The House resumed from October 19 consideration of the motion that Bill , be read the second time and referred to a committee.
Mr. Speaker, it is an honour to virtually join the debate in the House of Commons and participate in the second reading debate on Bill , an act to amend the Criminal Code, medical assistance in dying.
I will take a moment to speak to the progress that our government has made with respect to the rights of persons with disabilities in Canada.
Last year, we 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 advancements in disability rights since the charter in 1982 and it is designed to inspire a cultural transformation toward disability inclusion and accessibility in Canada. The act created Accessibility Standards Canada, an organization that will create and revise accessibility standards and support and promote innovative accessibility research. The CEO and board of directors were appointed and the 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.
Our government is taking real action to address the rights of persons with a disability. The careful writing of Bill is a testament to that. Representatives of disability organizations and leading disability scholars participated in consultations across the country and their input informed the reforms proposed in this bill.
We recognize that disability inclusion requires more than legislation and that is why we are continuing to work with the disability community and stakeholders to address stigma and bias. It is important to bring about cultural change to ensure that the important contributions made to Canada by persons with a disability are recognized and valued on the same basis as other Canadians.
Going forward, we will continue to focus on improving the social and economic inclusion of persons with a disability. This means moving forward with our commitment to build on the progress we have made over the past months and years with the development of a disability inclusion plan. This disability inclusion plan would include important initiatives like a new Canadian disability benefit modelled after the GIS for seniors, a robust employment strategy for Canadians with disabilities and a better process to determine eligibility for government programs and benefits. We all benefit when everyone can participate equally in our economy and society.
We will continue to work hard to ensure that every person in Canada is treated with the dignity and respect they deserve, especially when it comes to the deep and personal issue; that is ending one's life. It is imperative that the voices of all Canadians, including persons with a disability, continue to be heard on the issue of medical assistance in dying.
Madam Speaker, it has been said the character of a nation is revealed in how it treats its most vulnerable citizens. It is my priority to ensure that this type of legislation has the proper safeguards to protect the most vulnerable in our society, like our seniors and those with disabilities. Throughout COVID-19 we are learning of more and more persons with disabilities who are considering MAID as an option due to the increased economic challenges they are facing, as well as the increased social isolation that has arisen, as a result of COVID.
There also must be proper safeguards for the conscience rights of physicians and allied health professionals. The key principle of any democracy is freedom of belief and conscience, the freedom to be able to hold those beliefs, practise those beliefs and carry out in one's life what one feels is a true reflection of those beliefs, without impediment.
We have a responsibility as parliamentarians to make sure we get this legislation right. From the beginning, the federal government should have appealed to the Supreme Court, so that there could be certainty on the framework within which Parliament can legislate. Sadly, it did not and as a result there are still many questions surrounding this legislation.
There are many things we can talk about when it comes to an issue as sensitive as this, a bill that affects the lives of many Canadians and people throughout our country, many of whom are in situations where they find themselves struggling to cope or to handle a circumstance that has put them in a very vulnerable state. I feel that we as parliamentarians need to measure all options on this and be extremely cautious because of the ramifications this type of legislation can have, and not just now but for many years to come.
This issue is near and dear to my heart because of my background. I worked for many years in the private sector and spent some time working with vulnerable populations, people who have faced the tremendous challenges that can arise when they are battling mental health related issues, such as depression and anxiety. I have seen people who have had battles with addictions and considered taking drastic measures to somehow end the suffering they were going through at that time. I recall one particular instance, which I would like to share with the House today, that had a huge impact on my life and really informs some of what I would like to talk about here this afternoon.
I will never forget the day. I was called by a local police force in our region to get to the bridge in our local community as quickly as I could. At that time, my wife was visiting a friend of hers who had just had a baby in the hospital, and I happened to be out in the vehicle with our youngest child who was sleeping in the car seat. I told the officer that my wife was at the hospital and that I did not know what room she was in. I said that I did not know how to get to her and that I had an infant child with me, and I asked if he could help me. He said he would be right there and stay with my child, and the other officer would take me to the bridge.
Of course, immediately my heart started to pump and I felt the emotion of it. With my background, I said a quick prayer, hoping things would turn out okay. We rushed down to the bridge in our community. The traffic was backed up on both sides. I got out of the police car and ran up onto the bridge. Search and rescue was there in the water, and a lot of police officers were on the scene. There was the young lady, standing on the outside of the railing and clinging to a lamppost.
She was waiting there, because she wanted to tell me the things she wanted me to say to her parents and to her infant child. Of course, I was scrambling, trying to come with anything to say to dissuade her. As she told her story, I was holding her hand and trying to dissuade her from making the decision to jump. She told me what she wanted me to tell her mom and dad and her little girl, and I told her that she did not have to do this and that she could talk with them. I told her that her little girl needed her and that her parents loved her. I was doing all the things I could think of.
I will never forget. She looked me straight in the eye. She let go of my hand and said, “Thanks for doing this, Richard. Goodbye.” Then she jumped.
Immediately, everything flashed in front of me. I wondered if I could have said something different. I was very emotional at the time.
Thankfully, when she hit the water, the search and rescue teams had enough time to be in place so that when she emerged from her plunge, they were able to pull her out of the water and get her to the hospital. I am glad to say that she is on the road to recovery. She came through it. Even though her journey from that point has not always been easy, I am glad to report that, several years later, she is still with us. Now she is impacting many people's lives for the better. She is helping other young women who have found themselves in desperate situations and struggling with addictions and health related issues. She is helping to provide an example of hope.
I share that story, because I believe it is so important that we do everything we can to make sure we build in all the safeguards possible and all the bridges possible to allow people to make the choice of life and to choose to keep going, even in the midst of adversity, even when things look hopeless and even when things look like they cannot turn around. Some of the best stories that have ever been written, some of the most inspiring songs that have ever been sung, some of the best writings that have inspired generations were written from very dark places, places where shadows run deep. They have come from people who have literally walked through the valley of the shadow of death and came out on the other side.
I would encourage the House to do everything possible to put those safeguards in place and to make sure we do everything we can to foster an atmosphere where people who are in vulnerable places can be inspired towards hope and realize that they are not alone. All the adequate supports should be there with a full range of options for those in desperate times.
I am thankful for the opportunity to share that story today. I hope it encourages all of us to reflect and take the time to seriously consider the bill before us and to ensure that we put every safeguard possible in the bill.
Madam Speaker, I am really pleased to speak to this bill, Bill , in its current form, mostly because I did not support the original bill, Bill , from four years ago. I did not support it because I felt that it did not reflect the intent of the Supreme Court of Canada's ruling in Carter. I also felt, as a family physician who practised medicine for 20 years, that it did not act in the best interest of my patients.
As a family physician, I walked with my patients through many things: through the joys of having a baby, of giving birth and of marriage, but also through the difficult, challenging and painful times when they struggled with excruciating incurable diseases and with knowing they were going to die because of a terminal illness. They had to work with their families, who may or may not have wanted them to go through with this. I held their hand and walked with them, so this bill has a very personal meaning. That is why I am pleased to speak to it now.
I like the bill in this form in many ways, though there are a couple of things that have not happened in it that I would like to see. The first thing I am pleased with is that it removes the clause saying natural death has to be reasonably foreseeable. It was very difficult for physicians to understand what exactly that meant. If the clause meant only people who were going to die soon, it did not reflect the Carter decision by the Supreme Court, because it did not look at issues of incurable disease or intractable pain and suffering. This bill addresses that, I think, in that it is distinguishing what we mean by natural death becoming reasonably foreseeable. In other words, I think it recognizes that if a natural death, because of a disease or a terminal illness, is going to be foreseeable within maybe a week or two, then a person does not need to go through the 10-day reflection period that was asked for earlier on. However, if it is a longer period of time, maybe four months or so, a person can continue to reflect on whether this is what they really need.
I also like that it has brought back something called advance directives. It is interesting to note that long before medical assistance in dying was considered, physicians had advance directives. This is at the heart of a doctor-patient relationship. They would sit down with patients and go through all of the things patients faced and their concerns, especially if they were diagnosed with a serious and terminal illness, and they would say what they would like to do if something happened. That would be in writing, between the doctor and the patient. I was present when families of patients who were dying, in great pain and suffering and under the deep stress of this, would debate the decisions they had made earlier with their physician. Putting this back in means that we are respecting patients' desires. Regardless of their mental capacity at the time of their dying, we are respecting what they originally wanted, if they still want it, not having other people rule on their decision.
Inherent in everything I dealt with regarding patients who were terminally ill or had an intractable and incurable disease is that they wanted to die with dignity. Dying with dignity cannot be understated. Dying with dignity means that people can choose how they die, where they die and the manner in which they live with the suffering of dying and the mental anguish of leaving their loved ones. This is a deeply personal thing that patients face. It is impacted by their religion, it is impacted by their ethics and it is impacted by their family situation. It therefore has to be done on a case-by-case basis, and having an advanced directive with a physician is always a really important thing in that regard. That had been removed in the last bill and I am glad to see it back. It took the decision away from the patient and gave it to the state, at the end of the day, and now it is back with the patient.
