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View Brad Redekopp Profile
CPC (SK)
View Brad Redekopp Profile
2020-02-27 15:40 [p.1698]
Mr. Speaker, today I rise to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.
My office has received about 135 phone calls, emails or letters so far on this issue, and I recognize that this is a very touchy, personal and non-partisan issue.
I will begin with a quick bit of history. The MAID legislation came into law in June 2016. Recently, one judge in Quebec ruled that the wording in the legislation on “foreseeable death” was too restrictive. The Liberal government was very quick to accept this ruling. It chose not to appeal, and instead moved to rewrite the legislation taking into account the decision of the court.
This caused me to compare this ruling to the recent Alberta court ruling in which four judges found the carbon tax to be unconstitutional. It made me wonder if the government is going to be as quick to accept the Alberta court ruling as well and not appeal it, but that is a digression.
As I said, MAID is a very touchy, personal and non-partisan issue. One can always find examples of people for whom MAID legislation is a difficult but welcome option. Unfortunately, those simple examples are usually in the minority. Far more often, it is much more complicated than that. The stories I have heard reflect these complications, such as the case where families are caught by surprise with a death and then forced to deal with the aftermath of that.
There are cases where a person is at a particularly low point in their health but, under this proposed legislation, would be able to request and receive MAID with no waiting period. There are cases where physicians or hospital officials apply pressure on individuals to consider MAID. For example, Roger Foley, an Ontario man who is suffering from an incurable neurological disease, said that the medical staff repeatedly offered him MAID, despite his repeated requests to live at home.
There is also the B.C. case of Ms. S. Dr. Wiebe lamented the profound suffering of Ms. S. but felt that Ms. S. was not eligible for an assisted death. Then, unfortunately, Ms. S. decided to starve herself. Dr. Wiebe and another doctor then determined that, due to the severe malnutrition and dehydration of Ms. S., her natural death was reasonably foreseeable, so Dr. Wiebe euthanized her on March 2017.
According to a Globe and Mail article, this case is the first to be made public in which a medical regulator has ruled on the contentious question of whether doctors should grant assisted death to patients who only satisfy all the criteria of the federal law after they have stopped eating and drinking.
It is not difficult to imagine a situation where a hospital will, for reasons of efficiency, encourage its staff to suggest MAID to patients with chronically difficult and complex cases. It is not a simple problem. It is a very complex problem.
What bothers me about this is that the government is pre-empting the parliamentary review process that was specified in the legislation. We know that the current justice minister voted against the party on the original legislation because he felt that it did not go far enough. Now, as justice minister, he is able to make the changes that he desired. This is troubling, because he is choosing to pre-empt the legislated review process and get his desired changes into legislation without consultation.
The existing law mandates the review of the legislation every five years, and the review will happen in just a few months.
Why is the government is such a rush to make substantive changes to this legislation and pre-empt the legislated review process?
To me, it makes far more sense to deal with the specific issue raised by the Quebec judge only, then do a proper consultation with Canadians this summer and propose changes based on that. Instead, the government had an extensive online survey that lasted two weeks. While it received a lot of responses, I think it just proves that there is great interest, and Canadians have a lot to say about this issue. So far, the results of these responses have not been shared, and I ask for these responses to be shared. I call on the government to do the right thing and leave any changes beyond what the Quebec judge has asked for until the completion of the review process later this year.
Since we are talking about changes to this legislation, I want to talk about palliative care. There are calls for a pan-Canadian strategy on palliative care. I think it is convenient to point to the provinces and say that this is their problem, but there cannot be a full end-of-life strategy without funds and laws around palliative care.
The government broke a key election promise to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making.
I have a personal example from Saskatoon, which has 12 palliative care beds for an area with over 300,000 people.
My mother-in-law had a terminal disease. In her case, MAID was neither requested nor desired. She was fortunate in that her death was relatively quick, and by some miracle she was able to get one of those 12 beds in Saskatoon.
It should not take a miracle to get good end-of-life care. It should not be that MAID is the only reasonable solution at the end of life because palliative care is not available. Therefore, I call on the government to put as much effort into palliative care as it has into MAID.
Another significant area of concern is conscience protection. Physicians and health professionals must be given strong conscience rights. They must be free to not participate and be free of penalty or harassment for making that choice. They must also be free to not be required to refer to another health professional. They must have full conscience protection.
Further, it must be recognized that the conscience objection of institutions must be protected. Institutions are not bricks and mortar. They are collections of people with values. Therefore, institutions must also be given the right of conscience protection. Several Supreme Court cases are instructive here.
