufficient amount of consultation. My understanding is that it was mostly online submissions. This is not a way to get the pulse of Canadians with respect to a very significant issue that is going on in this country. I will continue to ask why there was not a longer or broader consultation.
I know this matter will be studied at committee, but having been a member of Parliament now for going on five and a half years, I understand the extreme limitations at committee. We will often have a panel of six witnesses. Those six witnesses will each get their 10-minute statement, and then members of Parliament might get a six-minute intervention to try and raise an issue.
If one is going to suggest that a committee study will be far broader in scope, or somewhat more encompassing than the mandatory statutory five-year review, I will respectfully disagree with that submission.
Committees absolutely do great work, but they also suffer from an extreme pressure of legislation and time. To suggest that one or two weeks or three meetings at committee is sufficient time to analyze, debate and discuss this legislation, I do not think that is the correct answer. We should be putting this legislation off until we have the mandatory five-year review in June, which would allow us to have a far more expansive discussion with respect to all of the issues that are being discussed in the legislation.
These are my comments and concerns with respect to the legislation. I certainly hope the government will listen to these concerns, act collaboratively and co-operatively, and not try to drive this legislation through without listening to legitimate concerns that are being raised by members of the opposition.
Mr. Speaker, I am pleased to join the debate on Bill , an act to amend the Criminal Code, specifically section 241 of the Criminal Code. That is the provision of the Criminal Code that makes it illegal to counsel a person to commit suicide or to aid someone to do so.
In the absence of more recent amendments, in the previous Parliament there was Bill in response to the Carter decision by the Supreme Court of Canada. In that case the court found that the plaintiffs' charter rights had been infringed upon by a strict interpretation of section 241.
Interestingly, Bill from the previous Parliament stated, as one of its objectives in paragraph six of the preamble:
...permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons...on the other;
The relevant provisions in the Criminal Code included that language. It states that qualifications for MAID, including with respect to the person:
their natural death has become reasonably foreseeable, taking into account all of their medical circumstances....
All of this is about to change because of the Truchon decision.
I am speaking to Bill , a bill that would eliminate the reasonable death foreseeability safeguard and expand MAID, medical assistance in dying, to a larger number of people. I have been encouraged to speak to the bill because of the many letters and the correspondence I have received from people in my constituency.
I have received some letters in support of expanding MAID, but the vast majority of the letters I have received encourage me to speak against expanding the availability of medical assistance in dying.
Correspondence that I am receiving from constituents repeat two basic themes. First is that the reasonable foreseeability of death safeguard should be maintained as an effective defence of societal interests and Canadian values. Second is that more should be done to expand palliative care services.
To quote one person, let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever expanding use of medical assistance in dying. We should alleviate the suffering, not eliminate the sufferer.
I am going to read quotes from two people who each made the effort to write me a letter.
The first is Dr. den Hollander, who states:
If Canada must allow MAiD in some form (and I wish it didn't), it is incumbent upon us to ensure that it is rare. Eligibility requirements should be tightened, not loosened. More safeguards are necessary, not fewer. Enforcement must be scrupulous, not relaxed. Without these protections, vulnerable people will be pressured by family members, friends and medical practitioners to MAiD.
The second is a woman named Ramona. She works in health care, including palliative care. She quotes a person to whose care she attended, and who died in the Langley Hospice facility, as saying, “I want to live well while I'm dying.” Ramona goes on to comment, “Surely this is what health care was created for, to support people while they are alive, not to speed up their death.”
This is the tenor of the input I am receiving from my constituents.
Behind Bill is the Superior Court decision in Truchon. The plaintiffs in that case argued that their constitutional rights had been infringed upon by the now amended section 241 of the Criminal Code. They argued that the Carter decision, on which Bill was based, did not require that a person's end of life be reasonably foreseeable, and that is a true statement. That is not what the Carter decision required.
Secondly, they argued that the legislated end of life requirement violated the right to equality, under section 15 of the charter, and the right to life, liberty and security of the person, under section 7 of the charter. The federal government, acting through the Attorney General's office, did the right thing at that time. It defended its law. That is what the Attorney General should do. Bill C-14 was the well-considered opinion of the previous Parliament. It was the law. The Attorney General must defend the law.
Remarkably, the Quebec Superior Court refused to accept the arguments advanced by the Attorney General. The Quebec Superior Court said that the court cannot accept the first two objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person's life and the importance of preventing suicide.
In the opinion of the justice writing that decision, those two principles were not the underlying philosophy of Bill . It was all about protecting vulnerable persons from being induced, in moments of weakness, to end their lives.
Remarkably, the Attorney General of Canada did not appeal that decision. That is what should have been done. Any self-respecting Attorney General would appeal a decision that attacked the laws of Parliament. This Attorney General elected not to do that. Now we are in this position where we are under pressure to amend the law, when we should instead be following the directive of Bill , and that is to have a comprehensive review of the whole legislation.
That is what we should be doing. What is the rush? The rush is caused by the Attorney General's failure to appeal this decision. It should have been tested through the court system, up to the Supreme Court of Canada.
With the reasonable foreseeability of death safeguard down, this is what we have left. An applicant for MAID qualifies if he or she has a serious and incurable illness, disease or disability; is in an advanced state of decline; or their physical or psychological suffering is intolerable to them, which is a completely subjective test. The reasonable foreseeability of death criteria is now gone.
Let us just test this against a couple of hypothetical situations. We can imagine that a person has Parkinson's or MS, or was in a terrible accident and is a paraplegic. Under this new regime, if it becomes the law, people who are not dying but who meet all the other criteria, however subjective they may be, will qualify for state-sanctioned suicide. One of my constituents has said that we should let Canada be a society that is known for its modern and advanced palliative care services, and not as a country that has ever-expanding use of medical assistance in dying.
Mr. Speaker, I will be sharing my time with the member for .
It is an honour to stand up in the House of Commons and participate in the second reading debate for Bill , an act to amend the Criminal Code to Canada's medical assistance in dying legislation.
In developing these amendments, Canadians were widely consulted in January 2020. During these consultations, approximately 300,000 Canadians completed an online questionnaire. In addition, the , the and the met with stakeholders in Halifax, Montreal, Toronto, Vancouver, Calgary, Winnipeg, Ottawa and Quebec City to discuss proposed revisions to Canada's medical assistance in dying framework.
These experts and stakeholders included doctors, nurses, legal experts, national indigenous organizations and representatives of the disability community. The high level of participation in both the questionnaire and the in-person sessions is a reflection of the importance of this issue to Canadians. Moreover, the results of the consultations were critically important in shaping the government's approach to medically assisted dying as it evolves to reflect the needs of Canadians.
