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View David Anderson Profile
Madam Speaker, I have a number of petitions on two subjects.
The first consists of eight petitions, including an electronic petition, with almost 4,000 signatures. The petitioners call on the government to ensure that conscience rights of medical personnel are protected by passing Bill C-418.
View David Anderson Profile
Mr. Speaker, I have 17 petitions to present from seven provinces, including my own province of Saskatchewan.
The petitions address the issue of Bill C-14, which prohibits compelling health care providers or institutions to provide medical assistance in dying but lacks clarity for effective enforcement.
Bill C-418 would provide that protection and make it an offence to intimidate a health care professional for the purpose of compelling him or her to take part in the provision of assisted suicide or to affect his or her employment.
The petitioners call on the Government of Canada to ensure that the conscience rights of medical personnel are protected by passing Bill C-418.
View David Anderson Profile
Mr. Speaker, I have four petitions on three subjects. The first two petitions deal with Bill C-418.
The petitioners ask Parliament to support the bill. It would amend the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part in the provision of medical assistance in dying. It would also makes it an offence to dismiss from employment or to refuse to employ such practitioners for the reason only that they refuse to take part in that activity.
View Robert Nault Profile
Lib. (ON)
View Robert Nault Profile
2019-06-05 17:32 [p.28602]
That the House: (a) call on the Standing Committee on Health to undertake a study and report its findings to determine (i) the factors that contribute to significant disparities in the health outcomes of rural Canadians, compared to those in urban centres, (ii) strategies, including the use of modern and rapidly improving communications technologies, to improve health care delivery to rural Canadians; and (b) call on the government to work with the provinces and territories, and relevant stakeholders, to further address and improve health care delivery in rural Canada.
He said: Mr. Speaker, it is an honour and a pleasure to get the chance to speak to my private member's motion, Motion No. 226, which relates to health care delivery in rural Canada.
As a representative of the Kenora riding, one of the largest rural ridings in Canada, which stretches from almost the American border all the way to Hudson Bay, I know this is probably one of the easiest ridings to use to explain what it means for an area to be remote and inaccessible, or accessible only by plane or a winter road when the lakes freeze over.
This is an important subject matter for all rural Canadians, because it is one of those issues all Canadians think about, which is their health care, the health care delivery and the ability of government to deliver health care products to all Canadians, particularly in the north. For these reasons, northwestern Ontario presents a unique case study in many ways. From infrastructure to environment, transportation and employment, the north forces us to think outside the box.
Health care can be approached from many different angles, including mental health treatment, health care providers and availability, prescription drug coverage and culturally appropriate care, just to name a few.
The 2016 Statistics Canada census data indicates that Canada's population was over 35 million individuals, of whom 16.8% live in rural Canada. The 2006 report by the Canadian Institute for Health Information entitled “How Healthy are Rural Canadians? An Assessment of Their Health Status and Health Determinants” found that rural Canadians have higher death rates, higher infant mortality rates and shorter life expectancies than their urban counterparts.
Health-related factors such as a higher proportion of smokers, lower consumption of fruit and vegetables, and obesity disproportionately affect rural residents. Additionally, the population in rural areas tends to be older than in urban areas.
The recruitment and retention of physicians and health care professionals are also a significant challenge. Throughout the years that I have been involved in this, it has never been easy to find enough professionals to work in rural Canada. According to 2016 data from the Canadian Institute for Health Information, there were approximately 84,000 physicians in Canada, of whom only 6,790, or 8% , practised in rural settings.
In 2006, the Canadian Institute for Health Information issued a report that found that populations living in rural areas had a shorter average life expectancy by almost three years for men, as well as higher smoking rates compared to their urban counterparts. These numbers are statistically significant, according to the report.
Mortality risk for diseases such as heart disease and heart attacks, as well as respiratory diseases like influenza and pneumonia, were also significantly higher in rural versus large urban areas. There is a variation in the levels of services available, as rural areas lack the population base to warrant the construction of extensive health infrastructure.
In addition, rural and remote communities face challenges in recruiting and retaining health care professionals. I will keep repeating that, because it is something we talk about in my riding almost weekly.
