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View Iqra Khalid Profile
Lib. (ON)
Good evening or afternoon, everyone. I call this meeting to order. This is the 10th meeting for the House of Commons Standing Committee on Justice and Human Rights.
For some very quick housekeeping, if members would like to speak, please unmute yourself. If you're not speaking, please make sure that you're on mute. When you are speaking, please speak slowly and clearly so that's there's no lag in interpretation.
We'll get right into it. We have our witnesses, as we consider clause-by-clause for Bill C-7, from the Department of Justice and the Department of Health. Members are obviously welcome to ask questions of them. I will name them very quickly. We have Carole Morency, Joanne Klineberg and Caroline Quesnel. They are from the Department of Justice. From the Department of Health, we have Abby Hoffman, Sharon Harper and Karen Kusch.
Very quickly, before we go into clause-by-clause of Bill C-7, there was a question that the clerk had asked me with respect to Mr. Cooper's motion to allow for briefs past the November 12 deadline. I am seeking clarity from members as to when we should stop receiving briefs. Right now we don't have an end date.
Mr. Cooper, would you like to speak to that?
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View Michael Cooper Profile
CPC (AB)
Madam Chair, I think we should continue to accept briefs until these hearings conclude.
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View Iqra Khalid Profile
Lib. (ON)
Okay. Thank you. That was the direction I needed.
Are there any members who want to say something?
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 18:37
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I have a point of order, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
Just give us one second, Mr. Moore. We're just dealing with a technical challenge here.
Thank you very much for that.
Just to clarify what Mr. Cooper said, the written briefs for Bill C-7 should be allowed until the end of our consideration of clause-by-clause. Is that correct, Mr. Cooper?
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View Michael Cooper Profile
CPC (AB)
Actually, I don't see any reason briefs couldn't continue to be submitted even after.
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View Iqra Khalid Profile
Lib. (ON)
Okay. Does anybody have any—
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View Michael Cooper Profile
CPC (AB)
I don't know that I have a specific date, other than to say that we should continue to allow briefs to be submitted to the committee for our benefit. Even after clause-by-clause, if it's going back to the House, I don't know that there would be any prejudice in.... Why would there be any issue with briefs continuing to be submitted for members to reference?
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View Iqra Khalid Profile
Lib. (ON)
Specifically, the briefs we're talking about are in reference to Bill C-7.
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View Michael Cooper Profile
CPC (AB)
Right.
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View Iqra Khalid Profile
Lib. (ON)
Once a brief is submitted to the clerk, there's a whole process of translation that also has to happen.
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View Michael Cooper Profile
CPC (AB)
Yes, I understand that, but I guess at this point I'm just suggesting we allow maximum flexibility.
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View Iqra Khalid Profile
Lib. (ON)
Right, and that's exactly why everybody voted in support of your motion at the last meeting. The question from the clerk was whether there was going to be an end date to the briefs that were submitted on Bill C-7.
Mr. Moore, is that on this question?
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 18:38
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No, Madam Chair, it's on another matter.
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View Iqra Khalid Profile
Lib. (ON)
Okay.
Then we'll go to Mr. Virani, if that's okay.
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View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2020-11-23 18:39
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Madam Chair, I would submit that we should receive the briefs until we have concluded the clause-by-clause review of the bill. Presumably, the purpose of submitting briefs to the committee is so that the committee members can use them to inform the positions they take on the various amendments. After that time, this is reported back to the House and obviously stakeholders can submit whatever information they want to all 338 members of Parliament. They can also avail themselves of the study that will take place in the Senate on the bill.
Sending them to the committee after the bill has left the committee and been reported back to the House, to my mind, would not be useful.
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View Iqra Khalid Profile
Lib. (ON)
Thanks, Mr. Virani.
Mr. Maloney, is this on the same issue?
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View James Maloney Profile
Lib. (ON)
Yes, it is, Madam Chair.
Very simply, Mr. Virani said what I was thinking. I agree with Mr Cooper's intention. I agree that there is no prejudice. The flip side is of course that we don't want to be disrespectful to anybody who is submitting a brief. If it's submitted after the clause-by-clause examination is concluded and there is an expectation that the committee is still in a position to review it, I don't want them to be misled. That's all. I think, therefore, we need to be conscientious regarding their intent.
Thank you.
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View Michael Cooper Profile
CPC (AB)
I think that's reasonable. I will leave it at that.
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View Iqra Khalid Profile
Lib. (ON)
Thank you.
Is it the will of the committee, then, to stop receiving written submissions once we have completed clause-by-clause?
Let me see a thumbs-up from everybody, if that's the case.
Perfect. Thank you very much, everyone.
Mr. Moore, I believe you had a point of order.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 18:40
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Yes. Our staff are to be able to phone in. Apparently there is a phone line they use to follow the proceedings, and we're each able to have one staff person on it. I am told by a couple of them that they are unable to connect right now.
Could someone look into the technical issue they are having in trying to follow in real time with us? I know there are two or three from the Conservative party. I don't know whether the other parties are experiencing the same thing.
Could we get that addressed so that we can have them fully engage with what's happening?
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Moore.
Are there other members whose staff are experiencing the same problems?
