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View Arnold Viersen Profile
CPC (AB)
View Arnold Viersen Profile
2021-06-07 15:46 [p.8030]
Mr. Speaker, I want to present a few petitions.
The first petition I am bringing to the attention of the House is signed by Canadians from across Canada. They are concerned with the Senate amendment to Bill C-7 that would allow Canadians with mental illness as their sole medical condition to access euthanasia.
The petitioners recognize that suicide is the leading cause of death for Canadians between the ages of 10 and 19. Therefore, they are calling on the government to reject the Senate amendments to prevent those struggling with mental illness from obtaining assisted death and to protect Canadians struggling with mental illness by facilitating treatment and recovery, not death.
View Garnett Genuis Profile
CPC (AB)
Mr. Speaker, the third petition I am presenting is with respect to Bill C-7 that recently passed and the issues raised in it around euthanasia or medical assistance in dying for those with mental health challenges. The petitioners are very concerned about the decision of the government to add in euthanasia for those with mental health challenges at the last minute, when it had previously said it did not support these measures. They want to see the government do more to protect Canadians struggling with mental illness by facilitating treatment and recovery, not death.
The petitioners are also supportive of the idea of having a national, three-digit suicide prevention line.
View Kelly Block Profile
CPC (SK)
moved that Bill C-268, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.
She said: Madam Speaker, I am proud to rise today to begin the debate on my private member's bill, Bill C-268, the protection of freedom of conscience act. I would be remiss if I did not acknowledge this bill is built on the hard work and determination of former members of Parliament. The first iteration that sought to address this issue was introduced by the late Mark Warawa in 2016, but it did not progress when the government introduced Bill C-14.
I do consider it a tremendous honour that my bill is the same number, C-268, as his was. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, which died on the Order Paper when the election was called in 2019.
I would like to thank all those who have been championing this issue for many years and for their willingness to work with me.
Experts throughout Canada provided information and advice, while thousands of Canadians have voiced their support for protecting our fundamental freedoms. While there are numerous dictionaries that define conscience, they are consistent in defining it as an individual's inner sense of knowing the difference between what is right and wrong and that guides their behaviour.
An article by Cardus called “The Imperative of Conscience Rights” references the following:
“Conscience” traces to the Latin conscientia, and is related to the Greek synderesis. While conscientia refers to the application of our moral knowledge to particular situations, synderesis refers to the moral awareness built into each person and that urges us to do good and avoid evil.
Bill C-268 is straightforward as it seeks to enshrine in law a minimum national standard of conscience protections for medical professionals while respecting the jurisdiction of my provincial colleagues to expand on it. It is a response to calls from disability rights groups, first nations, the Ontario Medical Association and many hundreds of medical and mental health professionals to protect conscience rights.
It would ensure the medical professionals who choose to not take part in, or refer a patient for, assisted suicide or medical assistance in dying would never be forced by violence, threats, coercion or loss of employment to violate the freedoms protected in section 2(a) of the charter. This bill also serves to protect the rights of patients to receive a second opinion, and by doing so, would protect our health care system.
In my consultations, I spoke with disability rights advocate Heidi Janz. She told me about being born in the Soviet Union. Doctors told her parents that Heidi would never walk, talk or think and that she would be dependent on others for the rest of her short life. They told her parents to put her into an institution and forget they ever had her. Heidi Janz has severe cerebral palsy.
Her parents did not listen to the dominant narrative of their day. They loved their daughter and believed her life had value. Eventually, they found the support they needed. Today, Dr. Heidi Janz holds a Ph.D. and is an adjunct professor of ethics at the University of Alberta. In her spare time she is a playwright and author, and somehow, despite how busy her life is, she also serves as the chair of the ending of life ethics committee for the Council of Canadians with Disabilities.
Dr. Janz is a remarkable woman. While some might pity her, she will have none of it. She says that everyone talks about how bad it must be to have a disability, but that she chooses daily to live in opposition to that narrative. She also says that disabled people can be so much more than their diagnosis, and that she is proof of that fact.
If it had been up to the dominant view of her day, she would never have had the chance to disprove that narrative. If her parents did not have the option to find the help they wanted to get that crucial second opinion, none of my colleagues in this place would be hearing about this marvellous woman. This is not just a theoretical story.
In a similar vein, earlier this year the Minister of Crown-Indigenous Relations, who is a doctor herself, wrote to her constituents about her experience of ageism in our health care system as it related to her 93-year-old father.
While I will not repeat the whole story, I will just quote her last two sentences:
My Dad got better without needing the ICU, but I remember thinking that as an MD I had been able to firmly take a stand. I worried that other families wouldn’t have been able to question the clear ageism in the choices being put in front of them.