This bill would amend the Criminal Code to allow medical assistance in dying for people who wish to relieve their suffering through a medically assisted death, whether their natural death is reasonably foreseeable or not.
This bill would remove the reasonable foreseeability of natural death from the list of eligibility criteria. It would also expressly exclude people seeking medical assistance in dying solely because of mental illness.
The bill proposes a two-track approach based on whether a person's natural death is reasonably foreseeable. Existing safeguards remain and are eased for those whose death is reasonably foreseeable. In addition, new and modified safeguards would be applied to eligible persons whose death is not reasonably foreseeable.
In the spirit of “nothing without us”, I would like to mention the government remains focused on addressing the concerns of the disability community around vulnerability and choice. The proposed changes to the legislation support greater autonomy and freedom of choice for eligible persons who wish to relieve their suffering by pursuing a medically assisted death.
At the same time, full consideration has been given to the protection of vulnerable persons and to respecting the equality rights and dignity of persons with disabilities. In short, this bill would maintain and strengthen safeguards to support fully informed decision-making, while also respecting individual autonomy.
In terms of advance consent, many participants were comfortable with implementing advance requests for those who have been assessed and approved for medically assisted dying, but are concerned about losing capacity before it is provided. This bill would allow people who risk losing decision-making capacity to make arrangements with their practitioner to receive medically assisted dying on their chosen date, even if they lose decision-making capacity before that date.
The bill would also make advance consent invalid if the person demonstrates refusal or resistance to the administration of medically assisted dying. The bill goes on to clarify that reflexes and other types of involuntary movements, such as response to touch or the insertion of a needle, would not constitute refusal or resistance.
In addition, the bill would allow eligible persons who choose to self-administer to provide advance consent for a physician to administer a substance to cause their death if self-administration fails and causes them to lose capacity. This type of advance consent would be available for all eligible persons, regardless of their prognosis.
I would like to take a moment to speak to the progress the government has made with respect to the rights of persons with disabilities in Canada. In fact, last year, the government enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact with areas under federal jurisdiction.
The act is one of the most significant advances in disability rights since the charter in 1982 and is designed to inspire a cultural transformation for disability inclusion and accessibility in Canada. The act created Accessibility Standards Canada, a new organization that will create and revise accessibility standards, and support and promote innovative accessibility research. The CEO and board of directors were appointed and operations began last summer.
That act also established National AccessAbility Week, a week dedicated to accessibility in late May and early June each year. National AccessAbility Week is an opportunity to promote inclusion and accessibility in communities and workplaces, and to celebrate the contributions of Canadians with disabilities.
It is also a time to recognize the efforts of individuals, communities and workplaces that are actively removing barriers to give Canadians of all abilities a better chance to succeed. The act applies to federally regulated organizations for now, but we know the culture shift will have a trickle-down effect, and that awareness and action on disability inclusion will increase across the country.
Our government is taking real action to address the rights of persons with disabilities. The careful writing of Bill is a testament to that. Representatives of disability organizations and leading disability scholars participated in consultations across the country. Their input informed the reforms proposed in the bill.
We recognize that disability inclusion requires more than legislation. That is why we are continuing to work with the disability community and other stakeholders to address stigma and bias. It is important to bring about a culture change to ensure that the important contributions made to Canada by persons with disabilities are recognized and valued on the same basis as those of other Canadians. Going forward, we will continue to focus on improving the social and economic inclusion of persons with disabilities.
We will continue to work hard to ensure that all people are treated with the dignity and respect they deserve, especially when it comes to deep and personal issues like ending life. It is imperative that the voices of all Canadians, including Canadians with disabilities, continue to be heard on the issue of medical assistance in dying.
Mr. Speaker, we have a unique opportunity to fix our assisted dying laws and to protect the individual right of all Canadians to make such a fundamental and deeply personal choice for themselves.
I opposed the assisted dying laws in the last Parliament because they were too restrictive. They were not in keeping with the Supreme Court's decision in Carter and I believed them to be unconstitutional, and here we are. A Quebec court found the law to be unconstitutional and we agreed, rightly, to abide by that decision. We have another chance to get it right.
As we look forward to what getting it right looks like, we should also look behind us at the Supreme Court's decision in Carter.
Those in the House have talked about striking a balance between the fundamental freedom of individuals to choose for themselves and the autonomy of the individual to make such a deeply personal choice, and protecting vulnerable persons.
For people who read the Supreme Court's decision in Carter, they will know that the Supreme Court struck that balance with a number of safeguards that look like this: to be eligible for assisted dying, one needs to be suffering intolerably and in an enduring way; one needs to be in a grievous and irremediable condition, an incurable illness; and the individual in question needs to be competent and to clearly consent.
The government in the last Parliament incorrectly, in my view, added an additional criterion for eligibility that one's death needed to be reasonably foreseeable. That is unnecessarily and unduly restrictive. I will get to a court case in particular that explains this in greater detail.
There are two core injustices that the new law proposes to fix. First, the question of removing the “reasonably foreseeable” requirement as a matter of eligibility, and also addressing the case of Audrey Parker.
We had another fundamental injustice where an individual who was eligible for MAID took her life earlier than she otherwise would have, lost time in her life that she otherwise would have spent with her family and loved ones. She was worried about losing competence and being unable to give consent near the very end, despite the fact that was exactly what she wanted.
The Council of Canadian Academies identified three levels of advance requests: where an individual is already eligible for MAID, such as in the Audrey Parker case; where an individual has been diagnosed and is not yet eligible, but is on the path towards eligibility; and where someone has not yet been diagnosed, so is farther from eligibility for MAID. In this case we have identified a solution to one of those categories, but we ought to solve advance requests more broadly going forward.
Is the law perfect? No, but it is worthy of our support at second reading. However, there are a number of concerns worth highlighting.
First, while a reasonably foreseeable death is no longer a criterion of eligibility, there are additional hurdles for individuals to pass if their death is not within the near future. One of two practitioners assessing eligibility must have expertise in the condition. Although that sounds very reasonable in theory, my only question for committee members as they look at this is to ensure that is not an impossible barrier in practice, particularly for those in rural communities where such expertise may not exist at all times.
There is also a minimum, and I would say somewhat arbitrary, period of 90 days for the assessment of the request. It looks like a backdoor cooling-off period. It would make far more sense for us to have no time limit and the assessment to be done in the ordinary course, or at least a much shorter time period, because we are talking about people who are suffering incredibly and are competent to make the decision for themselves.
