Justice Committee on Nov. 19th, 2020

[The Chair, Liberal, Iqra Khalid]

Thank you, Madam Findlay.

I have Mr. Cooper next on my list.

Go ahead, Mr. Cooper.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Thank you, Madam Chair. I will speak in support of this amendment.

I want to reiterate a point that Ms. Findlay made, also as a lawyer, that in order to execute a valid will, two witnesses are required. Here we're talking about the most significant procedure that could be undertaken in someone's life, namely to end their life, and the safeguard required would be less than that which is required to execute a valid will.

I can say that when Bill C-14 was debated, there was widespread consensus around the need for there to be two witnesses, and not only two witnesses, but two independent witnesses.

The legislation that the government has put forward not only removes the very common-sense requirement that there be two witnesses, but it goes further than that and removes the requirement that there be independent witnesses. Indeed, under Bill C-7, someone attending to a patient's health could be a witness. That obviously raises concerns around conflict of interest, coercion—subtle coercion, unintended coercion—having regard for the power imbalance that exists, for example, between a medical health professional and a patient, particularly vulnerable persons.

The evidence that we heard at committee, in the very limited hearings we held on this bill, was overwhelming in terms of support for maintaining this safeguard, including from the Canadian palliative care association, among other witnesses.

I have not seen any convincing evidence to demonstrate that the witness requirement in any significant way impedes access to physician-assisted dying. On that basis, I believe this is an important safeguard to protecting vulnerable persons. That was backed up by the evidence. On that basis, I hope that this committee sees fit to pass this amendment.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Cooper.

We'll go to Mr. Lewis next and then to Mr. Garrison.

Go ahead, Mr. Lewis.

[Chris Lewis, Conservative, Essex, ON]

Thank you, Madam Chair, for the opportunity to speak to this amendment. I think it's a very important amendment.

In my personal life, when I bought a car or when I bought a house, I had to get co-signers sometimes. In the world of business where I came from, I had to get co-signers. That was just for things were purely monetary. Here, we're talking about someone's life, the very breath that they breathe. To suggest for a moment that there shouldn't be at least two witnesses.... That's all we're asking for, two witnesses. When we force other people to have co-signers and witnesses for things that are monetary, such as a house, a business or a car, then I think the thinking on this is totally backwards.

This has been in the legislation. I guess I have to question now what exactly is the long-term goal of not keeping two witnesses. Is it so that eventually we'll have zero witnesses? Certainly, that's not what the government is thinking with this proposed legislation. Certainly there's nothing wrong with having two witnesses. This amendment is absolutely vital.

Again, I go back to this not being a monetary discussion. This is about the lifeblood of someone. I can't conceive of why anyone would suggest for a moment that someone's life is not worth having two witnesses.

I am going to be voting very much in favour of this amendment and I would totally respectfully ask everybody to really pay attention and consider this amendment.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you.

Mr. Garrison, please go ahead.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Madam Chair.

I'd just like to draw committee members' attention to the brief that was submitted by the Association of MAiD Assessors and Providers. They've talked about the real-life experience of applying MAID, and what they found was that in certain circumstances, sometimes especially in rural and remote communities, the requirement to have two independent witnesses raised privacy concerns and raised concerns about involving people from outside the narrow circle around the patient who was requesting medical assistance in dying. Their opinion was that, because the function of witnesses is not to assess but simply to verify identity, there was very little added in terms of protection by having a second witness.

I think we should listen to them when it comes to this narrow question of what might constitute an obstacle or what might create privacy concerns for those requesting medical assistance in dying. That is the testimony that we received from MAiD Assessors and Providers. I will not be supporting this amendment.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Garrison.

Madam Findlay, do you have something to add?

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

I do.

I understand that it may be inconvenient for assessors and suppliers. It's inconvenient when drafting a will or for drafting some other legal documents sometimes to have a second witness, but people know that's the legal requirement, and it always happens.

People in remote communities draft wills. In fact, the very people who might be asking for MAID in a remote community would probably have drafted a will before they decided to do it. I can't imagine if you put into the ending of your life the forethought it would take to seek medically assisted death that you wouldn't probably also deal with your assets. The very people we're talking about would normally have drafted a will and had two independent witnesses to its authenticity and intention. They would be independent meaning they would not be necessarily drawn in at all to someone's confidence regarding their decisions but the person would actually have had to go find those two independent witnesses to deal with their assets, no matter where they live.

Yet here we are saying that someone doesn't have to do that to end their life. I don't accept that and I think if one gives it some careful thought, it doesn't actually make sense given the other legal requirements we have in life.