The Supreme Court in 2015, in the Loyola case, stated:
Religious freedom under the Charter must therefore account for the socially embedded nature of religious belief, and the deep linkages between this belief and its manifestation through communal institutions and traditions.
In another 2015 decision, the Supreme Court stated:
A neutral public space free from coercion, pressure and judgment on the part of public authorities in matters of spirituality is intended to protect every person’s freedom and dignity, and it helps preserve and promote the multicultural nature of Canadian society.
We must respect the multicultural nature of Canadian society. We must respect both medical professionals and institutions, and allow them to have full conscience protections free from harassment and consequences.
There are some specific changes proposed that I am concerned about. The current legislation includes a 10-day waiting period between when MAID is requested and when it can be administered. The current legislation already allows for this waiting period to be waived. It states that if two medical practitioners:
...are both of the opinion that the person's death, or the loss of their capacity to provide informed consent, is imminent—any shorter period that the first medical practitioner or nurse practitioner considers appropriate [can be used] in the circumstances.
There already is a provision to deal with this issue. There is no need to make changes. The situation has been contemplated and addressed in the current legislation.
Another area of concern is the lack of safeguards for the mentally ill. Mental illness is a very complex situation. Patients diagnosed with an underlying mental health challenge are not required to undergo a psychiatric assessment by a psychiatric professional to determine whether they have the capacity to consent.
There is no one-size-fits-all solution to the issues of mental health. However, it is not difficult to imagine a scenario in which a person is in a particularly dark period and considers MAID. It may well be that with proper professional help that person can work through the darkness and emerge a bit better. This may not always be the case, but that is why having a general waiting period is so important. It eliminates the ability of medical professionals or others to make a quick decision that they regret.
A poll in January found that Saskatchewan and Manitoba had the lowest support in the country for MAID. In 2018, in Saskatchewan, only 67 of 172 applicants for MAID actually received medically assisted death. Some were declined, some withdrew and some died before the request could be completed.
In summary, I would make the following observations. Most importantly, in the words of a constituent I spoke with this week, “We need to slow this down, not speed it up.” Yes, we need to deal with the Quebec court decision, but that only requires one change. There is a legislated review that will happen this summer.
Let us wait for a proper consultation and use that lens to view any proposed changes. Let us have a pan-Canadian strategy for palliative care. Let us put full conscience protection in place for physicians and health care professionals. Let us put conscience protection in place for institutions. Let us leave the 10-day waiting period and the ability to create exceptions the way it is. Let us deal with the Quebec court decision and leave the rest until after the legislated review this summer. Let us slow this down.
View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-02-26 16:29 [p.1623]
Madam Speaker, it is a great pleasure today to rise as the shadow minister of justice for the official opposition to speak to the government's Bill C-7. As I rise to speak on this bill, I do so with concern over some of the contents within it and even over the way it was presented to the House this week when, unfortunately, many of us read about the contents of the bill in the media, rather than seeing it first in this House.
The bill was intended to be a response to the Quebec Superior Court decision that was made on September 11, 2019. The decision stated that the law as it stood was too restrictive around the requirement for death to be reasonably foreseeable. The official opposition called on the government at the time to appeal the decision to the Supreme Court of Canada in order for Parliament to receive clarity about the parameters in which we would legislate, but the bill was introduced without that clarity.
Not only was the bill introduced without that clarity, but it goes far beyond what was required to meet the Quebec Superior Court's decision. I believe that is an affront to this Parliament, because when the previous bill, Bill C-14, was passed in the 42nd Parliament, the wisdom of this Parliament required that there be a statutory review of our assisted dying regime in Canada. That statutory review was and is to take place in June of this year.
It is in that review period that parliamentarians would be able to go more into depth on how the government's legislation has worked over the past several years and on how best to proceed. Rather than wait for that review, as it should have done, the government has decided to start making amendments to the legislation now, avoiding the in-depth review that is to take place shortly.
The reality is that when we are talking about this legislation, we are literally talking about the matter of life and death. This is an incredibly sensitive issue. Members on all sides of the house have diverse opinions on it, and it is because of this diversity of opinions and because of the sensitivity of this issue that the Quebec Superior Court decision should have been appealed to the Supreme Court of Canada for further clarity. However, as the government has now opened this legislation up, it is upon us as legislators to now highlight other matters that should be addressed and included.
My office has heard plenty from concerned Canadians about the lack of protection for conscience rights for health care professionals. This is particularly important now that the government is broadening medical assistance in dying to include individuals whose death is not reasonably foreseeable. Expanding medical assistance in dying to more patients could in fact diminish the number of medical professionals willing to take part in the process. The fact is that this expanded access could result in a heavy emotional burden on those health care providers.