The minister's father and all Canadians have the right to find a doctor who will offer them hope, offer them another choice, offer them a second opinion. All Canadians deserve that same right.
Now, this is anything but a guarantee in Canada. We have passed laws that have the unintended consequence of forcing doctors and medical professionals to provide patients death, regardless of whether they believe it is in their patient's best interest. Bill C-14 and Bill C-7 create a federal standard for medical assistance in dying and assisted suicide, but not for conscience protections. Despite the claims of some, it is patently absurd to argue that a conscience rights bill would somehow interfere with the role of the provinces while the legalization of medical assistance in dying does not.
We are speaking of the very first fundamental freedom laid out in the charter. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed. Above all, it is the right thing to do for patients and medical professionals.
Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth. In fact, conscience rights are critical to how our health care system works. Patients have the right to a second opinion, but there can be no second opinion if every medical professional is forced to provide the exact same list of options.
Health care is fundamentally about the doctor-patient relationship. Take the case of a psychiatrist who supports MAID in certain circumstances, but who has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built up an understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under the current law, that psychiatrist would be forced to refer the patient to someone else so that the patient could die. The psychiatrist must do this, despite knowing that the suicidal thoughts are temporary, that otherwise the patient is joyful and loves life, and that ending that life is wrong. The psychiatrist's hands are tied. Is that what passes for medical care?
Some might claim that there are safeguards in place to prevent such tragedies, but I ask, are members completely sure? With the passage of Bill C-7, many of the safeguards have been removed. We are talking about ending a human life. There is no room for “maybe” when a life hangs in the balance. Should the first line of safeguards not be the expertise of the medical professionals who know best? If they do not believe death is the answer, should we not at least consider if they are right? This is, after all, a matter of life and death.
Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID is becoming the status quo. To claim that protecting the conscience rights of medical professionals will somehow block access for those who truly want it is both misleading and nothing but baseless fearmongering.
The Canadian Medical Association stated clearly that conscience protections would not affect access, because there were more than enough physicians willing to offer MAID. This is further reinforced by a McGill study that showed that 71% of recent medical school graduates would be willing to offer MAID.
Every court case on the subject, as well as common sense, has stated clearly that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we are clever enough to ensure access to MAID while still protecting the fundamental charter right to freedom of conscience.
I believe it is no accident that former prime minister, Pierre Trudeau, placed conscience rights as the first of the enumerated rights in our charter. It is an acknowledgement that the state cannot and should not attempt to force any one of us to do what we believe is immoral.
Dozens of first nations leaders wrote to every MP and senator. They said that, “Given our history with the negative consequences of colonialism and the involuntary imposition of cultural values and ideas, we believe that people should not be compelled to provide or facilitate in the provision of MAiD.”
We claim to be a pluralistic, free society. If that is true, it demands of us a tolerance of the moral views of others. Some have argued that protections already exist in Bill C-14. While I applaud the former minister of justice, the hon. member for Vancouver Granville, for ensuring that conscience rights were acknowledged in that legislation, acknowledgement is no longer enough. There are examples of medical professionals being forced or bullied into participation in assisted suicide against their conscience.
Dr. Ellen Warner, an oncologist who has served her patients for 30 years, told me about her experiences. She said:
I think it will shock Canadians to hear of healthcare providers being coerced into participating in MAID, yet such coercion has been happening frequently. A brilliant colleague of mine was bullied into becoming the physician legally responsible for MAID on his hospital ward. It was a great loss to us when he left for a different position. Two other co-workers told me that, despite strong, moral objections, they would carry out MAID if asked to do so for fear of losing their jobs. At one of our staff meetings, a psychiatrist stood up and announced that any physician who does not actively support MAID should not be working at our hospital.
Finally, some have suggested that medical professionals should leave their morality at the door. However, no one truly believes or wants that. As an example, no one would want a doctor to forget their morality if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. As Dr. Ellen Warner stated, “In the absence of conscience protection, the group with the most to lose are the patients—the people we are all trying to help,”
This bill would protect the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patient. Canadians need this bill to pass. Canada's medical professionals need this bill to pass. Additionally, they will need individual provincial governments to protect their rights through provincial regulations and legislation.
I encourage all members in this place to do our part and pass the protection of freedom of conscience act.
View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2021-05-27 17:59 [p.7528]
Madam Speaker, in light of the extensive protection for conscience rights in the charter; in the statute originally passed, Bill C-14, which the member opposite mentioned; and in the Carter decision, I am personally unaware of a single instance of a prosecution having been levied against an institution for compelling a doctor or nurse to provide MAID.
