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Results: 1 - 15 of 19
View Diane Lebouthillier Profile
Lib. (QC)
Madam Speaker, our government is introducing measures to help ensure the long-term financial security and independence of people with disabilities. In 2017, our government reinstated the disability advisory committee, which was dismantled by the Harper Conservatives in 2006. We thank the members of the committee for working hard to make recommendations to the Canada Revenue Agency concerning better support for people with disabilities. Our government is working on implementing most of the recommendations. The report released last spring will inform our future discussions.
View Luc Thériault Profile
View Luc Thériault Profile
2020-02-27 11:26 [p.1660]
Mr. Speaker, I would like to reassure my Conservative colleague.
A psychiatrist must absolutely conduct a mental health assessment of the person who is dying or suffering. Family doctors are able to prescribe antidepressants to treat depression. Sometimes, a doctor may have to tell a patient that there are no further treatments available and then refer that patient to palliative care to ease their suffering. If the patient immediately says that they want to access MAID, the doctor will prescribe antidepressants, because there are steps to go through long before a patient can access MAID.
I have a hard time understanding the problem my Conservative colleague sees, since the bill excludes mental illness.
Everyone thinks that pain relief in palliative care is common practice, regardless of whether the patient is receiving care. This is called a good medical practice. Relief is provided for pain. No terminal patient receiving good care that manages pain is forced to ask for medical assistance in dying. Patients who request it do so by choice. This choice is necessary, and for there to be a choice, there need to be options.
View Gérard Deltell Profile
View Gérard Deltell Profile
2020-02-27 12:11 [p.1666]
Madam Speaker, I will be sharing my time with my colleague from Coquitlam—Port Coquitlam.
I am very happy to be taking part in this debate, which is a departure from our usual political and often partisan work as elected officials.
This is the third time in my parliamentary career that I have been asked to debate and vote on the issue of medical assistance in dying. I was a member of Quebec's National Assembly for seven years, and I have served here in the House of Commons since 2015 with the support of my constituents.
I was elected to the national assembly in 2008. As a member of that assembly, I participated in the first debate we had in Quebec on this issue, the first time in a Canadian legislature, in 2010.
I also was a participant in the debate we had four years ago in the House of Commons, when, for first time, we addressed the issue. Therefore, in my parliamentary life, this is the third time I will participate and vote on this very touchy, personal and non-partisan issue.
That is why I would like to remind the House of certain cardinal rules that should guide our actions as parliamentarians in this debate, which we believe should be totally non-partisan. Things may get tense at times, but debate must remain respectful.
Respecting the free vote should be one of the cardinal rules of this debate. In my view, there is no right or wrong position in this debate. There are only positions that we are comfortable with as human beings. Whether we are for or against, there is no partisan politics behind it. There is only the personal opinion that we hold, share and analyze.
Consequently, it is important to keep a completely open mind and respect the fact that certain colleagues from our own party may not share our point of view, while colleagues from other parties may. That is fine. There is nothing wrong with that, really. Some positions we adopt, and some positions we cannot be comfortable with. That is all.
We must respect the debate. We must respect personal opinions. We must respect the fact that there is no place for partisanship in this debate and that positions are neither right nor wrong. There are positions that we can agree with and others that we cannot. We must respect that.
There are also certain elements that we must bear in mind before we dive into this. In our opinion, the bill has some shortcomings.
First, we must respect the freedom of conscience of physicians who are called on to provide MAID. If a physician feels that they cannot in good conscience provide MAID, they should be able to say so and not have to proceed. I have spoken to many people in the context of this debate, in which I have been participating for a very long time. Everyone I have spoken to has told me that physicians can show a certain openness in some circumstances, but change their minds in others. Physicians should never be forced to act against their conscience.
Furthermore, we should always bear in mind that MAID, by its very nature, is the last level of health care that can be offered. We must never forget that the role of palliative care is to ensure that those who are ill can live with dignity even in tragic circumstances. Therefore, we must respect physicians' conscience and focus on palliative care.
Taking our time is another cardinal rule that must be respected in this type of debate.
Let me remind members that the first time this issue was addressed in Quebec, it took six full years, three different governments and three different premiers. There was a huge debate about it, a strong and wise debate. Each and every position had been clearly established by those people who participated in the debate. There is no rush. We must take our time.
For some people, we are talking about assisted suicide. It is a very touchy issue. The worst-case scenario is to rush it. Quebec spent six full years, and we should follow this example. It obviously will not take six years this time, but the first step took six full years.
Let's agree that this debate cannot be rushed.
Why are we debating Bill C-7 today?
When the House of Commons adopted Bill C-14 in 2016, I was a member of the committee that studied it. We knew then that Canadians would challenge parts of it and that there would be court rulings. That is exactly what happened on September 11, 2019, when the Quebec Superior Court struck down the notion of “reasonably foreseeable natural death” in the bill that became An Act to amend the Criminal Code and to make related amendments to other Acts regarding medical assistance in dying.
I did not know this before I looked it up, but it is interesting to note that the current Minister of Justice, a man for whom I have tremendous respect and esteem owing to his experience as a lawyer and a McGill University professor, voted against Bill C-14. Now, as Minister of Justice, he is sponsoring this bill as the federal government's response to the Quebec Superior Court's ruling. The bill addresses some of the issues but sets others aside.
The first fundamental element of Bill C-7 is that it eliminates the 10-day waiting period that the current law requires as a buffer between the person's decision and the operation itself, to ensure that the second opinion provided for under the act is in fact obtained. The court deemed this provision invalid, and the minister decided to accept that opinion.