On the youth side, there is no process for measuring health disparities in Canada. If we look at the experience of rural children and youth in the health care system, we get a good idea of what is happening. Indigenous populations, particularly those that are rural and remote, are the most underserved communities in all of Canada.
I would like to take a minute to provide an example of health care delivery in the north so that we can see how different it is from the urban experience.
In September 2018, the Sioux Lookout First Nations Health Authority released “Our Children and Youth Health Report”, which represents the experiences of 31 first nations communities in the Sioux Lookout area.
Since 1991, the population of the Sioux Lookout area first nations has grown by 74%. The primary point of care for the majority of these communities is the local nursing station, and in many cases, emergency services are available only by plane. For example, women from Sioux Lookout first nations leave their homes and families and travel hundreds of kilometres to give birth at a hospital. Can members imagine being put in a situation like that? In these communities, basically for all the births, families have to fly out, leave for weeks when it is close to the due date, and then be prepared to spend weeks waiting for the child to be born.
The primary point of care for the majority of these communities is their local nursing station, and in many cases, emergency services are available only by plane. For example, women from Sioux Lookout area first nations leave their homes, as I said, and if infants need emergency care, they are transported out by medevac, because there are no emergency departments in these communities. Since 2012, there has been an 11% increase in the rate of emergency room visits for infants.
In the Sioux Lookout area, first nations youth attend the emergency room department for mental health reasons at a rate five times greater than the Ontario average. Between 2012 and 2016, the rate of emergency department visits for mental health increased by 123%.
These are examples of just some of the issues faced by rural and remote communities when it comes to health care delivery. I am here to talk about how we can find a way to deal with the challenges that rural communities face in making sure that their health care and their standards are equal to the health care standards of urban centres.
Jurisdictional issues pose one of the largest roadblocks to providing quality health care in the north. What is the role of our levels of government in this game of what I would call jurisdictional football? The federal government is responsible for the delivery of health care to certain population groups. Of course, the provinces are responsible for the general population of the province.
Section 10 of the Canada Health Act stipulates that each province's health insurance scheme must be universal, which means that it “must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan”. What does this mean? It boils down to the need for a collaborative approach. Rather than working from the top down, we need to approach these communities and regions to establish their unique needs and find those solutions.
Simply put, there is no cookie-cutter answer, and what works for one community may not work for another. The bottom line is that we need to listen to those who live and work within the system every day to make sure that we understand how to deliver health care in rural Canada.
When we have these discussions, sometimes it is hard for people to compare apples and apples or oranges and oranges, so I spent some time doing some comparisons between Canada and Australia. Like most developed countries, Canada and Australia have publicly funded, universal health care coverage. The two countries have similar population densities and geographic areas. As of June 2018, just under 25 million people resided in Australia, and 11.4% resided in remote or rural locations. The Australian federal government is playing an active role in addressing health disparities between urban and rural or remote populations.
The Australian government provides funding to incentivize physicians to work in rural or remote areas and to encourage the uptake of telemedicine technology in those areas. Like rural Canada, rural Australia is under-serviced with respect to the number of physicians. However, the Australian government also realizes that to change that, it needs to have a solution. This is what Australia is doing, and it is something that I think Canada should consider.
Like rural Canada, rural Australia is under-serviced, so in 2009, the Rural Health Standing Committee of the Australian Health Ministers’ Advisory Council was asked to develop a national strategic framework for rural and remote health. It was published in 2011, and then updated in 2016.
In 2014, the Australian government implemented the indigenous Australians' health programme to improve access to health services that are culturally appropriate, throughout Australia.
In June 2017, the Government of Australia passed legislation to establish a national rural health commissioner, as part of the government's efforts to reform health care in rural and remote Australia. As in Canada, the indigenous population in Australia is more likely than non-indigenous Australians to have respiratory diseases, mental health problems, cardiovascular disease, diabetes and chronic kidney disease, as well as reduced life expectancy.