I wonder if the member opposite can provide this House a single example of such a prosecution, a human rights complaint at the provincial level or a wrongful dismissal suit. I am struggling to understand the problem she is trying to identify and address with this private member's bill.
View Kelly Block Profile
CPC (SK)
Madam Speaker, I introduced this bill as it addresses the very real challenges that doctors and other medical professionals are facing regarding their conscience rights as defined in the charter and as a result of the legalization of medical assistance in dying in 2015 and the recent expansion of it through Bill C-7.
Doctors have come forward to tell us that they are being forced to offer death as a treatment option regardless of a patient's medical history. In my discussions with stakeholders, I heard that, without conscience rights, some medical professionals may choose to leave their field or the profession altogether. Furthermore, we have heard that there are doctors who are not necessarily opposed to MAID in theory but who are deeply concerned as to where the law has gone.
View Christine Normandin Profile
BQ (QC)
View Christine Normandin Profile
2021-05-27 18:00 [p.7528]
Madam Speaker, Quebec's legislation on medical assistance in dying requires that a doctor who does not practise MAID refer the case to a doctor who does.
The bill my colleague has introduced would make this requirement in Quebec illegal.
I do not need the details, but I would still like to know whether my colleague agrees that the bill not only interferes in Quebec's jurisdictions but also specifically tries to do indirectly what it cannot do directly.
View Kelly Block Profile
CPC (SK)
Madam Speaker, I would completely disagree with the member when it comes to the bill trying to do indirectly what it cannot do directly. That is exactly what compelling a doctor to refer someone to do would actually be doing. It is important to understand that a referral is a medical procedure and is essentially an endorsement by the referring doctor of the treatment in question. It is the same as a doctor saying a treatment is right for someone.
In every court case regarding rights and MAID, the courts have clearly stated that forcing doctors to refer patients is a violation of their charter rights. If we do not protect conscience in referrals, we end up with the same ethical issues we started with, which is what we are hearing from physicians.
View Randall Garrison Profile
NDP (BC)
Madam Speaker, I respect that the member has introduced this bill out of a clarity of conscience of her own. It always distresses me when we distort the law on medical assistance in dying by calling it assisted suicide, since people must have a terminal condition before they can even be considered eligible. When the member refers to people being required to refer, what she is referring to are the professional standards set by the College of Physicians and Surgeons in most provinces.
Is she saying that we should take away the ability of doctors and nurses to regulate their own professions and substitute her judgment in her bill for that of professional associations?
View Kelly Block Profile
CPC (SK)
Madam Speaker, what I am saying is that freedom of conscience is entrenched in our charter. It must be protected. Support for legislated conscience rights protection varies between associations and colleges as well as from province to province, and that should come as no surprise.
What is becoming more clear every day is that medical professionals are calling for conscience protections as a result of the legislation that has been introduced over the last six years.
View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2021-05-27 18:03 [p.7528]
Madam Speaker, I rise today to speak to Bill C-268, the protection of freedom of conscience act.
This bill proposes to create two new offences to protect the freedom of conscience of health care professionals in the context of medical assistance in dying, or MAID. The first offence would prohibit using violence or threats of violence, coercion or any other form of intimidation to compel a health care professional to take part in MAID. The second offence proposed would criminalize persons who refuse to employ or dismiss from employment health care professionals because they refuse to take part in MAID.
Protecting the freedom of conscience of our health care professionals is obviously a laudable goal. We have all recently debated Bill C-7, which amended the Criminal Code's MAID regime to remove the reasonably foreseeable death criterion. Some Canadians are very much in favour of MAID for anyone with decision-making capacity, others are profoundly opposed to it in any circumstance and many have opinions that fall somewhere in between those two positions. Many of my constituents in Parkdale—High Park, for example, are largely in favour of MAID, in favour of providing autonomy to Canadians and to empowering them with the tools to reduce suffering, with important safeguards being put in place to protect those who are vulnerable.
Our government understands that medical assistance in dying is deeply complex and personal. We were proud to have passed Bill C-7 in March of this year, which responded to the Superior Court of Quebec's September 2019 Truchon ruling and to the emerging societal consensus on the specific issues relating to MAID. We remain committed as a government to protecting vulnerable individuals and the equality rights of all Canadians, while supporting the autonomy of eligible persons to seek medical assistance in dying. We are working with the provinces and territories to implement the changes in Bill C-7 and ensure adequate access to health care support services and medical assistance in dying to all Canadians who wish to seek it.