Let's also not forget that the current law, which was passed four years ago, requires the provisions to be reviewed in just a few months, starting in June 2020.
The government decided to take note of the Superior Court of Quebec ruling and act accordingly. That is its right. However, regardless of our views on the issue, we feel that this subject involves some truly fundamental questions and raises highly complex legal concerns. We think this ruling should have been appealed to the highest court in the land, so that the nine justices of the Supreme Court could study every possible ramification.
This bill sidesteps the issue of mental illness entirely. That is a very good thing, because in our view, it is extremely difficult to pinpoint the instant when a mental illness becomes irreversible, which can raise doubts about whether consent was given fully and freely.
As I said earlier, the worst thing we could do in this matter is move too fast. There is no rush. This concern may eventually be debated, but for now, let's take it one step at a time.
Since my time is almost up, I would just like to say that in this debate on such a delicate, sensitive issue, the worst thing we could do is plough full steam ahead and attack people's convictions instead of respecting their choices. Let's take the time to do things right on this extremely delicate and extremely important issue.
View Yves Perron Profile
View Yves Perron Profile
2020-02-27 13:11 [p.1673]
Madam Speaker, I will be sharing my time with my very esteemed colleague from Shefford.
The debate we are having today must be handled with restraint, dignity and composure. Partisanship has no place here. This is a serious matter, and our decision will have significant repercussions on the lives of many, and perhaps even on our own lives one day, because we all have to leave this world sometime. It is inevitable.
The sad thing in all this is that, through decisions made in this very Parliament, our society has forced people who are suffering to suffer even more. People with severe medical conditions were forced to appeal to the justice system to have their most basic rights upheld. Worse yet, some had to go on a hunger strike to get access to medical assistance in dying by meeting the reasonably foreseeable death requirement. Do hon. members have any idea what we have asked these suffering patients to endure?
These long-suffering people coping with illness, trying to get through the day in unspeakable physical and psychological agony, were forced to go to court or put themselves in a position where their death was reasonably foreseeable. Everyone knows that the justice system is backed up. The costs and delays are typically unreasonable. These people had to endure a veritable ordeal because we made a decision for them.
We failed to make informed decisions that upheld individual liberty. It is a huge privilege to sit in this House, and with that privilege come serious responsibilities. We must honour our position. I want all members of the House to know that this time, we cannot fail. Courageous patients have had to fight the system to get us to make a wise, informed decision. The Superior Court of Quebec gave very clear directives. We must have the courage and vision to apply these directives and support this bill in principle, because it deserves to be improved in committee.
The Beaudoin decision in favour of Nicole Gladu and Jean Truchon is very clear: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu's rights to liberty and security, protected by section 7 of the Charter.”
We must read those last few lines carefully. They refer to the rights to life and freedom of choice. Which of us can presume to choose for someone else? I want to warn my colleagues against the temptation to think about themselves. I want to warn them against voting according to their own beliefs, philosophies or religion. Freedom to choose must be upheld, and in order to choose, we need options. The basis of the decision, which came after a very long wait and constant anguish, makes it very clear that this is about rights and freedoms. No one can choose for another person. We must remove the barriers so that everyone can live out their last moments in their own way, freely and without constraint. Of course, we must not fail to protect the most vulnerable, in accordance with the well-established rule, in medical practice, of free and informed consent. That means informed by exposure to all possible options, and free from any undue pressure.
This bill is a step in the right direction. It includes important precautionary measures and provides for the study of other important issues that need to be considered. Among other things, it would exclude people suffering solely from mental illness. I think that is a wise decision. This is an extremely complex issue that should be studied further. We cannot decide on this issue right now, hence the need to study it properly without skipping any steps.
We must also look at the issue of advance requests for persons newly diagnosed with a condition that may have an impact on their decision-making ability in the future. These are extremely sensitive issues that we must study with great care and a great deal of precaution. It is therefore wise not to include them for now.
Generally speaking, the purpose of this bill is to allow those suffering from degenerative, incurable diseases to have access to medical assistance in dying, whether natural death is reasonably foreseeable or not, except in cases of degenerative cognitive disease, as I was just saying.
For people whose death is reasonably foreseeable, this is about relaxing the rules by eliminating the 10-day waiting period between the written request and the administration of MAID. The 10-day waiting period may be waived if a person has been assessed and their request for MAID has been approved and arrangements have been made with their practitioner to obtain a waiver of final consent because the patient is at risk of losing their capacity to make a decision as the disease progresses or with the administration of pain-relief medication. That way, when making the request for MAID, the patient can agree to waive consent the second time if their pain is beyond treatment, even with care.
This last measure allows the person to live longer with a reasonable quality of life. The person therefore does not have to feel like they have to rush to request MAID out of fear of losing their capacity to do so.
For people whose death is not reasonably foreseeable, there is a 90-day delay between the request and the provision of the MAID service, unless assessments have been made and the loss of capacity is imminent. This time period must therefore be applied in a reasonable and reasoned manner. Who among us can guarantee that 90 days will be enough for some? Who among us can say whether 90 days will be too long a hell to endure for others? We are entitled to question the application of this delay. No one can say. That is why this clause and this entire bill will have to be implemented in a sensible, flexible and intelligent way. Practitioners are in the best position to determine what is valid and what is not when they work together with their patients, listen to them and, of course, treat them humanely. Ultimately, the priority must be the patients themselves, their well-being and their dignity.