[The Chair, Liberal, Iqra Khalid]

Thank you, Madam Findlay.

We'll go to Mr. Cooper next.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Actually, I'm okay.

[The Chair, Liberal, Iqra Khalid]

Okay. We'll call the question at this time for CPC-2.

Mr. Clerk, if you could, please administer the vote. Should CPC-2 carry?

(Amendment negatived: nays 7, yeas 4 [See Minutes of Proceedings])

We will now go on to CPC-3.

Mr. Moore, would you like to move that?

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair. I so move.

In terms of CPC-3, as we discussed in Bill C-7, there are two tracks: where death is reasonably foreseeable and where death is not reasonably foreseeable. The government has introduced on the track where death is not reasonably foreseeable a requirement that one of the physicians have expertise in the patient's ailment. What this amendment would do is require and apply that same criteria that one of the physicians signing off has expertise in the patient's ailment—which I think is a smart criteria—to all cases of assisted dying, not just where death is not reasonably foreseeable, but also where death is reasonably foreseeable.

As mentioned—we just had this debate—“reasonable foreseeability” is not defined. I thought we should have defined it a few minutes ago with the BQ amendment, which would define it at 12 months. We chose not to do that. In light of that and in light of the fact that the government did see fit to include it for the track where a death is not reasonably foreseeable, I think there's merit in that, and I think it should apply as well where death is reasonably foreseeable. That's why we've moved this amendment.

Again, we didn't pull this amendment out of thin air. It's partially based on what the government has done on the new track where death is not reasonably foreseeable, but also due to testimony. We heard very compelling testimony both from physicians and from specialists, as well as persons with disabilities, about the importance of having someone who knows what they're talking about with regard to someone's condition.

We're going to get to other prospective amendments later, but we've heard about the amount of time it takes someone to get in to see a specialist, to begin treatment and to have treatment take effect. If someone has had a diagnosis of a very serious ailment or a very serious injury, oftentimes there are ups and downs in their thinking about their future, but also in the prognosis. Ensuring that one of the physicians dealing with this patient has a speciality in the condition the patient has I think is a good safeguard that the government has introduced on the track of not reasonably foreseeable. I think it should apply where death is reasonably foreseeable as well, and that's why we've moved this amendment.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Moore.

Mr. Virani, you're next. Go ahead, sir.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Thank you very much, Madam Chair.

In terms of the notion of track one and injecting the expert requirement into track one, what we have is a situation around the country where health care providers have been exercising a great deal of judgment in delivering MAID. That's certainly what we heard in the consultations that took place in January and February. In cases where the medical team surrounding the patient doesn't have the necessary expertise in the patient's condition to do a comprehensive assessment, providers are already consulting experts as part of good medical practice, and we believe that they will continue to do so.

What we've done here is that we've reduced the barriers to accessing MAID for people who are reasonably foreseeable, but have enhanced safeguards for those who are on track two, because, by definition, their death is not as imminent or as foreseeable. Adding an additional issue of attaching an expert requirement here for the group that is in track one would not enhance safeguards—because the safeguards are already doing the work they need to do—but would in fact act as a new barrier for access. On that basis, I will be opposing this amendment.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Virani.

Mr. Lewis.

[Chris Lewis, Conservative, Essex, ON]

Again, I have to simplify things sometimes. I know when I had shoulder surgery to repair my broken shoulder some three or four years ago, the first thing I did was go to my general practitioner. He didn't say that he was going to do the surgery. No, he sent me to a specialist.

When I think about this, again, for me it's very black and white. If we're talking about life and death, I don't know why there is even discussion around this table with regard to ensuring there is a specialist there to say, “Yes, this, indeed, is the ailment and, indeed, this person should have MAID”, because, again, my general practitioner didn't do the arthroscopic surgery for my shoulder. He sent me to a specialist.

Notwithstanding that, Madam Chair, if I went to that specialist I could also get a second opinion.

My point is, in death, why would we ever put this weight on a practitioner and not have a second opinion? This, to me, is about giving protection to our practitioners, but also giving the real-life story for the person who may or may not need MAID. If I don't know what I'm talking about, as a practitioner, I certainly don't want to be the one who says to administer MAID. If it's not my speciality, why would I do that?

Madam Chair, this is a very important amendment, and I will be supporting it.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thanks, Mr. Lewis.

Monsieur Thériault, I see you next on the list. Go ahead, sir.