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View Kerry-Lynne Findlay Profile
CPC (BC)
My staff member also says the line is dead, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
IT is looking into it right now.
The phone lines have been activated. If you want to have them try again—
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 18:42
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Yes, it's working now.
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View Iqra Khalid Profile
Lib. (ON)
Thank you for raising that, Mr. Moore.
(On clause 1)
The Chair: Now that everybody has been sorted out, we left off at the last meeting in a bit of confusion around the language of amendment NDP-2. My understanding is that at around five o'clock today, revised language was submitted. Would members be comfortable if we subbed in this language to replace what was discussed under amendment NDP-2 at the last meeting?
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 18:43
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I'm just curious. Notwithstanding the fact that it is amendment NDP-2, and I respect that, I'm curious because it now becomes a Liberal amendment. Is it still an NDP amendment to Bill C-7, a Liberal-NDP amendment or a Liberal amendment?
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View Iqra Khalid Profile
Lib. (ON)
My understanding is that because the original amendment was moved by Mr. Garrison and what happened at the last meeting was that there were some friendly amendments that Mr. Virani attempted to provide, and then some confusion caused with respect to the language of the friendly amendments, this is what the friendly amendments now look like.
I'm suggesting to committee members that we just use this language to continue the debate on amendment NDP-2. I believe all members have it in front of them.
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 18:44
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Thank you, Madam Chair.
Just for clarification, this stays as amendment NDP-2. It is an NDP amendment. Is that correct?
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View Iqra Khalid Profile
Lib. (ON)
Yes, that is my understanding.
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 18:44
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Thank you, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
Go ahead, Madam Findlay.
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View Kerry-Lynne Findlay Profile
CPC (BC)
Thank you, Madam Chair.
This is a similar point to my friend's. It's really a point of clarification. On the agenda that was circulated for tonight's meeting, it says “clause-by-clause consideration”, and the first one says “LIB-1”.
I am rather confused because it was an NDP motion and a friendly amendment. The mover accepted the amendment, so I think it remains NDP-2, an NDP-led amendment. It doesn't suddenly, miraculously, become a Liberal amendment, but I may be wrong. I stand to be corrected, but are we not now debating NDP-2 as amended through a friendly amendment, or is there some different LIB-1?
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View Iqra Khalid Profile
Lib. (ON)
That's exactly what we're doing. We're debating NDP-2 with the friendly amendment, but I will pass it to our legislative clerk for clarification.
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Philippe Méla
View Philippe Méla Profile
Philippe Méla
2020-11-23 18:45
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Thank you, Madam Chair.
Yes, you would be correct. The problem is that there is no such thing as a friendly amendment. Either there's an amendment or there is something else, but the concept of a friendly amendment is non-existent, so to speak. That's the reason you have LIB-1 in the agenda, but once we go to the minutes of the proceedings, it will appear as NDP-2 since this is the will of the committee. This is how it's going to appear in the minutes of the committee.
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View Iqra Khalid Profile
Lib. (ON)
Thank you for that.
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View Kerry-Lynne Findlay Profile
CPC (BC)
It's clear as mud, as with most procedural rules. Thank you very much.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Madam Findlay.
I have Mr. Moore next on my list.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 18:46
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Thank you, Madam Chair. Through you, could Mr. Garrison offer any comment on how this amendment changes his amendment?
It's to get your thoughts on the change that's been made and how it improves it or changes what you originally had and what we originally debated.
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View Randall Garrison Profile
NDP (BC)
Thank you very much, Madam Chair.
The wording is, I believe, clearer than what I originally submitted, in the sense that it is more specific about who must consult whom, and who must inform whom of the consultation.
Really, the original intention of my amendment came at the request of the MAID assessors and providers, who felt that the new provision for track two was somewhat unclear about the process of consulting those with extra expertise.
The new wording achieves exactly the same goal, and on reflection, I think it does so in a way that is going to be easier for those who work with the act to do so.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Garrison.
Mr. Virani.
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View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2020-11-23 18:47
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I'm tempted to just say “ditto”, Madam Chair. It's basically just a clarification, observing the spirit of what Mr. Garrison was seeking, where expertise could be availed of when the expert is not physically on the ground in a given location and ensuring that whoever does the consultation with that expert shares the results of that consultation with the other assessor.
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View Iqra Khalid Profile
Lib. (ON)
Thank you for that, Mr. Virani. I don't have any more hands raised for further debate on NDP-2, so I will call the question for voting.
Madam Clerk, if we can record the vote, please, the question is “Should NDP-2 carry?”
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View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2020-11-23 18:48
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Madam Chair, so that we're crystal clear, is it NDP-2, as amended by the language that was suggested?
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View Iqra Khalid Profile
Lib. (ON)
Absolutely, this is NDP-2, as amended by the language that was sent via email to all members at 5:02 p.m. earlier today by our legislative clerk.
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View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2020-11-23 18:48
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Thank you.
(Amendment agreed to: yeas 7; nays 4 [See Minutes of Proceedings])
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Madam Clerk.
Now we're moving to PV-2.
Mr. Manly, you can briefly speak to it if you'd like, please.
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View Paul Manly Profile
GP (BC)
View Paul Manly Profile
2020-11-23 18:51
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Thank you, Madam Chair.