I remind all members that although we are talking about dignity, this is above all about rights and freedoms. Every person at end of life must have options, and that individual is the only one who should be able to make that choice. We must not impose our own values and opinions. We must simply ensure that we provide a suitable framework regulating the practice of and the right to medical assistance in dying. We must respect the freedom of the individual. That is fundamental.
I urge all parliamentarians in the House to consider the huge responsibility we must shoulder. We hold in our hands the fate of hundreds of thousands of people. Not only is the end-of-life suffering of these people in our hands, but the suffering and anguish of their family members is as well. It is horrific to watch a loved one suffer at end of life and to feel helpless. Some members of the House may be thinking about personal choices. As I mentioned earlier, we need to figure out a reasonable framework for this very complex act and, through all of this, maintain freedom of choice for these individuals.
View Yves Perron Profile
View Yves Perron Profile
2020-02-27 13:21 [p.1675]
Madam Speaker, I thank my hon. colleague. His questions are valid.
I will start by answering his second question.
With respect to mental illness, the Government of Quebec chose to study the issue more thoroughly before including it in the law. If two separate lawmaking bodies are making the same choices, that strongly suggests we are on the right path. I think it is a reasonable decision. Laws as impactful as MAID legislation must be drafted very carefully.
With respect to doctors' policies, I heard the horror stories some of our colleagues shared with the House. It is important to note that the medical profession is extremely well regulated. We need to make sure this bill provides a solid framework.
Some MPs shared examples of real cases with us, and I would encourage them to report those cases. I believe such cases are rare exceptions.
By far, most health professionals, including doctors, nurses and attendants, are dedicated to and care deeply about the well-being of their patients. They will take every possible precaution to ensure that the patient's choice is free and informed. As I said, for patients to make free and informed choices, they must be made aware of their options.
View Andréanne Larouche Profile
View Andréanne Larouche Profile
2020-02-27 13:26 [p.1676]
Madam Speaker, it is with great humility that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code with regard to medical assistance in dying.
Many MPs have very personal stories about the end of life of one of their loved ones. As the Bloc Québécois critic for seniors, it goes without saying that I have heard my share. Therefore, in my speech, I will recall the work done by the Bloc on this issue, the sensitivity that exists in Quebec regarding medical assistance in dying and, finally, the position of certain groups of seniors and women who have come to meet with me.
First, let me go over the context again. In September 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, both suffering from a serious degenerative disease, stating that one of the eligibility criteria for medical assistance in dying is too restrictive. This criterion, that of “reasonably foreseeable natural death”, is found in the federal government's Act to amend the Criminal Code and to make related amendments to other Acts with regard to medical assistance in dying, and the provincial government's Act respecting end-of-life care.
Justice Christine Baudoin said it well in her ruling when she wrote: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.” Those two individuals had argued that they were being denied medical assistance in dying because their deaths were not imminent.
Let me now remind the House of the Bloc Québécois's position and highlight the outstanding work of the member for Montcalm, to whom I offer my deepest sympathies. I want to thank him for the work he has done on this file because, as he quite rightly pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. That would be terrible, and yet that is what will happen if we cannot figure out a way to cover degenerative cognitive diseases.
However, we believe that it is important to be very cautious before making any decisions on questions related to mental health. That is why we are relieved that the bill does not address eligibility for MAID for individuals suffering solely from a mental illness. Indeed, this issue requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.
For the second part of my speech, I would like to talk about Quebec's sentiments on this whole issue. Quebec was the first jurisdiction in Canada to pass legislation on medical assistance in dying. Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada.
Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada.
In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:
Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009....I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.
For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared with me its concerns with MAID. I will quote the AFEAS 2018-19 issue guide:
Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....This process cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.
Many people are not eligible for MAID because of the federal law governing the practice, which was imposed by a court ruling in February 2015. Four years after Carter, individuals whose quality of life is severely compromised by degenerative diseases are still being forced to ask the courts for permission to end their suffering.
In February 2015, the Supreme Court even struck down two sections of the Criminal Code prohibiting Canadian doctors from administering MAID. In Carter, the highest court in the land stated that a competent adult who clearly consents to the termination of life is eligible for MAID if that person “has a grievous and irremediable medical condition...that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition”.
According to the AFEAS, the Supreme Court's criteria were very broad. In drafting the MAID eligibility criteria, the Government of Canada included the concept of reasonably foreseeable natural death only for people at the end of life, which excludes a significant number of people who are experiencing intolerable physical and mental suffering.
The entire process is based on the intensity of the suffering as assessed by a doctor and a panel of experts. The sick person's own assessment is not always taken into account. There are no compassionate criteria among the requirements for obtaining MAID. A person may be at the end of their life and be unable to make the request themselves because they cannot communicate. The law applies only to people who are able to give their free and informed consent up until the very end, which could be terribly traumatic and even cruel to those who have been suffering for years.
With regard to advance consent, the AFEAS spoke about the case of Audrey Parker, a woman from Halifax who died with medical assistance on November 1, 2018. She made a video three days before her death. In that three-minute video, she said that she would like nothing more than to make it to Christmas, but that if she became incompetent along the way, she would lose out on her choice of a beautiful, peaceful and, best of all, pain-free death.
The Barreau du Québec believes that the law should be amended to comply with the criteria set out in Carter and thus prevent court challenges from being filed by people who should not have to carry such a burden.