In the private members' business we are in, it is always good to try to do this from the perspective of making sure that it is non-partisan and that it crosses party lines. Last month, I was pleased to second Bill C-451, an act to establish a children’s health commissioner of Canada, which was put forward by the member for Simcoe—Grey. Bill C-451 puts priority on the well-being, health, security and education of children and youth by recognizing that every child has the right to enjoy a standard of living that allows for the child's physical, mental and social development to flourish. To help see these measures through, the bill seeks to establish an independent commissioner to report, advise and provide recommendations to Parliament.
To complement Bill C-451, my motion seeks to shed further light on the health care delivery gaps between rural and urban Canadians. This area needs to be studied, because current evaluations of the health status of rural Canadians are very limited. Because we do not have the population density to build some of the health infrastructure necessary to deliver adequate services, we must look at existing, new and emerging technologies to address this service gap. This particular type of study has never been undertaken in Canada, so I look forward to working with all parties to see that it takes place.
In my riding, we are working on an all nations hospital. We are looking at health care delivery in our region from the perspective of an all nations hospital health care system, to include everyone in the region. We have included all governments and the local communities to look at how best to deliver those kinds of services. This is a potential way forward.
I think that working together, as we did last week with the Minister of Indigenous Services when we announced our government's support for the all nations hospital health care system, we can find ways to better deliver health care in rural communities.
In conclusion, no matter whether a person is rich or poor, young or old, living in a rural or urban setting, Canada's public health care system must provide equal access and care to all. I believe very much that this government and this Parliament have a role to play in making sure that we do the right assessments and find the right structures to put in place good health care.
My last point is that if people are to be allowed to live their lives in rural Canada, including as seniors throughout their retirement years, we are going to have to find the right health care system to make sure that this takes place. Otherwise, as I hear from all my colleagues, a lot of seniors move to urban centres because they have few choices for places to live in rural Canada.
I thank the House for the opportunity to say a few words about this motion.
View Marilyn Gladu Profile
View Marilyn Gladu Profile
2019-06-05 17:53 [p.28605]
Mr. Speaker, I am pleased to rise today to speak to Motion No. 226. which seeks to give instructions to the Standing Committee on Health regarding health care delivery in rural Canada.
There is an extremely concerning shortage of family doctors and nurses in Canada, particularly in rural areas. The lack of broadband Internet also prevents rural communities from accessing online health services. The committee should also consider the worrisome deterioration of rural hospitals in its study.
I want to thank the member for Kenora for bringing the motion before the House. My daughter was a nurse in his lovely riding, so she is well acquainted with its hospital and the health care services that are available there.
As the member for Sarnia—Lambton, I note that Sarnia is a mixture of urban and rural, so there are also quite a number of parts of my riding where services and transportation are not available.
I would like to start by talking about the current situation in health care in general in Canada.
We know there is already a shortage of doctors and nurses across the country. I have travelled from coast to coast to coast and spoken with people in various ridings. I would like to give members a few examples of the shortage, starting with what I think is one of the worst cases I have heard, which is Cape Breton.
Cape Breton was missing 52 emergency room physicians and a vascular surgeon. People who cut an artery in Cape Breton would lose a limb or die because they would not be able to get to Halifax in time to get the services.
Let us look across the country. Given the wait times in Ottawa, it takes six years to get a family doctor. The former member for Nanaimo—Ladysmith ran provincially, and one of the priority issues she brought up was the shortage of doctors in B.C. Truly, there is a shortage of health care workers.
This is particularly disturbing, as we have an aging population. Right now, one in six people is a senior, and that will be one in four in the next six to 10 years. With that comes a need for a number of different services.
First of all, we are seeing a movement toward more chronic disease, in part due to rising obesity rates, smoking issues and so on. Also, as people are living longer, we are seeing an increase in dementia, and there is a need for palliative care. Of course, I have been a strong advocate for palliative care during my time in the House. About 70% of Canadians do not have any access to palliative care, and this is especially true in rural and remote places. It is a pressing problem.
As I look to the government that has been in power for four years, I see absolutely no plan to address the gaps that exist regarding the resources for health care workers and all the infrastructure needed in places like Petrolia, which is one of the hamlets within my riding. Right now, the electrical and mechanical systems in place at the Charlotte Eleanor Englehart Hospital are so obsolete and so likely to fail that Petrolia is planning how it will shut down the hospital when the systems fail. All of the patients will have to be moved to the nearby high school. Petrolia needs $5 million to repair that infrastructure.