This range of views also exists among health care professionals who are the ones directly involved in MAID, whether it be providing MAID, assessing a person's eligibility, dispensing the substances, being consulted or supporting the patient. Clearly there are practitioners who do not want to be involved in MAID at all and there are others who find meaning in responding to the wishes of their patients who are suffering by providing MAID.
Let us get to the heart of what is being moved by the member opposite. The Canadian Charter of Rights and Freedoms protects freedom of conscience and religion from government interference. That is subsection 2(a) of Canada's charter. That freedom is subject to reasonable limits prescribed by law that can be justified in a free and democratic society. It is important to keep in mind that the charter, not the Criminal Code, is the source of that constitutional protection for freedom of conscience and freedom of religion.
I also think it is critical to underscore that the Criminal Code does not in any way compel anyone's participation in MAID. Let me be crystal clear on this point, because it was raised by the member opposite. Concerns about conscience protection also arose in 2016 when she and I were both members of this House, when we enacted Canada's first MAID regime. In order to be abundantly clear, while the preamble already articulated this, our government supported an amendment to Bill C-14, which added to the Criminal Code. I am going to read it for the purposes of clarity. This amendment was to subsection 9 of section 241.2, which states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” We have the charter, we have the preamble and now we have subsection 9.
This provision exists to protect the conscience rights of medical practitioners, but it will not stop there. The entire MAID regime was prompted by the Supreme Court's decision in Carter. I will read from paragraph 132 of the decision of the court, which said, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.” The court itself has been crystal clear on this issue.
When I asked the member, in the context of the debate this evening, whether there is any evidence of criminal prosecutions against institutions that are compelling physicians or nurses to provide MAID, instances of a wrongful dismissal suit or a human rights complaint, the member was not able to provide a single instance of such a situation arising, which begs the question whether there is actually an acute problem that the member is trying to address or whether, apropos of the question posed by my Bloc colleague, this legislation is simply an attempt to address a broader concern about MAID generally that perhaps is held by the member opposite and members of her caucus.
While there may be requirements for practitioners to participate in MAID in some form, it is at the level of regulation of these practitioners as professionals. That was raised by the member for Esquimalt—Saanich—Sooke. For example, in Ontario, The College of Physicians and Surgeons has an effective referral policy for MAID. It requires that practitioners refer their patients in good faith to a non-objecting, available and accessible physician or agency if they do not personally want to participate in medical assistance in dying. That policy was challenged in court under subsection 2(a) of the charter, the very provision that I put to members in this chamber. In 2019, the Court of Appeal for Ontario upheld the policy and that policy was never taken to any higher level of court afterward. That is the highest example of a court ruling in this country on whether effective referral violates the charter. It does not, according to Canadian jurisprudence.
This is one example of an effective referral policy from a regulatory body created by provincial legislation that aims to reconcile patient access to MAID with physicians' freedom to refuse participating in MAID. As the Ontario Court of Appeal noted, it is a solution that is neither perfect for the patients nor perfect for the practitioners, when questions like MAID raise difficult moral issues that are hard to reconcile with absolute perfection.
I would also note that neither of the offences the bill proposes would have an impact on an effective referral policy from a regulatory body. Such policies are not using violence, threats or intimidation to compel participation in MAID and the colleges that would issue them are not the health care professionals' employers. The offences proposed in this bill are not aligned with that particular objective of the bill.
I also have some questions about the proposed offences. The offence of intimidation reflects an opinion that I think we all hold. Health care professionals should not be the victims of violence, threats of violence or intimidation, whether it is to force them to provide medical assistance in dying or for any other reason. That is such a fundamental principle that the Criminal Code already sets out offences that prohibit such behaviour, regardless of who the victim is and regardless of the objective of the violence, threats or intimidation.
What is more, we have not heard about any doctors being forced by threats, violence or intimidation to provide medical assistance in dying, or MAID. Although the offence of intimidation set out in Bill C-268 may send a message regarding the importance of not engaging in such behaviour to force a health care professional to provide MAID, it would duplicate the offences currently set out in the Criminal Code, such as assault, uttering threats, extortion and intimidation. In fact, it would not provide any additional protection and seems to target a problem that we have no proof even exists.
The employment sanctions offence raises questions about the appropriateness of using the criminal law, which is a very blunt tool that brings about significant consequences, including the deprivation of liberty to punishing employers who refuse to hire or who would fire health care professionals because they did not want to take part in MAID.
Again, I think many of us would agree that practitioners should not face employment consequences if they object to participate in medical assistance in dying, but this seems to me like an improper use of the criminal law to try and push feelings of conscience and religion in the workplace.