I want to applaud the inherent compassion I see in this bill. I think it is really important. The deeply held desire of every single patient I knew, regardless of whether they chose to have medical assistance in dying or not, was the ability to die with dignity. The patient's ability to choose where they die is really important. Do they want to die at home in bed? Do they want to die in a palliative care unit, where they have become accustomed to spending their last days? Do they want to die in a hospital? Most patients do not want to die in a hospital. They want to be surrounded by their loved ones.
The government is giving $6 billion to provide home and palliative care resources to the provinces, because it is the responsibility of provinces. They can facilitate this deeply held desire to die with dignity and help patients make this choice at a time when the ability to do so is often impacted by extreme pain and suffering and the extreme mental anguish of knowing they have to leave their loved ones. It simplifies this in a great way, and that is a compassionate thing.
There are some areas that can be improved, and one of them is the singling out of mental illness and disability as a sole diagnosis. I agree with everyone who has spoken in the House today, and with the desire of a lot people, to recognize that mentally ill people should not be put away and should not be allowed to simply decide they want to pass on because the people they live with think they are a burden. It is really important to also look at this from the perspective of the disabled.
I know the has taken a lot of time to speak with the disability community and physicians. This government is committed to dealing with mental health and illness. My colleague from the Conservative Party told a very moving story earlier about a particular woman who was contemplating suicide. Giving people options when they are depressed or disabled that let them know there are other options for them, that there is a better life available to them, is inherent to this bill.
The is going to look at this aspect and consult broadly with the disability community once again as he is looking at the legislative parts of the bill and the regulations. This is really important. Remember, if we single out mental illness and disability as a sole diagnosis, we may be contravening section 15 of the charter. It assumes that, because someone has a mental illness or is disabled, they do not have the right to make a decision regarding their own life and pain and suffering, whether it be mental or not. The idea that this issue will be addressed in work with the provinces, health care providers and the disability community is really important. The safeguards will be worked out. I will be really clearly involved in making sure they are worked out so they can be put into place to protect mentally ill people and people who are disabled.
I want to quote Justice Baudouin in the Truchon decision: “The vulnerability of a person requesting medical assistance in dying must be assessed exclusively on a case-by-case basis, according to the characteristics of the person and not based on a reference group of so-called ‘vulnerable persons’.” Justice Baudouin also added that the patient’s ability to understand and consent should ultimately be the deciding factor with a physician, along with looking at all of the legal criteria.
Those safeguards must be in place, but we should not assume we can make decisions for people who, because of mental illness and disability, may wish to get medical assistance in dying. Intractable pain and suffering is not merely physical; it can also be mental. With the help of good psychiatrists and good support systems, we will be able to put those safeguards in place.
This bill has come a long way in rectifying many concerns that some medical practitioners have raised. It is important that it respects the right of a medical practitioner or a health care provider to use their own ethics and religion to decide whether they wish to perform medical assistance in dying or not. I am—
Madam Speaker, medical assistance in dying is a sensitive issue that needs to be discussed calmly. It is a difficult subject, let's face it. It is especially difficult because, like all matters dealing with human dignity, any answers we might offer are a reflection of our own values, our beliefs, our way of defining what we see as right and wrong.
That is precisely where the potential pitfalls lie for us parliamentarians as we grapple with moral issues like medical assistance in dying, abortion and same-sex marriage. Relying solely on our own values in the legislative process is tantamount to subjecting the freedom of others to the dictates of our individual consciences. In this case, medical assistance in dying raises the kind of impossible questions that political thought has been considering since the dawn of the modern era. This issue compels us to seek a delicate balance between power, knowledge and freedom.
Everyone knows that, as parliamentarians, we have been given a certain power by our constituents. This legislative power means we have the ability to restrict the rights of our peers through legal prohibitions, directly affecting their freedom. However, it does not necessarily follow that we have all the knowledge to apply that power in a fair manner. To avoid any abuse, we must be humble enough to acknowledge that we are not experts in everything, even though we have to speak to everything.
Max Weber, the father of modern sociology, may provide valuable support to the legislator who is concerned about using their power properly. In his essay “Politics as a Vocation”, Weber says this about the career of politics:
Well, first of all the career of politics grants a feeling of power. The knowledge of influencing men, of participating in power over them, and above all, the feeling of holding in one's hands a nerve fiber of historically important events....
Weber then asks a very perceptive question that applies remarkably well to the debate on medical assistance in dying. He says, “What kind of man must one be if he is to be allowed to put his hand on the wheel of history?” Putting one's hand on the wheel of history evokes the idea that a legislator can change the course of society, as happened with same-sex marriage and abortion.
How does one go about changing the course of society? Weber says that, first, we must determine what qualities a legislator must have to enable them to do justice to the power they exercise and to the responsibility that power imposes upon them. Weber states that there are two pre-eminent qualities for a politician: passion and a feeling of responsibility.
He means passion in the sense of matter-of-factness, of passionate devotion to a cause. For me and my political party, that cause is Quebec's independence. For the Conservatives, who knows. Perhaps it is balancing the budget or some form of social conservativism. For the Liberals, it is multiculturalism and conflicts of interest. Just kidding.
Weber cautions us. “[M]ere passion, however genuinely felt, is not enough...passion as devotion to a 'cause' also makes responsibility to this cause the guiding star of action.” This passion must to some extent be controlled by a form of responsibility.
Weber warns us because he believes that the legislator must be a man of reason. According to Weber, the lack of distance from our passion is one of the deadly sins of legislators. In the context of the bill on medical assistance in dying, this distance means that we cannot let certain interest groups or certain religious groups guide our discussions because we feel that they may withdraw their support for us. In short, Weber tells us that political favouritism disregards distance and this leads us to political incapacity.
Therefore, on the issue of medical assistance in dying, we must adopt this attitude of “distance” in the strongest sense of the word. This distance implies that, on a matter of human dignity, partisan and ideological considerations must take a back seat.
The topic of medical assistance in dying forces us to deal with the complex relationship between ethics and politics. According to Weber, ethics must not be used as justification. He believes that contorting ethics in an attempt to justify one's behaviour is wrong, which brings us to the struggle between two well-known positions: the ethics of responsibility and the ethics of conviction.
The ethics of conviction often manifests in religious beliefs, in being dogmatic about ideologies. This type of ethics is meant to establish a definitive truth that must be protected at all costs in order to achieve one's objective.
Weber said, “If the consequences of an action that flow from pure conviction are evil, then for him the responsibility lies not with the actor but with the world, the stupidity of other people, or the will of God”. He continues, “He who seeks the salvation of the soul, of his own and of others, should not seek it along the avenue of politics”, which seeks to solve quite different tasks.
The ethics of responsibility has us look at the potential consequences of our actions. It forces us to use our legislative power responsibly and to look beyond our allegiances and personal beliefs. We are meant to be conscious of our collective duty and to accept that the greater good comes before personal interests.
I would like to comment briefly on the ethics of responsibility, which is something Quebec is familiar with, from the Select Committee on Dying with Dignity. The members of the commission were mandated by the Quebec National Assembly to hold a rather unique public consultation process, in which the members travelled across Quebec to meet with experts and Quebeckers.
The Parti Québécois's Véronique Hivon took the lead on this file. She handled the process transparently and tackled difficult issues in the realms of medicine, law, philosophy, ethics, sociology and psychology. The committee's work resulted in the passage of the Act Respecting End-of-Life Care, which came into force on December 10, 2015, in Quebec.
I see a striking contrast between Quebec's approach, characterized by the ethics of responsibility, and the federal government's approach. At the time it was passed, the Quebec law went as far as it could without running afoul of the federal legislative framework. Quebec was proactive in engaging in this social debate, whereas the federal government has, so far anyway, simply been reacting to court rulings. This is the old “government of judges”. Governments would rather refer thorny issues to the courts than take a stand. Maybe they are trying to protect their beliefs or avoid offending certain religious groups. Still, parliamentarians have a job to do.
I will now come back to Carter, in which the Supreme Court overturned the Rodriguez decision in order to give greater weight to respect for integrity of the person and the individual's decision-making authority. This opened the door to medical assistance in dying.
Previously, when religious values were more prominent, this situation would have been impossible. In this case, the Supreme Court served as a driver of social progress, but we cannot always turn to the Supreme Court. This raises the following question: Is it normal for elected officials to lag behind on social change and leave it up to the courts to bring legislation in line with the reality of citizens? This is not the first time that members of the House of Commons have turned to the judiciary to avoid making tough decisions so as not to offend anyone. Take, for example, same-sex marriage.
The truth is that these social issues must be discussed in the House with compassion. Bill responds to a decision of the Quebec Superior Court, which ruled in favour of Ms. Gladu and Mr. Truchon, both suffering from serious degenerative diseases. They claimed that the reasonably foreseeable natural death criterion was too restrictive in both legislative regimes, the federal and the provincial.
We are all driven by our personal convictions, but our thinking must transcend those beliefs. We have a duty to act with empathy. People suffering from incurable degenerative diseases should not have to go to court to fight the terms and conditions of the administration of medical assistance in dying.
In my view, Bill C-7 will undoubtedly make medical assistance in dying more accessible. We should be relieved that the bill specifically excludes individuals suffering solely from a mental illness from eligibility for medical assistance in dying. I think everyone agrees that this aspect requires further reflection, study and consultation. However, as legislators, we do need to address the issue of advance consent. Many people who reach end of life risk losing their capacity to consent. We therefore need to find a way to respect their choice, too.