A panel of experts has studied this issue and recommends, under certain conditions, ending the suffering of patients who have previously expressed their wish to receive medical assistance in dying, but who subsequently become incapable of expressing their consent, in particular people with various forms of dementia or cognitive loss such as Alzheimer's disease. This is why AFEAS is asking, with respect to human rights, that the process of medical assistance in dying be based more on the rights of individuals and on respect for their wishes.
With respect to reasonably foreseeable natural death, it requested that the reference to “reasonably foreseeable natural death” be removed from the eligibility criteria. With respect to advance consent, it asked that the person's informed consent be respected and that it be given in advance. Also on the subject of advance consent, it asked that the consent anticipated, stated and recorded by the person be recognized.
In conclusion, today's debate demonstrates the need to act so that people suffering from degenerative and incurable diseases are no longer forced to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying, and so that we can ensure the best possible continuum of care.
Let's take action so that everyone can die with dignity.
View William Amos Profile
Lib. (QC)
View William Amos Profile
2020-02-27 13:55 [p.1680]
Madam Speaker, I am pleased to rise on the topic of Bill C-7, as we embark on what I expect will be quite a lively and passionate discussion about issues that Canadians care deeply about and certainly my Pontiac constituents. I heard from them for several years on this topic, regular correspondence, regular discussions at the door, so I appreciate this opportunity to discuss certain aspects of our government's proposed changes to the federal MAID legislation.
It is timely to share some of the insights from three important studies on very complex and sensitive issues that were not included in the 2016 federal legislation. These are requests by people for whom mental illness is their sole underlying medical condition, advance requests and requests by mature minors. I hope we will get to all three of them, but may only get to the first two.
When Bill C-14 was debated in 2016, parliamentarians had difficulty finding common ground on how to address these types of requests within Canada's first assisted dying regime. Understandably, given the challenging nature of these issues and the limited time that was available, due to the Supreme Court's timeline, to deliver on acceptable approaches for Canada, parliamentarians collectively decided that more in-depth study and review of the evidence was needed.
The legislation in 2016 therefore included requirements for the government to undertake independent reviews. There were strict timelines set out in Bill C-14 and the studies that needed to be commissioned had to be done within six months of the coming into force of Canada's new legislation on assisted dying and the government was obliged to table the final reports on the studies within a further two years. Both of these timelines were met.
In December 2016, the government asked the Council of Canadian Academies, CCA, an independent organization that undertakes evidence-based expert study, to inform our public policy development and to take on these studies that were required by legislation. The resulting reports were tabled in December 2018, documenting extensive review of academic and policy research, stakeholder submissions and international experience in the three subject areas.
They also included a broad range of perspectives from relevant health care professions, diverse academic disciplines, advocacy groups, indigenous elders, essentially the whole of Canadian perspective was brought to bear. In accordance with the CCA practice, they did not in fact contain recommendations.
Two of the reports, one on request by individuals where mental illness is the sole underlying condition and the report on advance requests have been particularly informative during the development of our government's response to the Quebec's Superior Court decision in Truchon.
I will first talk about mental illness. Under the current law, very few persons with mental illness as the primary source of their suffering are likely to be eligible for MAID. This is because most mental illnesses do not cause a person's natural death to be reasonably foreseeable.
Removing the reasonably foreseeable natural death criterion introduces the possibility for persons with mental illness to be deemed eligible for MAID, if they meet the remaining criteria.
During the recent federal round-table consultations held on MAID, we heard many concerns from participants who felt that not enough is known to safely extend eligibility for MAID to people whose suffering is caused by a mental illness alone. They felt that the issue required further examination.
We also know that there is generally very little support for expanding eligibility among mental health care practitioners, such as psychiatrists and psychologists, and by organizations representing people with mental illness. The CCA report on this issue noted a number of challenges associated with the delivery of MAID to persons with a mental illness.
View Luc Desilets Profile
View Luc Desilets Profile
2020-02-27 14:14 [p.1683]
Mr. Speaker, on February 13, during my visit to Quebec's wonderful national capital, I stopped in at an original and unique café that is home to 16 cats and one dog. It is called Café félin Ma langue aux chats.
The purpose of this enterprise is to bring veterans out of isolation. It was launched by two veterans who were struggling with PTSD and other issues. I want to recognize the dedication and courage of Marie-Pier Tremblay and Lisa Cyr. Their goal is to provide veterans with a space that is free of judgment and labels, where they can get together and interact with complete peace of mind. Basically, it is a refuge.
With this initiative, these two women are changing perceptions, preventing suicide and reducing the stigma associated with mental health.
I salute Marie-Pier and Lisa.
View William Amos Profile
Lib. (QC)
View William Amos Profile
2020-02-27 15:15 [p.1694]
Mr. Speaker, I will continue to speak to the report of the Council of Canadian Academies on the provision of medical assistance in dying to those struggling with mental illness.
The complexity of the issue is reflected in the fact that the members of the Council of Canadian Academies working group had vastly different opinions on the subject. On the one hand, the reports note that symptoms of mental disorder can impair cognitive abilities, making it more difficult to understand or appreciate the nature and consequences of treatment decisions.
The word “incurable” is not generally used by clinicians in the context of mental disorders, which makes it difficult to assess the condition of a person with “irremediable” health problems under the current legislation.