This amendment was adapted from a request made by Inclusion Canada, and it was supported and sent to me by Graham Morry, the executive director of the Nanaimo Association for Community Living.
I also met with Inclusion BC and several local self-advocates who support this amendment. This amendment is a minor change to the safeguards for natural death not foreseeable. It calls to ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and have had consultations with the relevant professionals who provide those services or that care.
I have years of experience working with the diverse abilities community, through skills training and employment programs, with youth with barriers to employment and people with disabilities. As part of that work I connected people with all of the services that are listed above, except palliative care. I was able to make those connections and arrange appointments within a matter of weeks. Given that there is a 90-day period under the safeguard provisions for natural death not foreseeable, I believe there's plenty of time for people to seek out and receive these consultations and that this is not a barrier to people accessing MAID.
If the consultations listed specialists, then I could see how this would be a barrier because, unfortunately, it takes much longer to see a specialist in this country.
I think this is a very reasonable amendment that will give the disability community more confidence in the MAID process. It's important that this community is heard and feels heard and respected. I personally believe that there are adequate safeguards built into this legislation, but I would like the bill to be clearer for people with disabilities and the disability community, so that their concerns are heard.
Thank you.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Manly.
Mr. Kelloway, I have you next on my list.
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View Mike Kelloway Profile
Lib. (NS)
View Mike Kelloway Profile
2020-11-23 18:53
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Thank you, Madam Chair.
I want to take this opportunity to welcome MP Manly to the committee. I appreciate his voice, his viewpoints and his terms of reference, as just stated.
I respectfully oppose this amendment. The bill, as currently written, ensures that individuals are offered consultations with relevant professionals for appropriate services, while at the same time respecting the autonomy of patients to decide whether or not to pursue advice, information or services that may be suggested or offered to them. In addition, Madam Chair, the bill requires that they be informed of the means available to relieve their suffering, that they give serious consideration to those means and that they be offered consultations with professionals who provide that care.
The proposed amendment would force competent persons whose death is not reasonably foreseeable to undertake every consultation proposed to them in order to be eligible for MAID. For those reasons, I respectfully oppose the amendment.
Thank you.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Kelloway.
Mr. Virani, I have you next.
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View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2020-11-23 18:54
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I'm sorry, Madam Chair. I believe that was from the previous round. I tried to lower my hand. I apologize.
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View Iqra Khalid Profile
Lib. (ON)
Madam Findlay.
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View Kerry-Lynne Findlay Profile
CPC (BC)
I'm hearing what our colleague MP Manly has to say. We've certainly heard a lot of testimony in this committee from persons with disabilities or advocacy groups for those persons in Canada. They have a lot of concerns about the expansion of this legislation as proposed by the Liberals.
So far, every amendment we've tried to propose to either further protect persons with disabilities or give them some comfort level has been defeated, by the Liberal and NDP votes specifically.
It seems to me that this is a very reasonable addition. It's a clarifying addition. It's an amendment that I feel I could support. In light of Mr. Manly's comments about the timeliness that he has experienced in being able to connect people with further and other support services and consultations, this isn't a high onus. It doesn't change the effect of this legislation and what the Liberal government is proposing here, but it does give a comfort level. It is the reality on the ground.
In question period today Minister Lametti once again, in response to a question, said something to the effect that by the time people make this decision, there is no doubt in their minds, that they've gone through whatever it is they need to go through to process all of this and it's a done deal. However, we've heard testimony about transient suicidal ideation. We've heard testimony—actually, there are reports, which I've referenced before—about people in fact changing their minds.
Everyone is different. If we really believe in individual autonomy, then it seems to me we should make it very clear that people would have the opportunity and would be encouraged, to the extent it makes sense in their particular case, to consult with others and get all the support services they need.
The individuals are the ones driving this agenda. They would know whether they want to seek this. They would know whether they feel they would get comfort out of it. They may have already made up their minds but just have a little doubt and want to talk it out with someone else. There are so many different scenarios that could be played out.
It seems to me that there is a thoughtful suggestion in this amendment. When I hear that a group such as Inclusion Canada are good with this wording and perhaps even supported Mr. Manly in bringing the wording forward, that is very persuasive to me, given the testimony we've heard.
I don't frankly think it's a great idea for legislators to put forward legislation that virtually ignores a very important segment of Canadian society, which is persons with disabilities. They have made it very clear that they're reaching out to us and saying, please don't make us different from everyone else, but make amendments here and improve this legislation in a way that makes us at least more comfortable, so that we don't feel that we're being isolated or segmented out.
I don't see why we cannot answer that call, frankly.
With those comments, I'm supportive of this amendment. Thank you.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Madam Findlay.
I have Mr. Moore and then Mr. Cooper.
Go ahead, Mr. Moore.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 18:59
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Thank you, Madam Chair.
First of all, I think this is a very thoughtful amendment by Mr. Manly. We heard the testimony from witnesses, vulnerable witnesses, Canadians living with disabilities. This response to some of the concerns raised by some of our witnesses....
In this discussion, I often hear medical professionals or doctors cited, but often we're talking about MAID assessors or MAID providers, and I think, as a committee, we have a responsibility. I've listened to the MAID assessors and MAID providers, but the broader physician-doctor-health care community....