At the end of the day, it is fair to say that our reflections on a framework for medical assistance in dying relate to the fundamental freedom of individuals to determine their own condition. Our reflections must be guided by compassion.
I know some people have expressed strong reservations about medical assistance in dying. I can only hope that such personal beliefs will not be imposed on those already suffering.
Lastly, I hope the House will follow Quebec's lead and approach this issue with openness and empathy, rising above partisan lines.
Mr. Speaker, I appreciate the opportunity to speak to Bill , a very important bill that proposes to amend the Criminal Code provisions on medical assistance in dying, MAID.
It took me a long while to decide that I was going to speak to this bill. In fact, when I first learned that we would be debating this legislation this month, I decided I was not going to speak to it at all because I do not do very well with these topics. I have a very difficult time accepting that life eventually comes to an end, especially the life of those closest to me. In fact, I can come to terms and accept that my own life will end at some point, but I cannot deal with the thought of losing those closest to me.
Some of my colleagues' speeches earlier this week brought me to tears. When someone has strong feelings about a given topic, it generally means that they have something to say about it and that the topic should be discussed.
Canadians must know that, if they are eligible, they have been able to access MAID since June 2016. To be eligible for MAID right now, the person must meet all of the following criteria: They must be at least 18 years of age, be mentally competent, have a grievous and irremediable medical condition, make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence, and give informed consent to receive medical assistance in dying.
Furthermore, in order to be considered as having a grievous and irremediable medical condition, those seeking MAID must meet all of the following criteria: have a serious illness, disease or disability; be in an advanced state of decline that cannot be reversed; experience unbearable physical or mental suffering from the illness or state of decline that cannot be relieved under conditions that the person considers acceptable; and, lastly, be at a point where natural death has become reasonably foreseeable.
Bill proposes to repeal the MAID eligibility criteria by modifying the criteria that must be met to be considered to have a grievous and irremediable medical condition so that it includes persons whose natural death is not reasonably foreseeable.
Furthermore, the bill proposes to specify that those whose sole underlying medical condition is a mental illness are not eligible for MAID.
Last, it proposes to create two sets of safeguards that must be respected before MAID is provided. The first set of safeguards would apply to persons whose natural death is reasonably foreseeable and these would be the existing safeguards that have been in effect since 2016. The second set of safeguards would be for persons whose natural death is not reasonably foreseeable. These would include existing safeguards as well as additional ones that would apply.
In the interest of time, I will not address all of the safeguards that have been put in place. Rather, I will just focus on those that have been added recently.
A person whose death is not reasonably foreseeable must talk to a doctor about the options available to them to ease their suffering. The two parties must agree that they seriously examined all the possible options, including palliative care and mental health support, before making a decision to apply for medical assistance in dying.
Two independent doctors or nurse practitioners must provide an assessment and confirm that all the eligibility criteria have been met. This eligibility assessment period must take at least 90 days, unless the person is at risk of losing their mental capacity before that time is up. In such cases, the assessment must be a priority and completed before that deadline.
Bill seeks to respect the personal autonomy and freedom of choice for those seeking access to MAID while, at the same time, protecting vulnerable people and the equality rights of all Canadians. It aims to reduce unnecessary suffering. This issue is a deeply personal one. In fact, we saw from consultations held earlier this year that there was a wide array of opinions and feedback received. Many people were opposed to the idea of MAID altogether, while many others believed the safeguards were too restrictive and made it difficult for some people to receive MAID.
This is a profoundly personal matter for all those involved. I do not think that it is for anyone who has never faced death or end-of-life suffering to judge or determine whether this should be a right and for whom it should be a right. We all have a certain pain threshold, but it is not the same for everyone. We are talking about excruciating physical pain. Who then is in a position to say to what extent such pain can be tolerated?
MAID legislation was passed in 2016 with the intention of ending suffering for those facing death, those who do not have a chance to improve their medical condition. It was passed because the MPs in this chamber thought it would be the right thing to do: to give people the choice to receive MAID if they felt they needed it. Nobody is forced to go down that path, it is a choice, but legislators basically deemed it the right thing to do and the humanitarian thing to do to allow someone in that situation to receive medical assistance in dying.
If this was the humanitarian thing to do for people whose death is reasonably foreseeable, then it only makes sense that those suffering from an illness and experiencing unbearable pain whose death is not reasonably foreseeable and may be five or 10 years away should also be granted those rights. They should also have access to MAID if they have exhausted all other options and have decided with their medical practitioner that this is the way to go.
Again, it is extremely important that we remember this is a choice of the person who is suffering. However, it is also critical to give those in a position to provide medical assistance in dying, such as physicians and nurse practitioners, the choice to refer their patients to someone who is willing to administer MAID if they themselves are not. If administering MAID does not coincide with their values or religious beliefs, it must not be expected of them.
With that being said, it is important for everyone to respect the religious beliefs and values of all Canadians. As such, I completely understand that some may perceive the act of receiving medical assistance in dying as committing a sin. They have the right to die of natural causes if that is their will. In my own religion, this would technically be problematic for me. However, I feel comfortable knowing that if it ever comes to a point where I am in a situation where I am suffering, I have no chance of recovery and I am only going to get worse with time, I will at least have the choice.
One of my colleagues across the aisle in his speech earlier today spoke about an amazing comeback story of someone who was in a terrible situation, but who was on the road to recovery. My colleague was grateful that this person stuck it through and fought to survive. It is important to remember that those who will be eligible to receive MAID will have been assessed by two medical practitioners and both will have determined that the person's medical condition would never improve. If there is a chance for recovery, the person would not be eligible for MAID in the first place.
I understand that not everybody in the House will vote on this bill in the same way and I fully respect everyone's personal choice on this matter, because, once again, it is an extremely personal issue. All members are trying their best to represent their ridings and constituents in the best way they know how. I will be voting in favour of this bill because I do not believe it is my place to get in the way of someone receiving the kind of relief that MAID offers.
Mr. Speaker, today I am pleased to speak to Bill , which I will refer to as MAID throughout the course of my speech.
This can be a difficult issue for many to address because it intersects several issues in society. First of all, there are taboos, and societal norms associated with those taboos, around discussing dying, religious beliefs, social supports, or the lack thereof, related to people who are in difficult or life-threatening situations, love and compassion for one another, and the agency that each of us has to direct our future.
I would like to explain what this bill would do, what I am hearing from my constituents on this issue, my approach to addressing this legislation and my decision on how I will be proceeding on their behalf.
As has been mentioned in many speeches, this bill builds on previous legislation that allowed for legal, medically assisted dying in Canada. This bill would amend legislation to remove the “natural death has become foreseeable” clause, meaning that reasonably foreseeable death would not be a criterion for accessing MAID. Of course, this comes after a decision in the Quebec Superior Court ruled that reasonably foreseeable provisions violated section 7 of Charter rights to life, liberty and security of the person. It eliminates MAID access to those who only have mental illness as an underlying condition. My understanding is that the said this would be addressed in the parliamentary review of this legislation.
It would also create a second set of safeguards for people accessing MAID without a reasonably foreseeable death clause including that, for both those whose deaths are foreseeable and those whose are not, this bill would change the Criminal Code so that only one witness is needed to sign the MAID request, rather than the two currently needed. It would eliminate the 10-day waiting period for MAID and its administration for those with foreseeable deaths. For those without foreseeable deaths, Bill would create a 90-day waiting period request. There is a bit more technicality. It builds on legislation that has already been passed in this place.
I want to outline some of the things I have been hearing from my constituents on both sides of this issue. The response in my office has been pretty evenly split between people advocating for these changes and against them.
Those in support of this bill have been writing to my office on the need to exercise personal autonomy, which would be the agency issue that I mentioned. The constitutional right to make choices about end-of-life access to medicine and health care should be part of a health care option that is available to Canadians. There is a need to ensure that, in our country, we have the ability to die with dignity: to look at death as part of the life process, and to ensure that the continuum of care involves a death with dignity. Also, there is a need to normalize and end the stigma surrounding death, and to respect individuals' and families' desire to end unbearable suffering.
Those who have issues with this bill have mentioned consent by minors and those who have mental illnesses, and what the nature of consent is in those situations. There are concerns that it is not clearly defined. There are concerns about how this legislation would impact the nature of consent in jurisprudence, as well as religious concerns around life, and doctors' conscience rights. There are concerns around repealing the 10-day waiting period and also allowing medical professionals to shorten the 90-day waiting period if the capacity to consent would be lost. I have heard those concerns.
This is my approach to addressing this legislation. As a legislator, it is my duty to ensure that individuals have the ability to use their agency in their choice on medical decisions, regardless of my personal proclivities. I will be supporting this bill through to the committee stage. I understand that there may be amendments proposed.
At the same time, some of the concerns that constituents have raised in my community against this bill are valid. From my perspective, some concerns that I have are whether we have proper supports in place for people who might be considering MAID in a not-foreseeable-death situation. I am talking about social supports for those who are in situations of great disability: Do we have social supports for day-to-day living? What about poverty? Is it a determinant of mental health?