On the other hand, the report points out that the autonomy rights of an individual with a mental illness must be respected. The report cites the experiences of Belgium and the Netherlands, which permit assisted dying for psychiatric conditions, with additional safeguards. However, the report also acknowledges that assisted dying for persons with mental illnesses in these jurisdictions remains controversial, and the public debate is ongoing. Ultimately, the working group could not reach consensus on ways to address complexities and mitigate risks associated with mental illness and medical assistance in dying.
On the topic of advance requests, the Council of Canadian Academies report on advance requests also documents considerable evidence and provided many instructive findings on an issue of great interest and concern to many Canadians. Particularly in our riding, this was an issue I heard a lot about.
An advance request is a request for assisted dying made well in advance and in anticipation of the time when the person making the request may face suffering and other circumstances that may make them eligible for medical assistance in death. An advance request would set out conditions under which an individual requests MAID to be provided at a future date. Advance requests are premised on the likelihood that when people's health circumstances deteriorate to the point where they would want an assisted death, they would no longer have the capacity to affirm their decision immediately before receiving medical assistance in dying. In other words, that critical requirement of giving final consent would not be possible.
Many people express the desire to make an advance request so they have the comfort of knowing they will be able to avoid a lengthy period of grievous suffering for themselves and for their families. This is in the event they succumb to an illness that could leave them severely impaired and lacking cognitive capacity for a lengthy time period.
The CCA report helped unpack advance requests, in a way that really was helpful, by outlining several scenarios of increasing complexity. The first scenario involves an individual at the end of life who has been assessed as eligible for medical assistance in dying, but fears losing capacity while waiting to receive it. This is the situation experienced by Audrey Parker from Nova Scotia who chose to receive MAID earlier than she had wanted in fear of losing her eligibility status.
The second scenario involves an individual who has been diagnosed with a serious condition, but does not yet qualify for medical assistance in dying.
The third scenario involves an individual who wants to plan for various future outcomes, prior to any diagnosis.
The report indicated that when the request is farther in advance of the procedure, it becomes more challenging for health care providers to be certain that the request still reflects the wishes of the individual. The report found that the first scenario poses the least risk and is relatively straightforward. Canadians expressed a great deal of support for this scenario in the federal consultations and it is also widely supported by experts and practitioners.
Our proposed amendments in Bill C-7 would permit this type of advance request. This means that an individual who has a reasonably foreseeable natural death, and who is assessed and approved for medical assistance in dying, can wait for their chosen date without worrying about losing decision-making capacity. If the person does lose capacity prior to that date, they would still receive medical assistance in dying on the requested date or earlier, as expressed in their advance wish. It also means that individuals no longer need to reduce required pain medications and endure additional suffering in order to maintain their capacity to consent right before the procedure.
However, the other two scenarios, where significantly more time passes between preparing a request and medical assistance in dying provision, are far more complex and challenging.
I want to point out that we have definitely made movement on that first aspect. It is in those other two aspects where there is significantly more debate, and those need to be taken care of by Parliament in the coming months, which is exactly what this bill provides for.
View David Lametti Profile
Lib. (QC)
moved that Bill C-7, 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, I am pleased to rise today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.
The bill proposes a legislative response to the Superior Court of Quebec's Truchon decision, as well as some other changes to the Criminal Code provisions that set out Canada's medical assistance in dying regime.
In June 2016, former Bill C-14 amended the Criminal Code to create Canada's first law on medical assistance in dying, or MAID. The legislation created exemptions to Criminal Code offences so that individuals suffering unbearably and nearing the end of their lives could die peacefully and with the help of a physician or nurse practitioner, rather than in agony or in circumstances that they considered undignified.
This significant change in our criminal law was indicative of the value that Canadians ascribed to having choices, including about the manner and timing of their deaths when suffering in the dying process was intolerable. The most recent data obtained by the federal MAID-monitoring regime indicates that over 13,000 Canadians have received MAID since it has become decriminalized.
We are now proposing another important change to our criminal law. In Truchon and Gladu, the Quebec Superior Court ruled that it was unconstitutional to limit access to medical assistance in dying to persons whose death is reasonably foreseeable.
We decided not to appeal the decision because we want to reduce the suffering of people waiting for medical assistance in dying.
When we announced our decision not to appeal the ruling, our government also committed to changing the eligibility criteria for medical assistance in dying throughout Canada to ensure that criminal law is consistent nationwide.
Application of the court's ruling, which is limited to Quebec, was suspended for six months. The deadline is March 12. Because these issues are so important and because we want to ensure that our laws are consistent all across Canada, we have asked the court for a four-month extension, which would give Parliament time to thoroughly consider and debate the amendments proposed in this bill. There was a hearing yesterday regarding this request.
Consulting Canadians about the next phase of medical assistance in dying in Canada was crucial to drafting this bill. That is why we launched a two-week public consultation on January 13. The level of participation was unprecedented. We received over 300,000 responses, an indication of how important this issue is to Canadians.
At the same time, together with the Minister of Health, the Minister of Employment, Workforce Development and Disability Inclusion and our parliamentary secretaries, we held 10 round-table discussions across the country between January 13 and February 3.
This included round tables in Halifax, Quebec City, Montreal, Ottawa, Toronto, Winnipeg, Calgary and Vancouver. We met over 125 individuals, including doctors, nurse practitioners, legal experts, members of the disability community, indigenous peoples, and representatives of health regulatory bodies and civil organizations.
We are grateful to all who participated in the round tables. Their shared expertise and experiences were of immense value in developing this bill. I have no doubt that many will continue to engage in the parliamentary process as witnesses before committees.
The results of this consultation process will be published shortly in a “what we heard” report. We heard views on many different topics, but I would like to mention just a few.