I reiterate that our government is committed to the protection of health care workers, now more than ever, given how much they have worked for Canadians during this pandemic. As well, we are committed to ensuring that all Canadians have access to the right of medical assistance in dying. Our government is proud of what we have achieved in Bill C-14 in the last Parliament, and Bill C-7 in this Parliament.
I look forward to working with the Special Joint Committee on Medical Assistance in Dying to review where medical assistance in dying in Canada will be going with respect to the laws on MAID in Canada and recommending any necessary changes.
I urge all members to keep these things in mind as we continue our study of Bill C-268, a private member's bill.
View Rhéal Fortin Profile
BQ (QC)
View Rhéal Fortin Profile
2021-05-27 18:13 [p.7530]
Madam Speaker, Bill C-268 is part of a movement we have seen a number of times in recent years, especially in committee, to prevent individuals from accessing medical assistance in dying.
This is deplorable because the roots of the current system, which was brought in when Bill C-7 was passed in March, go back a long way. The idea was not to please certain lobby groups. The idea was to meet the needs of the general population and satisfy the courts' requirements.
Seven years ago, on June 5, 2014, under the leadership of MNA Véronique Hivon, Quebec passed Bill 52, the Act respecting end-of-life care. The bill contributed to a palliative care continuum.
Earlier, my Conservative colleague urged us to think twice because this is important, this is about terminating a human life. I would argue that this is not about ending a life. We are not talking about ending a life. We are talking about helping people who opt to end their own life do so with dignity and without pain. Those are two very different concepts. This is not about murder; this is about helping people exercise their rights as set out in our charters and laws. Quebec dealt with the issue on June 5, 2014, with Bill 52.
In February 2015, the Supreme Court of Canada added in Carter that criminalizing a person who wishes to end their days is contrary to the Canadian Charter of Rights and Freedoms.
In April 2016, Parliament passed Bill C-14, which was the first iteration of Canada's medical assistance in dying legislation. That legislation had some flaws; it was not perfect, but it was a step in the right direction. It was consistent with the decision of the Quebec National Assembly and the values of all Quebeckers and Canadians.
Subsequently, in September 2019, the Quebec Superior Court issued a ruling in Truchon. Based on that ruling, a criterion in Bill C-14, specifically the provision requiring a reasonably foreseeable natural death, was inconsistent with our laws and charters, and we were told that it had to be removed.
Just recently, on March 17, Bill C-7 received royal assent. Finally, the criterion requiring a reasonably foreseeable natural death was removed. This is a concept that I myself had been struggling with since 2016. In my view, from the moment one is born, death is reasonably foreseeable. We just do not know when it will happen. It is a bit of an odd concept.
Bill C-7 put an end to the debate, so that is good. Since March 17, we can proceed not only in accordance with the wishes of certain lobbies, but also while respecting the wishes of the vast majority of the population and in compliance with the charters and the court decisions.
Secondly, introducing Bill C-268 into our debates is simply an attempt to upset the fragile balance we achieved with Bill C-7 at the federal level and with Bill 52 in Quebec. Bill C-268 upsets the balance between freedom of conscience, freedom of religion and the right of patients to dignity and comfort in their most difficult moments. This fragile balance was difficult to strike and I think we must avoid taking any action that might upset it. We do not have the right.
Bill C-268 is worded in such a way as to relieve health care professionals of any responsibility to a patient who says that they have an incurable disease that they are certain to die from unless they die of other causes first, that life is intolerable, that they want to end their suffering by dying and that they need help. Indeed, the bill says doctors are not obligated to help patients end their suffering by dying. Therefore, this is a way to release doctors from any responsibility related to their duty, and I find that absolutely deplorable.
Beyond all the human considerations I just raised and of which my colleagues spoke before me, there is also the jurisdictional issue, which is of grave concern to us. The federal government must refrain from interfering in areas of jurisdiction belonging to Quebec and the provinces, as Bill C-268 would do.
The way the physicians' code of ethics is managed and the way physicians process MAID requests are already set out in Bill 52 in Quebec and Bill C-7. I do not think we can tell a physician who is helping a patient end their suffering and assisting in their dying in accordance with Quebec law that he is committing a crime.
Criminalizing something that is under Quebec jurisdiction and already enshrined in Quebec law has no place. It cannot be allowed. We must ensure that the House of Commons respects the jurisdictions of the provinces and Quebec, especially when it comes to end-of-life care legislation.