On the specific issue of this Green amendment, we received a submission as a committee—I know I did—from Physicians Together for Vulnerable Canadians. It was signed by more than 800 physicians. These are physicians—medical doctors—who say they feel compelled to voice their “dismay at how individuals who have little lived experience of the realities involved in the everyday practice of medicine suddenly and fundamentally changed the nature of medicine” by making changes to assisted suicide.
Specifically on this matter, and I want to home in on this, they say:
...the authors of Bill C-7 consider it sufficient to offer patients information about other possible means to alleviate their suffering, [but] there is no requirement that the service be available to the patient.
How many times did we hear that? In the limited testimony we had on the bill, I heard over and over, from persons with disabilities and from others who have concerns with this bill, that it's not a true choice between assisted death and other options if those other options aren't available.
They go on to say:
We live in a country where the wait time to see a psychiatrist in certain areas is 4-8 times longer than the 90-day waiting period proposed in the bill for those whose natural death is not considered “reasonably foreseeable”, and where 70% of citizens nearing the end of life still have no access to basic palliative care services. Yet MAiD has been deemed an essential service under the Canada Health Act and palliative care has not. This bill creates the conditions for cheap and easy death through euthanasia or assisted suicide.
This is not the medicine that we have devoted our lives to practicing. Our intent is to heal and to alleviate suffering....
These physicians sent our committee this information. They are saying that it's not a true choice, if a person has not fully been able to explore what services, including palliative care services, are available to them. They say that 70 per cent of Canadians nearing the end of life still have no access to basic palliative care services.
In Bill C-7 we have a significant expansion of Canada's assisted dying legislation. My goal in this is to listen to the testimony from witnesses and ensure that we as a committee do everything in our power to protect vulnerable Canadians, protect Canadians who are at a low point in their lives and protect Canadians' basic and fundamental rights, and to make sure that, when a decision is made that involves assisted dying, it is made with all the best available information.
If a person dealing with end-of-life issues has not been able to avail themselves of a consultation with a palliative care doctor, then how are they supposed to make that decision? This is the point that these physicians—more than 800 of them—have made to our committee.
It's for those reasons and others that I think this particular amendment is bang on. I think it is a further safeguard. I don't think it's too onerous at all. Remember, these are cases where death is not reasonably foreseeable, so we want to make sure that Canadians have been able to avail themselves of all possible options.
It's for those reasons that I'm happy to support this Green amendment from Mr. Manly.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Moore.
Mr. Cooper, you're up next.
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View Michael Cooper Profile
CPC (AB)
Thank you very much, Madam Chair. I too would like to express my support for Mr. Manly's amendment. I believe it is very reasonable and, in some respects, a modest amendment.
We heard over and over again from witnesses, particularly those representing persons with disabilities, of the inadequacy of the provision, in the context of where death is not reasonably foreseeable, to merely inform a patient of alternatives. To merely inform a patient without requiring them to seek any alternatives or without any guarantee of seeing that they have access to those alternatives puts vulnerable people at risk, vulnerable people who are often in their most vulnerable state upon making a request for medical assistance in dying.
I would note that the minister has often said, and others have said, that when someone makes a request for medical assistance in dying, they have long thought through the process and it's therefore somehow important that it be expedited, which I don't quite understand. When we're speaking about where death is not reasonably foreseeable, it opens the door to persons who might have had an accident or a traumatic event or a diagnosis that causes them to have their life literally turned upside down. We heard evidence of suicidal ideation, particularly in circumstances where people have bad news or where they are experiencing significant pain and suffering, without having an opportunity to identify or determine what possible treatments might be available to them.
I would note that Dr. Catherine Ferrier appeared before this committee. I'm going to read this into the record because I think it's important in the context of this motion. She is a physician who has worked since 1984 in the geriatric clinic at McGill University Health Centre. She noted in her testimony that:
The suicide rate after traumatic spinal cord injury is [five] times that of the general population for five years. Those who choose suicide may not [have a diagnosable depression] or [be] incapable of decision-making. Their options have been tragically narrowed, and it takes a long time to readjust, but people do. After five years, the rate is the same as that of the general population. They need protection from their despair. That's why our society responds to suicidal desires with prevention. That's why [it makes no sense to] allow MAID after 90 days [for people who are not near the end of life].
She objects to the 90-day period. One can debate that. I, too, don't agree with the 90-day period. With respect to Mr. Manly's amendment, I've cited one example, but there are many other examples of people who suffer from a disease or illness who have much higher suicide rates until after a period of time when they can adjust. It speaks, therefore, to the importance of the amendment, to not just provide information but to see that they can get appropriate consultations.
I would note that this amendment is consistent in some ways with what was said in the final report of the External Panel on Options for a Legislative Response to Carter v. Canada.
That report, which was very important when we were giving consideration to Bill C-14, said “a request for a physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person's suffering.” Surely someone should, at the very least, be required to go through a consultation in circumstances where death is not reasonably foreseeable.
