Mr. Speaker, there are few, if any, issues that have come before Parliament that more clearly touch on our fundamental values as Canadians than medical assistance in dying.
Let me start today by restating what I said at the beginning of my speech in favour of Bill at second reading. When it comes to medical assistance in dying, the priority for New Democrats has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already afflicted with terminal illnesses, and at the same time also avoiding prolonging suffering for the families who must bear witness to the suffering of their loved ones.
Here we are in late December, up against the deadline set by the Superior Court of Québec in the Truchon case. It does not really matter whose fault that is. Some of this delay was obviously due to COVID, but a good measure of the delay was due to the Liberals proroguing Parliament.
To me, it is manifestly unacceptable to hear some members arguing that we do not have to meet the deadline because it would “only affect Quebec.” In any case, the time has come for the House to act on Bill . It is also time to act on another task as well. Not only has our consideration of the bill been delayed, but equally important, the five-year statutory review of the original medical assistance in dying legislation, Bill , is now long overdue.
Members will know that some of us called on the government to get this review under way much earlier this year, so that it could have helped guide the consideration of Bill . Again, COVID and prorogation intervened.
When it comes to medical assistance in dying, Parliament had two tasks before us. One was the need to amend the MAID legislation to conform with the charter as required by the Superior Court of Québec ruling. This ruling found the current law too restrictive, and that was in fact the very reason New Democrats voted against Bill at the original vote.
Making MAID laws conform to this ruling is, of course, the central purpose of Bill . However, as I said, the second task with regard to medical assistance in dying was to conduct that statutory review of the broader issues, having had four years of experience with it.
As a result of growing increasingly concerned while waiting for the government to get the review under way, on October 8, I introduced Motion No. 51. My motion called for the creation of a special committee of the House of Commons to conduct this review. Special committees have some advantages when it comes to reviews of this kind. They are granted comparatively unlimited resources by the House and are not bound by the four hours per week schedule specified for standing committees, like the justice committee.
They are mandated to work on a single task, so they are not subject to the kinds of delays that can occur in standing committees, like the justice committee, where dealing with legislation must always, necessarily, take precedence over studies. Of course, special committees can make recommendations for actions needed beyond the confines of Bill or beyond the narrow court decisions.
Indeed, it was a special committee that made the original recommendations to the House that became Bill . To be clear, this broader legislative review of issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start last June at the latest. It should have taken place, and would have taken place, whether or not there was a court decision in Quebec.
Bill required that the review specifically look at the question of advance requests or advance directives, requests from mature minors and requests where mental illness is the sole underlying condition. However, New Democrats have argued from the beginning that the mandate of that statutory review was missing a key element. That is why my motion called for a special committee with an expanded mandate to include the question of whether the safeguards in our medical assistance in dying legislation are adequate to protect the most vulnerable among us.
I am happy to say that I believe all parties now seem to agree that the mandate should be expanded to include this question. I am still not sure why the government is so averse to a special committee, but I think it will find that members of the justice committee would reluctantly agree to the justice committee undertaking this review, as long as it had the expanded mandate. Though, of course, I will still worry that time, resources and the agenda of the standing committee may be too limited to do justice to the task.
Previously I have spoken about the issues of medical assistance in dying on very personal and very practical terms. I have spoken about my mother's fears of being trapped in a hospital bed while suffering and no longer knowing her family. I have spoken of a friend who chose medical assistance in dying much earlier than she might otherwise have done out of fear of losing her capacity to give final consent because of her growing brain tumour.
Now, in addition to these personal experiences, as a member of the justice committee I have had the privilege of talking to dozens of Canadians over Zoom, of hearing dozens of witnesses in committee and of reading even more briefs on medical assistance in dying.
I have been particularly and equally touched by the stories of families whose loved ones chose medical assistance in dying over prolonged suffering and the stories from those medical practitioners who provide that medical assistance in dying. My conversations with these families and with these doctors helped me understand how medical assistance in dying operates in real life. These conversations have made it clear to me that the current legislation has some unintended and cruel consequences. This was evident even before the Quebec court ruling.
Those who listened carefully to the terminally ill, their families and the practitioners providing medical assistance knew well that our current law often inflicts and prolongs unnecessary suffering. Bill addresses three of those cases of unnecessary and prolonged suffering. While it was not strictly required to do so by the Truchon decision, I rightly think the bill does take on that task of reducing suffering.