What does the Quebec law say? The first part of section 30 states, and I quote:
A physician practising in a centre operated by an institution who refuses a request for medical aid in dying for a reason not based on section 28 must as soon as possible notify the director of professional services or any other person designated by the executive director of the institution and forward the request form given to the physician, if such is the case, to the director of professional services or designated person. The director of professional services or designated person must then take the necessary steps to find another physician willing to deal with the request in accordance with section 28.
If a doctor refuses to administer MAID, Quebec's Bill 52 provides specific directions to ensure respect for patients' rights and compliance with existing charters and the decisions of the Superior Court and the Supreme Court. In my opinion, Bill C-268 must not be allowed to interfere with Quebec's legislation.
I urge my colleagues in the House to think carefully about the need to respect jurisdictions and, most importantly, respect a patient's right to put an end to their suffering for which there is no other viable option.
View Randall Garrison Profile
NDP (BC)
Madam Speaker, I am pleased to speak today to Bill C-268.
This bill picks up a tiny portion of the extensive and important debates on medical assistance in dying that took place on Bill C-14 in the previous Parliament in 2016 and again on Bill C-7 in this Parliament. I want to start today by restating the principle that has guided the New Democrats through these debates.
We believe that medical assistance in dying is an important tool for helping to end unnecessary suffering for patients facing end of life issues and for avoiding the unnecessary suffering of their families, who have to accompany them on this journey. This is the reason the New Democrats will always defend the right of access to information about MAID and access to the service for all those who qualify for assistance and choose to proceed.
In the debate on Bill C-7, many issues arose concerning the challenges Canadians face at the end of life, some of which Bill C-7 addressed and some of which have not yet been addressed. Two important concerns were front and centre, and these, for me, were very important. The first was to help alleviate unnecessary suffering by eliminating the waiting period, which was a cause of great concern for patients who feared loss of capacity before they could complete the waiting period, as this would make them ineligible for medical assistance in dying. The second was allowing a waiver of final consent, which deals with the same issue. It was often known as “Audrey's amendment”. This is a provision that I knew quite personally, as a friend of mine chose to go earlier than she would have liked because of a brain tumour and her fear that she would lose capacity to consent at the last moment. Bill C-7 would make some important improvements on eliminating suffering at the end of life.
A second challenge was debated: How do we preserve as much autonomy as possible for Canadians who are dying? Most of the issues related to this still have to be dealt with at the special joint committee on medical assistance in dying that will begin its work next Monday. This includes questions of advance directives and whether protections for people with disabilities from being pressured to seek MAID are adequate. I was disappointed that Conservative senators spent a lot of time holding up the establishment of this new joint committee. It was very frustrating because the five-year statutory review of Bill C-14 was supposed to have started over a year ago. However, it is good news that this committee will commence its first regular meeting next Monday and will deal with the outstanding issues that were not dealt with in Bill C-7.
A third challenge that came up in the debate on Bill C-7 was access to services at the end of life. We learned there are a great many gaps in services in our Canadian health system for those who are facing death. There are gaps in diagnostic and treatment services, depending on where one lives, whether it is in a major city with excellent facilities or in a rural and remote area. We learned of important gaps in palliative care. Again, depending on where one lives, access to palliative care is highly variable. Of course, we also learned of gaps in the ability to access information about medical assistance in dying and the ability to access the service.
There are some very important questions here about the absence of services in rural and remote areas, about the inadequacy of services and about the shortage of trained professionals. Very important to me was the testimony we often heard about the complete absence of culturally appropriate services for indigenous Canadians and for new Canadians from different cultural backgrounds.
However, instead of addressing these challenges, the challenges of autonomy and the challenges of access to services, Bill C-268 is about something else. What this bill would do is override a patient's right to access information about, and to have access to, legally provided medical services, based on the personal beliefs of a service provider.
Let us put that in plain language. Let us suppose there are a variety of treatments available to a patient. It does not really matter in this case what they are. If a medical professional believes that one of them should not be available, this bill says there is no obligation to make sure patients find out all the options available to them. Professional organizations like colleges of physicians and surgeons and colleges of nurses have found this to be unethical behaviour, so they have required doctors, to varying degrees, to refer patients to someone who is supportive of those services and is accessible to them.
This requirement to refer, as mentioned in a previous speech, has been upheld by the courts. That is the main reason I cannot support this bill. It would result, on a practical basis, in the denial of access to necessary health services for many Canadians.
Many communities have a very limited number of doctors, and if one of those doctors, or even more than one of those doctors, is unwilling to let their patients find out about medical assistance in dying, then we are condemning those Canadians to suffer at their end of life in ways that other Canadians would not have to suffer. No health care professionals are, in fact, required by the law to participate. It is the professional associations who require some form of referral. Whether a referral is actually participation, I will grant to author of this bill, is debatable. I do not really believe it is.
