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Results: 1 - 15 of 129
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-03-11 17:53 [p.4938]
Madam Speaker, several times, I have been touched by the speeches and have been able to understand where my Conservative colleagues are coming from. I am in favour of any speech urging more social measures to help the most vulnerable and marginalized people.
When we consider the position of the Conservatives, who voted against Bill C-14 and Bill C-7, we get the impression that the only solution for dying with dignity is palliative care.
Unfortunately, palliative care and suicide prevention require investments in health and social services. How can the Conservatives get so worked up over the idea that these conditions could be trivialized, when they made cuts to health transfers, reducing the escalator from 6% to 3%? It takes money to offer social services, suicide prevention services and access to care. I cannot follow their logic.
For 50 years, holding up palliative care as the only solution has not resolved the end-of-life issue, as they know full well. Why do the Conservatives not sit down with us in 30 days? They could invite anyone they like, and we could have a cross-party discussion to find solutions.
View Cathay Wagantall Profile
CPC (SK)
View Cathay Wagantall Profile
2021-03-11 17:55 [p.4938]
Madam Speaker, the government agreed to a motion to bring in a framework for palliative care across this country and has done nothing. We cannot compare palliative care to assisted suicide when it does not exist to the extent it should in this country.
If he wants to talk about money, I assure him that the government has been printing it faster than it can spend it and in these circumstances has not done anything to help those who are facing a bill that says they have no value.
I repeat what the young woman said in regard to this legislation, which is basically that there is no way any safeguards the government tries to put in place will work, because those who are mentally ill need the opportunity to live, not to be faced with a circumstance in which their government says, “You do not really have any value. Here is an option for you, and by the way, we will will not focus on mental health and palliative care the way we should.”
View Marilyn Gladu Profile
CPC (ON)
View Marilyn Gladu Profile
2021-03-11 19:13 [p.4949]
Madam Speaker, I am glad to be able to rise this evening to speak to these amendments from the Senate on the medical assistance in dying bill.
It is unfortunate that we have such a short amount of time to talk about these amendments, because this is quite literally a matter of life and death. I would think the government, on something as serious as this, would want to spend some time thinking about these changes, which are far outside the scope of the original bill.
Let me talk about the purpose of the Senate. The Senate was put in place at its inception as a mechanism to look at the legislation from the government of the day and decide whether it was good for Canada. If not, it was to provide fixes for it and send it back. Clearly, what has happened with Bill C-7 is far beyond that.
The unelected members of the Senate have come with items like MAID for people suffering only from mental illness, advance directives, and all kinds of things that were beyond the scope of what was presented. That is not its role, and the government, by accepting these things outside of its scope, is really putting ideas in the minds of the senators to encourage them to continue to do what is not their role.
Let us go through the amendments one at a time. The first one allows those with only mental illness to have access to MAID and says we will talk about it in a while: not in 18 months, but in 24 months. This is really unacceptable. After the first medical assistance in dying legislation was brought in, the Liberal government put together consultants and a panel from the Council of Canadian Academies. This was done by the honourable Jane Philpott and the hon. member for Vancouver Granville, to study whether people with mental illness only should have access to MAID.
That working group could not agree that this was a good thing to proceed with. It was quite concerned about whether people with mental illness really had the capability to give informed consent. It was concerned as well that we were going down the wrong path. Even the Netherlands, which has such a broad euthanasia range, only allows people with dementia to have medical assistance in dying, and there is still a ton of controversy with that. Even the Netherlands has not gone down this very dark path.
The Centre for Addiction and Mental Health issued a report to the government and said:
Canadians themselves are divided on the issue of MAiD, and most do not support making it available to those with only mental illness.
If the government is not going to listen to Canadians when they say this is not what they want, that is a concern.
These experts from CAMH also said:
The federal government should not make an amendment to MAiD legislation for people with mental illness as their sole underlying medical condition at this time due to a lack of evidence that mental illness is an irremediable medical condition in individual cases.
CAMH also expressed:
The concern is that many individuals with mental illness...[may have] impairments in [their] reasoning capacity that [would] make it difficult for them to connect their symptoms with their illness, fully understand the risks and benefits of treatment, and/or make...decisions based on personal goals and values.
With that, the Liberal government should be listening to Canadians who do not think this is a good idea, the mental health experts who do not think this is a good idea and the many people who are suffering from mental illness.
Not to be coarse, but the reality today is that people who only have mental illness as their condition can already commit suicide. In fact, sadly, thousands of Canadians are doing it, and thousands more are likely to do it as a result of the failure of the government to address the pandemic and restore the economy. People are losing their businesses and their livelihoods, and they have been under lockdown. This is a very serious condition.
A time when the government is talking about suicide prevention is no time to be saying, “Let us put extra help in here so people can have medical professionals assist them in their suicide efforts.” That is offensive at the very least.
The second amendment has to do with the review of the MAID regime. Absolutely, I see the government wants to have a review, but the fact is, there was a review in the first legislation, and the government did not do it. That was unacceptable and should have been addressed then. I do not think we need a new formula on how to do a review. I think we just need to do the review.
The third amendment is about collecting race-based data regarding MAID. I see in the discussion of this and it has been mentioned that we collect this kind of data on other things, such as palliative care. Well, palliative care, as members know because my private member's bill on palliative care was unanimously supported in the House, is a topic that is near and dear to my heart. In fact, the framework on palliative care to get consistent access for Canadians was begun because the data shows that where there is good quality palliative care, 95% of the people choose to live as well as they can for as long as they can.
However, sadly, this government has prioritized the killing of people through medical assistance in dying and de-emphasized palliative care. When we talk about people who, maybe due to their race and social standing, do not have good access to palliative care, we are talking about 60% of Canadians left without any access. That certainly should have been the priority for the government, instead of expanding the regime to help people end their lives.
I see that the clarification of neurocognitive disorder not being considered a mental illness was rejected as an amendment. The justice minister clarified in his testimony that the exclusion is not intended to capture neurocognitive disorders that are due to Alzheimer's or Parkinson's disease. Well, the justice minister has a habit of needing to clarifying things, because what is in the bills is never clear enough. We saw that in Bill C-6 where a clarification had to be put on the website about the definition. It was not in the bill, but it needed to be done because of the hurry with which these things are brought forward. I think that we need to take the time to get things right and not rush.