I would note that Canada, by going down this road, would be an outlier in the world. We would have, arguably, the most permissive regime in the world. I would note that in the Netherlands, for example, a physician must confirm that there are no other potential means to relieve suffering before administering medical assistance in dying to a patient. Here we would provide merely information but no obligation to ensure that the person could truly make an informed decision. You can't make a truly informed decision and you can't exercise your autonomy if the choice is simply intolerable suffering versus medical assistance in dying.
I believe that Mr. Manly's amendment, for all of those reasons, makes sense.
I will say I find it troubling that when we have heard from 72 national organizations representing persons with disabilities and the rights of persons with disabilities, when we have heard concerns expressed by the UN special rapporteur on the rights of persons with disabilities and when we have heard questions asked about Canada's compliance with its international obligations under the Convention on the Rights of Persons with Disabilities, including article 10, that the members on the government side have given short shrift to all of those concerns. I would just—
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View Iqra Khalid Profile
Lib. (ON)
Mr. Cooper, just talk about the amendment, please.
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View Michael Cooper Profile
CPC (AB)
—hope, taking into account those concerns, that members on the government side would be open to supporting what I believe is a good but very modest amendment.
Thank you.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Cooper.
Mr. Manly, if you want to respond to some of the concerns or issues that have been raised, briefly, sir, please go ahead.
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View Paul Manly Profile
GP (BC)
View Paul Manly Profile
2020-11-23 19:12
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I was just going to say that many of the things are listed here say “where appropriate”, so these aren't services that everybody will need to access. It has, “where appropriate, counselling services, mental health and disability support services, community services and palliative care”. I think that many people will have already sought out some of these things before they seek a medically assisted death.
I don't want to take away somebody's agency to say that they don't want to have to seek mental health services or disability support, but I think many people seek these things out already. We want to make sure that, for people in the disability community, they have actually had the opportunity to get those consultations and see what supports are available to them.
In my work I have had youth who were threatening suicide. They were at their wit's end because they weren't getting the services and the things they needed. It just took some patience and some time to work with them, and to work within the community, to ensure that they had access to the things they needed so that they could thrive in the community.
That's all I have to add. Thank you.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Manly.
I have Mr. Lewis next on the list.
Go ahead, Mr. Lewis.
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 19:14
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Thank you, Madam Chair. I certainly appreciate the opportunity to speak to this tonight.
Just as a point of clarification with regard to Mr. Cooper, I thought Mr. Cooper actually was very much speaking to the amendment. I'm just wondering what the rules of engagement are. I have quite a bit to say on this as well. I guess I'm asking you, Madam Chair, whether as long as I'm speaking to the amendment I'm fine to continue on. Is that correct?
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View Iqra Khalid Profile
Lib. (ON)
Absolutely. We're talking about relevance and specifically what the amendment does and how it would impact Bill C-7, as with all clause-by-clause.
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 19:15
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Excellent. Thank you very much, Madam Chair. I appreciate that information.
As I noted earlier, the speed at which Bill C-7 is being pushed through has been quite distressing, to say the least. It has left very little time for consultation with the proper groups. Medical professionals and groups advocating for vulnerable Canadians have been excluded from the consultation process, but thankfully tonight we did allow briefs to come forward. I think that's a fantastic step forward for this committee.
It has always been common practice in other nations with laws that allow euthanasia that it is treated as a last resort, not as an initial treatment option. The typical requirement in these nations is that the standard of care must be applied before it is offered. This has been a point raised by many doctors and other health care professionals across the country as they voice their concerns over how this bill puts vulnerable groups in our country at risk.
I am grateful that our colleagues in the Green Party put forward this valuable amendment that could very well save lives. The amendment proposes to change the wording of proposed paragraph 241.2(3.1)(g). This would require that those whose death is not reasonably foreseeable go through consultations with professionals who have relevant experience in the care of and services for those with a similar diagnosis or condition.
It is of the utmost importance that patients are also given this consultation by the proper professionals. These professionals must be individuals who currently provide the service or care that is applicable to what the patient's diagnosis or injury would require. The responsibility to ensure that individuals considering MAID are fully informed prior to making such an important decision ought to be paramount. When a person is in such a desperate position that they are driven to consider ending their own life, they should be afforded every available support, and this necessarily includes being informed of alternatives to MAID.
I'm sure that often when someone receives a diagnosis of a chronic issue or disability, they can feel like the world is falling—
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View Iqra Khalid Profile
Lib. (ON)
Mr. Lewis, your audio and your video aren't of good quality.
Are members able to hear and understand Mr. Lewis?
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View Ramesh Sangha Profile
Lib. (ON)
View Ramesh Sangha Profile
2020-11-23 19:17
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No, not clearly.
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 19:17
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Is that any better?
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View Ramesh Sangha Profile
Lib. (ON)
View Ramesh Sangha Profile
2020-11-23 19:17
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It's not very clear, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
Mr. Lewis, could you check your connection? Maybe you can connect with IT and we'll come back to you, if that's okay.
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 19:18
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Absolutely. Thank you, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Lewis.
Monsieur Thériault, it's good to see you in good health in our committee. Please go ahead, sir.
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View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2020-11-23 19:18
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Thank you, Madam Chair. That's kind of you.
I'm sorry, but I do not agree with my colleagues' comments, relevant though they are, because they are based on assumptions like the following. Paragraph (g) is located at the end of the safeguards in subclause 241.2(3.1), which states that: Before ... provides medical assistance in dying to a person whose natural death is not reasonably foreseeable...