An equally important reason for opposing this bill is the dangerous precedents that this bill would set. Its role as a potentially precedent-setting bill has already been noted by anti-choice advocates who have been vocal in their support of this bill. They recognize it would provide a precedent for denying referrals for access to contraception and abortion services. I want to point out that denials of service and denials of information are very real in our existing Canadian medical care system.
Just this year, Providence Health Care, which runs St. Paul's Hospital in Vancouver and is building a new hospital with $1.3 billion of public money, announced that in this new facility, abortion and contraceptive services will not be provided, nor will medical assistance in dying. I find this particularly problematic. I know of several cases in Vancouver where those who wished to access medical assistance in dying were forced to leave the hospital where they were being cared for and transfer to another facility, at a time when they and their families were already in a great deal of distress.
This bill would also be a very bad precedent for the current attempts to deny trans minors the counselling and medical services they need to affirm who they are. Without access to the services that others may think are appropriate, this will leave families with trans minors struggling to find the information and support their kids need. If this kind of precedent is allowed, medical professionals would not have to provide a referral to someone who would be providing a medically necessary service.
As a gay man who lived through the AIDS epidemic, I am also concerned about any precedent that allows the denial of access to medically necessary services. The AIDS crisis was generally ignored by the public, and treatment for those suffering from HIV and AIDS was regularly denied to members of my community, who quite often suffered very painful and tragic deaths as a result of that.
As I approach the end of my comments today, I cannot end without mentioning yet another unfortunate precedent set in this bill, and that is its use of inflammatory language. I have no doubt, as I said in my question to the sponsor of this bill, of her personal convictions and their strength.
However, as sincere they may be, the language used in this bill conjures up a spectre of the use of violence to intimidate medical professionals, something of which there is no evidence of happening in Canada. Using the kind of language that involves violence is certainly not conducive to an informed debate on the real principles that are in question here.
I will close my comments today by restating that on principle, New Democrats are opposed to any legislation that would limit access for Canadians to medically necessary services based on the personal beliefs of others, no matter how strong the beliefs the others hold are. There is a right in this country to access legal medical services, and that right can only be effective when, as professional organizations have recognized, doctors who do not wish to participate make referrals to doctors who will provide those services.
There is no doubt that the end of life is a difficult moment for all families and medical assistance in dying, I still believe, is an important way of ending unnecessary suffering, both for patients and families at the end of life. I would not like to see anyone denied access to the information they need to make a choice that protects their own autonomy about how their lives end.
View Michael Cooper Profile
CPC (AB)
View Michael Cooper Profile
2021-05-27 18:32 [p.7533]
Madam Speaker, it is an honour to rise in strong support for Bill C-268.
This is a straightforward piece of legislation, the objective of which is extremely important, namely to ensure that the charter rights of health professionals who conscientiously object to participating in medical assistance in dying, or MAID, are protected, charter rights that include freedom of religion and freedom of conscience, those rights being not any rights but fundamental freedoms guaranteed under the charter.
For that, I want to commend my colleague, the hon. member for Carlton Trail—Eagle Creek, for her steadfast leadership in bringing forward this timely and targeted bill to address an issue of charter infringements on health care professionals. I would also acknowledge my former colleagues Mark Warawa and David Anderson for their leadership in bringing forward similar pieces of legislation in previous Parliaments.
Contrary to the assertion of the Parliamentary Secretary to the Minister of Justice, the infringement of charter rights of health professionals is not a hypothetical. It is real. It is happening in Canada and has been happening since the Supreme Court of Canada struck down the blanket Criminal Code prohibition against physician-assisted death in the Carter decision.
Many health professionals have been pressured or coerced into participating in MAID, notwithstanding their conscientious objection to doing so. At the justice committee, on Bill C-7, we heard many witnesses who came forward and spoke about serious concerns about coercion and pressure, the need for clarity in the law and a set national standard. That is precisely what this legislation seeks to do by amending the Criminal Code to see that no one will lawfully be able to coerce or pressure health care professionals for the purpose of compelling them to participate in MAID, or refuse to hire or terminate one's employment on the basis of a health care professional objecting to MAID.
The Parliamentary Secretary to the Minister of Justice made reference to Bill C-14 in his speech. It is a piece of legislation that I am very familiar with, because I sat on the special joint committee leading up to Bill C-14, and I sat on the justice committee when Bill C-14 was studied. At that time, there was much discussion around protecting conscience rights.