From the public online consultations we heard that, while the majority of respondents think the current safeguards are adequate to prevent abuse, in a MAID regime that is expanded to persons who are not dying in the near term, a majority of respondents also thought it would be important to require additional safeguards in such a broader regime. Many round-table participants suggested two separate sets of safeguards in an expanded regime. Others shared their experiences with existing safeguards as they apply to those who are near the end of their lives.
Specifically, many felt that the requirement for two witnesses when a person's written request was made was too onerous and afforded little protection, and that the 10-day reflection period unnecessarily prolonged suffering.
Informed by these in-depth consultations, and by the Canadian experience with medical assistance in dying to date, along with many other sources of information, Bill C-7 proposes to respond to the Truchon decision by adjusting both the eligibility requirements and the safeguards. It also proposes to enable patients in certain circumstances to waive the requirement for final consent so that they do not lose their access to MAID.
We know there are other issues about which many Canadians still feel strongly but which are not subject to the Superior Court of Québec's deadline, such as eligibility in cases where mental illness is the sole underlying condition, advanced requests and mature minors. These will be examined in the course of the upcoming parliamentary review.
Before describing the proposed amendments, I would like to address the concerns we heard from many in the disability community following the Truchon decision and during our consultations. Disability groups were very clear that, for them, removing the end-of-life limit on MAID would create a law that holds disability as a valid reason for ending a life and reinforces the false perception that disability is equivalent to a life of suffering.
Our government is sensitive to these concerns. We strongly support the equality of all Canadians, no matter their situation, and we categorically reject the idea that living with a disability is a fate worse than death. However, we are also mindful of the need to balance these concerns, along with others that have been expressed, with other important interests and societal values, in particular the importance of individual choice.
The bill's objectives are therefore to recognize the autonomy of individuals to choose MAID as a means of relieving intolerable suffering, regardless of their proximity to natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life. More concretely, Bill C-7 proposes to expand eligibility for medical assistance in dying beyond the end-of-life context by repealing the eligibility criteria requiring that natural death be reasonably foreseeable.
Recognizing that intolerable suffering also arises outside of the end-of-life context and that Canadians want to have choices, medical assistance in dying would be become available to all those who are intolerably suffering; who have a serious and incurable illness, disease or disability; and who are in an advanced state of irreversible decline in capability, without regard to whether they are dying in the short term.
At this time, the bill proposes that persons whose sole underlying condition is a mental illness not be eligible for medical assistance in dying. First, we are subject to a court-imposed deadline and this matter requires more in-depth review and debate. We have learned that the trajectory of a mental illness is more difficult to predict than that of most physical illnesses. This means that there is a greater risk of providing medical assistance in dying to people whose condition could improve.
It is also more difficult to carry out competency assessments for individuals with a mental illness. In the case of some mental illnesses, the desire to die is itself a symptom of the illness, which makes it particularly difficult to determine whether the individual's request is truly voluntary.
Like the Government of Quebec, we are of the opinion that we need to continue consultations, discussions and policy development on the issue of MAID requests based solely on mental illness.
The parliamentary review that will be launched next June will be an appropriate forum for examining these issues, without the time constraints of the court-imposed deadline.
I would now like to turn my remarks to the question of safeguards. Many experts believe there are greater risks in assessing requests for MAID from individuals who are not nearing the end of their life. We agree. While these individuals would have a choice to seek MAID, the bill proposes that these requests be treated with greater sensitivity and care.
Accordingly, the bill proposes two streams, or two sets of safeguards. To distinguish these cases the bill proposes to use the concept of reasonably foreseeable natural death. Let me be clear on this point. Not having a reasonably foreseeable death would no longer be grounds for rejecting a MAID request; however, it would be used to determine which of the two sets of safeguards are required in a given case.
As enacted by Parliament in 2016, reasonable foreseeability of natural death refers to a death that is expected in the relative near term. It means that in light of all the person's medical circumstances, his or her death is expected in a relatively short period of time. Natural death is not reasonably foreseeable just because an individual is diagnosed with a condition that will eventually cause death many years or decades into the future.
In practice we know that practitioners are more comfortable prognosticating when death is expected in shorter time frames. The standard of reasonably foreseeable natural death provides flexibility in a way that maximum fixed prognosis would not. The standard also has the advantage of using language that practitioners have become familiar with over the last four years.
Those who are dying in the short or near term would benefit from the current set of safeguards in the Criminal Code, which the bill proposes to change in two ways.
First, the 10-day reflection period would be eliminated. We heard during the consultations that most persons have already given their MAID request a lot of thought by the time they sign their written request, resulting in the reflection period unnecessarily prolonging suffering.
Second, the requirement for two independent witnesses would be amended so that only one independent witness to the written MAID request is required. Further, we have added an exception so that health care and personal care workers who are not the person's provider or assessor would now be able to act as an independent witness.
Again, we heard that it is difficult for some who live in long-term care facilities or in remote areas to locate two independent witnesses. The purpose of the independent witness is simply to verify the identity of the person signing the request. The witness is not involved in the assessment process.
For persons whose death is not reasonably foreseeable, the existing safeguards would all apply with some additional ones. Specifically, the bill proposes a minimum 90-day assessment period, which will help ensure that practitioners spend sufficient time exploring the various dimensions of the person's MAID request, which, outside the end-of-life context, could be motivated by different sources of suffering requiring greater attention.