Does it cure the case for Audrey Parker? I think largely it does, but I worry that if the main procedure must be scheduled already, what does that mean? If Audrey Parker was in a situation to say, “I am not exactly sure what the time period will be. I know it is not now but I know it will be soon”, is she to have scheduled a particular date, which would make her eligible for the advance request, or are we going to put people in a situation where they are scheduling something earlier than they otherwise would?
Mental health is a real challenge because we are building an additional criterion into this legislation that says:
For the purposes of MAID eligibility, a mental illness is not a “serious and incurable illness, disease or disability”...
It sounds reasonable on its face in many ways, because we can immediately imagine a situation where mental illness impinges upon one's ability to give consent, impinges upon one's ability to conduct himself or herself as a competent person, but that is not always the case.
I am aware of some opposition from the Conservative benches. I am also aware of the number of Conservative MPs who come from Alberta. Therefore, want to quote a case from the Alberta Court of Appeal from 2016.
This is about a 58-year-old woman, identified as E.F., with severe conversion and psychogenic movement disorders.
The court wrote:
She suffers from involuntary muscle spasms that radiate from her face through the sides and top of her head and into her shoulders, causing her severe and constant pain and migraines. Her eyelid muscles have spasmed shut...Her digestive system is ineffective... She has significant trouble sleeping and...is non-ambulatory...While her condition is diagnosed as a psychiatric one, her capacity and her cognitive ability to make informed decisions, including providing consent to terminating her life, are unimpaired.
This woman was eligible to take advantage of MAID because we did not yet have an unconstitutional law in place to prevent her from accessing the regime. The Alberta Court of Appeal determined this woman was competent and was able to consent for herself. It noted further that she had consulted with her husband and adult children, who were all in support.
I worry that if we look at restricting mental illness completely, even if it does not impinge upon people's consent or their ability to conduct themselves as competent persons, we are telling those individuals that they are unable to make fundamental and deeply personal choices for themselves and that they have fewer rights than we do. That cannot possibly be right in this society.
This was a recurring problem for the justice department. When it argued the case of E.F. and lost at the Alberta Court of Appeal, it argued that the current criteria meant that terminal illness was required. The court said no. It argued that illness for a psychiatric condition should be deemed ineligible. Again, it lost in the Alberta Court of Appeal.
Therefore, if we are to respect the Carter decision and the precedent in case law since the Carter decision, I do not think we ought to have such a categorical exclusion in our law.
In Carter, the Supreme Court noted:
It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.
The Alberta Court of Appeal stated, “The cruelty in the situation is there regardless of whether the illness causing the suffering may be classified as terminal”, and certainly continues to be there regardless of whether the suffering has, as its primary focus, a psychiatric disorder.
As a final note on this subject, this law, if carried forward without an amendment, will treat mental illness as lesser than physical illness, a stigma we have worked hard to combat in other settings.
As I said previously, we have to tackle advance direct requests more seriously than we have in this legislation. I know there is an ability to have this broader conversation later this year, as we revisit this conversation. I certainly think if people are diagnosed with a condition and they can clearly see where it is heading, they should be able to determine their futures. I would want to, as a matter of my fundamental freedoms, be able to determine my future. Also, in directing our own futures, we ought to be able to provide advance requests more broadly and more easily, even if we have not been diagnosed.
I recognize the Council of Canadian Academies has identified that we need certainty. How do we provide certainty? Through sunset clauses. If we have not revisited and re-upped our commitment to our advance request within a certain period of time, then it would fall away. That would allow for certainty to take hold.
There are other things we could look to in the law, including mature minors, because minors have the ability to make life-changing decisions in medical contexts in other settings outside of MAID. However, in the end, this law needs to ensure that anyone eligible for MAID, pursuant to the Carter criteria, continues to be eligible for MAID through this law. It is a matter of fundamental freedoms and dignity in the end.
Madam Speaker, I will be sharing my time with my colleague from .
I am very happy to be taking part in this debate, which is a departure from our usual political and often partisan work as elected officials.
This is the third time in my parliamentary career that I have been asked to debate and vote on the issue of medical assistance in dying. I was a member of Quebec's National Assembly for seven years, and I have served here in the House of Commons since 2015 with the support of my constituents.
I was elected to the national assembly in 2008. As a member of that assembly, I participated in the first debate we had in Quebec on this issue, the first time in a Canadian legislature, in 2010.
I also was a participant in the debate we had four years ago in the House of Commons, when, for first time, we addressed the issue. Therefore, in my parliamentary life, this is the third time I will participate and vote on this very touchy, personal and non-partisan issue.
That is why I would like to remind the House of certain cardinal rules that should guide our actions as parliamentarians in this debate, which we believe should be totally non-partisan. Things may get tense at times, but debate must remain respectful.
Respecting the free vote should be one of the cardinal rules of this debate. In my view, there is no right or wrong position in this debate. There are only positions that we are comfortable with as human beings. Whether we are for or against, there is no partisan politics behind it. There is only the personal opinion that we hold, share and analyze.
Consequently, it is important to keep a completely open mind and respect the fact that certain colleagues from our own party may not share our point of view, while colleagues from other parties may. That is fine. There is nothing wrong with that, really. Some positions we adopt, and some positions we cannot be comfortable with. That is all.
We must respect the debate. We must respect personal opinions. We must respect the fact that there is no place for partisanship in this debate and that positions are neither right nor wrong. There are positions that we can agree with and others that we cannot. We must respect that.
There are also certain elements that we must bear in mind before we dive into this. In our opinion, the bill has some shortcomings.
First, we must respect the freedom of conscience of physicians who are called on to provide MAID. If a physician feels that they cannot in good conscience provide MAID, they should be able to say so and not have to proceed. I have spoken to many people in the context of this debate, in which I have been participating for a very long time. Everyone I have spoken to has told me that physicians can show a certain openness in some circumstances, but change their minds in others. Physicians should never be forced to act against their conscience.
Furthermore, we should always bear in mind that MAID, by its very nature, is the last level of health care that can be offered. We must never forget that the role of palliative care is to ensure that those who are ill can live with dignity even in tragic circumstances. Therefore, we must respect physicians' conscience and focus on palliative care.
Taking our time is another cardinal rule that must be respected in this type of debate.
Let me remind members that the first time this issue was addressed in Quebec, it took six full years, three different governments and three different premiers. There was a huge debate about it, a strong and wise debate. Each and every position had been clearly established by those people who participated in the debate. There is no rush. We must take our time.
For some people, we are talking about assisted suicide. It is a very touchy issue. The worst-case scenario is to rush it. Quebec spent six full years, and we should follow this example. It obviously will not take six years this time, but the first step took six full years.
Let's agree that this debate cannot be rushed.