None of us here can fully appreciate the burden put on those health care providers currently working in the system and providing medical assistance in dying. The fact is that there is nothing about ensuring proper support to health care professionals who provide this service and there continue to be no penalties for pressuring a medical professional into providing medical assistance in dying, nor are there penalties for punishing or penalizing a medical professional who does not participate in medical assistance in dying. This means there continues to be no real protection for conscience rights for health care professionals.
The issue of advance directives, now rebranded as a “waiver of final consent” by this government, is a complex one that poses questions of ethics and safety and issues with oversight. The fact that the legislation legalizing this is half a page of a bill shows a lack of care given to this issue. This issue rightly should have been discussed as part of the parliamentary review to take place this summer.
The process for the creation and execution of this agreement remains ambiguous. Further, there is a lack of clarity on the process for proceeding with an advance directive agreement upon the date selected. The process will only be stopped if a patient expresses a form of resistance, but we do not know what that looks like. What if they are simply confused or groggy at the time? Under the legislation, unless they resist, the process will still proceed.
The bill also removes the 10-day waiting requirement when a person's death is reasonably foreseeable. When I read in media reports before the bill was tabled that this would be included, I, like many of many of my colleagues and parliamentarians, questioned as to what prompted its removal. I still remain incredibly concerned as to why this was included. This is particularly true because there was already the ability to remove the 10-day waiting period if a person's death or loss of capacity to consent was imminent, so why proceed with the removal of a safeguard that Parliament saw fit to include in the previous legislation?
It is also confusing that Bill C-7 requires a 90-day waiting period when a patient's death is not reasonably foreseeable. Why add an extended wait period for one, but remove the wait period entirely for the other?
On the issue of whether a death is reasonably foreseeable or not reasonably foreseeable, there is no clarification or guidance for health care professionals. As a result, it is not up to them to make the determination as to what category to put a patient under. That determination will decide whether a patient can access medical assistance in dying immediately or if they will require a 90-day waiting period. This is an extraordinary amount of pressure that the government is putting on health care professionals across this country.
The changing of witness requirements under this legislation has also been mentioned. The law requires only one independent witness, which is down from two.
All of these changes lead to an expansion of the law in Canada far beyond what was addressed in the Quebec court decision, an expansion that should have required deeper reflection through the study that is to take place this summer.
For a moment, let us speak to a point that seems to be lost in this conversation: palliative care services in this country.
The reality is if the choice is between a lack of quality palliative care and medically assisted dying, that really is no choice at all. Unfortunately, over the past number of years there have been instances of patients feeling they were forced to choose death because of a lack of palliative care.
The story of Archie Rolland comes to mind. Archie was a Montreal landscape architect who chose to end his life rather than continue suffering at a long-term care facility that was failing to provide him adequate care.
He had ALS and had his life upended when he was forced to move from a Montreal hospital that specialized in treating patients with severe respiratory ailments to a long-term care facility for geriatric patients. Mr. Rolland did not want to go, but he was transferred against his wishes. He called the system “inhuman”. He felt he was not getting adequate care, so he chose death.
I do not think that this is any real choice at all. We must have the discussion in this country about palliative care because people must not feel forced into a decision on medically assisted death. Mr. Rolland's story makes it clear that there was a failure of the system to provide him with adequate care. We risk medically assisted death being seen as some sort of bureaucratic solution for people who require an extra level of care. In a country like Canada, that is simply not acceptable. The government risks expanding a culture of not valuing life, and we should all agree in this place that we must place value on human life.
In closing, the bill disrespects Parliament and the parliamentary process. With Bill C-14, parliamentarians did a significant amount of work in the House and committee in an attempt to build consensus. The work was challenged by the Quebec Superior Court, but rather than defending the will of elected representatives in court, the Liberals immediately backed down.
Now the Liberals are responding not just to that decision but are also undoing the work of the joint committee on Bill C-14 by adding new measures.
Many of these issues should be dealt with in the summer when we have our scheduled parliamentary review. This is a complex matter that requires proper scrutiny and debate.
View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-02-26 16:40 [p.1625]
Madam Speaker, I thank the parliamentary secretary for his question. He covered a lot of ground.
If the government agreed with the decision, and that is the basis for not appealing it, then why was that not in the original legislation to begin with?
All too often we see on the other side of the House a willingness to let the courts do the work that is rightly the work of Parliament, and we are seeing that again here. One court decision is made in one province, and then the government will hide behind that decision rather than appeal it to the Supreme Court of Canada as it should.
Now the government has brought in legislation that goes far beyond what this court was dealing with, which is reasonable foreseeability of death. That again should have been dealt with in the review that is coming up this summer, when all parliamentarians can get input from their constituents and from experts on this issue.
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