[Luc Thériault, Bloc, Montcalm, QC]

I think that my Conservative colleagues are forgetting a few things. We are talking about people whose death is foreseeable, sometimes within a few days. We are talking about the end-of-life phase. When we say that the patient is the norm, it means what is learned from the patient's condition.

General practitioners who provide medical assistance in dying are perfectly capable of reading the entire file of a terminally-ill patient who arrives at emergency. They can tell whether the patient has a few hours or a few days, at most, to live.

Why then must a specialist be brought in when the cancer is metastatic? A specialist in what, precisely? Surely not orthopaedics? When the kidneys are completely dysfunctional, do you need to call in a kidney specialist?

The overall status of patients is what determines whether they are at the end-of-life phase and whether they are suffering. If they ask for medical assistance to die, it's not just because they want to put an end to the suffering, but also because there are other criteria that must be met before acting.

That's why I don't understand how a doctor who is a specialist in one particular part of a person's physiology can add anything other than further delays for those who have been irreversibly dying for a long time and who are now at the end of their tether. Those who want to die at the end of this process can do so, provided that they do not request it.

For those who do, you have to go back to the meaning of the expression “the patient is the norm”. It doesn't require a specialist in every organ of the body to understand when someone is terminally ill.

[The Chair, Liberal, Iqra Khalid]

Thank you, Monsieur Thériault.

Madame Findlay, I have you next on the list. Go ahead.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Thank you, Madam Chair.

I'm finding some distress here when we're discussing these things. There are a lot of assumptions being made within these discussions about patients' conditions, about what a medical practitioner may or may not do, from a lot of us who, frankly, aren't doctors. We've heard a lot of testimony. I would like to have heard a lot more. We've heard testimony before this committee that says some of that is quite contrary to a lot of the assumptions being made here about capacity, about who is signing off on this.

We're legislators; we're not medical practitioners. It's our job to try to have at least some safeguards on a legislation that is literally about life and death. One-size-fits-all is not a good public policy, in my view. We have to be aware that there are differences. There are regional differences; there are patient-centred differences. Having one of the physicians signing off with an expertise in that patient's ailment seems to me to be the minimum criteria I would want for any procedure relating to my health of any serious nature.

I don't see that as overly onerous, but it is a safeguard, again, to just make sure that everything is as it should be, and that it's understood at the time that a big decision like this is being made. There seems to be an assumption in the discussions here that it's just an inevitable thing. It should be a clear choice right up to the end of life—that what you're doing is your clear choice, and for valid reasons.

Again, in the legislation as presented, we seem to be throwing out so many safeguards way outside of the Truchon decision, without the careful thought put into it that some of these safeguards would allow for.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Madame Findlay.

Mr. Moore, do you want to make your closing remarks on what you've heard?

[Rob Moore, Conservative, Fundy Royal, NB]

Sure. I hadn't planned to actually speak again, but Mr. Thériault made some points that I don't think are on point with what's being proposed here.

He mentions a scenario where someone has hours or weeks to live. Just by the discussion around his own amendment, around reasonable foreseeability of death, we already know that under the previous bill, Bill C-14, individuals with a prognosis of living for well over a year have received assisted dying. We're not being overly prescriptive here, but we have to recognize that some of the individuals who may, depending on the assessment, fall under reasonable foreseeability of death may still have quite a bit of time to live naturally.

What we're saying is, in the wisdom of what the government has put in place under individuals whose death is not reasonably foreseeable, there are going to be people who fall in the margins on both sides of that issue, of that line, that ill-defined line. We've chosen today not to even attempt to define what “reasonable foreseeability” is.

In light of that, I think it's abundantly clear that in the consultation with the physicians one of them should have an expertise in the person's ailment. Whatever that ailment is, we're asking that one physician have that consultation with the patient.

This is not about people who have days to live. This is about people who could have years to live. This requirement has been adopted by the government on their other track. Based on the testimony that we've heard, I think it's abundantly clear that it's important and relevant for those throughout the MAID regime, not just on one track but throughout, that there should be a requirement that they have a consultation with a physician who knows something about their ailment. The risk otherwise is just too great, in my view, for abuse of this system.

I'll leave it at that. Thanks, everyone, for your consideration of the amendment.

[The Chair, Liberal, Iqra Khalid]

Thank you.

Sorry, Monsieur Thériault, was that your hand up that I saw?

I'll call the question at this time then, on CPC-3.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Chair, what I wanted to say is that it is always a medical specialist who tells patients that nothing more can be done for them, and that is when palliative care begins.

[The Chair, Liberal, Iqra Khalid]

Monsieur Thériault, thank you. We've started the vote already, so we'll continue with that, if that's okay.