Also, at least one of the practitioners assessing eligibility would have to have expertise in the condition that is causing the person's intolerable suffering. The safeguard aims to prevent people from obtaining MAID when something could have been done to relieve their suffering or improve their condition.
The bill would also clarify the notion of informed consent for these kinds of cases.
First, a person who is not dying would have to be informed of the means available to relieve suffering, including counselling services, mental health and disability support services, community services, and palliative care, and be offered consultations with professionals that provide these services.
Second, the practitioners and the person would also have to agree that these means of relieving their suffering were discussed and seriously considered.
The bill also proposes to allow people whose death is reasonably foreseeable and who are eligible for medical assistance in dying to give prior consent if they risk losing capacity to consent before the date set for MAID. At present, the Criminal Code requires the practitioner to ensure, immediately before MAID is provided, that the person gives express consent to receiving MAID.
The bill would enable a patient who has already been assessed and approved to enter into an advance consent arrangement with their physician that sets out all the relevant details, including the date selected for the provision of MAID and the fact that the person consents to receiving MAID in case they lose the capacity to consent by the day in question.
Although this scenario was not covered in Truchon, experts told the government that it presents relatively little complexity and risk. Doctors also told us they would be comfortable with the idea of providing MAID under such circumstances.
To our government, compassion means ensuring that people waiting for MAID do not lose their opportunity to die in the manner or on the date of their choosing just because their medical condition robs them of the capacity to make decisions in their final days.
Another narrow form of advance consent would also be allowed in the unlikely event that complications arise after a person who has been assessed and approved self-administers a substance intended to cause their death and loses the capacity to consent to MAID, but does not die.
The patient and their physician could enter into an arrangement in advance, stipulating that the physician would be present at the time the patient self-administers the substance and would administer a substance to cause the patient's death in case the patient loses their capacity but does not die.
The data show that there have been very few cases of self-administration so far, perhaps due to fears of possible complications stemming from self-administration of a substance. Offering such an option could provide greater reassurance and allow more Canadians to choose this form of medical assistance in dying.
There are other changes in the bill that my colleagues will speak to, including changes to enhanced data collection and the monitoring regime that brings accountability and transparency to the practice of MAID in Canada.
A transitional provision would ensure that patients who have already signed their request when the bill comes into force would not be required to undergo any additional safeguards set out in the bill. At the same time, they would be able to benefit from the safeguards that would be eased, such as the elimination of the 10-day reflection period and the possibility of preparing an advance consent arrangement if it applies to that person's situation. We are committed to making the process as easy on patients as possible.
I would also like to briefly discuss the constitutionality of the bill. I have examined the bill as required by the Department of Justice Act. This involved consideration of the objectives and features of the bill. I am confident that the bill responds to the Truchon ruling in a way that respects the charter.
As is required by the Department of Justice Act, I will table a charter statement in the near future, which will lay out some of the key considerations that informed the review of the bill for inconsistency with the charter. This will serve to better inform parliamentary debate on this important piece of legislation.
I will conclude by thanking all those who participated in the consultations on medical assistance in dying and who contributed to the drafting of this bill. Bill C-7's proposed amendments to Canada's medical assistance in dying regime represent a fundamental policy shift, with the regime becoming less about end-of-life care and more about autonomy and alleviating intolerable suffering.
I look forward to working with all members of both chambers to ensure Bill C-7 is passed.
View Steven Blaney Profile
Mr. Speaker, the minister should apply the existing laws, because he is certainly not familiar with the law. The law is clear that the police can suspend a firearms licence, and they can also prevent someone with mental health issues or someone involved in criminal activities from acquiring firearms.
The law is clear, so nothing needs to be changed. Why go after law-abiding citizens instead of tackling street gangs, which are the real problem?
View Justin Trudeau Profile
Lib. (QC)
View Justin Trudeau Profile
2020-02-05 14:55 [p.954]
Mr. Speaker, we recognize that there are more investments that need to be made in mental health support for Canadians, whether it is for PTSD for veterans, correctional services officers or policemen and women, or whether it is moving forward on greater supports for young people, indigenous communities or people who have experiences within our justice system.
We know there is more to do on fighting for mental health, which is why we actually made a commitment of billions of dollars more in investments in mental health for the provinces. We are looking forward to working on that.
View Justin Trudeau Profile
Lib. (QC)
View Justin Trudeau Profile
2020-02-05 14:57 [p.955]
Mr. Speaker, I am pleased to be able to inform the member opposite of what we are planning to do.
There are many individuals who have a firearms licence and own firearms and who begin to present a threat to themselves or to their family. At that point, medical health professionals can alert them not to just take away the firearms, which exists—
Some hon. members: Oh, oh!
View Justin Trudeau Profile
Lib. (QC)
View Justin Trudeau Profile
2020-02-05 14:58 [p.955]
Mr. Speaker, the police currently have the ability to remove firearms from someone who presents a threat to themselves or others, but they cannot suspend the licence and prevent that person from acquiring new firearms. That is what the red-flag law is all about.
View Monique Pauzé Profile
View Monique Pauzé Profile
2020-02-05 17:50 [p.981]
Madam Speaker, as this is my first time rising for a debate, I want to begin by thanking the people of my riding, Repentigny, who put their trust in me once again last October. I hope to be worthy of their trust.
I will address two aspects of this debate, namely dairy producers and, of course, aluminum.
I will talk about the lack of consideration for the dairy farmers of Quebec from a completely different perspective than people might expect. That perspective is necessary because we have to find solutions. This is imperative.