I could tell members similar stories, from across the nation, of hospitals that have not received any funding for infrastructure. Clearly the provinces do not have money for that. One solution the government could bring forward in that light is a program that would specify rural hospitals and their infrastructure needs, which would address some of the outstanding issues there.
Another need in many rural and remote places is broadband Internet. As we move increasingly to using virtual services, such as virtual palliative care and virtual consultations, communities need broadband Internet to receive them. There is a huge need for this in the north. My riding has several places without good access to the Internet. I think it will be incredibly important to address this need.
One of the other problems with the rural and remote health care system is just accessing the services. Transportation can be very costly and, as the member for Kenora has mentioned, it can take a really long time. In Kenora, people transit by airplane. In my riding, even though there are many services, a lot of people have to go to nearby London, which is an hour away. For low-income people and those who do not have transportation, there is no service to take them for weekly cancer treatments or other procedures. Transportation is a big barrier, and we need to find solutions to address that.
There have been some really innovative solutions that I discovered when I was working on the palliative care private member's bill. One of them was the use of paramedics to deliver palliative care. Trained paramedics, during the hours they are not taking care of emergencies, would distribute pain medications and perform procedures that patients need. This is really cost-efficient, because they are already on the payroll, and it is a great service for people who have trouble accessing services and cannot get the transportation they need. It is those kinds of innovations that will be really important as we move forward.
Another issue in my riding—and I heard it is also an issue in Kenora—has to do with how to attract doctors, nurses and health care workers to go to rural places. There has to be some kind of incentive. One of the great innovations, also in Petrolia, was a clinic that was put together with multiple family physicians and nurse practitioners providing various services. Because the doctors did not have to be sole family physicians working umpteen hours in practice and then being on call for emergencies, the balance of life and work was much better. There was a real effort made to attract doctors to that practice. They are doing a fine job and making services very accessible to people who live nearby. In fact, because of the quality, in some cases people are even coming from Sarnia to Petrolia to access services.
We need to come up with solutions on how to provide health care and work with the provinces and territories. Every region is different. We talked about some of the barriers, such as travel during bad weather, for accessing services, but in some places, the problems are different. Some places have an aging population. In my riding, 50% of people are over the age of 57, so care for seniors is a key issue, and I know that is true as well in Nova Scotia and a number of places across the country.
At the end of the day, I would be happy to have the health committee study this issue. I wish we had time in this parliamentary session, but, as has already been pointed out, it is unlikely that a study could be taken up at this point in time. Perhaps it will happen in a future Parliament.
This is an urgent need and something we need to consider. We need to put together a plan that will identify the health care workers required and how to get them. In some cases, there are enough workers in Canada; in some cases, we will have to change how we train doctors, for example. There was a very innovative example in New Brunswick, where, although there is no teaching hospital or university for residencies, the province partnered with Dalhousie University and Sherbrooke for a residency program that would provide medical services in New Brunswick and allow doctors to be certified. That kind of innovation is needed to address the health care worker issue.
In addition, there is a need for an infrastructure plan, as I have mentioned, for broadband Internet and hospital care and other services. For example, we see an increasing need for home care. Home care in rural and remote situations is increasingly difficult because of the amount of travel time and, in some cases, the weather, etc.
When we get this plan together with the resources and infrastructure and decide which services we will need as we move toward more chronic disease and an aging population with more dementia, thus requiring more palliative care, then we can start to execute that plan. It could not happen soon enough because, as I have said, one person in six being a senior now will be one in four within six to 10 years.
It is an urgent issue, and I am happy to support this motion.
View Ben Lobb Profile
View Ben Lobb Profile
2019-06-05 18:22 [p.28609]
Mr. Speaker, it is a pleasure to rise in the House of Commons today. As a lifetime resident of a rural community, it is a pleasure to talk about rural health care and rural issues.