With respect to palliative care, I do not think our country has yet addressed that issue adequately. I would like to see complementary legislation on that issue so we can be assured as a society that, in proceeding with this legislation, people are in the position of exercising their agency: They are not making a decision based on desperation or on our failure as a society to provide them with adequate social supports.
Another question I would like to see the committee address is this. When a person has lost the capacity to give consent, who will decide what is intolerable suffering? We need to suss that out. There needs to be some path to that. Parliament needs to give some direction to that so it is not simply left to the courts in the future. I think Parliament has a role in this because, as I am bringing the concerns of my constituents, both for and against, this is the place to give direction to the courts on any future decisions, and I would like to see the committee address some of those issues.
Another concern is for those struggling with mental health issues, such as depression, when death is not reasonably foreseeable. How will this legislation impact them?
With respect to mature minors, determining their capacity to decide and voluntary choice, free from duress, are concerns that have been raised. I also have those concerns.
I want to re-emphasize that I do not feel many Canadians have appropriate access to palliative care across the country. This is not the fault of any medical association, but I feel as a society we often spend a lot of time focusing on getting to a diagnosis. We have spent a lot of time in this place talking about dying with dignity, but we do not talk about how to live with dignity, and the choice of a person to see their life through to its natural end. If we are talking about choice and agency, somebody who makes the choice to see their life through without medically assisted dying should have the right and capacity to make that choice knowing that we, as a society, are caring for them. We are not just offering this as an alternative: that the only way to end suffering is to provide this as an option.
I give this nuanced answer because my own views on this have changed over the course of my term as a legislator with two very personal experiences. One experience was with both of my grandmothers, whose lives ended naturally. They both suffered from severe dementia. I do not think either of them would have chosen to have medically assisted dying because of their religious beliefs, but that option was not available to them, so I take that into consideration.
I am also living a situation right now, and she allowed me to share this, where earlier this year my mother-in-law, Debbie Garner, was diagnosed with a severe form of aggressive breast cancer. She has been fighting so hard and I feel so robbed because I just met this incredible woman a few years ago. She is fighting and giving it her all, but she lives in a jurisdiction where she does not have this option available to her. As part of her fight, she does not have the ability to exercise her agency in the way we are talking about, so this is now adding stress on her. She is doing everything she can to try and beat this disease, but the reality is there is a 50% chance, and probably greater with the form of cancer she has, that this will spread to her brain and leave her in a state I know she does not want to be in as a person. As a family member, I want to ensure that people in the position of my grandmother, who I know would have chosen to see her life through her way, have their wishes respected as do people in my mother-in-law's situation, who is saying she does not have the ability to exercise that choice, so she could use that agency as appropriately as possible.
That is my approach to this legislation. I would like to see this go forward to committee. I would like to see our society ensure that people have agency in both situations: that they are fully supported through the choice to see their life to its natural end, or are fully supported in a choice to end it with dignity and in a way that recognizes their own beliefs, their own agency and their own right to determination in these matters.
I thank the House for its time and I am happy to answer questions.
Mr. Speaker, I am very happy to have an opportunity this evening to share my thoughts on Bill , an act to amend the Criminal Code regarding medical assistance in dying.
This bill has generated a lot of debate. It is good to talk about this because it is extremely important. It is important because too many sick people are suffering, knowing they will never get well.
I worked with such people for a long time, and I can say that knowing them, learning about their struggles, and helping them through their ordeal fosters a much better understanding. It goes without saying that medical assistance in dying is a matter of societal choices, choices that must be carefully considered from all angles.
I strongly believe that the government did its homework before introducing Bill C-7, which is the outcome of a series of round tables with experts and stakeholders, as well as a number of public consultations. We had to go through this process after the Quebec Superior Court's decision in Truchon and Gladu, which found that limiting medical assistance in dying to persons whose death was reasonably foreseeable was unconstitutional.
Ms. Gladu and the late Mr. Truchon both suffered from incurable degenerative diseases but were not eligible for medical assistance in dying because their deaths were neither imminent nor reasonably foreseeable.
The government's Bill C-7 proposes significant changes. It broadens the eligibility criteria to include people whose natural death is not reasonably foreseeable, as was the case for Mr. Truchon and Ms. Gladu. It also adjusts certain safeguards, allowing patients to waive final consent, for example. These are significant changes.
Let us first consider the reasonably foreseeable death criterion. A number of MPs are concerned about removing this criterion because they believe it would make it too easy to access medical assistance in dying. There is also some concern that people with disabilities or mental illness will not be properly protected. Life is precious and has so much to offer. I believe in that, and the government believes in it, too.
Under the provisions of this bill, mental illness is not considered to be an illness, disease or disability. The bill also expressly excludes people seeking medical assistance in dying solely because of mental illness. The government knows that the best treatment for mental illness is effective therapy, so greater emphasis needs to be placed on enhancing preventive measures and support resources.
What exactly is a reasonably foreseeable death, anyway? It is an assessment of the amount of time between a person's current state of health and their death. It is not something that can be measured with a blood test or a thermometer. It requires a clinical judgment based on an exhaustive medical evaluation of the patient. The fact remains that it is a difficult and sometimes imprecise exercise, and that is why the amendment is necessary.
Expanding patients' right to request medical assistance in dying does not necessarily mean it will be administered. Requesting medical assistance in dying does not automatically mean it will be administered. Even if the legislation is changed by removing a criterion, the spirit in which it will be applied does not change.
Requests will be evaluated based on the other criteria in the legislation and the new safeguards that I will get to shortly.
The government's priority is to strike a balance between the autonomy of eligible persons, the protection of vulnerable persons from being induced to end their life, and the important public health issue of suicide.
We care about compassion and dignity for both the patients and the process. In fact, that is why, in the first version of the legislation, the government included safeguards that would support decision-making, reflect the finality of the act, provide robust procedural guarantees to prevent errors and abuse, and protect vulnerable people.
Nevertheless, experience has exposed some gaps, and that is why we are proposing that two of these measures be amended.
The first change is to eliminate the 10-day waiting period between the date the request is signed and the date on which medical assistance in dying is provided, for individuals whose death is reasonably foreseeable. This 10-day waiting period needlessly prolongs suffering. Patients who are worried about losing their cognitive abilities and no longer being able to provide final consent live in fear. They may even refuse to take their medication and sometimes choose to request medical assistance in dying earlier.
The patient's stress also extends to their loved ones, making those last moments more painful than they need to be. Being able to choose when to die allows patients to go with their head held high, bolstered by the presence of their loved ones. These patients show noticeable relief when they realize that no matter what happens, they will get medical assistance in dying, as requested.
Although reasonably foreseeable natural death is no longer an eligibility criterion, it will be used to help determine which safeguards will be applied to requests for medical assistance in dying.
For people whose death is not reasonably foreseeable, a period of at least 90 days will ensure that there is informed consent. The sources of suffering causing the patient to request medical assistance in dying must be verified. Furthermore, it must be verified that the decision is being made without any outside pressure or influence.
The assessment of the person's overall medical condition is even more rigorous. We may be withdrawing the criterion of reasonably foreseeable death, but that does not mean greater access to medical assistance in dying. The bill continues to ensure that there is proper protection for the process, our medical practitioners and, above all, our patients.
Having recently discussed the bill with palliative care specialists, I can confirm that the 10-day waiting period often negatively influences a patient's decision and that removing this provision will make their last moments more peaceful.
The second safeguard I want to discuss today is the waiver of final consent.
Under the current legislation, immediately before providing medical assistance in dying, the medical practitioner or nurse practitioner must ensure that the person gives express consent to receive medical assistance in dying and give the person an opportunity to withdraw their request. The government's amendment means that final consent can be waived if certain conditions are met, such as the loss of cognitive ability and the signature of a written agreement stating that medical assistance in dying will be administered on a specified date. This measure helps to ease patients' anxiety so they can take their medication, suffer less and set a later date.
It is important to note that this is not the same thing as an advance request, meaning a request for medical assistance in dying on an unspecified future date under particular circumstances. That type of request could be included in a notarized health care directive. Currently, a person can state in their health care directive whether they would want to undergo aggressive treatment and what that term means to them, but they cannot request medical assistance in dying in advance.
That is a more complex subject because, in such cases, a legal representative is being asked to make a decision on behalf of someone else. This issue will be examined by a parliamentary committee. The committee will also discuss other issues, such as medical assistance in dying for minors.
All these changes to the reasonably foreseeable death criterion and adjustments to the safeguards reflect the government's desire to keep doing better, to create a more dignified, freer and more progressive society. I therefore encourage all members to vote in favour of this bill.
I would like to conclude with a quote from the late Jean Truchon: “I ask you to try to understand me and not to judge me”.
Mr. Speaker, I am very honoured, as always, to rise in the House, particularly on such a profoundly important issue.
I am going to ask the Speaker's indulgence for a few minutes to speak about an issue that is occurring right now. I have learned that in Treaty No. 9 tonight families in Neskantaga First Nation are being evacuated because they have no access to water. For an Oji-Cree community in the middle of a pandemic to be willing to be flown out to an urban centre shows how severe the situation in Neskantaga is. I think every member in every party will understand the importance of bringing this forward.