Why are we debating Bill today?
When the House of Commons adopted Bill in 2016, I was a member of the committee that studied it. We knew then that Canadians would challenge parts of it and that there would be court rulings. That is exactly what happened on September 11, 2019, when the Quebec Superior Court struck down the notion of “reasonably foreseeable natural death” in the bill that became An Act to amend the Criminal Code and to make related amendments to other Acts regarding medical assistance in dying.
I did not know this before I looked it up, but it is interesting to note that the current Minister of Justice, a man for whom I have tremendous respect and esteem owing to his experience as a lawyer and a McGill University professor, voted against Bill C-14. Now, as Minister of Justice, he is sponsoring this bill as the federal government's response to the Quebec Superior Court's ruling. The bill addresses some of the issues but sets others aside.
The first fundamental element of Bill C-7 is that it eliminates the 10-day waiting period that the current law requires as a buffer between the person's decision and the operation itself, to ensure that the second opinion provided for under the act is in fact obtained. The court deemed this provision invalid, and the minister decided to accept that opinion.
Let's also not forget that the current law, which was passed four years ago, requires the provisions to be reviewed in just a few months, starting in June 2020.
The government decided to take note of the Superior Court of Québec ruling and act accordingly. That is its right. However, regardless of our views on the issue, we feel that this subject involves some truly fundamental questions and raises highly complex legal concerns. We think this ruling should have been appealed to the highest court in the land, so that the nine justices of the Supreme Court could study every possible ramification.
This bill sidesteps the issue of mental illness entirely. That is a very good thing, because in our view, it is extremely difficult to pinpoint the instant when a mental illness becomes irreversible, which can raise doubts about whether consent was given fully and freely.
As I said earlier, the worst thing we could do in this matter is move too fast. There is no rush. This concern may eventually be debated, but for now, let's take it one step at a time.
Since my time is almost up, I would just like to say that in this debate on such a delicate, sensitive issue, the worst thing we could do is plough full steam ahead and attack people's convictions instead of respecting their choices. Let's take the time to do things right on this extremely delicate and extremely important issue.
Madam Speaker, Bill , an act to amend the Criminal Code in relation to medical assistance in dying, is one that I believe was written with the intention of providing compassion to those who are suffering through an unfathomable, unbearable degree of pain by allowing a lawful, expedited termination of their suffering and granting access to a dignified death. The intention is kind. I see an urgency from the government to extend this expression of compassion to those who are suffering beyond comprehension.
However, from the perspective of a visionary and a lawmaker who cares for the long-term wellness and prosperity of our country, I would like to invite all members of the House to pause and bring into our dialogue the long-term effect of this bill and the impact of this bill on the guiding principles of lawmaking going forward.
I do not stand to speak on this bill with the moral authority of one who has reached a point of suffering equal to those who may be applying for MAID. I do not think most members of the House here have the personal experience to speak on that level. However, I do stand here to speak on this issue because there has been a force in my life that carried me through some very dark nights of the soul when adversity, pain and repeated cycles of injustice were poignant enough to wear down my will to fight and to try, sometimes causing me to question the value of my existence.
I have seen this force raise addicts, cancer patients and those experiencing deep depression from deep pits of psychological paralysis and darkness. This force transcends the distinctions of race, gender, socio-economic background, etc. It is almost as vital as life itself. It is a force that is central to the existence of the human race, and that force is called “hope”. While hope is easier to access for some than others, for others it may be almost impossible, because their painful experience is choking the light from their vision.
As caring individuals, as communities and as a nation that prides itself on compassion, it is our duty to turn over every stone to help others find hope when they can no longer access it themselves. Hope is a journey that demands an unrelenting search until it is found.
We saw it with Terry Fox. He is a national symbol of hope, because despite his painful struggle with cancer, he made the sacrifice he made with his cross-country campaign for cancer research because he was in search of hope and giving that hope to others. The story of his triumph over adversity, though his life was tragically truncated at such a young age, still continues to champion Canadians today, as Canadians respond by revering him as a national hero, because we value hope. We have seen the power of hope that compelled Terry to pass the finish line of his last breath.
We see hope whenever we see Team Canada send our Paralympians to the Olympics. Many of them have overcome deep physical, emotional and mental suffering. Their focus, discipline and excellence have helped them to overcome their challenges.
Our nation is built on a foundation that values the sustenance of life and the right to prosper. We invest millions of dollars every year in first responders, medical services, infrastructure and laws to protect the survival, sustenance and prosperity of the people.
However, expediting the administration of death is counterintuitive to the inner reach for hope in the human condition. Our very Constitution is founded on the principles of the value of human life, the prosperity of each human being and each one's access to the opportunity to flourish.
While deep with the intentions of compassion and the appropriation of dignity, intervening with easier access to MAID opens a door to a very complicated path of further suffering, even for those who live on.
I would like to bring to the attention of the House the story of a man named Alan Nichols, from my province of British Columbia. As reported by CTV this past September, his family has stressed that Alan struggled with depression and should not have qualified for assisted death.
Alan's brother Gary told CTV:
He didn't have a life-threatening disease. He was capable of getting around. He was capable of doing almost anything that you had to do to survive.
Like many Canadians, Alan's life was altered dramatically when his father passed away. Especially since his father had been so involved in his life, his father's death made him particularly vulnerable, and he stopped taking antidepressants and became more angry and isolated:
Not going out in public, not seeing anybody, not eating properly.
This is how Gary described it.
Alan's family knows that he rid his home of furniture, apart from a bed and chair, and that he would refuse medication and food because of his depression. Another disturbing aspect to Alan's story is that despite his family's attempts to be involved in his life and an advocate for his life, his family members report that the hospital staff would not share information with them and shut them out from hearing the key facts.
There is more to this story, but I will leave it at that. This is accessible information.
The point I would like to illustrate here is that this is a very complicated issue. It is one that touches something so deep and necessary to our existence and our country, and that is hope. All because of the irreversibility of death, there is little intervention that can be done afterward when hope is terminated because there is no breath to receive the assistance of hope.
Rather than be in a rush to legislate this bill, we should focus on tackling things like the epidemic of suicide among first nations communities and youth. We should also focus on giving Canadians better access to mental health care so Canadians have greater access to hope when faced with situations of suffering, as people who are suffering so much consider MAID. We must do this until there are enough measures to show the flourishing of hope and human prosperity to counter a potential culture of death from capturing our nation, if we are to be too swift and lenient in our decisions surrounding issues of death.
It pains me to watch others suffer, but it also pains me to think that as lawmakers, our focus is on expediting access to death rather than expediting access to hope.