I will start by reminding hon. members that Quebec's dairy producers are resilient. They live and breathe their work 365 days a year. They look after their herd, invest in their facilities and prepare the next generation. It is not easy, because the economic outlook is something of a concern.
I invite hon. members to put the numbers aside and give a thought to the human dimension of the consequences of agreements on a top-notch nourishing industry.
The member for Mégantic—L'Érable and the Standing Committee on Agriculture and Agri-Food came to a sad conclusion in the summer of 2019. They heard testimony from artisanal farmers and agricultural producers who were struggling and facing real psychological distress. If you know what rural areas are like, you know that people in the regions help each other and work together. However, when pressures, obligations and constraints increase, but protections disappear, distress is inevitable.
Would it be fair to think that, since the Minister of Agriculture and Agri-Food launched a campaign acknowledging that the agricultural industry is struggling, the agreement should work along the same lines instead of causing the industry any additional distress?
In Quebec, the Au cœur des familles agricoles organization has been instrumental in this area for 10 years now. Since 2016, in collaboration with the Canadian Association for Suicide Prevention and the Union des producteurs agricoles, the organization has trained 1,200 industry workers to recognize psychological distress in farmers and direct them to specialized resources.
As we have said in the House, supply management is an economic model that suits Quebec well. It goes well with our culture. This economic and trade model is what allows for stability and predictability, which was exactly what the agriculture industry asked for during negotiations for this new agreement.
In its current form, CUSMA's provisions and economic repercussions for Quebec's dairy industry are troubling. The Bloc Québécois strongly believes we must condemn all of the harms that our dairy farmers will suffer. We will never stop demanding that this government and the House respect Quebec, and we will never stop calling for consistency and integrity on this file.
We have been doing this for two months now, but I will now set the record straight yet again on the aluminum industry's position on CUSMA.
The House has repeatedly heard that Jean Simard, the president and CEO of the Aluminium Association of Canada, agreed with the current CUSMA. However, Mr. Simard made his position clear to the House of Commons Standing Committee on Finance yesterday. My colleague from Joliette asked him straight out whether he would rather have had an agreement like the one the steel sector got. Mr. Simard answered that that was what the association had asked for and was about to get, thanks to the efforts of Ms. Freeland and her team. However, at the end of the negotiations, Mexico said yes to steel but no to aluminum for strategic reasons.
Mr. Simard gave the committee an honest answer. We know that a committee involves multiple stakeholders, detailed questions and background work, since members take the time to study the topic being debated by the committee. Mr. Simard's candid answers clearly show that the aluminum industry was hoping to get the same protections as the steel sector.
Where in Canada is there a dynamic aluminum industry with tremendous potential for expansion? Where has this industry been creating jobs for decades, well-paying jobs that allow workers to develop professionally, start a family in their region, and in turn, contribute to the regional economic vitality that all levels of government so desperately want?
Well, that place is Quebec.
CUSMA proposes an economic free trade model that will allow aluminum from China to flood the North American market via Mexico. That is what we have been saying over and over for months now.
Parts manufacturing should be done within partner countries under the agreement. However, unlike steel, the metal used for manufacturing could come from anywhere. Mr. Simard was very clear on that point in committee yesterday.
What we want to hear from the government is simply a statement from the Prime Minister along the same lines as what he said the night of his election victory.
Here is what he said: “Dear Quebeckers, I heard your message tonight. You want to continue to go forward with us, but you also want to ensure that the voice of Quebec can be heard even more in Ottawa. And I can tell you that my team and I will be there for you.”
Were those words meaningless, forgotten as soon as they were said?
The Bloc Québécois wants to work in a proactive and practical way to help Quebec's aluminum industry and obtain fair results. We want to work with the government to find solutions. We refuse to accept that this agreement is already settled and that it must absolutely be signed.
The conditions currently set out in CUSMA regarding this industry will cause serious harm to thousands of Quebec workers and Quebec's economy. Since I am our party's environment critic, I would be remiss if I failed to mention the absolutely essential manufacturing process used by the aluminum plants in the Saguenay—Lac-Saint-Jean region.
Alcoa and Rio Tinto chose the Arvida aluminum plant to establish a research and development centre called Elysis, valued at over $550 million. Together, they will develop all of the technology needed to eliminate greenhouse gas emissions in the production of aluminum and produce pure oxygen. Does the Prime Minister remember when that project was unveiled? He was at the project launch in 2018.
The aluminum industry is not only changing and developing its potential with a clean, renewable and nationally-owned source of energy, but it is also producing aluminum using a zero-emission technology developed in Quebec. How many inconsistencies must we point out before the government does the right thing?
Since I am running out of time, I will not talk about the importance of concrete action to reduce GHG emissions. The aluminum industry is on the right track, and I encourage members of the House to review this issue and be honest with their caucuses about what I am saying.
Let me be clear: The Bloc Québécois is not against free trade. Nevertheless, we believe that, in any trade or other relationship, the parties must communicate, be open, negotiate and make compromises. It would be disingenuous to argue that Quebec's economy was not ignored in the CUSMA negotiations. I gave two examples of that. Members of the House of Commons who claim it was not ignored are, in my opinion, acting in bad faith or are misinformed on the agreement.
We will not ignore what industry representatives are telling us. They came to Parliament Hill last week. During the election period, Quebeckers voted for a voice that would raise their concerns here, in this chamber. That is exactly what we are doing and that is exactly what we will continue to do.
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