Just talking with different health care providers in the riding, talking to farmers in our communities and what we see in the news, mental health issues in our rural communities are probably the most significant we have ever seen. I do not mean to point farmers out, but people in the agriculture sector feel this due to the stresses of finances, crop prices, trade, last year's harvest and this year's spring planting. Therefore, when we look at the entire package of health care, mental health needs to be a priority. Of course, the proposed study will not happen in this Parliament, but hopefully it will in the 43rd parliament.
Youth suicide is another issue. The youth suicide rate in rural communities is higher than anywhere else. Any information or strategies we can put together to dovetail mental health and youth suicide rates would be very important.
Another topic is addiction. There is an opioid addiction crisis from coast to coast in our small communities. Opioids are a big issue as is crystal meth. It does not really matter what part of the country we are in at this point in time, it is in every one of our communities. Therefore, addiction and mental health treatment and having facilities that are world class and state of the art would help people of all ages deal with these issues, but primarily in a rural area where one has to go so far. People cannot just go down the street for their treatment; it could be several hours away.
Another issue is the number of health care providers who provide a certain service. If we look at mental health, people may require treatment, but they might be told it could take three months to get an appointment. When people are at the point where they have come forward and have asked for help, to tell them that can get that help in three months is not a solution to the problem. Getting hard data to put into this report would be fantastic and would build out these action plans. I know there is lot of it out there, but we need to hammer this home.
In rural Ontario, where I am from, there have been higher rates of diabetes, heart disease and obesity for years and decades. Numerous strategies have been put together with respect to this, but we need proactive health care in our rural communities. We need facilities that will promote a healthy lifestyle and get people out exercising.
COPD are is unique to communities as are some forms of cancer. We need further information on that moving forward.
Baby boomers are getting to the age where they have a different set of health care requirements than they once had. In my community, there is now a geriatrician, which is a vital specialist, to provide help to our aging population. I am from a rural community, Huron County and Bruce County, which is on Ontario's west coast. It is a favourite destination for retirees to head to when they are of that age. We have a higher proportion of seniors than other communities. Therefore, a geriatrician is a vital physician.
A couple of weeks ago, one of our beloved members from British Columbia talked about the issue of palliative care doctors. We could use a lot of palliative care doctors in our rural communities, which would help provide a fitting tribute to some of our hard-working Canadians.
Doctor attraction and retention has been an issue in our rural communities. Going back 20 years ago, for example, Goderich, with a population of over 10,000 people, needed doctors. It put together a great doctor attraction and retention program.
Many may know of Gwen Devereaux from Seaforth, Ontario. From coast to coast, she has been educating and informing Canadians on how to attract doctors to rural communities. She has been on CBC and different radio stations, talking about what she has done.
Someone else mentioned that having a beautiful state-of-the-art clinic would attract physicians to the area. Spouses having meaningful employment would go a long way in attracting a physician to a certain community. The provision of services, which can be as basic as broadband Internet or a community centre with a fitness centre, would also help. All of these things contribute to attracting well-educated physicians, nurses, radiologists or whatever position to go into communities, plant roots and live there.
When most doctors and other health practitioners make a commitment to rural communities, they love it and want to stay, and people are happy to have them.
There has been a lot of improvement with e-health records from coast to coast. It defies logic to look at our phones and see what the technology sector can do, yet health continues to lag behind. It is making innovations, but it is lagging behind. Another good innovation is the Ontario Telehealth Network, which we are happy to have. It is changing outcomes in people's lives.
I think we can all agree that we need hard infrastructure. For example, communities need CT scanners. For people who have strokes or heart attacks, scanners can make a difference in their lives. However, does it make sense that a community has to fundraise to have a CT scanner in its hospital? It defies logic. When we talk about ways the federal government can work with all jurisdictions, why make a community pay for that? There may be strategic ways to provide funding for CT scanners.
Something else communities desire are hospices. They are few and far between. Communities have to fundraise to build them. In Ontario, where I am from, if communities are fortunate enough to have funding for the land, which is only 60%, they have to continue to fundraise in perpetuity for the other 40%. The federal government could play a role in working on a national plan to change this and be a little more fair to communities.