My statement in the House today is to inspire all members of this House to not only consider the dignity of the people suffering seeking release through death, but the dignity of existence and human prosperity for the long term.
Removing the mandatory 10-day waiting period reduces protections for vulnerable members of society. The government's original legislation, Bill , went through extensive consultation. It is scheduled for parliamentary review this summer. I would ask the Liberal government to respect the process and allow the review to proceed rather than rush this very sensitive and complex issue in legislation. Let us give this time because death is irreversible.
I have decided to look at this bill through a filter of hope and preserving a culture of hope, as being a force that guides the laws we make not only today but for decades and centuries to come. Therefore, I stand today in the name of hope and invite my colleagues across all aisles to examine this bill through the lenses of hope and preserving hope in our country.
Madam Speaker, I rise today to address a very important piece of legislation. Looking at it, I could not help but reflect on the previous debates that we had and the process in the development of Bill , which led us to the point where we are today.
If members who were not here want to get a good sense of how thorough the debate and discussions were, I recommend they take a look at some of the comments in the standing committees, the many lead-up discussions, different presentations and the pre-study that was conducted.
I enjoyed listening to the debates then, because like the member who just spoke said, we heard a lot of personal stories. When people ask me what I enjoy about being in the chamber, it is the different types of debates that we have. These are the ones, like the debate today, that I learn from. I appreciate the stories that come before the House.
We are all concerned about protecting vulnerable individuals in our society. At the same time, it is important as legislators to have a role to support the eligible person to be able to seek medical assistance in dying. It is a very difficult issue.
A good number of us felt with the passing of Bill that we had something that would move us forward. Even during the height of that discussion, there was a feeling that in a number of years we should review it and take a look at what has transpired in the previous years. We are quickly getting to that point.
However, last September, a Superior Court in Quebec made a determination. Members of the Conservative Party say maybe we should have appealed that decision. I respect that opinion. I do not necessarily believe that would have been the best direction for the government. The direction we have chosen is to make changes to the legislation now, in the hope that we will better serve Canadians.
Having said that, once we get into the summer months, there is going to be a great deal of discussion because it is mandated. When I think of the Bill debate, and I will provide some personal thoughts on the issue of palliative care, I would like to see us talk about the issue of mental illness. I am hoping that, when we do that comprehensive review, we incorporate that along with palliative care.
I am sure I am not unique and that all 338 members would concur when we think of health care in Canada, there are a couple of issues at our doors: the issue of mental health care services and palliative care services. I used to be the health care critic 15 years ago in Manitoba. We did not have the same sort of dialogue that we hear in the last number of years on those two critically important issues.
British Columbia many years ago elevated the issue of mental illness and made it a separate ministry. There was a minister of health and a minister of mental health illnesses.
I say that because, more and more, provinces are aware of the issue and the importance of mental illness. The Government of Canada has invested hundreds of millions of dollars over the last number of years, and continues to invest in mental illness and palliative care across the country. We are on a very strong footing when we look at where we are today.
We need to reflect on what brought us here. There were many consultations: literally thousands of people were engaged and many hours of debate and dialogue took place. It could have been in the thousands of hours. I do not know that for a fact, but I am sure that, between the time committees met on second reading of Bill , the amount of consultation with Canadians in all regions of the country and the responses received via all sorts of mediums, hundreds of thousands of Canadians in all regions of our country were able to weigh in on this issue.
If we advance to January of this year, again there were consultations and round tables that took us to the different regions of Canada. There was the survey that has been referenced already today on several occasions. Approximately 300,000 Canadians were engaged in that particular survey at the beginning of the year. I do not know if all of the results have gone public to date, but I trust the individuals who helped formulate the legislation we are debating today did their homework in terms of consultations and incorporating all of the ideas. I know the Department of Justice and the Department of Health are following this debate and listening to what members have to say.
From a personal perspective, based on experiences I have garnered over the years, there are two concerns I want to express. One is with regard to health care services and the other deals with the legislation itself. Let me expand on both points.
If we were to ask Canadians what makes them feel good about being Canadian, we would often hear our health care services. I suspect this is probably number one. I referenced mental illness and palliative care. I have witnessed first-hand the evolution of palliative care.
My grandmother was in the St. Boniface Hospital, and many hospitals in our country have palliative care sections. Many of them panel seniors, in particular, who cannot get the quality care necessary in personal care home facilities or the supports they need in their communities and in their homes, so they end up going into hospitals and are panelled.
Many of them will go into palliative care because there are no designated palliative care units in health care facilities, so they end up in hospitals. My grandmother was one of them. She had terminal cancer, and we watched as the weeks went by. Family members visited and it was very difficult on them.
We had a very special relationship, as we all do with our grandparents. Many of us wondered why she had to be in a hospital. Even though it was kind of sectioned off from the emergency department and other aspects of the hospital, she was still in a hospital. It is a different type of a situation, and not necessarily the most comfortable.
Ultimately, my grandmother passed. Then, a number of years later, I had the personal experience of being there for my father in the days prior to his passing. He had to go from home into a hospital, and we were very fortunate that we were able to get him into the Riverview Health Centre. In that centre, with its large windows and beautiful atmosphere, you get the feeling that the type of care is very different.
I reflect on that. I was there at the moment of my father's passing, and we had discussions a number of days prior when he was in fear of what was going to happen, because he witnessed what had taken place with his mother, my grandma, at the St. Boniface Hospital. He did not have that choice, but we talked about having that choice.
I think, knowing my father, he would have been very happy with the way in which he ultimately passed. I really attribute it to his world-class treatment at that particular facility, and I kind of wish that my grandmother had the same sort of atmosphere. Not to take away from the fantastic work that those health care providers and others did at the St. Boniface Hospital, but it was a totally different atmosphere.
During the Bill debate, we heard many stories like the one we just heard from the member opposite. They are very touching, they are compelling and they make us ask what we can do here in Ottawa to ensure that we have the best quality of health care services we can possibly provide.
It is one of the reasons I am very passionate on the issue of the national framework. It does not have to be a system where we have one thing in British Columbia and another in Atlantic Canada or in the province of Quebec, or in provinces that do not have the same economic means or the same sort of treasury to provide the type of service that they should. This is where the national government has a role to play.
When I listen to comments inside the House with regard to where we might want to go from here, or very serious concerns about the current legislation, I would suggest that we reflect on what we are going to be able to potentially do in the coming months, when we have the opportunity.
Unlike in the Manitoba legislature, our standing committees can be exceptionally effective. It is truly amazing, the type of authority, ability and participation that we can witness if we are prepared to park our partisan hats at the door and try to do what is best for Canadians on this issue. If we can take a look at what took place, with regard to , there is absolutely no doubt in my mind that we can do that.