The parliamentary secretary is correct that the preamble of the bill was amended to include an expressed recognition of conscience rights. He is further correct to note that at subsection 241.2(9) of the Criminal Code, there is a “for greater certainty” clause that simply provides that no one shall be compelled to participate in MAID.
In that broad sense, there was an expressed intention of Parliament to protect health care professionals. However, what is missing is teeth. There is no enforceability mechanism provided for in the legislation. That was something that I saw as a problem at the time, and it has borne out to be so. That is precisely what this bill seeks to do, to fill that very real void.
The Parliamentary Secretary to the Minister of Justice as well as my colleague, the member for Esquimalt—Saanich—Sooke, spoke at varying lengths about the Ontario Court of Appeal decision in Christian Medical and Dental Society of Canada v. the College of Physicians and Surgeons of Ontario and the issue of access, that somehow this bill would interfere or undermine access to medical assistance in dying.
I say two things to those who would raise the issue of access. Manitoba passed Bill 34, which provides for conscience protections, not dissimilar to what this bill proposes. There has not been one instance that has been brought forward where access has prevented a willing patient from accessing MAID in that province, a law that has been on the books for more than four years. With respect to the Ontario Court of Appeal's decision, although the court, in its analysis, looked at hypothetical issues around access, the court actually incorporated the divisional court's finding into its ruling. The divisional court said on the question of physicians who object on the basis of conscience, “...there was no direct evidence that access to health care is a problem caused by physicians' religious objections to providing care”. There we have it right from the Ontario Court of Appeal that on the issue of access, when it came to providing direct evidence, it simply was not there. At the justice committee, when we studied Bill C-7, it was not there either.
When we talk about the Carter decision, it is important to emphasize that it is predicated upon two things: number one, that there be a willing patient; and, number two, and equally important, that there be a willing physician. Too often over the last five years, we have focused singularly on the issue of a willing patient, which is very important, to the exclusion of a willing physician notwithstanding charter rights of those physicians that are very much at play.
In the Carter decision, the Supreme Court did expressly acknowledge the rights of health care professionals in terms of freedom of religion and freedom of conscience, but the court actually went further. The court warned against compelling health care professionals to provide or otherwise participate in MAID. More specifically, at paragraph 132 of the Carter decision, the court said:
However, we note...in addressing the topic of physician participation...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief.
Now, the foundational principles that underlie freedom of religion and freedom of conscience, guaranteed under paragraph 2(a) of the charter, were set out in the Big M Drug Mart Ltd. decision; and, in enunciating those principles, this is what the Supreme Court had to say:
Freedom can primarily be characterized by the absence of coercion or constraint. If a person is compelled by the state or the will of another to a course of action or inaction which he would not otherwise have chosen, he is not acting of his own volition and he cannot be said to be truly free.... Coercion includes indirect forms of control which determine or limit alternative courses of conduct available to others.
Those are precisely the principles that this bill seeks to uphold and on that basis I urge its passage.
View Mark Gerretsen Profile
Lib. (ON)
Madam Speaker, it is an honour to rise today to speak to this private member's bill on a topic that I know has been discussed a lot in the House. I look forward to having the opportunity to conclude my remarks when it next returns to the House.
From the outset, this is a very hotly charged issue, one that I have spoken very passionately about in the House after going through the experiences of watching my father-in-law suffer through an extremely painful death just before Christmas last year.
I always admire any member for bringing forward legislation to the House for debate and I can appreciate that we might not always assume that it will become law. However, the House and members have made it very clear what their position is on this. I cannot help but think that the sponsor of the bill must have known its fate from the outset, particularly when I know that members of her own party support the MAID legislation. Trying to amend it in this manner is really contributing to fuelling the fire of the debate we continue to have in the House.
There are two sections in the bill. The first is on intimidation and making it an offence, and prohibiting any form of intimidation to compel a health care professional to participate in MAID. However, I would also point out, as the parliamentary secretary did, that the Criminal Code already prohibits all forms of this type of intimidation.
More important, the parliamentary secretary asked the question directly of the sponsor if she was aware of any cases where this may have been the case to which she was unable to reply. Not only did she not answer that, she completely deflected and went off onto another course instead of addressing his question.
If members are bringing forward legislation like this, it has to be backed up by reason and purpose that is quantifiable.
View Carol Hughes Profile
NDP (ON)
The hon. member will have seven and a half minutes the next time that this matter is before the House.
The time provided for the consideration of Private Members' Business is now expired and the order is dropped to the bottom of the order of precedence on the Order Paper.
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