With respect to the advance request amendment, I would say that the same group that was put together to consult on this issue consulted on advance consent. The government already had this information, and it was not recommend that we go with advance consent. There were concerns about a few things.
First of all, who decides what is intolerable suffering when the person has lost capacity? When do we take action? How do we prove that it is informed consent? How do we make sure there is a third party responsible to enforce the decision if there is a disagreement after the person has lost capacity? These were the issues that had been brought forward, and they were ignored altogether in this discussion. I would add that Belgium and Luxembourg only allow advance consent when a person is permanently unconscious, and so that should be a consideration.
I would be remiss on the palliative care discussion if I did not do a plug for the Granfondo Cycle of Life fundraiser in my riding on April 9 at 7:30 p.m. Members can get details from my web page.
The other topic of discussion is about the work that needs to be done to actually make sure there are alternatives. We talked about the need for mental health supports and the need for palliative care. These are important considerations.
In short, I feel that the Senate overstepped its bounds with the amendments that it brought. I feel that the government should have appealed to the Supreme Court with the Quebec decision in the first place. Certainly, the government should not be expanding the scope of medical assistance in dying without doing its due diligence on the review that was originally desired, and spend more time listening to what Canadians want and what the people who are going to be impacted are feeling.
With that, it is clear that I will be voting against these amendments, as well as the medical assistance in dying legislation that has been brought forward.
View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2021-03-11 19:25 [p.4951]
Madam Speaker, I thank the member for Sarnia—Lambton for her commentary, but I find it is much in the same vein as many of her party colleagues in terms of the level of hyperbole and the terminology that has been used. She has used terms about things being offensive. Many of the members who have spoken this evening are missing some of the fundamental points about this legislation.
Regardless of the discussion on mental illness, entry into the entire discussion of MAID requires informed and voluntary consent and that people be enduring an intolerable level of suffering. That is exactly what we are trying to address.
The second point about the inconsistency in approach is not borne out by the facts, because $11 billion was committed by our government in 2017 to address palliative care and mental health supports. She urged us to “spend more time”. Twenty-four months is the time that will be spent to ensure that when this clause sunsets, there will be a review by an expert panel and at least 12 months of deliberation by Parliament. Is that the type of time that the member opposite is seeking?
View Marilyn Gladu Profile
CPC (ON)
View Marilyn Gladu Profile
2021-03-11 19:26 [p.4951]
Madam Speaker, I think I did quote quite a few facts and that most Canadians do not want to have medical assistance in dying for the mentally ill. I think I presented the fact that the government itself has consulted and received answers that say that this is not a good path to go down, including with regard to advance consent. This was not recommended after they had consulted.
In terms of the time that needs to be spent, there is no point in spending time consulting if we do not listen to the results of the facts that come out of that consultation. I would encourage the government to review the consultations that have already been done, and in terms of Senate amendments, we have had only a very brief amount of time to talk about these despite the fact they are the most radical of the suggested changes.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-02-23 11:26 [p.4422]
Madam Speaker, I do not want to keep members in suspense for too long. The Bloc Québécois will support the government's motion, and I will explain why.
I would like to tell all my colleagues that we need to work across party lines on these sensitive issues and find a way to move forward.
I remind my colleagues that Quebec's end-of-life legislation has often been cited as an example, not only because it is a good system, but also because of the way all members of the Quebec National Assembly worked together to create that system. Quebec's act came into force in 2015. The Select Committee on Dying with Dignity was created in 2009. The legislation was passed in 2014 and assented to in June 2014. This means that there was a process that ultimately involved debate. The Quebec National Assembly was able to consider all the differences and find common ground, which served as the foundation for the act. At the end of the process there were very few people against the act. There was broad consensus on this piece of legislation, both in the National Assembly and among Quebeckers.
In Ottawa, members have always taken action in response to court rulings. The amendments that need to be made to the Criminal Code in order to incorporate all of these sensitive issues are related to a court ruling. In this case, the legislators finally need to take action because the law has been deemed unconstitutional and found to violate fundamental rights.
According to Baudouin and Carter, Bill C-14 deprives people of the right to life. For example, it was depriving Ms. Carter, Ms. Gladu, Mr. Truchon and Ms. Taylor of their right to life because they were being forced to shorten their lives. That is not a trivial matter. It is serious.
My Conservative colleagues are saying that we need to protect human dignity and life. I completely agree, but it is important that we not create the opposite effect of what we claim to defend through government paternalism. Vulnerable people are capable of defending and exercising their rights.
However, it is rather appalling to see that, since Bill C-14 was introduced and since a decision was rendered in Carter, we have placed on the shoulders of vulnerable people, people with irreversible diseases, people who are enduring unbearable suffering, the burden of defending their case before the court in order to get access to medical assistance in dying.
Why are we agreeing to vote in favour of the motion? We are doing so because we need to make progress in a debate like this.
I have said this before and I will come back to it again later. Even though we said that we agree with the underlying principles of Bill C-7, we would have liked for the bill to go a little further. However, we still need to recognize that Bill C-7 responds to situations like those of Ms. Gladu, Mr. Truchon and Ms. Parker.
Bill C-7 also makes it possible for people in the terminal phase of life—I am not talking about the terminal stage of an illness when death is not foreseeable—to avoid waiting the mandatory 10 days with two witnesses before finally proceeding. Many people with cancer go through a long process. Even in the most aggressive cases, it takes a few months. People wait until the last minute to proceed because nobody wants to die. Everyone wants to wait until the last minute and push the limits of what they can tolerate. Once they reach that limit, these people want help.
Once in the terminal phase of life, a person who had been receiving palliative care at home may be taken to the hospital urgently, where health workers will note their rapidly deteriorating condition. Consider a person who, for the past two years, six months or three months, has always told their therapists that they want medical assistance in dying because they do not want to suffer. This person has been receiving palliative care and medication at home, but their condition is deteriorating. Why should they have to wait 10 days for access to medical assistance in dying in the terminal phase of life when the process of dying has begun and is irreversible? Bill C-7 covers this situation and offers this option. That is a step in the right direction.