If members listened to the previous speaker, they would get a sense of what was taking place when we had the debates on . Whether it is in the health standing committee or whatever it is that we come up with collectively, with representation from all the parties, I would encourage them to take into consideration the possibility of going outside of Ottawa.
Maybe we should look at different regions and see what some of these other provinces are doing, and maybe tour some of the palliative care facilities. There is a great variance.
We need to look. If I reflect on the province of Manitoba, we should take a look at what is happening in Winkler, Flin Flon or Winnipeg. We should take a look at the difference between Riverview Health Centre and what takes place in the Seven Oaks hospital.
Where, and what role, can we play as a national government to ensure that we are maximizing the benefits of providing the type of palliative care that Canadians expect and deserve, given the limitations that we actually have? Only the national government can do that. I suggest it is going to be in a very important role.
Earlier today, the standing committee on trade tabled the CUSMA deal, the trade agreement between Canada, the United States and Mexico. Many of the members were taking pictures of that particular committee, feeling very positive in terms of what they had been able to accomplish.
My challenge to the health committee, if that is going to be the standing committee, is to take that role very seriously in terms of the potentially life-changing report it could produce for Canadians.
I truly believe that the will is there to support what that committee is hoping to accomplish. It is just as significant as, and maybe even more important than, the report tabled today by the trade committee, which from what I understand was supported unanimously by all members of the House. If one listens to the speeches thus far, I do not think anyone would dispute what I said in regard to it.
I really encourage the standing committee, in the strongest way I can, to look at the mental illness issue using the same principles I talked about regarding palliative care. It is such a critically important issue, and Ottawa needs to play a stronger national leadership role on that. Hopefully that will happen, but because of time I am only going to highlight a few very brief points.
The proposed amendments would allow for a waiver of final consent for persons whose natural death is reasonably foreseeable, in the sense that they have been assessed and approved to receive medical assistance in dying, and have made arrangements with their practitioners for a waiver of final consent in certain situations because they were at risk of losing decision-making capacity by their chosen date to receive MAID.
I also want to highlight that the government is very aware of the concerns about the increased risks when MAID is provided to persons who are not dying in the short term. The bill, therefore, proposes additional safeguards that would apply when a person's natural death is not reasonably foreseeable.
These new safeguards aim to ensure that sufficient time and expertise are devoted to exploring requests for MAID from persons whose natural death is not reasonably foreseeable and that such people are made aware of, and seriously consider, available means for relieving their suffering.
There is another really important part to me, but maybe I will do it in the question-and-answer period.
Madam Speaker, I will be sharing my time with my very esteemed colleague from .
The debate we are having today must be handled with restraint, dignity and composure. Partisanship has no place here. This is a serious matter, and our decision will have significant repercussions on the lives of many, and perhaps even on our own lives one day, because we all have to leave this world sometime. It is inevitable.
The sad thing in all this is that, through decisions made in this very Parliament, our society has forced people who are suffering to suffer even more. People with severe medical conditions were forced to appeal to the justice system to have their most basic rights upheld. Worse yet, some had to go on a hunger strike to get access to medical assistance in dying by meeting the reasonably foreseeable death requirement. Do hon. members have any idea what we have asked these suffering patients to endure?
These long-suffering people coping with illness, trying to get through the day in unspeakable physical and psychological agony, were forced to go to court or put themselves in a position where their death was reasonably foreseeable. Everyone knows that the justice system is backed up. The costs and delays are typically unreasonable. These people had to endure a veritable ordeal because we made a decision for them.
We failed to make informed decisions that upheld individual liberty. It is a huge privilege to sit in this House, and with that privilege come serious responsibilities. We must honour our position. I want all members of the House to know that this time, we cannot fail. Courageous patients have had to fight the system to get us to make a wise, informed decision. The Superior Court of Québec gave very clear directives. We must have the courage and vision to apply these directives and support this bill in principle, because it deserves to be improved in committee.
The Baudouin decision in favour of Nicole Gladu and Jean Truchon is very clear: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu's rights to liberty and security, protected by section 7 of the Charter.”
We must read those last few lines carefully. They refer to the rights to life and freedom of choice. Which of us can presume to choose for someone else? I want to warn my colleagues against the temptation to think about themselves. I want to warn them against voting according to their own beliefs, philosophies or religion. Freedom to choose must be upheld, and in order to choose, we need options. The basis of the decision, which came after a very long wait and constant anguish, makes it very clear that this is about rights and freedoms. No one can choose for another person. We must remove the barriers so that everyone can live out their last moments in their own way, freely and without constraint. Of course, we must not fail to protect the most vulnerable, in accordance with the well-established rule, in medical practice, of free and informed consent. That means informed by exposure to all possible options, and free from any undue pressure.
This bill is a step in the right direction. It includes important precautionary measures and provides for the study of other important issues that need to be considered. Among other things, it would exclude people suffering solely from mental illness. I think that is a wise decision. This is an extremely complex issue that should be studied further. We cannot decide on this issue right now, hence the need to study it properly without skipping any steps.
We must also look at the issue of advance requests for persons newly diagnosed with a condition that may have an impact on their decision-making ability in the future. These are extremely sensitive issues that we must study with great care and a great deal of precaution. It is therefore wise not to include them for now.
Generally speaking, the purpose of this bill is to allow those suffering from degenerative, incurable diseases to have access to medical assistance in dying, whether natural death is reasonably foreseeable or not, except in cases of degenerative cognitive disease, as I was just saying.
For people whose death is reasonably foreseeable, this is about relaxing the rules by eliminating the 10-day waiting period between the written request and the administration of MAID. The 10-day waiting period may be waived if a person has been assessed and their request for MAID has been approved and arrangements have been made with their practitioner to obtain a waiver of final consent because the patient is at risk of losing their capacity to make a decision as the disease progresses or with the administration of pain-relief medication. That way, when making the request for MAID, the patient can agree to waive consent the second time if their pain is beyond treatment, even with care.
This last measure allows the person to live longer with a reasonable quality of life. The person therefore does not have to feel like they have to rush to request MAID out of fear of losing their capacity to do so.
For people whose death is not reasonably foreseeable, there is a 90-day delay between the request and the provision of the MAID service, unless assessments have been made and the loss of capacity is imminent. This time period must therefore be applied in a reasonable and reasoned manner. Who among us can guarantee that 90 days will be enough for some? Who among us can say whether 90 days will be too long a hell to endure for others? We are entitled to question the application of this delay. No one can say. That is why this clause and this entire bill will have to be implemented in a sensible, flexible and intelligent way. Practitioners are in the best position to determine what is valid and what is not when they work together with their patients, listen to them and, of course, treat them humanely. Ultimately, the priority must be the patients themselves, their well-being and their dignity.