Most important to me, Bill will end the spectre of patients like Audrey Parker of Nova Scotia, who felt she had to leave early and choose an earlier date for receiving medical assistance in dying because of her fear of losing the competence required to give consent at the moment the assistance is rendered. Audrey Parker felt she had no choice but to miss one last Christmas with her family. I think we all owe her thanks for making her personal struggle public so that others would not have to face the same awful choice.
Bill will fix this by waiving the requirement for final consent for those already assessed and approved for medical assistance in dying. This waiver of final consent takes away that need for any person, and let me stress this again, who has already decided to request medical assistance in dying and has already been assessed and approved for that assistance. It will prevent them from having to go early in order to avoid the loss of competence that would prevent them from receiving the end to their suffering and the end to their family's suffering that they desire.
Whether one supports waiving the requirement of consent at the moment assisted dying is provided or does not support that, Bill does not open the door wide to advance consent or advance directive. It is simply providing that waiver of final consent for those already assessed and approved. The topic of advance requests remains part of the mandate of the special committee I would like to see doing the statutory review.
This is a question of great concern to many of my constituents. In fact, it is the single thing I have heard the most about from my constituents. They are concerned about maintaining their autonomy and decision-making over how their end of life takes place. They want to make sure that their wishes are respected. I have to say that my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not so simple as it appears on first look. As I have said, this will remain an important question for a statutory review to address, but it is not part of Bill .
A second cause of unnecessary suffering that Bill will also eliminate is the mandatory 10-day waiting or, as it is sometimes called, reflection period. The evidence provided in the report of the Association of Medical Assistance in Dying Assessors and Providers shows that nearly half the patients receiving medical assistance in dying chose to do so on or about the 11th day. What does that tell us? It tells us that their suffering was prolonged simply to meet that statutory waiting period of 10 days.
I know concerns have been raised by members of Parliament about people changing their minds, but the statistics on people changing their minds about medical assistance in dying show that people do that during the assessment period, before they are actually approved. What the waiting period does is it makes patients hold out for days longer on what has already been assessed as intolerable suffering just to meet the statutory requirements. All patients are made to spend this time suffering and few if any are actually reflecting on the situation, because at this point to relieve the pain they are heavily sedated. If we truly respect the agency of patients who are terminal and suffering, then we ought not to impose a cruel waiting period.
Let me say as an aside how disappointed I have been to hear some members of Parliament alleging that Bill somehow creates the possibility of what they call “same-day dying”. It does nothing of the kind.
That would only be possible if the medical professionals involved skipped their duties and their professional responsibilities as prescribed in law and in their own professional codes of conduct. That is what it would take to produce such a result. Making this false allegation is insulting to the patients and the medical practitioners who provide this service. It demonstrates how little those who use that term know about the actual process of medical assistance in dying.
Another misleading “fact” that has often been cited in this debate occurs when members ask how can anyone support Bill when “doctors oppose it”. What those members are referring to is a petition submitted to the justice committee, a petition signed by more than 700 physicians. What this selective siding ignores is that the Canadian Medical Association, which represents more than 70,000 doctors, has come out squarely in favour of Bill . That is nearly 100 times as many doctors as those who signed the petition.
Let me point to another positive change in Bill that reduces suffering, which has been willfully misconstrued: the reduction of the requirement that two independent people witness the signature of the patient requesting medical assistance in dying.
This change was suggested by practitioners as a result of the experience they have already had with Bill . Clinicians and families often found the process of identifying a second independent witness was difficult, especially in rural and remote areas, because of the requirement of independence. It often also raised privacy concerns, as it involved an extra person in this process.
We must remember that the purpose of witnesses is only to verify the identity of the person making the request. Two independent medical assessors have already been involved each and every step of the way throughout the process. They have already had to certify the patient's eligibility for MAID. Practitioners have said this second witness provision is unduly restrictive and, again, often only ends up unnecessarily prolonging suffering.
At this point, I want to turn to some of the specific concerns about Bill that were raised at the justice committee.
The first concern is about the removal of the requirement that death be reasonably foreseeable in order for someone to proceed with medical assistance in dying. Of course, this provision was removed by the Quebec court decision, not by Bill .
Bill makes sure that medical assistance in dying legislation conforms with the decision of the court. It said limiting medical assistance in dying to cases where death was imminent was a violation of the Charter rights of patients whose death might not be on the immediate horizon but whose condition left them in intolerable suffering.