There are of course other sensitive issues to be addressed, such as mental illness as the sole underlying medical condition. In my remarks last December, I had the opportunity to say that, as a parliamentarian and legislator, I did not have the expertise to reach a decision on that point. I think it is wise that the motion implies two things and that an independent panel of experts is being set up. The panel will have to look at the recommended protocols, guidelines and safeguards for MAID requests from patients with mental illness as their only condition.
Earlier, my Conservative colleague was talking about the requirement to have safeguards that protect the individual and help prevent abuse. Our Conservative colleagues would have us believe that we are in some sort of house of horrors, as though the health care system itself were inherently evil, and we need to protect persons with disabilities because our prejudices about these individuals might cause health care professionals to give up, as though people are going to be coerced and euthanized without their consent. I find it very difficult to understand that kind of rhetoric.
A similar independent panel of experts was set up in Quebec and a report was prepared. I think we should carry on with this work to get a clearer picture. Not only will the panel of experts deal with this issue, but there will also be something else we have been asking for for a long time and that is the creation of a review committee for the entire body of work. Bill C-7 could have included amendments to C-14, An Act to amend the Criminal Code, which could have led to a new review of the legislation in two, three or four years. In just 30 days a special joint committee will study the issues of mature minors, advance requests, mental illness, palliative care in Canada and the protection of Canadians with disabilities.
Whether or not an election is triggered and there ends up being a change in government this committee is enshrined in law and will begin sitting in 30 days. It will work for a year before tabling its recommendations. We may reach a consensus or hold discussions for at least 12 months, which the court-imposed deadlines did not allow Parliament to do in relation to Bill C-7 and its previous version, Bill C-14. I think it is necessary.
To come back to the social acceptance of Bill C-7, I would point out to my Conservative colleagues that an average of 80% of people across the country approve it, from 88% in Quebec to 77% in Alberta. I think moving forward is a reasonable compromise. If in 24 months MAID is made available to people with mental illness, this deadline will help determine the necessary safeguards to make practitioners comfortable with this as well. In fact, we need to hear their point of view on this.
On the issue of advance requests for medical assistance in dying, I find it timely that the committee will start sitting in 30 days and that its members will work hard across party lines for the benefit of people who are suffering, like Sarah Demontigny. We will not forget these people, and we will establish a process to ensure that the advance requests they are drafting today will apply once our work is done. That is my hope.
Without making assumptions about the results of our efforts, I think we can come up with something better than the amendment proposed by the Senate if we have meaningful discussions and hear from witnesses. This would make it possible for Quebec, which is responsible for implementing this practice of advance requests, to properly regulate it. We could identify how to best amend the Criminal Code to allow for this.
I spoke about the legal aspect, but I will now come back to the fundamental principles. We are in the process of reaching a compromise because reason dictates that we must move forward. Bill C-7 represented a step in the right direction with the official commitment of an expert panel on mental health. I think it would be a good idea that the special committee I mentioned be a joint committee. This would ensure that everyone is doing the same work and hearing the same witnesses at the same time to eventually arrive at a conclusion, rather than having a game of ping pong between the two chambers—one of which is outdated, in our opinion. Let us rally together.
We are doing this for those who are suffering, who have waited too long and who, today, have hope that we will finally complete this work. I believe that the government's motion represents the light at the end of the tunnel for these people, because there is a deadline and we will get there if we all act in good faith and without partisanship.
Bill C-7 already contains fundamental principles, which I will repeat. First, death—my death, just like my life—belongs to me. Why did I say that and why did I say earlier that the Conservatives are practising government paternalism?
I said those things because my own death is a very personal thing, and the state must not tell me what to do or make decisions for me. The state should be creating a framework to protect my decisions. I do not think people should be pressured or forced to go into palliative care until their last breath or to request medical assistance in dying.
During any clinical study, the patient is the standard. When someone who is ill has determined their own limit of what is tolerable, we need to listen to what they are telling us and what comes out of their suffering. This allows us to provide support.
I find it very disturbing that in the debate on medical assistance in dying, MAID and palliative care are always pitted against each other, but in reality, it is a continuum and they complement each other. Later in my speech I will define the notion of human dignity.
Who would not want to receive palliative care before dying from a serious degenerative disease that causes intolerable suffering? We all want relief; no one wants to suffer.
When it comes to end-of-life care, the least you can give someone is palliative care. Unfortunately, for the past 50 years, palliative care has not been the only answer for everyone, unless one is ideologically committed and determined to prove it. At that point, someone comes to the patient's bedside and imposes some religious or other ideology. No, that is not it.
We are in a process where it is imperative that we consider that palliative care can be successful even when a patient's request for MAID emerges. Why? Because the patient is at peace and ready to let go. In fact, I hope all my colleagues are at peace and able to let go when the time comes. This could also be an example of very good palliative care. Palliative care is about support when someone is dying, the easing of suffering and psychological support. It is possible that some will die after suffering until the end, but it is also possible that some are ready to let go. That is when they can be supported.
It is not up to the family or the state to make decisions on behalf of the dying patient or the person suffering from a serious and irreversible condition causing intolerable suffering. The underlying principle of Bill C-7 puts into perspective what is enshrined in law for every human being, namely self-determination.
The law guarantees everyone the right to self-determination. Why take this right away from me at the most intimate moment of my life, meaning my death? Why should the state be allowed to take away my right to self-determination in my decision to suffer until I die in palliative care or to seek MAID? It would be utterly absurd for the state to assume that power.
The state must provide us a framework to be able to do this. I often hear members talk about human dignity. Human dignity implies that we must absolutely—
View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2021-02-23 13:00 [p.4435]
Mr. Speaker, I am very pleased to participate in the consideration of the amendments proposed by the Senate to Bill C-7, which seeks to amend the Criminal Code provisions on medical assistance in dying.