I remind all members that although we are talking about dignity, this is above all about rights and freedoms. Every person at end of life must have options, and that individual is the only one who should be able to make that choice. We must not impose our own values and opinions. We must simply ensure that we provide a suitable framework regulating the practice of and the right to medical assistance in dying. We must respect the freedom of the individual. That is fundamental.
I urge all parliamentarians in the House to consider the huge responsibility we must shoulder. We hold in our hands the fate of hundreds of thousands of people. Not only is the end-of-life suffering of these people in our hands, but the suffering and anguish of their family members is as well. It is horrific to watch a loved one suffer at end of life and to feel helpless. Some members of the House may be thinking about personal choices. As I mentioned earlier, we need to figure out a reasonable framework for this very complex act and, through all of this, maintain freedom of choice for these individuals.
Madam Speaker, it is with great humility that I rise in the House today to speak to Bill , an act to amend the Criminal Code with regard to medical assistance in dying.
Many MPs have very personal stories about the end of life of one of their loved ones. As the Bloc Québécois critic for seniors, it goes without saying that I have heard my share. Therefore, in my speech, I will recall the work done by the Bloc on this issue, the sensitivity that exists in Quebec regarding medical assistance in dying and, finally, the position of certain groups of seniors and women who have come to meet with me.
First, let me go over the context again. In September 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, both suffering from a serious degenerative disease, stating that one of the eligibility criteria for medical assistance in dying is too restrictive. This criterion, that of “reasonably foreseeable natural death”, is found in the federal government's Act to amend the Criminal Code and to make related amendments to other Acts with regard to medical assistance in dying, and the provincial government's Act respecting end-of-life care.
Justice Christine Baudouin said it well in her ruling when she wrote: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.” Those two individuals had argued that they were being denied medical assistance in dying because their deaths were not imminent.
Let me now remind the House of the Bloc Québécois's position and highlight the outstanding work of the member for , to whom I offer my deepest sympathies. I want to thank him for the work he has done on this file because, as he quite rightly pointed out, legislators did not do their job properly with Bill . As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. That would be terrible, and yet that is what will happen if we cannot figure out a way to cover degenerative cognitive diseases.
However, we believe that it is important to be very cautious before making any decisions on questions related to mental health. That is why we are relieved that the bill does not address eligibility for MAID for individuals suffering solely from a mental illness. Indeed, this issue requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.
For the second part of my speech, I would like to talk about Quebec's sentiments on this whole issue. Quebec was the first jurisdiction in Canada to pass legislation on medical assistance in dying. Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada.
Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada.
In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:
Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009....I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.
For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared with me its concerns with MAID. I will quote the AFEAS 2018-19 issue guide:
Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....This process cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.
Many people are not eligible for MAID because of the federal law governing the practice, which was imposed by a court ruling in February 2015. Four years after Carter, individuals whose quality of life is severely compromised by degenerative diseases are still being forced to ask the courts for permission to end their suffering.
In February 2015, the Supreme Court even struck down two sections of the Criminal Code prohibiting Canadian doctors from administering MAID. In Carter, the highest court in the land stated that a competent adult who clearly consents to the termination of life is eligible for MAID if that person “has a grievous and irremediable medical condition...that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”
According to the AFEAS, the Supreme Court's criteria were very broad. In drafting the MAID eligibility criteria, the Government of Canada included the concept of reasonably foreseeable natural death only for people at the end of life, which excludes a significant number of people who are experiencing intolerable physical and mental suffering.
The entire process is based on the intensity of the suffering as assessed by a doctor and a panel of experts. The sick person's own assessment is not always taken into account. There are no compassionate criteria among the requirements for obtaining MAID. A person may be at the end of their life and be unable to make the request themselves because they cannot communicate. The law applies only to people who are able to give their free and informed consent up until the very end, which could be terribly traumatic and even cruel to those who have been suffering for years.
With regard to advance consent, the AFEAS spoke about the case of Audrey Parker, a woman from Halifax who died with medical assistance on November 1, 2018. She made a video three days before her death. In that three-minute video, she said that she would like nothing more than to make it to Christmas, but that if she became incompetent along the way, she would lose out on her choice of a beautiful, peaceful and, best of all, pain-free death.
The Barreau du Québec believes that the law should be amended to comply with the criteria set out in Carter and thus prevent court challenges from being filed by people who should not have to carry such a burden.
A panel of experts has studied this issue and recommends, under certain conditions, ending the suffering of patients who have previously expressed their wish to receive medical assistance in dying, but who subsequently become incapable of expressing their consent, in particular people with various forms of dementia or cognitive loss such as Alzheimer's disease. This is why AFEAS is asking, with respect to human rights, that the process of medical assistance in dying be based more on the rights of individuals and on respect for their wishes.
With respect to reasonably foreseeable natural death, it requested that the reference to “reasonably foreseeable natural death” be removed from the eligibility criteria. With respect to advance consent, it asked that the person's informed consent be respected and that it be given in advance. Also on the subject of advance consent, it asked that the consent anticipated, stated and recorded by the person be recognized.
In conclusion, today's debate demonstrates the need to act so that people suffering from degenerative and incurable diseases are no longer forced to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying, and so that we can ensure the best possible continuum of care.
Let's take action so that everyone can die with dignity.
Madam Speaker, I will be sharing my time with the hon. member for .
I want to start by saying that this subject is no doubt difficult for many Canadians watching. It is one in which we try to reconcile our deeply held view that life is precious with the right to liberty and the right to make our own independent decisions. This is a place where parliamentarians need to reflect not only on our own values but on what our courts have said.
In the Carter decision, the Supreme Court determined that section 7 of the charter meant that our provisions in the Criminal Code on assisted suicide were invalid. It said there was a class of people who were entitled to have doctors and nurses assist them in dying, so in 2016, Parliament had to move forward with legislation.
I had the pleasure of being the chair of the Standing Committee on Justice and Human Rights at the time. I listened to witnesses who had a myriad of opinions. I listened to professionals from all sides, including doctors, nurses, psychologists, people representing the disabled, and groups that advocated the right to die with dignity. What we crafted was a law that attempted to bridge all of those gaps. We knew that this law would not be in place forever. We knew that we, as a society and a country, would learn from the experiences of that law and that we would move forward with changes.