When a person makes a request of that nature, we cannot assume that they are doing so on an uninformed basis. There is a whole process for requests made by people with degenerative illnesses or conditions, impairments that lead to intolerable disability and suffering, or grievous or irremediable conditions or states.
Bill C-7 says that, when such a request is made, a certain number of things must be done. I do not think we should assume that, just because somebody has a physical or cognitive disability, they do not have as much moral autonomy than any of us here. That assumption is forgotten at the outset. Another forgotten assumption is the following: when legislation or the Criminal Code includes an exculpatory measure, it cannot be misleading or unevenly accessible across the country.
After all the other safeguards in Bill C-7, paragraph (g) states the following: ensure that the person has been informed of the means available to relieve their suffering...
I would like to emphasize that an assessment of the irreversibility of a person's state has been conducted beforehand. We talked about this, because the core issue is the irreversibility of a person's state of suffering. That is what medical professionals must assess. The full wording of paragraph 241.2(3.1)(g) is as follows: ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or that care;
After that entire list of the services available, Mr. Manly would like us to say “and has had consultations with the relevant professionals who provide those services or that care”. If that is not a requirement, I wonder what is. Does the requirement for consultation apply to only one of these services? Does it apply to all of them? Mr. Manly mentioned palliative care, but that is not the only service listed here.
In this context, I would hope that, by the end of the process, people have made a completely free and informed decision, with no one pressuring them into doing so. However, they are being told that a certain number of parameters still have to be checked and that professionals can be consulted. When someone is suicidal due to an accident, the suicidal state is reversible. We cannot be comparing apples to oranges. When someone requests medical assistance in dying, their state, condition, problem, disability... Disabilities are always social. I always have a difficult time referring to people with disabilities as “disabled”. It's we, as a society, who disable them.
They have the same moral autonomy as you and I, yet the Criminal Code would require them to undergo additional consultations, as if their decision was not informed by a consultation process already. State paternalism can only go so far, and this amendment runs contrary to the principles set out in the Carter decision and in the one rendered by Justice Baudouin. That is why I am opposed to it.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Thériault.
Mr. Moore, I have your hand raised for a response to any of the comments you've heard since your last intervention.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 19:24
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Thank you, Madam Chair.
It's interesting to hear people, different members, giving their opinions. I suppose we're all entitled to our opinions. I would hope all of our opinions are informed opinions.
When we're talking about palliative care, which this amendment does, I think it's important to listen to what palliative care doctors have to say. We received a submission—or at least I did, and I'm assuming other members did—from the Canadian Society of Palliative Care Physicians. I just want to draw the members' attention to one of their significant points. It's their first point. They gave our committee several recommendations, and their recommendations help inform, I think, a number of the amendments we're going to deal with.
In particular, on this amendment, their point is that:
Time is often necessary to ensure careful assessment of an illness, proper diagnosis, impeccable symptom management, and appropriate monitoring of treatment interventions that can provide benefit to a person facing a new illness or situation.
We've heard this many times. They continue:
When a new and often complex reality is being faced, an individual may normally experience an existential crisis and question the meaning and value of their life. With time and support, a person can come to a new sense of normal and find meaning in their circumstance.
Now this is the relevant point, Madam Chair. They say:
This may take many months or even years for some people.
Under the provisions of Bill C-7, for the first time ever, Canadians whose death is not reasonably foreseeable can now access assisted dying. What these palliative care doctors are pointing out is that:
Any professional assessing a patient’s request for MAiD must have access to appropriate consultative support for that patient according to their need.
That means the patient's need, and we have, or we should have, a patient-centric system. They continue:
This may include palliative care, psychiatry, chronic pain specialists...physiatry, spiritual care, and services to support people dealing with mental health issues, substance use disorders, disabilities, as well as physical and social isolation.
We're hearing more and more about isolation in the context of COVID right now. They continue:
This would ensure all reasonable treatment options have been provided to manage physical, psychological, social, spiritual, and emotional suffering.
Here is the relevant point. They say:
Simply having information about the available treatment options is not enough; people need the lived experience of care to make an informed decision.
I'm going to repeat that because it is the exact point of Mr. Manly's amendment. Mr. Manly's amendment is directly on point to what we're hearing. Is it from some random person on the street? No, it's from palliative care doctors, people who deal every day with Canadians who are in this situation. How often, when we see an obituary in the newspaper, do we see that it thanks palliative care doctors for the care they got, no matter what hospital they may have been in? What they say, for emphasis, is that simply having information about the available treatment is not enough. They need the lived experience to make an informed decision.
They say that under the two-track system that we now have, the 90-day assessment period, which we'll get to later with another amendment, may:
...not provide sufficient time for a person to receive appropriate palliative care or other supports needed to reduce suffering and live with dignity. Instead, they may feel that a premature death via MAiD is the only option. This may also lead to people “requesting MAiD” to jump the queue to access these needed services.
We're a big, diverse country. We're dealing with, certainly, a topic that we have varied opinions on. I'm hopeful that what unites us as a committee is a desire to protect vulnerable Canadians.