Our colleagues did a lot of work on Bill C-7 and proposed reasoned amendments following careful deliberations. The Standing Senate Committee on Legal and Constitutional Affairs heard from a variety of witnesses as part of two different studies. I followed the debate at second and third reading and thought that the speeches given in the Senate reflected the range of perspectives shared by the many witnesses.
It is therefore with great respect for the work of the Senate that we are examining the amendments it is proposing to Bill C-7. As the minister explained, there are three amendments that we plan to support, with some adjustments.
The first relates to the collection and analysis of data about the race of persons seeking MAID. Let me say here that we have heard extensively in the House of Commons and the Senate about the need for better and more robust data collection with respect to MAID. That data has been collected since MAID first entered into the legislative landscape, but certainly improvements can be made.
It is important now, especially during Black History Month, to note that one of the Senate amendments proposes tracking the analysis of data on the race of persons who are accessing MAID. This is important because we have clearly seen a light shone on the important issue of systemic racism in Canada, North America and around the planet. We need to understand how racialized persons, because of their inherent vulnerability, may be disproportionately impacted by MAID and address that vulnerability with our legislative response.
I would say, however, as articulated by previous speakers, including the minister, that the amendment the government proposes to make to this portion of what the Senate is suggesting would make it more inclusive in light of all of the witness testimony given in both the House and the Senate. By that I mean in addition to race-based data, data about disability and indigenous identity would be collected and analyzed. This, of course, is important, especially and specifically as we broaden the MAID regime to circumstances where death is not reasonably foreseeable, in response to the Truchon decision, which creates the real possibility that people will seek and obtain MAID because of vulnerabilities in their lives as opposed to their health conditions. I am grateful to the Senate for proposing this important legislative change.
The second Senate amendment the government supports, with some adjustments, is the sunset clause that attaches to the mental illness exclusion. We heard extensively about this from the previous speaker and in other interventions that have been made. The Senate amendment proposes a sunset clause of 18 months. The government is suggesting that the sunset clause be extended to 24 months.
Second, and very importantly, we are requiring that the Minister of Justice and the Minister of Health ask a group of experts to make recommendations on safeguards, protocols and guidance for MAID on the basis of mental illness alone. Those experts would be required to report back to the ministers within one year, which would leave an additional year for the government to consider what safeguards should be legislated and for Parliament to consider things when enacting any subsequent legislation.
I want to give some context surrounding the sunset clause because it is obviously a pressing matter for today's debate and a pressing issue for all parliamentarians.
The government's position is that it needs more time to consider and enact safeguards for the population of people whose sole underlying condition is a mental illness. The Minister of Justice was always clear that the questions of whether MAID for mental illness should be allowed and, if so, what safeguards were needed would be studied in the course of an upcoming parliamentary review.
What the sunset clause would do, in combination with a requirement for an expert review, is commit to a definite timeline for eligibility of persons whose only medical condition is mental illness. This would reduce the risk that some Canadians would feel the need to challenge the exclusion before the courts should they believe it is unconstitutional. It would also provide them with the certainty that two years following royal assent of Bill C-7, eligibility on the basis of mental illness would be considered with the requisite safeguards attached.
This point about potential constitutional challenges is not an academic point alone. We know this is a complicated issue that balances competing constitutional rights. Obviously we know from the Truchon decision that there has been litigation with respect to the old Bill C-14, and virtually all observers recognize that there is very likely to be constitutional challenges related to the current bill, Bill C-7, should it be enacted. In fact, we heard testimony about this at a House of Commons standing committee. Some witnesses said the exclusion of mental illness alone could perhaps give rise to a section 15 challenge. We are trying to ensure that Canadians who are concerned about this exclusion would have a remedy that is not via the court process, but rather through the task force of experts and the parliamentary study that would follow therefrom.
We heard a lot from the previous member about evidence and whether the government believes in evidence-based approaches. I would reiterate for the record that absolutely we do, and some of that evidence relates to a very specific document in the submissions that were made by the Association des médecins psychiatres du Québec.
In November 2020, the Quebec association of psychiatrists, or AMPQ, published a very informative discussion paper on access to medical assistance in dying for people with mental illness, which underscores the reasons that the government believes that a 24-month sunset clause is needed.
The work of this association will no doubt be foundational to the expert review of this issue. It points to some possible solutions, but they are fairly complex. That is why we need to carefully consider solutions that could work nationally.
The association is of the view that whether a mental illness is incurable or not can “only be determined at the end of a long process, after attempting several treatments and assessing their effects”. The association further notes that before coming to a conclusion on eligibility a psychiatrist “should explore other aspects that shape the patient’s life experience and consider strategies to improve the social circumstances that add to the suffering”. This dovetails exactly with some of the interventions made in the last portion of the debate by members of the NDP, who talked about supports that surround a person's life circumstances, such as income security, housing security and so on.
Going back to the submission from the association, it notes, “Psychiatrists must be involved as both the first and second assessors”, and also notes, “access to psychiatric care varies significantly from one region to the next.”
In light of all of these considerations, the Association des médecins psychiatres du Québec suggests that we create a new administrative body with regional offices dedicated to MAID on the basis of mental illness that would coordinate such requests, identify MAID assessors and providers, and ensure access to psychiatrists. It also suggest that such an administrative body could monitor the assessment process in real time instead of after the fact.
I highlight this in some detail because I believe the association's discussion paper is focal to why we as a government believe that a 24-month sunset clause is needed. The work of the association will no doubt be foundational to the expert review of this issue. The paper points to possible solutions, some of which are fairly complex in nature, which underscores the need for careful consideration of what could work nationally. Further, I underscore that government and Parliament will need time to make decisions about which safeguards should be codified in federal MAID legislation as a matter of criminal law relating to mandatory access across the country.
I will now turn to the third amendment.
The third amendment being proposed by the Senate, which the government proposes to support with some modifications, relates to the notion of the parliamentary review. The government has repeatedly committed to facilitating the start of the parliamentary review required by Bill C-14 as soon as possible following the adoption of the current Bill C-7. Our proposed adjustments to the amendment proposed by the Senate would ensure that all of the relevant issues are front and centre for the joint parliamentary committee that would undertake this work. I underscore the notion that it is joint, because it would be a combined study by the Senate and the House of Commons, similar to what we saw prior to the advent of the original Bill C-14. Its mandate would look at things that were contemplated by the original intended review of Bill C-14, such as requests by mature minors and issues that relate to advance directives.