Indeed, I was very pleased that the Standing Committee on Justice and Human Rights made some significant changes to the legislation. We carved out conscience protection for medical professionals so that they were not obliged to assist with medical assistance in dying if it violated their own conscience or their moral values. We said that the law needed to be looked at again five years later to look at various classes of people we had left out of the original law, such as mature minors and people suffering from mental illness, as well as to examine the issue of advance directives whereby people could make decisions before they declined into dementia.
We also required the review to look at palliative care and its availability across Canada, because the two issues are intrinsically tied together. We do not want people to ever make a decision that they need medically assisted death because they will be deprived of proper palliative care.
That review is coming up. I know that Canadians across the country will have the opportunity to pronounce on these issues.
However, our courts have made another decision.
In the Truchon-Gladu ruling in Quebec, the court ruled that a class of people were entitled to access medical assistance in dying in accordance with Carter. The legislation passed in 2016 had removed this class of people from the list of people eligible for medical assistance in dying. We must therefore remove the section that limits medical assistance in dying to people whose death is reasonably foreseeable. This amendment to the original law is designed to remove this class of people and to enable people who meet all of the other criteria to access medical assistance in dying, even if their death is not reasonably foreseeable.
I support that position because I have not only looked at the court decisions but have also walked the experience of Canadians over the last four years.
We have heard of people who were enduring grave suffering and who should have been entitled to medical assistance in dying because they met every aspect of the law, except that no one could say with reasonable certainty that their death would happen in the near future. We heard, from Canadians everywhere in Canada who fall under that class, that this is unfair. The courts in the Truchon case and in a number of other cases have hinted that this requirement is unconstitutional, so the government is moving forward to respect the court's decision in Truchon and remove from the law the requirement for death to be reasonably foreseeable.
However, the government is also adapting the law to deal with other difficulties that have arisen.
We never talked about, or if we did, it was rare, the issue of people deciding to prematurely end their lives because they were worried they would lose capacity at a future date. People should not shorten their lives because they are worried that a month later they will no longer have the capability or capacity to make that decision under the terms of the law. If it will give people an extra two or three weeks or an extra month with their family, we should do that.
Therefore, the law is being amended to allow people to offer consent to a medically assisted death even if they lose capacity, but it also establishes safeguards. In the event they get to that date and they no longer wish to have medically assisted dying, even if they have lost capacity, by any word, any gesture that is not involuntary, then the pre-consent will disappear.
I want to clarify this, because it has been talked about a great deal today. This is not an advance directive. These are people who already know exactly what their illness is, they are already suffering from this illness, they are in an advanced state of decline, they have no ability to relieve their pain by medical treatment reasonably accessible to them and they have, after being reviewed by two medical professionals and declaring before an independent witness, decided they want to offer consent to end their lives on a certain date, even if they have lost the capacity to consent.
This is a really important change, and I credit the government for doing so.
I also want to look at the issue of how we have handled that class of people whose death is not reasonably foreseeable. We have established a 90-day waiting period in that case. We have not made this something that could happen in the 10 days that was previously reflected under the law. We have done so with due seriousness. We understand the differences and the challenges that the issue poses for people when their death is not imminent.
For example, people could have a catastrophic event that occurs and their circumstances change suddenly. We want them to have a proper reflection period before moving forward with medically assisted dying. We also understand and have made the exception for those people who may lose the capacity to consent during that 90-day period.
The amendments to the bill reflect well where Canadian society has gone.
I do want to say that when we passed the legislation in 2016, very few jurisdictions around the world allowed medical assistance in dying. It existed in Belgium, the Netherlands, Uruguay and five or six U.S. states.
We were one of the first countries in the world to allow medical assistance in dying. For that reason, we chose to take things slowly.
This new amendment to the original law takes us to a place where Canadian society has moved. Canadian society, much more than in 2016, accepts and supports medically assisted dying, because they have watched the practice happen. We have seen the challenges we have confronted with the existing law and we have taken steps to improve the law and comply with the Truchon decision.
Madam Speaker, I am pleased to rise on the topic of Bill , as we embark on what I expect will be quite a lively and passionate discussion about issues that Canadians care deeply about and certainly my Pontiac constituents. I heard from them for several years on this topic, regular correspondence, regular discussions at the door, so I appreciate this opportunity to discuss certain aspects of our government's proposed changes to the federal MAID legislation.
It is timely to share some of the insights from three important studies on very complex and sensitive issues that were not included in the 2016 federal legislation. These are requests by people for whom mental illness is their sole underlying medical condition, advance requests and requests by mature minors. I hope we will get to all three of them, but may only get to the first two.
When Bill was debated in 2016, parliamentarians had difficulty finding common ground on how to address these types of requests within Canada's first assisted dying regime. Understandably, given the challenging nature of these issues and the limited time that was available, due to the Supreme Court's timeline, to deliver on acceptable approaches for Canada, parliamentarians collectively decided that more in-depth study and review of the evidence was needed.
The legislation in 2016 therefore included requirements for the government to undertake independent reviews. There were strict timelines set out in Bill and the studies that needed to be commissioned had to be done within six months of the coming into force of Canada's new legislation on assisted dying and the government was obliged to table the final reports on the studies within a further two years. Both of these timelines were met.
In December 2016, the government asked the Council of Canadian Academies, CCA, an independent organization that undertakes evidence-based expert study, to inform our public policy development and to take on these studies that were required by legislation. The resulting reports were tabled in December 2018, documenting extensive review of academic and policy research, stakeholder submissions and international experience in the three subject areas.
They also included a broad range of perspectives from relevant health care professions, diverse academic disciplines, advocacy groups, indigenous elders, essentially the whole of Canadian perspective was brought to bear. In accordance with the CCA practice, they did not in fact contain recommendations.
Two of the reports, one on request by individuals where mental illness is the sole underlying condition and the report on advance requests have been particularly informative during the development of our government's response to the Quebec's Superior Court decision in Truchon.
I will first talk about mental illness. Under the current law, very few persons with mental illness as the primary source of their suffering are likely to be eligible for MAID. This is because most mental illnesses do not cause a person's natural death to be reasonably foreseeable.
Removing the reasonably foreseeable natural death criterion introduces the possibility for persons with mental illness to be deemed eligible for MAID, if they meet the remaining criteria.
During the recent federal round-table consultations held on MAID, we heard many concerns from participants who felt that not enough is known to safely extend eligibility for MAID to people whose suffering is caused by a mental illness alone. They felt that the issue required further examination.
We also know that there is generally very little support for expanding eligibility among mental health care practitioners, such as psychiatrists and psychologists, and by organizations representing people with mental illness. The CCA report on this issue noted a number of challenges associated with the delivery of MAID to persons with a mental illness.