It is the same thing for long-term care. Many long-term care facilities are way out of date and need serious upgrades. There are no addiction treatment centres in my area. They are regional, yes, but there is a whole pile of changes we could make to that.
Last, and probably most important, if we do this study in the 43rd Parliament, the Gateway Centre of Excellence in Rural Health should be invited. It is in my riding and it is the only research facility like this in Canada. It was modelled on a U.S. idea. It does rural health research in partnership with universities. The best and brightest minds come to my community every year to do rural health research, and people are so happy for it. Again, they do it on their own dime. It would great if the federal government and the provinces could come together and provide operational funding to different research facilities like this, which provide great research to rural Canada and, in some cases, encourage these bright, young minds to stay in the area.
I look forward to coming back in the 43rd Parliament. I am sure my colleagues across the way would like otherwise. Regardless of the outcome, it would be great if the health committee would do this study and look at moving beyond jurisdictions.
National defence provides health care and we provide all sorts of health care to indigenous Canadians. There is a role for us. If we all work together, we could rise above the partisan lines.
I wish all my colleagues the very best this summer and in the election in October.
View Lloyd Longfield Profile
Lib. (ON)
View Lloyd Longfield Profile
2019-06-04 17:04 [p.28517]
Mr. Speaker, I thank the hon. member for touching on so many things in a short period of time, but she really got my attention when talking about training people in new technologies as workforces change. She was a nurse and my wife was a nurse. My wife saw a lot of change over the years, going to the metric system and the new technologies in nursing. Could the member comment on how this could help health care in Canada?
View Kamal Khera Profile
Lib. (ON)
View Kamal Khera Profile
2019-06-04 17:04 [p.28517]
Mr. Speaker, I would like to thank my hon. colleague for all the work he does on behalf of his constituents, and to thank his wife as well, who served as a nurse.
With this budget, we introduced the Canada training credit. This would help working Canadians get the skills they need to succeed in the changing world. This is a new tool that would help working Canadians find the time and money to upgrade their skills and progress in their careers.
This is extremely important for health care. We are moving in such a way that people need more training. The digital economy is here, and we need to be innovative in everything we do, which is exactly why we are ensuring that people are prepared for the new skills of the future.
View David Anderson Profile
moved that Bill C-418, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.
He said: Madam Speaker, the first thing I would like to do is to thank the many people across Canada who have shown up to work on this bill. It has caught on across the country. It has restored my faith in the good judgment of Canadians and, hopefully, we will see that same good sense shown in the House and we can have some restored faith here as well.
I am here today to speak to Bill C-418, which is the protection of freedom of conscience act. I need to point out again that I am surprised at the way this has caught on and caught the attention of the Canadian public. We should thank many Canadians and groups for whom this is an important issue for their work on publicizing and advancing conscience rights in Canada.
To begin to understand Bill C-418, we need to back up a bit. The Charter of Rights and Freedoms has a number of sections in it. Section 1, of course, guarantees our rights and freedoms. However, immediately following that is section 2, which declares the most fundamental rights, and that begins with freedom of conscience and religion. In 2015, the Carter decision in the Supreme Court said that although section 7 of the charter provides for the right to die, it also explicitly said that no one is required to participate in or be part of it.
We then came to Bill C-14, the government's assisted suicide bill. It is a bill that attracted much attention and controversy and laid out the groundwork for the first round of assisted suicide legislation in Canada. Whether they call it euthanasia, medically assisted dying or assisted suicide, they are all different names for the same thing. Medical practitioners were divided on the issue of participating in ending the lives of Canadians. Whether we supported Bill C-14 or not, it was clear that many within the medical community were very concerned. They did not and still do not want to participate in this activity.
When Bill C-14 was passed, it included subsection 241.2(9) which did say, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” That was not adequate because it did not lay out an offence, there was no framework for it and there was no penalty in Bill C-14 if someone violated that. It ended up being nothing more than a statement in Bill C-14.
While the Liberal talking points have repeated this, and the Liberals also claim that everyone has freedom of conscience and religion under section 2 of the charter, this is not the reality that medical personnel are facing across Canada. In spite of the fact that on the surface the charter, Carter and Bill C-14 supposedly agree, the reality is that physicians and medical personnel in this country are being pressured to participate in something with which they fundamentally disagree and there is no protection provided to them.