The people who deal with people in their most vulnerable state are palliative care doctors, the specialists who are informing this committee that they do not think it's enough to mention to somebody, or to hand them a brochure, about what may be available to them. They think it's important that we actually have engagement with a specialist.
Even the government saw the wisdom of this, for those on the second track where death is not reasonably foreseeable, requiring that one of the two doctors making an assessment be someone who has a speciality in the individual's condition. When a person is nearing an end-of-life situation or when a person is looking for what options they have, it's having that consultation with a palliative care specialist so they can tell the individual what services can be offered, in a real consultation.
We're talking about life and death. We heard it over and over. It's not a true choice unless the patient is informed in a fulsome way of all of their options.
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View Iqra Khalid Profile
Lib. (ON)
Thank you.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 19:30
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I don't want to see my constituents or any of our constituents, any Canadians, in a situation where they are choosing assisted death because of a lack of information and consultation on the options they have.
Madam Chair, that is why, again, I thought it was important to mention, when we're talking about palliative care issues, what the palliative care doctors are saying. What they are saying is that we should all around this table be supporting this amendment.
That's why I'm pleased to support it.
Thank you, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Moore.
I'll just remind members as we're continuing the important debate, as you speak to amendments, it doesn't make sense to keep making the same arguments.
I really appreciate, Mr. Moore, that you are quite adamant and quite eloquent in voicing your opinion and your concerns. However, I would hope that everything is on the record and that we could move things along.
Mr. Lewis, do you have anything to add, based on what you said before?
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View Chris Lewis Profile
CPC (ON)
View Chris Lewis Profile
2020-11-23 19:31
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First and foremost, Madam Chair, my apologies to the committee. I apologize for my IT issues. I want to thank the IT department for helping me through this—many thanks. I hope that my connection is a little better now, if nothing else.
I have quite a bit to add to this.
One thing I was going to speak to was Dr. Catherine Ferrier, but, of course, my colleague Mr. Cooper already spoke to that.
With respect to what you just said Madam Chair, again, we don't want to add a whole bunch of verbiage to this discussion, but I think it's very important that this committee takes a good hard look at Mr. Manly's amendment. I think it's an amendment that truly speaks to protection of all Canadians. Additionally, this amendment will aid in the prevention of abuse and malpractice, which ought to be a central concern, especially when dealing with individuals whose mental and/or physical states are especially fragile or vulnerable. There will always be the risk of coercion, undue pressure and things of this nature.
However, this legislation should mitigate the risk as much as possible, ensuring that every patient is informed of all available alternatives, including receiving counselling regarding the continued management of their condition with ongoing treatment or therapeutic measures. That should be seen as a basic and fundamental prerequisite for the consideration of the procedure to end one's life.
Madam Chair, I would again ask respectfully that this committee gives a good hard look at supporting this amendment. I think it's a great amendment.
Again, I apologize to the chair and to the committee for my IT issues here. I will certainly have more to say on further amendments.
Thank you, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Lewis. I'm glad your IT problems have been resolved. It's good to have you back.
Mr. Cooper, I have you next on the list.
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View Michael Cooper Profile
CPC (AB)
Thank you, Madam Chair.
In my previous comments, I made general reference to the UN Convention on the Rights of Persons with Disabilities. What I would add to that is that Mr. Manly's amendment clearly falls in line with the purported intent of the legislation, inasmuch as the preamble of the legislation provides that Canada, first of all, a “State Party” to the UN Convention on the Rights of Persons with Disabilities and, as the preamble states, “recognizes its obligations under it, including in respect of the right to life”.
If the bill actually does what the preamble states as the intent of the bill, then it is imperative that Mr. Manly's amendment do pass. I would note article 10 of the convention.
What is article 10 of the convention? Article 10 very simply states:
States Parties reaffirm that every human being has the inherent right to life and shall take all necessary measures to ensure its effective enjoyment by persons with disabilities on an equal basis with others.
The UN special rapporteur, again, speaking directly to the issue, that is, Mr. Manly's response—
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View James Maloney Profile
Lib. (ON)
I have a point of order, Madam Chair.
I'm not a fan of interrupting, and I apologize to Mr. Cooper, but Mr. Cooper is raising points that could have been raised previously. I don't want to impede someone's ability to get their points across, but I don't think it's necessary that people do it multiple times.
If you have something to say, I would suggest that you do it the first time. Unless you have something in response to an opinion that was opposed to what you said to earlier, I don't think it's appropriate that we just give somebody a second chance to prolong the discussion unnecessarily.
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View Iqra Khalid Profile
Lib. (ON)
Thank you for that, Mr. Maloney.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 19:37
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On that point of order, Madam Chair, we can talk about “appropriate” all we want, but as you know, each member of Parliament who wishes to speak to these things—I'm sure you're going to let us know, Madam Chair—is entitled to do so, because those are the rules of how we conduct ourselves.
If someone in discussion, as has happened with me on other interventions on an amendment, makes a point that I wish to respond to, much in the same way that Mr. Maloney raised his point of order and now I'm responding to it, we're able to do that as members of Parliament. We're able to speak to these amendments. This is the House of Commons, where members of Parliament give voice to the Canadians we represent. A part of the rules of this place is that every member can speak as often as they wish to these amendments.