In addition, we would include palliative care and safeguards for persons with disabilities within the scope of that mandatory joint parliamentary review by the Senate and the House. We also proposed to adjust the timelines, so they are both realistic in a pandemic environment but still ambitious, given the seriousness of the issues at hand. These are important features we feel would enable us to move forward in a collaborative manner involving the work of both Houses of Parliament, as well as the work of all legislators from various parties.
I would note parenthetically that, obviously, the member for Esquimalt—Saanich—Sooke has been very instrumental in leading the charge and a call for a study in Parliament of the previous bill, Bill C-14. Some of what we are proposing incorporates his views on the scope of what that review should look like.
Finally, there are two Senate amendments that, in the government's view, cannot be supported.
The first is the amendment to the mental illness exclusion itself. While I appreciate that some have advocated for greater clarity around what mental illness means in this context, the government is concerned that this particular amendment, as drafted by the Senate, implies that neurocognitive disorders are ordinarily understood as being mental illnesses, which, in fact, may not be the case. The federal government will work with its provincial and territorial counterparts to ensure a consistent application of the mental illness exclusion until it sunsets.
The second Senate amendment we propose to reject is the amendment to expand the waiver of final consent. Providing MAID in the absence of final consent is extraordinary and carries risks, and we acknowledge that. The Senate amendment goes beyond the scope and principle of Bill C-7, which would permit the waiver of final consent only in narrow circumstances that present the fewest risks. Any expansion of advance consent or proposal for advance requests, which are sometimes called advance directives, will involve greater risks and should be the object of careful consideration by the parliamentary review.
It has always been the notion that the issue of advance directives should be contemplated only after consideration by the broader parliamentary review. This was the case with the previous Bill C-14, and it is certainly the case now with what we are proposing as a government with respect to the parliamentary review that should ensue herefrom.
In the time I have remaining here, I would like to canvass a couple of points.
One is the notion that has arisen during the discourse of today's debate that somehow the government and de facto the Senate are somehow pursuing a route that is putting undue focus on facilitating an end of suffering, including facilitating the passing of an individual, as opposed to making the condition of life more viable and also more supported. That assertion is categorically false. The government's record over the last five and a half to six years speaks for itself in terms of the supports we have put in place, whether they are in long-term care, home care or supports for mental illness.
It relates to, as the previous member mentioned, a unanimous consent motion being passed regarding a suicide hotline. The supports we have put in place, such as the Canada health and social transfer, and a few intensive efforts to address home care and palliative care, are significant investments. We are ensuring that people are making such significant decisions based on the full understanding of what options are available to them and what supports are available to them. Can more be done? Of course, more can be done. I think that is what is important about what arises from a debate such as this.
The second thing I want to underscore is something that arose many times when Bill C-7 was in our chamber the first time, meaning its second and third readings prior to being sent to the Senate, which has again arisen today in the context of today's debate, and that is this idea that persons with disabilities are somehow being victimized, targeted or unfairly treated by this particular bill. I will raise a couple of important points, which I think are really important for all members of Parliament to understand. I have raised these points before, but I will reiterate them.
What we are talking about here is autonomy and the autonomy of individuals to make choices about the end of their lives and their passing, and that butts up against the need to protect vulnerable people. It is an important balance, and that is what is at the heart of this. This makes it probably the most difficult issue any of us have dealt with, at least it has been for me in my five and a half years as as parliamentarian. That being said, people need to understand that the case that was brought before the courts that we are responding to now was brought by two individuals: Monsieur Truchon and Madame Gladu.
Both suffered from disabilities, but because they were not near the end of their lives, they were prevented from accessing the MAID regime under Bill C-14. This is because it was, at that point and even now, until the law is potentially changed, an end-of-life only regime.
I want to read for members what the court analyzed with respect to that, because we have heard a lot in this discussion that somehow what we are trying to do in Bill C-7 is discriminatory of persons with disabilities. The notion of discrimination under section 15 was squarely in front of the court in the Truchon case, and what the court said is quite the opposite. I am quoting from paragraph 678 of the Truchon decision. The court said:
The requirement at issue reveals a legislative regime within which suffering takes a back seat to the temporal connection with death. Where natural death is not reasonably foreseeable, the consent in suffering of the disabled are worthy only of the sympathy of Parliament, which has adopted a protectionist policy toward every such person, regardless of his or her personal situation. As soon as death approaches, however, the state is prepared to recognize the right to autonomy. This is a flagrant contradiction of the fundamental principles concerning respect for the autonomy of competent people, and it is this unequal recognition of the right to autonomy and dignity that is discriminatory in this case.
The judge went on, in paragraph 681:
By seeking to counter only one of the stereotypes that the disabled face—vulnerability—the challenge provision perhaps perpetuates another probably more pernicious stereotype: the inability to consent fully to medical assistance in dying. Yet the evidence amply establishes that Mr. Truchon is fully capable of exercising fundamental choices concerning his life and his death. As a consequence, he is deprived of the exercise of these choices essential to his dignity as a human being, due to his personal characteristics that the challenged provision does not consider. He can neither commit suicide by a method of his choosing nor legally request this assistance.
I read this into the record to remind parliamentarians that discriminating against anyone in Canada should not be countenanced. However, what was squarely before the court was whether the old regime was discriminatory against persons with disabilities who want to make autonomous choices about their passing, but were not near the end of their lives. The court found, conclusively, that the old regime was discriminatory. That is what prompted this and other changes to the legislation.
I think it is very important to understand that. When I, and others, talk about the heterogeneity among people with disabilities, that is what we are driving at. It is not for Parliament, in my respectful view, to impede, limit or curtail the competence and autonomy of persons, including persons with disabilities, who want to make significant choices about how and in what manner to end their suffering.