Conscience forms the basis of medical professionals' motivation to pursue their particular field. Doctors practise every day with the knowledge that it is their conscience that motivates them to test the limits of their knowledge and skill. Medical professionals know that patient care will suffer if they are deprived of the ability to live with integrity and to follow their consciences. They know the importance of these beliefs to them and their patients better than anyone else.
For a great many Canadian doctors, the core of their conscience prohibits their participation in taking a life. Indeed, many doctors remain devoted to the black and white of the ancient Hippocratic oath, a pledge that prohibits the administration of a poison to anyone. Through the availability of assisted suicide on demand across Canada, threats to conscience are no longer confined to the theoretical or to the rhetoric of the courtrooms. They are increasingly present in the examination room as well.
That is why I believe it is time to take action in defence of conscience rights that have stood the test of time for generations. Therefore, Bill C-418 seeks to amend the Criminal Code to do two things.
The first is to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of physician-assisted suicide.
The second provision makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or any other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of physician-assisted suicide.
My bill would provide the teeth that Bill C-14 acutely lacks. The Liberals' attempt to provide protection for doctors consisted solely of a rudimentary clause, which stated, as I said earlier, that nothing compels someone to provide or assist. However, the provision lacked the teeth needed for its effective enforcement, as evidenced by the ongoing pressure that is being exerted on physicians, particularly by their regulating bodies.
I guess the question is whether these protections are really necessary, and I would say that they are. Throughout the legislative process, I have spoken to doctors who feel overt pressure to leave family medicine because of their conscientious beliefs. I have heard of palliative care doctors in Ontario who have stopped practising altogether. Nurses who feel increasingly bullied are choosing to shift their focus or retire early. I have had personal conversations with people who work in old folks' homes who explain they do not want to participate in this but are increasingly feeling pressured to do so. The pressure on these professionals exists and they are looking for relief.
What is more, regional associations such as the College of Physicians and Surgeons of Ontario have introduced regulations compelling conscientiously objecting physicians to participate by providing what they call “effective referrals” for physician-assisted suicide. A recent court decision has upheld this directive, contravening the assurances provided in Carter v. Canada and creating an even more urgent need among physicians for protection. This is in spite of the fact that in this situation in Ontario I am told that the majority of physicians support an allowance for conscientious objections, but the college has not taken that position.
As strange as it sounds, the recent court decision refers to the college's suggestion that if physicians do not like to participate then they can find other areas of medicine to take up. This is unusual, particularly in a situation where we have such a shortage of physicians and medical services. The college suggests that if they do not like participating they can take up things like sleep medicine, hair restoration, sport and exercise medicine, skin disorders, obesity medicine, aviation examinations, travel medicine or perhaps become a medical health officer.
For many of us across this country, particularly those of us in rural areas, we know there is an increasing lack of physicians in an increasingly challenged medical system. I find it passing strange that the college would be the one suggesting such a thing for its physicians. The answer does not have to be to do it, find someone else to do it or get out of medicine. Medical personnel and resources are scarce. Why would one try to force people into doing what they believe to be wrong? The example of the province of Manitoba and its conscientious objection legislation shows there does not need to be compulsion in the medical system when it comes to this issue.
My bill does not address the social acceptability of euthanasia and assisted suicide; that is not the point of it. Protecting physicians' conscience rights is not at all a physicians versus patients scenario. By protecting physicians' conscience rights, patients' rights are enhanced. Bill C-418 is about protecting the fundamental freedom of conscience and religion guaranteed to all Canadians in the Charter of Rights and Freedoms.
Parliamentarians from all parties cannot ignore the groundswell of support this bill has received from average Canadians who believe it is time to stand up for doctors and health care providers who are not willing to leave their core ethics behind when they are at a patient's bedside. This is not theoretical. I have had photos sent to me of the revolving TV screens that we see in hospital wards, with pictures of what seems to be a physician's hand gently resting on the arm of a senior citizen, touting assisted suicide as a medical service whereby physicians or nurse practitioners help patients fulfill their wish to end their suffering and a phone number is provided. Interestingly, it makes no mention of palliative care or other ways to reduce pain and suffering. It makes no mention of access to counselling.