So far, from what I've heard, everything has been on point with the amendment we're dealing with.
I just wanted to respond on that point. Thank you, Madam Chair.
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View Iqra Khalid Profile
Lib. (ON)
Thank you.
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View Arif Virani Profile
Lib. (ON)
View Arif Virani Profile
2020-11-23 19:38
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On the same point of order, Madam Chair, I think it's important that what we try to do in this context is that we actually try to have some precision in our commentary. I think the point that Mr. Maloney is attempting to make is not an attempt to limit the debate. It's an attempt to ensure that people focus their commentary, and that if you're going to reply in a second go-round, you do exactly that. You respond to something new that you've heard.
In the entire context of the approximately 30 minutes we've spent on this discussion, all of two people have raised opposition to the views of the Conservatives. They are Mr. Thériault and Mr. Kelloway. I do not find that, in the secondary submissions that are being made by multiple Conservative members, we're finding people responding to comments made by either Mr. Kelloway or Mr. Thériault.
Perhaps we could have some clarification, because I think it's your role as chair, Madam Chair, to guide the debate in an efficient and appropriate manner so that we can move through these amendments out of respect for the people who are on this call, out of respect for the departmental witnesses and out of respect for House staff.
Thank you.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Virani.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 19:39
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On that point of order, Madam Chair—
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View Iqra Khalid Profile
Lib. (ON)
Sorry, Mr. Moore. I have Madam Findlay next.
Is this on the same point of order, Madam Findlay?
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View Kerry-Lynne Findlay Profile
CPC (BC)
Yes, it is.
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View Iqra Khalid Profile
Lib. (ON)
Go ahead, Madam Findlay.
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View Kerry-Lynne Findlay Profile
CPC (BC)
I actually find these comments offensive.
I have the right as a member of Parliament, as do all of my colleagues from every party, to make comments in committee on amendments as I choose to make them. I don't believe that any other member here has the right to tell me, “I don't think what you're saying is succinct enough, MP Findlay. I don't think what you're saying is the way I would say it.”
I'm not aware of any such rules. My understanding of the standing committee rules is that we have the opportunity to make comment on these amendments as we go forward, clause by clause. Sometimes our comments are just commentary. Sometimes they're hoping to persuade other members of the committee to see things the way we see them. That is our right. That is our right as parliamentarians, to make ourselves heard.
Sometimes you make an intervention and maybe you think after the fact, “Oh, I should have mentioned that.” Well, you have the right to put your hand back up and finish those thoughts.
I am not aware that there is any rule that says you, Madam Chair, or any other member of this committee, can say that I only have the right to put my hand up again if I have some specific point, and that I must do it in a succinct way so that someone else on this committee decides how succinct I am. That is ridiculous. That is not the way that committee is to proceed. That's not the way that debate proceeds.
If we want to do this in an efficient but also effective manner, we should let people make their points on each of the amendments as they arise to the extent that they wish to. Otherwise, we're going to be sitting here all night, with me saying, “I don't like the way that person said this”, “I don't like the way that person said that” and “I have a comment on whether I think they used the most efficient language.” That is not sustainable, Madam Chair.
Thank you.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Madam Findlay.
Mr. Moore, go ahead on the same point of order.
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View Rob Moore Profile
CPC (NB)
View Rob Moore Profile
2020-11-23 19:41
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I'm going to exercise my right to simply say that I agree with everything MP Findlay just said, and it doesn't bear repeating because it was excellent and she made the point. Her understanding of the rules is exactly correct, and in the time we've spent discussing this, we could have been discussing the amendment.
I hope that there are no further interventions about the rights of members of Parliament to speak to each and every one of these amendments and to have a good discussion around the amendments and to make points that they've heard from witnesses about these amendments.
I agree with everything that Madam Findlay just said.
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View Iqra Khalid Profile
Lib. (ON)
Thank you.
Did you want to speak, Mr. Cooper?
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View Michael Cooper Profile
CPC (AB)
I'll speak very briefly to simply say that I first of all agree with all of the comments of Mr. Moore and Ms. Findlay. I think it's important that we have a thorough debate on amendments.
This process has been completely rushed from start to finish. It's been, frankly...not out of any disrespect to you, Madam Chair—
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View Iqra Khalid Profile
Lib. (ON)
Speak to the point of order, Mr. Cooper.
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View Michael Cooper Profile
CPC (AB)
I will simply leave it at that. However, my comments are very relevant to the amendment before us, introduced by Mr. Manly.
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View Iqra Khalid Profile
Lib. (ON)
Thank you, Mr. Cooper.
On that point of order, I will reference page 1059 in the green book, chapter 20. It states:
In addition, the Chair may, at his or her discretion, interrupt a member whose observations and questions are repetitive or are unrelated to the matter before the committee. If the member in question persists in making repetitive or off-topic comments, the Chair can give the floor to another member. If the member refuses to yield the floor and continues talking, the Chair may suspend or adjourn the meeting.
On that ruling with the point of order raised by Mr. Maloney, members, I will encourage you to please keep your comments within that scope, within the scope of the specific amendments, within the scope of what is being discussed, and to please refrain from being repetitive with your arguments.
Mr. Cooper, you can continue. Go ahead.
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