One of the beautiful things we have said during the pandemic in Canada is that we are all in this together, but we are not, not in Canada. We have never all been together, not when it comes to the poverty, the casual degradation that indigenous people suffer and the systemic negligence of the most basic rights to life and dignity that Canadians take for granted as part of how this country is run. We cannot find a community that has suffered more than Neskantaga. For 25-plus years they have lived with unsafe water. That is a second generation growing up with improper water.
What does that mean? I remember meeting a beautiful young girl from Treaty No. 9. She had this incredible long, thick hair and she said she did not like to take a shower because it gave her blisters. That is what we put young people through in communities like Neskantaga. At age 13 or 14, they have to leave home because the federal government will not bother to give them a school. They have to go to a foreign culture in Thunder Bay. We know of the horrific treatment and abuse that indigenous children have suffered in Thunder Bay, the deaths of children in the rivers and the racist attacks, yet they have to leave their homes.
We are talking about something as profound as medical assistance in dying. However, when one has had to go to a hotel room in Thunder Bay to say sorry because a beautiful young girl from Neskantaga gave up hope at age 14, we could say this nation does a lot of work to assist in the dying and hopelessness. Tonight, in Neskantaga, after 25 years of not having water, where the schools cannot be opened because they cannot get water to the schools. They have had to shut the water system down. It is winter there and elders are going to the river and getting water in buckets.
Yes, this is Canada in 2020. Therefore, when I hear people say that we are all in this together, we could say it more clearly by saying we are all in this together, except when it comes to indigenous people, because they are at the back of the line again and again. I am not saying this from a partisan point of view. This was the primary program. Neskantaga was going to be fixed. We were told that by the . The previous prime minister put enormous amounts of money into water, yet the government continues to refuse to put in place the basic infrastructure that will support safe communities: the sewage lifts, the water pipes, the proper water treatment centres.
I am asking my colleagues tonight, in light of the crisis in Neskantaga and the risks people are taking by being flown out in the middle of a pandemic, to say we have to make the guarantee of access to clean water a fundamental human right. It has to be done, and it has to be done now. We cannot have any more nice words. We have all the beautiful words that come from the government, yet there are people who cannot even live in their own community because they do not have water. I am asking my colleagues to work with us to guarantee that the people in Neskantaga will be able to go home to safety, decency and water.
The issue of medical assistance in dying is an important conversation for us to have in the House. The last time we had this conversation, we were under the gun because it was a court decision that pushed the federal government to act. I had a number of concerns about the previous legislation. We knew it was not going to withstand a court challenge, yet the government went ahead with it. Now we have to come back and do it again. We need to work together because we have some fundamental principles that we have to protect in terms of how this moves forward.
I worked on a national palliative care strategy across the country before the last election. The one thing I have learned, and I saw this with my beautiful sister who died so young, is that the will to live is incredibly strong. People deal with an incredible amount of suffering, and they have the will to have family and have support. The right to die in dignity is a fundamental human right. Part of that is making sure we have a proper medical system in place to give people this support, so we have to have the provisions in place with this legislation.
Nobody's claim of dealing with someone who is dying is more precious than anyone else's. In our lives, it is the most intimate thing we can be involved in, and those deaths can actually be good deaths, deaths of dignity and of hope, where families are together. The day my sister died, as my mom said the rosary I sang Danny Boy for her because that is how we go out in our culture. It was terrible to see my sister go, but we came together and it was beautiful.
There are deaths that do not have dignity, and deaths of suffering. It is incumbent upon the House to make sure that the legislation in place meets a number of steps in the right to dignity, but also that it makes sure that people who are making this choice are not doing it because they feel they have been neglected or they are in a substandard seniors home, as we have seen with so many of our seniors in Quebec and Ontario who died in the pandemic. People must actually have dignity, and if they are in a home, there must be support for them so that they do not have to make that choice.
I will agree with my Conservative colleagues and all the people I have talked to in all the work I have done with palliative care, that if that choice has to be made, it is one that people do not want to make. People want to go out in a way that allows them as much time as possible. However, when that decision is made, as it is a right upheld in the courts, we have to make sure that the provisions are there to allow it to be done properly, to allow it to be done so that people are of a mind that they understand what they are doing and that they can do this in a way that meets the test of a caring society.
To that end, we have seen a staggering number of our elders die without dignity in this pandemic. It has exposed the fact that we do not put investments into care for our elders and they have suffered needlessly. That we had to send in the army to keep people from dying is a fundamental failing of our system for seniors and their health.
Of course, it is not just seniors who have to make this decision. My sister died much too young. Her husband died at 42, and he was one of the greatest people I have ever met. People die at different ages, and some of those deaths are very difficult.
I am very pleased to say that we will support the bill being sent to committee because it is at committee where we will hear witness testimony. We need to hear from the experts. We need to have a conversation and start to make sure that in the legislation, which we are compelled to bring forward because of the Quebec superior court decision, we meet the tests of the court and we meet the tests of dignity.
Again, I do not believe this needs to be a partisan issue, where a party is going to be on one side or the other. We have to put first the rights of the individual and their dignity, and the support for their family, because death should never be a lonely act. Death has to be part of family and community, and when it is, it can actually be a moment of real grace and learning.
The New Democrats are supporting the motion to send the bill to committee to be studied. We want to make sure that we get it right this time so that we do not have to change it for the next court decision.
Mr. Speaker, it is really an honour to participate in this important debate on Bill , alongside my colleagues, the , and the .
By way of background, in 2015, the Supreme Court of Canada struck down the sections of the Criminal Code that made assisted suicide illegal. In 2016, the federal law in medical assistance in dying came into effect. This law created an end-of-life regime, which limited access to medical assistance in dying to individuals whose deaths were reasonably foreseeable. A number of specific eligibility criteria were put into place, along with procedural safeguards.
As we all know, in September of 2019, the Superior Court of Quebec found it unconstitutional to limit the availability of medical assistance in dying to people whose deaths are reasonably foreseeable. The federal government has once again been tasked with changing the law.
In early 2020, the Government of Canada held consultations across the country. There was also an online survey that received almost 300,000 responses. The feedback was thoughtful, compassionate and candid. From my perspective as the minister responsible for disability inclusion, I am working to ensure that the voices of persons with disabilities are heard on this important issue.
Medical assistance in dying is a human rights issue. The proposed legislation recognizes the equality rights of personal autonomy, and the inherent and equal value of every life. Disability rights advocates have long fought for these rights. Being able to make decisions about one's own life is fundamental. There are many examples in our history of where the personal autonomy and equality of our citizens with disabilities has been threatened, denied or taken away. I can assure my colleagues that these concerns are top of mind as we undertake this important legislative work.
The proposed legislation before us explicitly recognizes equality rights. The preamble refers to the Charter of Rights and Freedoms, as well as Canada's obligations as a signatory to the United Nations Convention on the Rights of Persons with Disabilities. The preamble also expressly differentiates between these fundamental equality rights and the various societal interests and values we need to balance with this legislation, such as the important public health issue of suicide. To put it another way, we wanted to be clear that ensuring equality rights underpins this legislation.
I will mention one more important aspect of the preamble that frames this proposed legislation, which is the importance of taking an approach to disability inclusion based in human rights. With these words, we are committing to using human rights principles to guide the development and implementation of our systems, programs and processes. This is important because the full realization of the rights we enshrine in law is predicated on having systems and structures in place that do not themselves create barriers, discriminate or infringe upon these rights.
I will digress here for a moment to take us back to June of 2019. That month, this House unanimously passed the Accessible Canada Act, which I believe to be the most significant advancement in disability rights since the Charter. Section 6 of the Accessible Canada Act sets out guiding principles, which include that everyone “must be treated with dignity”, everyone “must have meaningful options and be free to make their own choices,” and everyone “must have the same opportunity to make for themselves the lives that they are able and wish to have regardless of their disabilities”.
Another guiding principle states, “laws, policies, programs, services and structures must take into account the disabilities of persons, the different ways that persons interact with their environment and the multiple and intersecting forms of marginalization and discrimination faced by [individuals]”.
These principles must also guide us as we tackle the important task of responding to the 2019 Superior Court of Quebec decision. As this House has heard, Bill proposes a two-track approach to medical assistance in dying, with less or more stringent safeguards depending on whether a person's death is reasonably foreseeable.
The House has heard about the safeguards when death is reasonably foreseeable, and it is our hope that these will allow for dignified end-of-life decision-making. I will focus my attention on the new track where MAID is permitted even though the individual's death is not reasonably foreseeable. As I mentioned, in these situations there are heightened safeguards. These include the requirement that two independent doctors or nurse practitioners assess and confirm eligibility, with one of these having expertise in the individual's medical condition.
It is also required that the individual be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability services, community services and palliative care, and that the individual be offered consultations with professionals who provide these services. The individual and their medical practitioner must have discussed these measures and agree the individual has seriously considered them.
Finally, the eligibility assessment must take a minimum of 90 days, unless loss of capacity is imminent.
As we look to broaden access to MAID as directed by the court, we are very aware of the need for Canadians to know their options, to ensure their consent was informed and to have a real choice. I spoke earlier about equality rights and personal autonomy. I also spoke about taking a human rights-based approach to disability inclusion, having meaningful options and having the opportunity to make a good life for oneself. If our systems, processes, programs and services do not offer these options, and if our citizens do not see these options are available to them, then their equality rights are not being fully realized.