Bill creates a second track for those whose death is not imminent and specifies a second set of requirements and safeguards appropriate for the second track. The decision about whether the reasonably foreseeable provision should be removed is not made by Bill . It is a decision made by the Quebec courts. I believe this is consistent with the Carter decision.
I want to take a moment to address those who say there is no need to meet the deadline opposed by the Quebec Superior Court. I remind them that without Bill , those whose death is not reasonably foreseeable will come under the existing requirements immediately and will be without any of the conditions specified in Bill as appropriate for the second track. Regardless of whether people believe the safeguards are adequate, I ask them to understand that if we do not meet the deadline, there are no safeguards in the second track at all.
I believe most of us accept that there are good reasons to differentiate between the two tracks and to have additional requirements appropriate for those whose death is not imminent. Bill rightly sets out a more restrictive process and therefore requires more time for assessment and decision-making for the second track.
In addition, it does not set a reflection period of 90 days. It sets an assessment period of 90 days. That is an important distinction. It is not a maximum of 90 days; it is a minimum of 90 days. I do not think we should get confused on that point.
The second concern I want to address is a very important concern of the disability advocates: with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.
Nothing in Bill changes the very high standards set in the original Bill for receiving medical assistance in dying. To receive this assistance, patients must have a condition that is incurable, must be in an advanced state of irreversible decline and must face intolerable suffering. This means Bill does not open the door wide, as some have suggested.
However, let me be clear here. I do not, in any way, wish to dismiss the concerns of the disability community over their vulnerability. That is why I have been calling for an expanded mandate of the statutory review so that we require it to consider the question of whether safeguards to protect the vulnerable in our medical assistance in dying legislation are adequate. Again, this may require us to look beyond the narrow confines of the medical assistance in dying legislation to other health legislation and other social support legislation.
That is why my colleague, the member for , and I have just delivered today a joint letter to the calling for a new national income support program, set at $2,200 per month, for all persons with disabilities. This would be a single, national program to replace the patchwork of provincial programs that rarely come close to the amount that we have all now acknowledged with CERB as the minimum necessary. Providing such a benefit would be an important step toward a guaranteed basic income for all Canadians. More importantly, in the context of the bill, this would provide support at a level that would help avoid placing persons with disabilities in a position where dying looks like a better option than living without the supports they need.
Failure to provide the necessary resources to ensure that everyone can enjoy full and equal participation in life is a long-standing and ongoing black mark on the federal Parliament and all provincial parliaments. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities.
As we consider how to recover from the pandemic, I hope we can adopt this proposed federal program that would provide all people with disabilities the equivalent of a living wage. This would be an important step toward relieving the fears about having to make a terrible choice eventually with medical assistance in dying.
Given the speeches from all parties stressing the need to take the situation of people with disabilities seriously, and in light of the Quebec Superior Court decision, I believe we should be able to marshal immediate support for this proposal in a minority Parliament. It would be an important step in mending the gaps in our social safety net that COVID has revealed. COVID has taught us that we can roll out income support programs quickly when we really want to do so.
As I near the end of my time, let me take a moment to address one last phenomena I observed in our committee discussions and one that I found very disturbing. It was the tendency of some members to mix together issues of suicide and medical assistance in dying. These are two completely different issues, distinct both medically and morally.
Medical assistance in dying does not provide a way to take one's own life. The testimony from physicians and families involved in medical assistance in dying told us very clearly that no one involved in medical assistance in dying wants anyone to die: not the families, not the physicians and certainly not the patients themselves. Medical assistance in dying is about those who are already dying and are far along that path and in intolerable suffering. It is about them being able to have control about how their life ends and when that suffering for them and their family will come to an end. It is not about choosing to die.
The New Democrats continue to support Bill , as it contains significant measures that will help bring an end to unnecessary suffering and provide the necessary safeguards in the second track for those whose death is not reasonably foreseeable. It will do so in time to meet the deadline hopefully imposed in the Truchon decision.
We will continue to demand that we get started on the statutory review, which should already have begun. Proceeding with Bill without proceeding with the review is only getting half the job done on medical assistance in dying. At the same time, it potentially undermines public support for medical assistance in dying, which so far has only continued to grow.
In conclusion, I want to say again that I believe as a society we must do a better job of providing for the most vulnerable among us and those who are differently abled. In the case of the tragic deficiencies in end-of-life care and in the lived experiences of people with disabilities, COVID has taught us how much further we have to go toward a fully compassionate and fully equal society. I urge all parliamentarians not to ignore those lessons.