With government, the courts and health care facilities promoting access as a right, should not those who object be allowed to have that fundamental freedom of conscience that is so important?
I want to close with a quote from “The Imperative of Conscience Rights” by the CRFI. They write:
The outcomes of the current controversies that engage freedom of conscience will not only signal the extent to which Canadians can conscientiously participate in public life—in other words, whether they can live in alignment with who they are and what they stand for in matters of morality. These outcomes will also speak volumes about who we are and what we stand for—as a society. Suppressing beliefs with which we disagree or that we find offensive in the name of tolerance and liberalism is a contradiction in terms. The fact that the state has deemed something legal does not remove a person’s freedom to express her moral opposition to it. This freedom is not absolute, but its roots—integrity, identity, and dignity—are necessary for human flourishing. These roots must therefore be top of mind whenever limitations on freedom of conscience are proposed. We believe that governments should only limit this human right if there is a compelling justification.
View David Anderson Profile
Madam Speaker, I can tell my colleague opposite that the OMA, as far as I know, has come out in favour of protecting the conscience rights for the doctors who are part of its association, so the college and the OMA are not on the same page on this one.
The college in Ontario has brought in a much stricter set of guidelines, if we want to call it that, than virtually anywhere else across Canada. Manitoba has brought in a conscientious objection law, which would allow physicians to opt out of this and make it much simpler for them to do that. In Ontario, the requirement is that they “must effectively refer”, which are the words that are used. Many people feel that they just do not want to participate at that level and in this day and age of electronics, there are many other ways that people can access the information. There are a number of other suggestions out there about how that might be done.
The point of this bill is, first of all, to give the conscience protection that people need if they want to be able to continue to do their work.
View David Anderson Profile
Madam Speaker, I actually believe that we can. It has been done in other places across the country, but there are numerous ways that people can come to information about assisted suicide or medical assistance in dying. There are certainly a number of options open as to how they might access that information. The question is whether physicians are obligated to refer that, to provide that, or if they can opt out and give them another way to find that information. We believe that is very possible.
View John Nater Profile
View John Nater Profile
2019-05-29 17:47 [p.28242]
Madam Speaker, in my riding of Perth—Wellington, I have received a fair bit of correspondence on this matter in support of the member's bill. I was wondering if he could highlight some of the support he has had for his bill from constituents in his riding and Canadians across the country.
View David Anderson Profile
Madam Speaker, the interest in this bill has been surprising to me. There are some bills that really catch people's imaginations across the country. There are other ones that we really have to work hard to try to get people to pay attention to. It has been surprising to me how people have taken this on. There is an onslaught of petitions coming into my office every day and I am passing them on to my colleagues as well so that they can understand the interest that people in their ridings have in this issue.
People generally want to be fair to other people and allow them to have the capacity to operate off of the things they believe in. Every single one of us has a set of beliefs. We have a right to operate under our set of beliefs as long as we are not destroying somebody else's life or are in other people's faces. In this situation, we should be giving medical professionals, who operate every day from a sense of conscience in what they do, the opportunity to do that.
View Robert Oliphant Profile
Lib. (ON)
View Robert Oliphant Profile
2019-05-29 17:48 [p.28242]
Madam Speaker, I want to refer the mover of this piece of legislation to the report that was done by the special committee on medical assistance in dying. There was a strong concern in that report that, indeed, we do honour the conscientious objection of medical practitioners, while at the same respect the right of patients to get absolute medical attention. If it comes down to a patient's right or a physician's right, which would the member choose?
View David Anderson Profile
Madam Speaker, as I mentioned earlier, there are a number of options for people to find the information they need. There are many doctors and facilities that will provide this service if they want it, but there are other doctors and medical personnel who do not feel that assisting in someone's premature death is a part of the mandate of what they have been called to as physicians or medical personnel.
There are enough choices out there that people can have and we can allow those who disagree with this procedure to have their freedom of conscience and be able to live their professional lives in that fashion.
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