This proposed legislation recognizes the significant role that social, mental health, disability and community support services play in the full realization of equality rights. Accessing MAID should not be easier than accessing disability supports. The new legislation makes it the responsibility of the medical practitioner to ensure that the individual is made aware of the supports available to them because the harsh reality is that many Canadians with disabilities are not living with dignity. They are not properly supported. They face barriers to inclusion and regularly experience discrimination.
We have seen during this pandemic how many of our systems fall far short of truly supporting and including all Canadians. Canadians with disabilities are rightfully calling for governments to address these inequities, and we must.
In the recent Speech from the Throne, our government committed to a disability inclusion plan. This will include a Canada disability benefit modelled after the GIS, an employment strategy, and a modernized approach to eligibility for Government of Canada disability programs and services. The disability inclusion plan is an important next step in advancing the rights and inclusion of person with disabilities. I look forward to sharing more on this with the House and all Canadians in the coming months.
Before concluding, I will mention the need for robust federal monitoring and data collection on MAID. We need a reliable national dataset that promotes accountability and improves the transparency of implementation. Quite frankly, we also need to better understand who is accessing MAID and why. This is of the utmost importance to the disability community. It is incumbent upon all of us to ensure the regulations that flow from this legislation allow for fulsome data analysis.
We have before us legislation that seeks to balance making medical assistance in dying available, without undue obstacles to those who choose it, and having safeguards to ensure this decision is truly informed and voluntary. A truly progressive medical assistance in dying law is one that recognizes, without compromise, the equality rights of everyone.
I am thankful for the opportunity to contribute to this debate.
Mr. Speaker, today we are talking about Bill , an act to amend the Criminal Code with respect to medical assistance in dying. While I realize this is a very sensitive and difficult issue, I want to be very clear that I will not be supporting the bill. I would like to take a few minutes to talk about why that is and to provide some context to all Canadians, specifically from my constituents in Niagara West.
On February 6, 2015, the Supreme Court of Canada ruled that grievously suffering patients had the right to ask for help in ending their lives. This was the Carter v. Canada decision. The court declared that paragraph 241(b) and section 14 of the Criminal Code, which prohibited assistance in terminating life, infringed upon the charter right to life, liberty and security of the person for individuals who want to access an assisted death.
The Supreme Court decision was suspended for a year to give the government time to enact legislation that reconciled the charter rights of individuals, doctors and patients. As a result, the government introduced Bill on April 14, 2016, which received royal assent on June 17, 2016. Medical assistance in dying has been legal since then.
On September 11 of last year, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing their end of life. Basically, the court said that the Criminal Code requirement that natural death should be reasonably foreseeable to get medical assistance in dying is against the rights and freedoms of Canadians as they are written in the charter. It is important to note this ruling will come into effect on December 18, 2020, unless a third extension is granted by the court.
The focus and priority of all of us in the chamber should be to ensure safeguards are always in place for the most vulnerable in our society. We also have to keep in mind that we need to be respectful and accepting of the conscience rights of physicians and health professionals. Doctors are trained to save lives, not to end them. I actually believe we should go a step further and protect the conscience rights of all health care professionals.
I am supportive of doctors and health care providers who are not willing to leave their core ethics behind when they are at their patient's bedside. I do not believe it is appropriate to force a doctor or other health care provider to participate in assisted suicide. I also do not believe it is appropriate to hire or fire an employee based on their willingness to be involved in assisted suicide. Physicians who wish to follow their conscience on serious moral issues should be free to do so. Again, we need to be respectful and accepting of the conscience rights of physicians and health professionals.
The last time I voted on this issue, I went through the legislation, which at the time was Bill , and I made a determination that it did not include sufficient safeguards for those most vulnerable, so I opposed it. I had the chance to examine the current bill before us today and I still do not think it has sufficient safeguards, so I will oppose it again.
Let us be clear about something. Medical assistance in dying is a tremendously difficult issue to debate. It absolutely is. It is a highly emotional topic for all sides, and there are many factors and personal convictions that come into play. In the House we agree on many things, but we also disagree strongly on others. The key is to respect one another in the process as we discuss sensitive issues, especially issues relating to human life. Medical assistance in dying has to do with some of the most vulnerable people in our society. That is why it is important we, as representatives of the people who voted for us, have utmost respect for all who have an opinion on this topic. This includes many folks in my riding of Niagara West who are people of faith and disagree with what this bill would do.
I would like to highlight some critical evidence from an expert who appeared before the Quebec superior court on this issue. Dr. Mark Sinyor is a Canadian psychiatrist widely recognized for his clinical expertise and research on suicide prevention. He was an expert witness in the case, who provided important testimony before the Quebec superior court.
In his 50-page affidavit, Dr. Sinyor detailed for the court the likely impact of expanding medical assistance in dying to those who are not at the end of their lives. He notes that under an expanded law, which is what we have in front of us here today, physicians would bring about a death that is not otherwise foreseeable. This is something that is exceptionally difficult to accept for many Canadians across the country and for many in my riding of Niagara West. Issues like the planned legal death of someone who is terminally ill is a very delicate matter to begin with, but to open up the door for more people to qualify for a planned death, a legal death, to me and to many of my constituents, is very troubling.
I would like to return to Dr. Sinyor again.
He talks about a well-established phenomenon referred to as suicide contagion. Dr. Sinyor explains that suicide contagion occurs “through a process called social learning in which vulnerable people identify with others who have had suicidal thoughts and/or behaviour.” He goes on to say, “Expansion of MAID to include suffering, not at the end of life is likely to lead to suicide contagion and higher suicide rates, and to have a negative impact on suicide prevention.”
Dr. Sinyor also talks about the extent to which many elderly people with chronic conditions and younger people with severe disabilities are impacted. He says that they “feel like a burden to their loved ones and that their families would be better off if they were dead.”
When one of our friends, of family members or loved ones is in a similar circumstance and they begin to think that they will be solving this problem of being a burden, knowing that this law will allow it, would it be more comfortable for us? My answer is no, I do not think it would be.
To quote Dr. Sinyor again, “Normalizing suicide death via MAID as a remedy for suffering not at the end of life is likely to increase suicide rates in Canada at a time where there is a universal consensus among public and mental health experts of the imperative to decrease suicide rates.”
In short, the bill would simply make it possible for a person to choose to access medical assistance to end their life, even if their death is not reasonably foreseeable. I am concerned for people with disabilities. I am concerned that, if passed, the legislation will allow people with disabilities to die with medical assistance because they have a disability.
Michael Bach, managing director for the Institute for Research and Development on Inclusion and Society confirms this, saying “people who are not at the end of life will nevertheless be able to access assisted death on the basis that their disability is grievous and irremediable and they experience suffering they find intolerable.” I am concerned that people with disabilities may be coerced into ending their life while they are in a state of personal suffering.
Michael Bach also said, “Negative stereotypes are an undeniable cause of disability-related disadvantage and suffering. The Quebec Superior Court struck a blow to social rights in Canada when it rejected the end of life requirement.”
One of Bach's most striking statements on this issue is that the court's decision “institutionalizes the idea that disability can justify terminating a life. Stereotypes don’t get much worse than that.”
I am afraid that the bill may reinforce horrible stereotypes that a life with a disability is a life not worth living or that living with a disability is a fate worse than death. This cannot happen. I am also concerned that the suffering may not be caused by the disability but because of a lack of services and supports needed by many people with disabilities to lead a full life.
As an example, we have the story of Sean Tagert, a B.C. man who was living with ALS. Sean chose to access medical assistance in dying because he was unable to secure funding for the 24-hour care he needed to live in his home, in his community and raise his young son. The story is heartbreaking. This young man chose death because he was unable to get the proper care for his disability, and he left a young child behind.
It is so sad to hear stories like this. That is why I believe that providing high-quality palliative care is critical. Palliative care is so important because it puts patient care at the forefront of this discussion and not the patient's death. Palliative care helps improve the quality of life, reduces or relieves physical and psychological symptoms and supports the families and loved ones of those struggling with the condition. It could be provided in a variety of settings, including hospitals, at home, long-term care facilities and hospices.
The focus of palliative care is on respecting dignity and having compassion for human life. That in my view is the right approach. I do not think any of us in the chamber should ever underestimate the importance of this issue and its complexity. We all understand the delicate and sensitive nature of it. We all have views and we all know the views of our constituents. They sent us here to represent them, and that is what we are doing.
My hope is that we will all uphold the original objective of this legislation, and that is to affirm the inherent equal value of every person's life to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled. This bill does not do that, and for that reason I will be voting against it.
No worries, Mr. Speaker. With virtual Parliament, all members of the House of Commons and, of course, you, Mr. Speaker, and your team, should be really proud of the work that we have done to keep Parliament functioning.
I am so happy to speak to the House today to address Bill . I have been listening to the debate quite closely. I have to say that I am so impressed by the passion and compassion that I have heard in all of my colleagues' voices in talking about this very personal and very emotional topic.
In responding to the ruling of the Superior Court of Quebec on Truchon, we have had the opportunity to consider measures for which there is strong public support, and that is why we are proposing changes that will help clarify and strengthen Canada's medical assistance in dying legislation that is in place today.