I think a compassionate response by this Parliament, a response that entrenches dignity, requires us to do the opposite. I know it is difficult. I know it is moral. I know it is an issue fraught with a lot of personal conviction, and that it is a difficult task for many of us, but that is the task before us as parliamentarians. As somebody who is familiar with discrimination law, I wanted to correct the record, in terms of what I have heard in today's debate and previous debates, about how discrimination plays into the analysis.
View Mark Gerretsen Profile
Lib. (ON)
Mr. Speaker, I listened with great interest to this member's intervention, particularly when she talked about at the end of life and the dignity that one should have. She talked about those sweet moments of somebody laying on their bed just before passing away swiftly into the beyond death, as though it could only ever be this incredible experience for family and friends to sit around and to take great solitude in the dignity of what was happening.
Let me paint another scenario. The end of November of last year, my father-in-law had an operation for tumour on his brain. After coming out of that operation, the doctor said, “I am sorry Don, there's nothing we can do for you. Unfortunately, you're going to die.” Don spent about seven to nine days in the hospital, with his wife at his side, often having seizures and going through some very intense pain before he finally passed away. He did not have that opportunity of which she spoke. Where was his dignity?
View Tamara Jansen Profile
CPC (BC)
Mr. Speaker, the death of a parent is a very difficult thing. That is why we have been calling for better palliative care. Things can be peaceful and different.
My father-in-law passed away also. We as family were able to be around him and sing psalms from the Bible. It was a wonderful time in our lives where we could reconnect and remember the history my father-in-law passed down to us and our grandkids. Palliative care must be our first goal. We must ensure that all Canadians can access it. Right now only 30% of Canadians can access good quality palliative care. I ask the member to please support that.
View Mark Gerretsen Profile
Lib. (ON)
Mr. Speaker, this is just in response to the back-and-forth intervention with the previous member about palliative care.
Out of curiosity, does the member believe that the pain of all people who are at the end of their life can be relieved through palliative care measures? Does she believe that every person's pain can be relieved by various palliative care measures?
View Tamara Jansen Profile
CPC (BC)
Mr. Speaker, what I do believe is that because only 30% of Canadians can access palliative care, we are failing our seniors. We need to make a change. We have been begging and asking. My dear friend, Mark Warawa, was begging for us to look at palliative care and the needs of seniors. We need to get on that right away.
View Ted Falk Profile
CPC (MB)
View Ted Falk Profile
2021-02-23 16:01 [p.4463]
Madam Speaker, as I reviewed the amendments to Bill C-7 that have been proposed by the Senate, I was struck by how quickly some legislators have embraced radical, unstudied changes to Canada's medical assistance in dying. In many cases, the direction these amendments take Canada's MAID laws was rejected just a few short years ago.
When Parliament legalized medical assistance in dying in 2016, there was a commitment included in that legislation to review the impacts of the law five years after it received royal assent. That was June 17, 2016. We have not yet arrived at that five-year mark. We have not yet done a proper and thorough review of the original MAID legislation, yet now, before this review is even under way, not only are some in this place pushing to expand the accessibility and availability of MAID without the benefit of that study, but we are also considering amendments that disregard all the thoughtful and considered debate of this House, the Senate and the committees of each place that wrestled with this complex subject matter and initially chose not to go down the road that many of these new untested amendments would take us.
The Council of Canadian Academies considered some of the amendments now being proposed, producing several reports in 2018. Former MP and health minister Dr. Jane Philpott and the member for Vancouver Granville wrote in a Maclean's article about the council's conclusions. The article states, “...there is very limited guidance on these issues because there are not enough places in the world that have allowed broader access to assistance in dying.”
That is the context in which we are having this discussion, so it is troubling that the Liberal government has essentially accepted the amendments to throw the doors wide open to MAID for patients with mental disorders, something the justice minister previously had said there was no consensus on. This is a significant reversal that the Liberals ought to explain to the thousands of Canadians who have expressed concerns about the expansion of MAID to those with mental illness.
I am certainly mindful of the fact that COVID-19 and the restrictions imposed by governments as a result have created a tenuous mental health situation in Canada. Loneliness, social isolation and reduced care for vulnerable populations are all very real concerns.
Law professor Trudo Lemmens and Leah Krakowitz-Broker wrote this in a piece for the CBC:
Introducing a social experiment by expanding MAID when people are more vulnerable than ever is not progressive policy making — it is reckless. In its desire to accommodate some who want to control the timing and manner of their death, it puts others at risk of premature death.
I am reflecting on the question of why we are even here at all. Why are we having this discussion before meeting the five-year commitment for the MAID review? It is because the Liberals chose not to appeal the ruling of a Quebec judge.
As Senator Plett said:
Bill C-7 is a result of the federal government choosing to cave in to the opinion of one judge in one province who decided to unilaterally strike down legislation which had been extensively debated and passed by both houses of parliament.
I am speaking, of course, about the Truchon decision in Quebec. The Liberals could have simply appealed the decision in recognition of the upcoming review. It would have allowed for a substantive and careful discussion about the impacts of opening the door to MAID for seriously vulnerable individuals. Even in the Truchon decision, the assumption was that there would be enforcement of strict requirements that ensure the capacity and informed consent of those requesting MAID. Bill C-7 removes some of those very safeguards, including the requirement that the patient remains competent until the very end.
Truchon was also premised on the conclusion that medical assistance in dying, as practised in Canada, is a strict and rigorous process that in itself displays no obvious weaknesses, but that simply has not been shown to be true. According to the chief coroner of Ontario's review of 2,000 MAID cases, case reviews have demonstrated compliance concerns with both the Criminal Code and regulatory body policy expectations, some of which have recurred over time. As well, according to the Quebec end-of-life commission, at least 62 cases in Quebec between 2015 and 2018 did not fully comply with federal and/or provincial law. How can we move forward like this without properly responding to these serious failings?
In one of our last debates in the House, when I suggested that if Bill C-7 were to pass as it was, even before the amendments by the Senate were added, it would be believed to be the most permissive bill with respect to MAID in any country in the world, one of my colleagues expressed surprise that I did not think it was a good thing, as if being the most permissive jurisdiction was somehow inherently a good thing. A law's success should be judged by its outcome, not its permissiveness.