Canadians have shared their views since we had passed the original legislation in 2016. Earlier this year, I had the opportunity to listen to their opinions and ideas. I also listened to the practitioners who have been providing these services over the past four years. I have to say, on a personal note, that the stories of both groups really were very moving, but particularly from the practitioners who have been using the legislation to provide choice to patients who oftentimes had been suffering terminally for a very long time. It is very clear that their compassion and expertise is something we should all be very proud of and grateful for as Canadians. However, it is also clear, through those conversations, that certain aspects of the current legislation could be altered to improve access, protect the vulnerable and respect this personal choice that is at the foundation of the legislation. With this bill, I think that we achieve a balanced approach that reflects the best interest of all Canadians.
The proposed changes to this bill have been informed by years of study and consultation. In December 2016, we asked the Council of Canadian Academies to review three types of requests for medical assistance in dying that are currently outside the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying condition. As part of our analysis, we also consulted a number of other sources, including evidence submitted before the court in Truchon, as well as domestic and international research.
Medical assistance in dying is a complex and deeply personal issue, as so many of my colleagues have illustrated in their remarks. We knew that before going forward with changes to the current law, we needed to hear from Canadians. We held public and online consultations for Canadians to participate to complement our discussions among cabinet ministers, medical experts and other stakeholders in the country.
Protecting the safety of vulnerable people, a focus of many of the comments today, while respecting the autonomy of Canadians, another key aspect that was so important in our consultations, remain our central objectives. That is why the bill proposes a two-track approach to safeguards based on whether or not a person's death is reasonably foreseeable. The bill would no longer make reasonably foreseeable natural death the basis for determining eligibility, but it would use it to establish whether a more rigorous set of safeguards should be applied.
If a person's death is reasonably foreseeable, a set of safeguards similar to the existing regime would apply, but after hearing Canadians' feedback on the barriers that some of those original safeguards pose to those seeking medical assistance in dying, some of the conditions have been changed. I will expand on the specifics of the bill's proposed changes to these safeguards in this case.
For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards that we know have not served their purpose of protection. For example, under the current system, there is a requirement for a 10-day reflection period. Health care providers and family members, those who have been through this and have shared their loved ones' stories, have told us that the safeguard often prolongs the suffering of individuals who have already given extensive consideration to their decision to request medical assistance in dying. As a result, the proposed bill would remove this requirement.
During the round table discussions, we also heard that the existing requirement for two independent witnesses posed a barrier to those seeking medical assistance in dying, especially for those living in a care home or institution. We proposed only requiring one witness and allowing this witness to be a care provider. Those involved in assessing or providing medical assistance in dying would still not be eligible as witnesses.
Last, we heard from Canadians about the waiver of final consent.
Under the current legislation, a practitioner must ensure the person seeking and deemed eligible for MAID gives their express consent immediately before providing MAID. This is often referred to as the final consent and provides final confirmation of the person's desire to proceed with MAID.
This safeguard also prohibits MAID for individuals who have lost the capacity to provide final consent, regardless of how sure and definitive they were about their intention when they had capacity. This safeguard unintentionally created situations for individuals who had chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive MAID because of an impending loss of capacity.
I know many of members are aware and have spoken about Audrey Parker, who last year died and used her final days to advocate for changes to this very part of the legislation. In one of her last posts, she said, “the law has forced me to play a cruel game of chicken... I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free.”
Inspired by Audrey's memory, we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable, but who are at risk of losing decision-making capacity. As proposed in the bill, the individual would be able to provide written consent for their practitioner to administer MAID on a specified date.
In addition to easing certain safeguards, the bill also proposes strengthening others for those whose death is not reasonably foreseeable. We heard concerns from stakeholders and Canadians alike that eliminating the reasonable foreseeability of natural death requirement could result in increased risk for some people. Their concern is for people who are suffering, but not at the end of their life, who might make a choice that is not fully informed, with respect to treatments and supports. We think it is important while improving access to ensure vulnerable individuals are protected.
For example, the bill proposes a minimum period of 90 days for assessing the MAID requests in these circumstances. This period would allow for exploration, discussion and consideration of options by the person seeking MAID in collaboration with his or her practitioner. The bill would also require that the people requesting MAID in this circumstance be provided with information about the available counselling, mental health supports, disability supports and palliative care to ensure he or she were making an informed consent.
Following the Truchon decision, some have expressed concerns about individuals suffering solely from mental illness receiving MAID. Many clinicians argue that the trajectory of mental illnesses is harder to predict than that of physical disease. In light of this consideration, the wording of the bill precludes individuals suffering solely from a mental illness from accessing MAID. This proposed change does not mean that people will be excluded if they have a mental illness; it means that mental illness cannot be the only underlying medical condition. We anticipate that the issue of mental illness and medical assistance in dying will be further explored as part of the parliamentary review process.
There is also an agreement among experts that allowing advance requests for people with illnesses like Alzheimer's disease is very complex and would require careful consideration and consultation before it could be implemented.
During round table consultations, I heard from health care providers who were worried that because they had seen patients who, as their condition progressed, might not have had the same desire for MAID as when they were first diagnosed, it would be very difficult to assess these types of requests. The Council of Canadian Academies expert panel report on advance requests came to the same conclusion. For this reason we believe this topic is deserving of deeper examination through a parliamentary review. We need to approach this area with the careful consideration that it warrants.
Since MAID legislation was first enacted in 2016, nearly 14,000 Canadians have chosen the option of a medically assisted death, and this is not unexpected. We have seen a gradual increase in the numbers over the last three years, and Canada's experience is in line with other similar regimes around the world.
This is why we are also proposing changes to expand data collection to help provide a more complete picture of MAID in Canada. Today we are taking steps to clarify and add precision to Canada's medical assistance in dying legislation to respect the issues and the concerns raised by participants and numerous consultations about the need to place the personal autonomy and protection of vulnerable persons at the centre and the heart of this legislation.
I believe this legislation would improve the existing legislation, especially for those people whose health conditions lead them to consider this difficult decision. I urge all members of the House to support Bill .
Mr. Speaker, Bill on medical assistance in dying is an important, sensitive and justifiable bill on a very difficult subject.
I am quite happy to be speaking at the end of the day, at the end of the debate. Before getting into my speech, I would like to lighten the mood for a moment and wish my young, beautiful daughter a happy 19th birthday. Last year she had to celebrate her 18th birthday on her own because her mother was on the campaign trail. This year she has to celebrate her 19th birthday on her own because her mother is in the House of Commons. I want to tell her that I love her and wish her a very happy 19th birthday. This will give us some energy to continue with the debate. It feels good to lighten the mood a bit and talk about our lives.
A year ago, I was elected in the riding of Beauport—Côte-de-Beaupré—Île d'Orléans—Charlevoix, and I was given a very important mandate: to represent, here in the House, Quebec's values in matters of culture, languages, the environment, the green economy and health. A year ago, I had no idea that I would be rising in the House and speaking to my distinguished colleagues in favour of Bill on medical assistance in dying. To be perfectly frank, this is not usually a topic we find easy to talk about.
However, something happened that gave me the courage to get more involved in this issue of late, and so, despite everything, I am pleased to do so. This is not an easy debate because what we are doing will have a major influence on the fate of courageous individuals with conditions that cause them extreme and irremediable pain and suffering that will never end.
To help us do this work, we must turn to our own experience. I will share some of my own experiences that, sad as they are, will put a human face on this afternoon's debate.
As an only child, I accompanied my parents on the sad and often difficult path leading to the end of life. My father was the captain of a schooner, a small wooden boat, that he sailed on the St. Lawrence. His entire life he claimed that his schooner was a leaky boat and that he had to learn to sail in order not to drown.
His lung specialist told him that he was going to drown, that the cancer would drown his lungs and that he would suffocate to death. My father had a great deal of character and thought that he had not worked all his life without drowning to then die by drowning. That was out of the question. He wanted the doctors to find a solution. Surprisingly, he was told that, in his particular case, he had to right to a medical protocol involving sedation to avoid a situation of imminent death, respiratory distress. On the morning of August 12, 2010, he decided that he could not go on, that his condition was deteriorating, that he wanted relief. He was relieved to learn that he would not die by drowning, because he could avail himself of the protocol on the day that he decided that he could take no more. He passed away peacefully and serenely.
My mother was not as lucky. She had pancreatic cancer and died in excruciating pain. She was dehydrated and her stomach was perforated by the disease. She was in palliative care for 17 days. In her case, palliative care could not ease her suffering. Use of the respiratory distress protocol was not an option, even though there was plenty of distress for her, me and all her health care providers. In short, there are many ways to die, but in her case, morphine never did any good. Her heart was too good, too strong and it resisted. It resisted for far too long, much longer than the specialists could have predicted.
My experience with my parents is certainly just as valid as those of my dear colleagues. It allowed me to compare what it means to die when you can control how things happen and the consequences, and what it means to die in desperation without any way to ease the pain.