Any time life is devalued or death is made easy, clearly, is not good. Life is to be valued and treasured as the gift it is, which is why we need to put our energy into supporting positive alternatives, such as strengthening a patient-focused palliative care service for all Canadians. There was unanimous agreement from the special joint committee studying physician-assisted death on the need for a pan-Canadian strategy on palliative care with dedicated funding.
Those suffering deserve the best possible care. After all, there is no real choice for Canadians facing end-of-life decisions without adequate palliative care options available to them.
As parliamentarians, we have a high calling to actively listen. Our obligation is to protect our most vulnerable citizens. Unfortunately, none of the proposed amendments addresses the serious concerns raised by disability advocates. As many in the House have mentioned during these debates, over 70 of Canada's leading disability rights organizations and advocates have expressed deep concerns regarding this bill. Therefore, so should we.
We should be especially concerned for disabled Canadians who lack socio-economic means and face a greater risk of coercion. If there is even a tacit suggestion that their lives are not worth living, we should care about the implications of that. Their lives matter. Canadians should never feel pressured or as though the law perceives their lives as a burden.
The Christian Legal Fellowship writes that by singling out life with a disability as the only existence deserving state-sanctioned termination, Bill C-7 perpetuates ableism in a most dangerous way.
We have already discussed in the House what UN experts have highlighted as a contradiction in Canada's international human rights obligations. We do not want to create a two-tiered system in which some would get suicide prevention and others get suicide assistance based on their disability status and specific vulnerabilities.
The justice committee was faced with very difficult stories where some of our most vulnerable felt pressured to accept MAID. Numerous groups were represented. Fifty religious organizations and faith leaders, including Jews, Muslims and Christians, expressed their opposition. Nine hundred physicians and 145 members of the legal community stated their positions.
It is not just the disabled who are vulnerable. Practising physicians fear that they will face legal charges if they refuse to participate in the deaths of their patients. There are blatant inequities and legitimate anxieties with this legislation.
Let us be clear: any inequities of support, systemic discrimination, family network or specific community should be addressed before people choose death. We need to make every accommodation for people to choose life, which is why I am perplexed by the Liberal government's decision to support the Senate amendments based on race-based data collection.
There is nothing wrong with collecting data to better inform policy, but we are sure going about this in an odd way. Rather than considering how expanded access to MAID would impact marginalized communities today, this amendment suggests we should investigate the impact when it is already too late for those many who have already accessed MAID.
This amendment seems to acknowledge that, but data may have a troubling story to tell us while opting to study that impact on the fly, before we understand what it will mean for the life-and-death decisions of the members of marginalized communities.
That being the case, we should refer back to the Council of Canadian Academies' expert panel, which identified a number of concerns associated with expanding MAID in this way. Its claim suggests that the data is predictable, as having a mental disorder is strongly correlated with certain social, economic and environmental inequalities such as poverty, unemployment, homelessness, social isolation, stigma and discrimination, and that people with mental disorders face impediments to accessing appropriate mental health care in Canada. Let us not wait for people to feel forced to make the choice of death to collect this data.
It has not taken long for us to forget the safeguards that we put in place for the protection of our most vulnerable just a few short years ago. I have expressed my deep concern for this bill a few times in the House. My conviction is that life is a gift to be valued. These amendments only heighten my deep concern.
Life is a gift. I am reminded of when my kids and grandkids brought home gifts that they had made at school. Sometimes they were not very attractive and, quite frankly, perhaps I was not the proudest to put them on my mantle or display them on my fridge, but they were gifts.
Life is a gift. I did not then take those gifts and give them back, saying that I did not really want their gifts because they did not look very nice. No matter what the gift looked like, no matter in what condition it was, it was a gift and I recognized the gift. I showed appreciation to my grandchildren for the expression of their love toward me. For each and every Canadian, life is a gift and we need to appreciate it for what it is. They do not all look the same and some life circumstances put some of our constituents and fellow citizens in situations that are not desirable, yet we have to recognize that life is precious and life is a gift.
View Mark Gerretsen Profile
Lib. (ON)
Madam Speaker, the member spoke about palliative care. He talked about the drugs that were available for pain, suffering and anxiety while in palliative care. Indeed, those drugs exist, but the member must know that they are not effective treatment in every scenario. There are scenarios where the drugs provided are not adequate to relieve the pain or the anxiety somebody is facing.
Is the member willing to acknowledge that this is a reality, or is he steadfast in his belief that all pain can be alleviated through drugs when it comes to end of life?
View Ted Falk Profile
CPC (MB)
View Ted Falk Profile
2021-02-23 16:19 [p.4466]
Madam Speaker, I think the member recognizes that I am not a medical expert. We know that the Liberals always say they want to base everything on the science, so that is what I have to go back to.
I go back to the discussions I had with the doctors who treated both my mother and father and the nurses who provided palliative care. They said we have the drugs available to us today, in our arsenal, to address issues of both pain and anxiety, and that those are the two predominant issues people are concerned about when facing the end of life.
View Mark Gerretsen Profile
Lib. (ON)
Madam Speaker, it is indeed an honour to rise today to speak to such an important topic. I had the opportunity to speak to this bill back in December when it was voted on before it was sent over to the Senate.
I will say from the outset that I do not pretend to be an expert on this matter, but I certainly have had a lot of personal experiences that have informed my opinion over the last few months. I think it is safe to say that before that, although I have always been an individual who supports people's right to choose when it comes to their own health and their bodies, I did not really take a strong position one way or the other on this particular legislation. That was until I had those personal experiences, which perhaps I will touch on in a few minutes.
First, I will talk a little about how we got here. I think it is important to talk about this, because it has come up a number of times from the other side of the House in questions about the rush. I mean, the number of times I have heard about the rush today could make my head spin. I would argue that there has been very little rushing going on when it comes to this issue. Let us go back to the start of this.
The Supreme Court made a ruling. Stephen Harper was the prime minister then, and he, as the prime minister, and the government were tasked with coming up with legislation that could address and respect that ruling. However, he chose not to do anything about it. I think it is quite clear he did that because of his political motivations.