I now want to talk about my friend Sophie, who died on Saturday. Sophie was 39 years old and had two young children aged 11 and 13. Sophie had cystinosis, a nasty disease that took her sight, then her ability to swallow, and finally her kidney function. She had had a kidney transplant, was part of an American research program and had access to some new potential medications developed in the United States, which were able to help some people with the same disease. Unfortunately for her, the disease had progressed too far. The experimental treatments did not work, in spite of the 100 pills a day she had to swallow, at a cost of $300,000 a year.
I share my friend Sophie's story because it needs to be heard here today. When her condition started to get worse, she wanted to request medical assistance in dying. She had already started the process and started filling out the mountain of paperwork, as she called it. Unfortunately, even with the help of her loved ones and her doctor, she did not have the time to go through with it, because she suffocated and collapsed, dying in front of her powerless, terrorized and unprepared young children, who will forever be traumatized by these memories. This happened on Saturday at 6 p.m. in Quebec City.
Things could have been very different for our dear Sophie and her two children. Simplified access to medical assistance in dying based on criteria that suited her situation could have given her children a chance to say goodbye to their mother, to hold her in their arms and to be with her as she passed away quietly and serenely. Their experience of death, while deeply sorrowful, could have been tempered by the dignity and peace that only medical assistance in dying can provide in some cases clearly defined by law and the experts when given the chance.
Bill is a step in the right direction. We must make it so that other people suffering from degenerative or incurable diseases need not go to court to challenge the eligibility criteria for medical assistance in dying. This bill is a step in the right direction because a person's eligibility for medical assistance in dying no longer hinges on their death being reasonably foreseeable.
The complexity and diversity of Sophie's symptoms made it impossible for her death to be reasonably foreseeable and to know what would ultimately be her cause of death. Everyone around her knew that her only hope of dying with dignity and without suffering was quick and easy access to medical assistance in dying after obtaining the appropriate medical opinion.
Sophie's story will not be reported in the papers or on television. Maybe it will be shared a bit on the family's social media, but Sophie is the perfect example of what we have failed to do so far.
On behalf of all those who are sick and waiting for medical assistance to die in peace and with dignity, I call on all hon. members to stop playing games and acting superior to those around you, and drop all the political strategies that often animate and sometimes drag out our debates. I ask each one of these people to take a deep breath on behalf of all those we have yet to help who are anxiously waiting and hoping that our good collective judgment will help us reach a consensus. Let us set aside all the parliamentary back and forth and let us be guided instead by our humanity and compassion.
Mr. Speaker, I appreciate the opportunity to rise and speak this evening on Bill , or MAID.
The meaning and consequence of this bill should weigh heavily on all Canadian parliamentarians. Today we are debating the competing interests of individual autonomy and the sanctity of human life. We are addressing the suffering of our loved ones, the dignity of the elderly and disabled and the moral, legal and ethical concerns that are inextricably tied to medically assisted death. We are setting out the rules, standards and boundaries by which Canadian doctors and nurses can, at a patient's request, terminate life. This cannot be taken lightly and it is not legislation that should be rushed, but that is the predicament that this Parliament finds itself in.
In 2016, the Liberal government passed Bill , legalizing MAID. Last year, in the case of Truchon v. Attorney General of Canada, the Quebec Superior Court ruled that it was unconstitutional to restrict the availability of MAID to individuals whose natural death was reasonably foreseeable. Contrary to the requests of my Conservative colleagues and many advocacy groups, the Attorney General, who bears the responsibility of upholding laws passed in Parliament, chose not to appeal the ruling in Truchon. It is difficult for me to understand how something as essential to life as one's departure from it is not important enough for the Liberal government to appeal. This is something that should have had both comment and decision from the Supreme Court of Canada.
Because of the Liberal government's inaction, we are now working up against a December 18 Quebec-court-imposed deadline to enact a legislative response for the whole country. Its declaration of constitutional invalidity expires on that date. I want to assure my constituents in South Surrey—White Rock and all Canadians that, as a member of Parliament and a member of the Standing Committee on Justice and Human Rights, I will stand up for their shared values and beliefs and work tirelessly to ensure the amendments proposed in Bill , and their consequences, are carefully studied and considered despite the impending December deadline.
Turning now to the substance of Bill , I am concerned that the bill, as written, is too broad and lacks the safeguards necessary to protect Canada's most vulnerable populations. Let me be clear. The removal of the “reasonably foreseeable” standard will significantly increase the number of Canadians eligible for MAID. The breadth of qualifying conditions widens considerably under Bill C-7. For anyone who initially opposed MAID on slippery slope concerns, it appears we are now sliding down that proverbial hill. Will we eventually follow the Netherlands' lead, which recently ended up in its announced plans to offer MAID to children under 12?
As a group of physicians recently put in a letter to the , urging an appeal of the Truchon decision, “Canada will have moved well beyond allowing an autonomous life-ending decision at the end of life into the realm of death on demand for almost any reason at any time.”
We know, from Health Canada's annual report published in July, that 2% of deaths in Canada in 2019 were medically assisted.
How much higher would that number be under Bill , and how many Canadians would be eligible for MAID without the “reasonably foreseeable” requirement? Both questions must be answered.
If this is in fact the direction in which Parliament decides to take this legislation, we need more safeguards to protect the more vulnerable, not fewer. As written, Bill redefines who qualifies for the end-of-life procedure and strips away some of the protections put in place a mere four years ago.
One such amendment is the elimination of the mandatory 10-day reflection period. Under the original legislation, unless an exception applied, individuals wishing to receive MAID had to wait a period of 10 days after submitting their signed requests. In most instances, the waiting period makes sense. It ensures time for reflection before taking the irreversible action of ending one's life.
We know from Quebec's annual end-of-life care reports that since 2015, over 300 patients in Quebec alone changed their mind after requesting medical assistance in dying. In any event, exceptions already exist under the original law for those whose death is fast approaching and for people who will soon lose the capacity required to provide the necessary informed consent. Why then remove this 10-day reflection period?
Bill also takes aim at another safeguard included in the previous laws, reducing the number of independent witnesses needed to sign and date the candidate's application for MAID, from two to one.
This amendment would now apply to the newly eligible class of persons who are not faced with reasonably foreseeable or imminent death. Contrary to statements made in the House by the member for , this is a real concern for many.
As a civil litigation lawyer, I have had my fair share of exposure to all sorts of legal documents requiring the signatures of independent witnesses to ensure both authenticity and true intent: wills, divorces, financial disclosures, affidavits and mortgages, to name a few. To express one's intentions in a will in B.C., a person must have two independent witnesses not named in the will to witness the authenticity of their signature and their intention at the time of signing. If these requirements are there to safeguard intentions regarding possessions, should they not also be there to safeguard a person's intentions regarding the method and timing of their death?
It should be noted that Bill does include a 90-day assessment period and directive that applicants be informed of available alternative treatments, but will these safeguards sufficiently protect our most vulnerable populations? When does the 90-day period begin? Is it recorded?
Another piece of the bill that I have difficulty with is that it allows patients who may lose capacity before the end-of-life procedure is performed to give their final consent in advance. This troubles me for the same reasons discussed before with respect to the 10-day waiting period. As we have seen, people do change their minds.
In recent weeks, we have heard from many representative groups that have expressed concern about the decision in Truchon. The Council of Canadians with Disabilities, the Canadian Mental Health Association, the ARCH Disability Law Centre and others have articulated the concern that making individuals with disabilities who are not facing imminent death eligible for MAID would be harmful to the disabled community at large, affirming the untrue stereotype that a life with disabilities is not worth living.
We must pause to reflect on that. Those who are passionate advocates for Canadians with disabilities are very concerned about the direction these court and policy decisions are taking us, yet the Liberal government moves forward.
There still exists the legal concept of undue influence. Who are most susceptible to undue influence and coercion? It is the vulnerable. We have also heard from hundreds of physicians who share a concern that some patients have chosen the path of MAID due to the suffering caused by a lack of proper supports. A tragic example is from B.C., where a father suffering from Lou Gehrig's disease chose to undergo the end-of-life procedure because he did not receive the support and resources he so desperately needed.
The government is not listening to the heartbreaking stories of these ALS sufferers and their cries for the fast-tracking of life-lengthening and life-sustaining hopeful therapies that we cannot get in Canada. Is the government giving those sufferers and Canadians true options? We need compassion, yes, but compassion takes many forms.
Hospices are not readily available to all Canadians as an alternative. A good friend of mine died a couple of years ago of inoperable brain cancer. He was a doctor. In his case, he very carefully weighed MAID as opposed to living in hospice. He chose hospice because it extended his life for five months, which he could spend with his family. They were okay with his deterioration because they loved him, and they wanted to support him and be with him. However, he had that true option.
If we are going to expand the legislation, the government should equally ensure robust support for the vulnerable, hospice care and hopeful therapies are available. Everyone matters.
Finally, I would like to reflect on the health care professionals who are asked to implement this proposed law. We are now celebrating our doctors and nurses for their tireless efforts to keep our country healthy and safe. We should also ensure that they have the ability to decide whether this is compatible with their will or beliefs, and not be mistreated for any refusal to administer it.
To conclude, I have heard from constituents in my riding who are on both sides of this argument. I ask my colleagues to really take the necessary time to study the bill and reflect on these proposed amendments, especially as they affect the most vulnerable. We must be compassionate but we must also respect human life.