It would have exposed him to a lot of what we are seeing now. He probably figured it was best to put this on the back burner and not do anything about it. Politically speaking, it was probably the best thing to do. Certainly, it was not the responsible thing to do. Certainly, it was not the thing a responsible government would do. He should have tackled this head on as he was charged to do by the Supreme Court. Nonetheless, he really did not act on it.
However, when the Liberal government was first elected in 2015, the first committee it set up, if I remember correctly, was a committee to study this issue. This was so we could respond in due course to the Supreme Court's ruling and bring forth legislation.
That happened, and there was obviously a lot of controversy about it at the time. Some said it was not going far enough. Some said it was going too far, and people voted as they saw fit. Ultimately, the legislation was passed. Now, here we are addressing the fact that a superior court in Quebec has ruled that it was unconstitutional, and we are tasked with making amendments in order to reflect that.
To the point that it has taken so long to get here, well, come on. This has been going on since 2014. We are seven years into this. Do not say that this is taking a long time and that there is a sudden rush. If there is a rush to get this done now, it is quite clear that is because we are responding to the superior court's ruling, which has already been extended as a result of COVID-19.
I have heard a number of Conservatives criticize us and say, “Why wouldn't you take it to the Supreme Court?” Well, it is very obvious what to do when a government goes to its lawyer and that lawyer says that we could go to court but we would be wasting money in doing that because, in the lawyer's opinion, we would probably not win.
Usually one listens to one's lawyers. That is why we get lawyers. They give advice on how to move through a process. If the lawyer says, “Guys, it's probably not in the best interest to go to the Supreme Court, because you're probably going to lose”, one listens.
Maybe the Conservatives would like to see taxpayer money tied up in the legal fees associated with that. Alternatively, we could take the realistic, rational approach to respond to it and do what we think is right.
For the Conservatives to stand up and say that we should have taken this all the way to the Supreme Court is a misuse of the Supreme Court. We go to the Supreme Court when we feel as though we are in the proper position and that the legislation is correct. We saw the government reflect on the superior court's ruling and decide that, yes, maybe we do need to fix this and that maybe we do need to make some adjustments to this. Going to the Supreme Court would have wasted taxpayer money, and it would have wasted time.
However, we will do the hard thing, which is to bring this very sensitive topic back before this House so that people, including me, can get emotional and talk about this in order to make the legislation better and make the lives of Canadians better.
Members will recall that a few moments ago I spoke to Stephen Harper's approach, which was basically not wanting to deal with this and pushing it out of the way. This government could have done that. It could have gone to the Supreme Court, tied it up, did this and that to really slow down the process, and pump this a few years down the road to feel better about itself. This was the approach that Stephen Harper took, but that is not the approach this government took.
Instead, this government said that the superior court is right. We need to respect it. We need to do the right thing, not just because we want good, proper laws that are constitutional, but also because we want to do the right thing in the name of Canadians.
Therefore, for me to hear Conservatives question why this was not challenged all the way to the Supreme Court just goes to show that they would have done anything to slow this down or block this all the way along. That is how we basically got here.
One of the other issues I find very troubling, having sat here and listened to the debate, is the number of people who have gotten up and said, “All that needs to happen is for somebody with a disability to go into a hospital and just like that the doctor can prescribe MAID. Do we really want to create a scenario like that?”
That is fearmongering. That is absolute fearmongering. That behaviour is illegal, unethical and completely improper, but that is not the picture the opposition members want to paint. They want to paint a picture of disabled individuals' rights being stripped away from them with doctors suddenly able to say, “Oh, you have a disability. Well then, you should get MAID”. Come on.
To suggest that a doctor is going to act in bad faith like that is a completely unfair characterization of the incredible work that doctors do throughout this country. By the way, if a doctor does act in bad faith, there are laws in place to take care of them, to bring them before their professional bodies to make sure they are properly brought to account for their actions. This is a red herring, at best. This is a false notion that doctors are going to suddenly act irresponsibly is ludicrous.
I will accept the argument that there could be a slippery slope and that we need to put proper safeguards in place to make sure that people are properly taken care of. Most important, we need to make sure that people get all the information they need in order to make these very important decisions. This is the information that comes with talking and consulting with one's doctor and perhaps going for another opinion.
People need information to make decisions, and we should not neglect giving people information. We should definitely be investing in making sure that people have the information they need, and the proper tools and resources to make these decisions on their own, because they are their own decisions to make.
I also would like to address the issue of palliative care. It is the default go-to argument of the Conservatives that if we had palliative care, then all the problems would be solved. To the previous speaker, I said that surely he must agree that not all cocktails of drugs can alleviate pain for people in their last days. The response was that they had been told by doctors that they can do whatever it takes to alleviate anxiety and pain so people can be in a comfortable state during their last days.
I will tell the story of my father-in-law from just two months ago. This is not disconnected from me. I saw this with my own eyes. My father-in-law was diagnosed just after the 2019 election with colon cancer. In July of this year, they found a tumour in his brain. They removed the tumour, but everybody knew that it was still only a matter of time.
At the end of November, he went back into the hospital and the doctors operated again. This man wanted to live. He wanted to live, and he would have fought to stay one more day for his grandchildren, but it just was not going to happen.
My father-in-law never would have accepted MAID. He would have said, “Are you kidding? I don't want that.” He would not have accepted it under any circumstance. After they operated on him again and removed as much of the tumour as they could, they said, “Don, we're really sorry to inform you that you're going to die very soon. We cannot do anything else for you.”
It was at that moment, at the end of November in 2020, he realized the end was near. He told my wife, his daughter, that the fight was over. For 10 days, the tumour raged on. He laid in a bed in palliative care, getting all the medicine that supposedly, according to Conservatives, puts people in a state of ease.
He received all this medicine, and I am telling members right now, it did not help him. He was convulsing in the bed and having seizures at times. He was in pain. My mother-in-law sat next to him the whole time and watched it all.
For Conservatives to paint this narrative all the time that it is a peaceful moment of one laying in bed at home with their wife by their side as they slowly slip away into the night is absolute baloney. It does not always happen like that.
Is the member standing on a point of order in the middle of my speech?
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